The problem of initial entry into the profession after graduation is not specific to nursing practice. However, nursing education is designed to train prepared professionals and therefore has a more practice-oriented focus than some academic disciplines. Beginner nurses are often not ready for occupational activities due to subjective factors and stress, as well as a lack of professional competence. According to Hickerson, Taylor, and Terhaar (2016), there is an issue of the “deficits in knowledge and skills that novice nurses may demonstrate on entry into the clinical setting” (p. 17). This paper discusses and evaluates the qualification and competence of post-education nursing practitioners. It also addresses the issue of developing professional identity among novice nurses and explores the ways to bridge the gap between education and professional activity.
Preparation and Competence
It should be noted that it is impossible to require novice nurses to perform their work functions immediately and perfectly. At the same time, the researchers point out that post-education professionals now suffer from a severe lack of confidence, critical thinking skills, and “clinical judgment” (Kavanagh & Szweda, 2017, p. 58). This assessment may be due to a number of factors, including the expectations of senior staff, who evaluate recent students by unrealistic standards. For instance, Hickerson et al. (2016) provide the data that nurse administrators claim that their beginning subordinates are “less-than-competent with respect to the 36 competencies” (p. 18). However, in addition to the subjective assessment of senior healthcare workers, some factors affect the objective unpreparedness of novice nurses.
Evidence-based medicine and healthcare research are developing at an unprecedented rate, which is why the quantity of information and approaches to treatment is rapidly increasing. The literature notes that, at present, the “information exceeds our capacity to assimilate it,” and this is especially relevant for novice healthcare workers (Kavanagh & Szweda, 2017, p. 58). Moreover, it is noted that the education system does not meet the standards of practice-oriented approach to treatment and care of the patient, which is why the preparation-practice gap is formed (Kavanagh & Szweda, 2017; Hickerson et al., 2016). As a result, hospitals and other healthcare institutions have to spend time and resources on additional training of nurses. This raises the issue of reviewing the structure of the educational process of nursing practitioners.
Professional Identity
Students form their initial professional identity precisely during their education by learning specific rules, values, patterns of behavior, and cultural traces. However, the real and final vision takes shape already during the work period. According to Maranon and Pera (2015), nursing students note the critical role of the professional reality that changes their early perceptions about “what they had been taught in theoretical and academic classes” (p. 859). Thus, at the very beginning of their careers, they are faced with a drastic change in their concepts about the nature of the clinical setting. These perceptual transformations are also caused by a preparation-practice gap and can strongly affect the performance of novice healthcare professionals.
A favorable working environment does not always accompany these psychological experiences and, as mentioned earlier, maybe exacerbated by criticism of senior staff. Moreover, the increased acuity of the patient and the reduced length of stay in the hospital are significant tendencies at the current time (Kavanagh & Szweda, 2017). Under such conditions, beginner professionals experience additional stress, as they face criticism both from the management, which expects them to perform their responsibilities, and from the patients. Due to the increased rate of patient flow, they do not have time to develop an emotionally trusting relationship with the patients. Thus, the professional identity of recent students can develop under stressful conditions and contribute to the gap between education and professional reality.
Bridging the Gap
It should be emphasized that bridging the preparation-practice gap is a particularly significant concern for the healthcare system. Researchers note that its adverse effects include but are not limited to “high turnover among novice nurses, increased costs to the institution, and patient safety issues” (Hickerson et al., 2016, p. 21). The solution to this problem implies a change both on the part of education and healthcare institutions, where nurses begin to work. The main goals are to create more favorable conditions in the workplace and to cover the lack of competencies in the learning process. It should be noted that the development of transitional opportunities and programs may allow students to adapt more easily to the professional environment.
Nursing education reform is being proposed in various versions and has been discussed for a considerable amount of time. Researchers note that the full range of necessary educational experience related to the skills of critical thinking and clinical judgment is often overshadowed by an excessive focus on task performance (Kavanagh & Szweda, 2017). At the same time, establishing a clinical learning environment within an educational curriculum can be effective. It is also essential that students have access to a professional environment. There are various programs and internships that allow prospective nurses to test their knowledge and skills in practical applications. However, the residency and the establishment of special conditions for first-year nurses are particularly helpful in addressing the preparation-practice gap.
Clinical Learning Environment
The clinical learning environment (CLE) is an opportunity to experience real clinical settings during the educational process. Researchers note that various authors define CLE in different ways, giving it multiple attributes, including personalization, individualization, instructor facilitation, and a working atmosphere (Flott & Linden, 2016). Diverse educational institutions organize the CLE according to their own standards. At the same time, it has several common functions, including bridging the gap between nursing education and practice. According to Omer (2016), CLE “exposes learners to realistic clinical scenarios in a simulated learning environment rather than waiting for the uncommon and rare situation to occur in real-life settings” (p. 131). Thus, the future nurses, firstly, acquire initial clinical experience, and secondly, greater competence and psychological preparedness for working conditions.
Due to the fact that CLE represents a safer space for students, it is only a partial simulation of the working environment. Researchers claim that it increases the satisfaction of future nurses with their education and increases their professional self-confidence (Omer, 2016). At the same time, the literature notes that no training activities can replace subsequent professional experience (Flott & Linden, 2016; Omer, 2016). It may be concluded that, in this regard, the value of student internships in hospitals and other healthcare institutions can significantly contribute to preparing them for employment. Furthermore, the organizational environment in which novice nurses are introduced also plays a crucial role.
Organizational Policies
Hospitals and other medical institutions are interested in nurses being more prepared and feeling more confident. According to Hickerson et al. (2016), “the strongest evidence suggests some form of on-the-job remediation, such as nurse residency or preceptor programs, as being the most efficient and effective solutions” (p. 20). The mentoring system is widely used in organizations, and the collaboration of novice nurses and senior professionals is no exception. In this way, beginners receive guidance that assists them in developing a professional identity and a more transparent framework of responsibilities and accountability.
Residency programs are the most appropriate transitional phase between education and clinical setting. They are a kind of supplementary education and an opportunity to acquire additional skills and knowledge that will be related to a specific professional environment. These programs are usually developed by individual entities and last for a period of twelve months, although there are exceptions. Researchers state that they have been “shown to improve nurse satisfaction two-fold and decrease turnover by 55%” (Hickerson et al., 2016, p. 21). Moreover, due to the fact that the residency conditions are similar to the working ones, hospitals get more trained and competent nurses who experience less stress and make fewer mistakes. As a result, patient safety and quality of medical services are improved, and the cost of internal training for newcomers is reduced.
Conclusion
It should be noted that the existence of a gap between education and professional activity is particularly characteristic of nursing practice. Novice specialists do not have a sufficient level of competence and confidence, and they lack the necessary skills, which is consistent with current healthcare realities. The results of the analysis suggest that this gap can be bridged through nursing education reform and clinical learning environment as well as through nursing residencies and preceptor programs.
References
Flott, E. A., & Linden, L. (2016). The clinical learning environment in nursing education: a concept analysis. Journal of Advanced Nursing, 72(3), 501-513.
Hickerson, K. A., Taylor, L. A., & Terhaar, M. F. (2016). The preparation–practice gap: An integrative literature review. The Journal of Continuing Education in Nursing, 47(1), 17-23.
Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses’ clinical reasoning. Nursing Education Perspectives, 38(2), 57-62.
Maranon, A. A., & Pera, M. P. I. (2015). Theory and practice in the construction of professional identity in nursing students: A qualitative study. Nurse Education Today, 35(7), 859-863.
Omer, T. (2016). Nursing students’ perceptions of satisfaction and self-confidence with clinical simulation experience. Journal of Education and Practice, 7(5), 131-138.