Continuing the Conversation Between Academia and Practice: Using Simulation to Close the Academic-Practice Gap

By: Beth Fentress Hallmark, PhD, RN, CHSE-A, ANEF, Belmont University; Anne Marie Monachino, MSN, RN, CPN, CHSE-A, Children’s Hospital of Philadelphia; and Alexis Ramirez, DNPc, MSN, RN-BC, CCRN, PCCN , Fresno Heart & Surgical Hospital

The academic-practice gap has been reported in the nursing literature for more than 40 years, with little evidence of significant progress in narrowing the gap (Hickerson et al., 2016; Huston et al., 2017). Educators in acute care settings are quick to say that new graduates lack core professional behaviors and skills, including critical thinking, clinical judgment, and effective communication techniques. The presence of the academic-practice gap impacts patient care and contributes to turnover (Hickerson et al., 2016)

Nursing education models have changed greatly over the last century and a half, transitioning from hospital-based programs to academic studies of the social and natural sciences with adjunct clinical practicum experiences. Especially in times of war, nurses received on-the-job training. However, today, less time is spent in the clinical environment, and the gap between academia and clinical practice continues to grow.

The transition to nursing practice is often a time of mixed emotions. Many new nurse graduates express feelings of excitement at achieving their goals and working with patients, but they also describe feelings of anxiety and fear of the added responsibility of managing patient care (Dyess & Sherman, 2009). New-to-practice nurses face several challenges as they adapt to their new role, challenges that include the need to collaborate and communicate with the interdisciplinary team (Thomas, 2012), and they experience job-related stress, fatigue, burnout, and even workplace bullying (Hofler, 2016). They struggle with performing integrated nursing interventions (Lee & Sim, 2019) and feelings of inadequacy related to lack of knowledge, clinical skills, and the need to translate theory into practice (Houston et al., 2018). Twenty-five percent  of frontline nurse leaders are dissatisfied with the clinical skills of new graduate nurses (Huston et al., 2018). The inability to successfully transition into their new role leads to resignations by 25 percent of novice nurses (National Council of State Boards of Nursing, 2019).

The use of simulation offers one way to help bridge the gap between academia and practice. Medical-based simulation is widely accepted in hospital orientation and transition-to-practice programs (Morse et al., 2019). This educational modality allows learners to practice cognitive, psychomotor, and interpersonal skills in a psychologically safe learning environment where, through guided reflection, both positive actions and mistakes are viewed as opportunities for growth. The Theory of Organizational Learning stresses the importance of psychological safety, the shared belief that it is safe to take interpersonal risks within the team. Psychological safety contributes to organizational learning, creativity, and the ability to speak up and provide feedback, a key tenet of simulation that is important to the transition to professional practice (Lyman et al., 2020).

New graduate nurses participate in simulation activities as a single discipline to build clinical reasoning and competency or with interprofessional teams to practice communication and teamwork. At one children’s hospital, simulation is embraced by the nursing department and used with new graduate nurses in several ways; for example, it is incorporated in a nurse residency program, clinical practice assessments, and just-in-time training as follows.

  • Nurse Residency. A clinically based Escape Room was created where nurses must practice clinical reasoning, problem-solving, and effective communication to care for a simulated patient in a fun learning environment. Nurses report the supportive environment provides them the opportunity to gather clinical information and synthesize findings, knowing the patient won’t be harmed during the activity.
  • Clinical Practice Assessments. Nurses are presented a patient case and perform focused assessments and accompanying interventions while being observed by a trained rater who documents proficiency using a checklist. Results so far demonstrate the need for reinforcement of some basic assessment skills that may be overlooked because the nurse is focusing only on a specific aspect related to the diagnosis. Emphasis is placed on environmental checks, developmentally appropriate interventions, and safety behaviors to improve communication.
  • Just-in-Time Training. This is training that takes place prior to performing an actual intervention on a patient (Monachino, 2014). This training method is becoming more widely used by preceptors and educators to refresh knowledge and skills, especially for high-risk, low-volume procedures.

In conclusion, we believe it is important to emphasize the importance of continuing the conversation between academia and practice. We must continue to investigate ways to narrow the gap and prepare our future nurses for the ever-changing health care landscape.


References

Dyess, S., & Sherman, R. (2009). The first year of practice: New graduate nurses’ transition learning and learning needs. Journal of Continuing Education in Nursing, 40(9), 403-410.

Hickerson, K. A., Taylor, L. A., & Terhaar, M. F. (2016). The preparation–practice gap: An integrative literature review.  Journal of Continuing Education in Nursing47(1), 17-23. https://doi.org/10.3928/00220124-20151230-06

Hofler, L. (2016). Transition of new graduate nurses to the workforce. North Carolina Medical Journal, 77 (2), 133-136. doi:10.18043/ncm.77.2.133.

Huston, C., Phillips, B., Jeffries, P. T., Rich, J., Knecht, P., Sommer, S., & Lewis, M. (2018). The academic-practice gap: Strategies for an enduring problem. Wiley Nursing Forum, 53, 27-34.

Lee, J., & Sim, I. (2019). Gap between college education and clinical practice: Experience of newly graduated nurses. Wiley Nursing Open Forum, 7, 449-456. doi:10.1002/nop2.409 .

Lyman, B., Gunn, M.M., & Mendron, C.R. (2020). New graduate registered nurses’ experiences with psychological safety. Journal of Nursing Management,28, 831-839. https:/doi.org/ 10.1111/jonm.13006

Monachino, A. (2017, July). Just-in-Time Training. In Foisy-Doll, C, Leighton, K. (Eds). Simulation champions: Fostering courage, caring, and connection. Wolters Kluwer.     

Morse, C.J., Fey, M., Kardong-Edgren, S., Mullen, A., Barlow, M., & Barwick, S. (2019). The changing landscape of simulation-based education. American Journal of Nursing, 119(8), 42-48.

National Council of State Boards of Nursing. (2019). Transition to practice: Why transition to practice (TTP)? https://www.ncsbn.org/transition-to-practice.htm

Thomas, C. B. (2012). The transition from student to new registered nurse in professional practice. Journal for Nurses in Staff Development, 28(5), 243-249.

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