What graduates of mental health nursing programmes need to know from an industry perspective. Journal of Clinical Nursing 23(24) 3449-3459.
Nursing professionals are at the central pillar of primary secondary and tertiary healthcare services. The delivery of quality health care services is anchored on the scientific expertise and the clinical preparedness of nurses to address the various health care needs of the public. Given this nursing education plays a central role in imparting graduate nurses with the necessary clinical skills/theory to deliver high-quality healthcare services. Clinical skills alone are not enough to ensure the delivery of high-quality healthcare services because they need harmonizing with practical skills. Nurse graduates who possess both skills successfully transits in the workplace because they are adequately prepared. However the gap between nursing education and clinical skills continues to be a major problem in nursing. The gap between nursing education and clinical skills often present various challenges for newly graduated nurses in their place of work. The challenges include physical practical and psychological challenges in bridging the educational and clinical divide. The nursing education issues that create the gap relate to the faculty students the syllabus and association among stakeholders in the field of practice and academic. In contrast the practice issues that create the gap include issues on the quality of care and means of bridging the gap such as coaching orientation and mentoring. In this literature review seven empirical research articles will be examined with the aim of answering the question with the gap between nursing education and clinical skills being a major problem in nursing are new graduate nurses ready for the workplace.
(Raurell-Torred et al. 2015)
In their study Raurell-Torred et al. (2015) compared the skills shown by undergraduate students with no past clinical practice and nurses with clinical practice registered in Continuing Professional Education (CPE) courses. According to Raurell-Torred et al. (2015) the undergraduate students who did not undertake Case-Based Learning (CBL) scored lower on patient assessment compared with those that undertook CBL. Moreover the CPE nurses made more rule-based mistakes such as failure to identify patient correctly and failure to examine for allergies before giving medication compared to the undergraduate students undertaking CBL classes. Raurell-Torred et al. (2015) concluded that the undergraduate students with no past clinical experience but who incorporated CBL in their classes developed better patient assessment skills compared to others groups. The significance of the study results is that including CBL in the nursing curriculum can bridge the gap between nursing education and clinical practice because it enhances nurses preparedness for the workplace. Additionally nursing educational programs that incorporate CBL play an active role in nurses skills acquisition process.
(Numminen et al. 2014)
Using a cross-sectional comparative design Numminen et al. (2014) assessed whether learning outcomes of nurse education met the needs of the nursing practice. Numminen et al. (2014) explored the correspondence between nurses instructors and nurse administrators evaluation of new graduate nurses professional skills. According to Numminen et al. (2014) nurses instructors evaluated new nurses skills to a significantly higher level compared to nurse administrators in all skill areas. According to Numminen et al. (2014) active collaboration during evaluation of new nurses ensures they are fit for practice. According to the findings of this research the lack of collaboration between nurses instructors and nurse administrators during the evaluation of new nurses results in a gap between nursing education and clinical skills.
The findings of the research support the hypothesis that the nursing education and practice are disconnected such that stakeholders in the field of practice and academic are not working together to prepare nurses for the workplace. Citing the results from the Numminen et al. (2014) study additional research is needed to find ways of ensuring collaboration between nurses instructors and educators besides having standardized criteria for evaluation of new nurses competence level. These mechanisms would ensure nurses know what is expected of them in the workplace and not suffer transition shock.
(Esmaeili Cheraghi Salsali & Ghiyasvandian 2014)
According to Esmaeili et al. (2014) practical clinical education prepares new graduate nurses for the workplace. In this research Esmaeili et al. (2014) described the expectations of nursing students as regards what comprises an effective clinical education. According to Esmaeili et al. (2014) student nurses considered appropriate communication and relations between them and their instructors as a key to bridging the gap between theory and practice in nursing. The findings also showed that evaluating students based on an appropriate benchmark could reduce the gap between theory and practice.
The nursing students also felt that having instructors who were highly qualified knowledgeable and motivated could reduce the gap between nursing education and practice because students nurses learn better because what they observe/learn in the presence of the instructors they remember later. For instance a fifth-term nursing student remarked that
We had an instructor who performed well with patients once a patient asked a question he was so knowledgeable and explained so well that patients respected him more than they respected the unit personnel and we also had a lot of pride for him (Esmaeili Cheraghi Salsali & Ghiyasvandian 2014 p. 465).
According to Esmaeili et al. (2014) the nursing student who participated in the study reported that lack of mentors in providing valuable educational and clinical experiences led to the gap between nursing theory and practice. Yeh and Yu (2009) also identified the lack of mentorship programs as a gap between nursing theory and practice.
(Yeh & Yu 2009)
Employing a cross-sectional research design Yeh and Yu (2009) identified job stress and factors that prompt newly graduated nurses to quit and stay in their new workplaces. According to Yeh and Yu (2009) new graduate nurses experience the highest level of work-related stress in their first month on the job and intention to quit in the first two months of beginning work after school. Moreover according to Yeh and Yu (2009) new graduate nurses that experience high job stress are twice likely to quit working in the first months in the workplace. Moreover the nurses that lacked a clinical practicum in the working hospital were twice likely to quit working in their first two months in a new work environment.
According to the study results the gaps between nursing education and clinical practice identified included lack of mentorship programs lack of support to new graduate nurses from nursing administrators to adapt to the new workplace and student lacking clinical practicum. The findings also show that new graduate nurses are entering the workplace unprepared; hence increasing the rate of medical errors and lowering the quality of health service offered by these nurses to clients and patients.
(McAllister Happell & Flynn 2014)
In their study McAllister Happell and Flynn (2014) explored the viewpoints of nursing managers regarding the competencies and attributes of nurse graduates of a comprehensive nursing program. According to McAllister Happell and Flynn (2014) the gap between nursing education and practice skills is resulting in a global shortage of properly qualified nurses graduate with the scientific knowledge skills and attitudes in the workplace. Regarding mental health McAllister Happell and Flynn (2014) argue that the curriculum is short of the right content to prepare nursing graduates for practice in the field. According to McAllister Happell and Flynn (2014) the preparation of the nursing curriculum in Australia has ignored the voice of the industry and leans towards the academic perspective. The researchers employing an experimental design found out that industry experts are concerned that the curriculum is not comprehensive enough to ensure nurse graduate provide high-quality care to clients.
According to the article various stakeholders in the field of nursing are working alone in developing the nursing curriculum. Therefore the curriculum gap is forcing new nursing graduates to enter the workplace without the right skills and knowledge which are indispensable components of high-quality health services.
(Watt & Pascoe 2013)
Watt and Pascoe (2013) employing an interpretive descriptive design studied the way experiencing clinical school based at a university affected graduate nurses views of their readiness for field practice. According to Watt and Pascoe (2013) nursing students who studied in a clinical school within a hospital felt they were ready for practice after graduating from nursing school. Studying in a clinical school within a hospital reduced or eliminated the gap between nursing education and practice because the nursing students had the opportunity to learn how the culture administration systems and hospital environment interact. Being accustomed to a hospital setting meant that a new graduate nurse would be prepared as everything was familiar. Moreover being familiar with the hospital administration systems meant that a new nurse knew where and how to access medical resources and information once in the workplace.
According to the findings of the study one way of linking nursing education with practice would be to ensure nursing students have access to functional health care centers. Therefore the gap between nursing education and nursing practice can be minimized through collaboration between universities and medical facilities and offering clinical internships for all nursing students.
(Saifan AbuRuz & Masadeh 2015)
Employing an exploratory qualitative approach Saifan AbuRuz and Masadeh (2015) sought to identify the reasons the gap between nursing education and nursing practice exists and offer recommendations to overcome the problem. According to Saifan and coauthors a majority of the nursing students sighted the lack of qualified clinical instructors as a critical factor leading to the increasing gap between nursing education and clinical practice. Additionally the student alleged lack of correspondence between the clinical instructors that taught theory and those that imparted practical skills as another factor widening the gap. Moreover according to the study findings nursing students lack support in clinical training leading to frustration and unpreparedness for the workplace.
According to the results of the study nursing education needs reform to straighten out administrative and curriculum issues that present the gap. One way of linking nursing education with practice would be to ensure nursing instructors are qualified and improve the correspondence between theory and practice tutors. Therefore the gap between nursing education and nursing practice can be minimized through the collaboration of all stakeholders.
Esmaeili M. Cheraghi M. A. Salsali M. & Ghiyasvandian S. (2014). Nursing students expectations regarding effective clinical education: A qualitative study. International Journal of Nursing Practice 20(5) 460-467.
McAllister M. Happell B. & Flynn T. (2014). Learning essentials: What graduates of mental health nursing programmes need to know from an industry perspective. Journal of Clinical Nursing 23(24) 3449-3459.
Numminen O. Laine T. Isoaho H. Hupli M. Leino-Kilpi H. & Meretoja R. (2014). Do educational outcomes correspond with the requirements of nursing practice: educators and managers assessments of novice nurses professional competence. Scand J Caring Sci 28(4) 812821.
Raurell-Torred M. Olivet-Pujol J. Romero-Collado . Malagon-Aguilera M. C. Patio-Mas J. & Baltasar-Bagu A. (2015). Case-based learning and simulation: Useful tools to enhance nurses education? Nonrandomized controlled trial. Journal of Nursing Scholarship 47(1) 34-42.
Saifan A. AbuRuz M. E. & Masadeh R. (2015). Theory practice gaps in nursing education: a qualitative perspective. Journal of Social Sciences 11(1) 20-29.
Watt E. & Pascoe E. (2013). An exploration of graduate nurses perceptions of their preparedness for practice after undertaking the final year of their bachelor of nursing degree in a university-based clinical school of nursing. International Journal of Nursing Practic 19(1) 23-30.
Yeh M.-C. & Yu S. (2009). Job stress and intention to quit in newly graduated nurses during the first three months of work in Taiwan. Journal of Clinical Nursing 18(24) 3450-3460.
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