A collaborative project has created a training programme to bridge the theory-practice gap for student and newly qualified nurses
Abstract
There is a gap between what student nurses learn and what they experience in practice; this causes anxiety as they transition into the newly qualified nurse role. To address this, Birmingham Women’s and Children’s Hospital NHS Foundation Trust and Birmingham City University collaborated to develop a programme of additional teaching sessions for student nurses, covering self-reflection, physiology and clinical competencies. The aim was to upskill the student nurses and prepare them for clinical practice, thereby benefitting both the nurses and the trust. The programme has been delivered to 200 students and feedback shows it improves their confidence and competency. The programme recently won a Student Nursing Times Award and has now been rolled out to other trusts.
Citation: Paget S, Britten L (2020) A programme to smooth the transition from student to newly qualified nurse. Nursing Times [online]; 116: 4, 60-62.
Authors: Stephanie Paget is senior lecturer, Department for Children and Young People’s Health, Birmingham City University; Louis Britten is practice placement manager, Birmingham Women’s and Children’s Hospital NHS Foundation Trust.
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Introduction
There is a difference between what student nurses are taught in the classroom and what they experience in clinical practice – this is referred to as the theory-practice gap, and has been widely addressed in research literature (Ajani and Moez, 2011). There has been much debate about where this gap exists, whether it is positive or negative, and whether attempts to bridge it should be made. Corlett (2000) found that student nurses thought improved communication, information sharing and collaboration were necessary to improve the theory-practice gap. They also identified that visits to clinical settings would support students and help them discuss problems; this remains relevant to what is currently being observed in practice.
Student nurses can experience heightened anxiety and stress during their training, and often feel unable to perform clinical tasks, even if they know the theory. It can be difficult for mentors and supervisors to find a balance between supporting them and encouraging them to work more independently, which is required later in their training (Sharif and Masoumi, 2005). By having clear support in place and being allowed to practise in a safe environment, student nurses can gain the confidence to use their knowledge and skills in practice. This gives qualified nurses an active role in students’ education and gives mentors and supervisors the chance to pass on their own skills and knowledge.
Student nurses also experience elevated anxiety when finishing their undergraduate course and while transitioning into the newly qualified nurse (NQN) role (Maben et al, 2006). Health Education England (2018) has stated that the transition needs to be as smooth as possible. With the current shortage of nurses, it is vital for universities to retain students and for employers to retain qualified nurses; minimising their anxiety is likely to help with this. Henderson (2002) showed that the disparity between university and professional practice is an ongoing concern and must be challenged during the pre-registration phase, so NQNs are better prepared for practice. Monaghan (2015) found that preceptorship programmes reduces the stress on newly qualified nurses.
Identifying the need locally
Birmingham Women’s and Children’s NHS Foundation Trust (BWC) – which cares for women, children and families through a variety of specialist services – identified a need to support the transition from student nurse to NQN to retain these nurses and help them become confident practitioners as quickly as possible. To do this, it collaborated with Birmingham City University (BCU) to develop an education programme – called Theory into Practice (TiP) – to bridge the theory-practice gap for student children’s nurses.
The development of TiP was based on research conducted by Pressick and Taylor, (2018), collaboration and student experience. BCU conducted a literature review in 2015, which found that NQNs felt unprepared for practice and lacked confidence in their ability. We identified that NQNs’ resilience and confidence in their own skills, knowledge and leadership were key problems while transitioning from student nurse. It also identified the three issues most commonly reported by students as perceived risks during the transition:
- Patient assessment;
- Medicine management;
- Communication skills.
These formed TiP’s foundation.
What does TiP involve?
TiP is a comprehensive programme of teaching sessions that supplement the curriculum and offer extra support for student nurses while on placement. Box 1 lists examples of subjects covered. The programme is delivered every week when students are on clinical placement throughout the academic year; attendance is optional and there are one or two sessions per week, each of which lasts for 2-4 hours.
Box 1. Theory into Practice: examples of topics covered
- Patient observation and assessment
- Medicines management
- Communication and team working
- Scenario based physiology
- Reflective coaching
Although the programme’s central focuses were originally patient assessment, medicine management and communication, over time it was expanded to include fortnightly reflective coaching sessions. These enable students to identify areas for their own development and build resilience and problem-solving techniques. Self-reflection was then incorporated into all sessions to enable students to:
- Become critical thinkers;
- Learn evaluation skills;
- Develop self-efficacy and independence.
TiP also involves scenario-based physiology sessions that assimilate the medical conditions and changes observed in patients during clinical practice with associated anatomy and physiology; games and real-life case studies are included to engage students. The sessions improve students’ understanding of the potential causes of ill health and treatment in the patients they see.
TiP also helps student nurses to achieve clinical competencies in intravenous medication and blood-glucose monitoring; this prepares them for the transition into clinical practice. Students’ feedback highlighted that attaining these skills enabled them to excel on clinical placement. As the largest placement and employment provider for children’s nursing in the West Midlands, BWC employs a large proportion of student nurses going from BCU’s undergraduate programme to their first job after qualifying, so the trust also benefits from the students developing these skills. This is why it wanted to deliver teaching through TiP, which enables students to both attend study and have their competencies signed off.
Aims and objectives
The purpose of developing TiP was to give student nurses a greater understanding of how the theory they learn applies to the care they provide. The programme aimed to provide students with the knowledge and skills to recognise their individual learning style and strengths. This is key during their transition to NQN, as it enables them to adjust to life in their professional role. The aim of using reflective practice was to give them the skills to cope, learn and develop when they are receiving less-intensive support as an NQN, as suggested by Frankel (2009).
Another aim of the programme was to help students get the most out of their clinical placements by linking them to the theoretical components of the curriculum. This has benefits for both the students and the trust: by investing in student nurses before they qualify, the trust hoped to bridge the theory-practice gap and ensure they would be as prepared for qualifying as possible. BWC also aimed to give mentors and supervisors a better understanding of the student nurses’ journey by involving them in their education. They encourage students to attend TiP sessions and help them use what they have learned in teachging sessions when they are back in the placement area.
Getting involved in partnership working that can bring benefits to NQNs was another objective. A senior manager at BWC said: “I think it’s really important for us to have the strong relationships with the HEIs [higher-education institutions]. The students are being encouraged to feel part of [the] BWC team from the beginning.”
Students select their first nursing job based on the reputation of the preceptorship programme and level of support they will receive (HEE, 2018). BWC already provided preceptorship to all NQNs, focusing on certain skills and pastoral support, but intended that TiP would further alleviate students’ worries about the NQN role. The programme would do this by upskilling them and reassuring them they would be supported by a recognisable, approachable team when they first qualified.
To make sure this happened, BWC merged its practice education, advancing practice and newly qualified teams with its clinical education team, which supports, educates and innovates non-medical practice at the trust. This allowed developments or impacts in practice to be incorporated into other areas and ensured that there was a more-consistent approach to the nurse’s education journey, from pre-registration to advanced practice. BWC made sure this team worked closely with the TiP programme.
Outcomes
A total of four focus groups were held to identify how TiP affects students’ learning, confidence and competence. Participants reported increased confidence and competence in patient assessment, medicine management and communication. They also reported that the programme helped reduce loneliness and isolation while they were on placement, due to their having regular contact with staff and other students (Pressick and Taylor, 2018). Bryan (2018) also observed that students appreciated seeing a familiar face in clinical practice.
To date, TiP has delivered sessions to approximately 200 students. Sine 2017, attendance has increased from between four and eight students per session to between 15 and 20. The TiP team also continues to grow; when faculty staff join BCU’s children and young people’s health team from clinical practice, the head of department asks, and supports, them to help facilitate TiP and assist students in clinical practice.
The programme was originally intended to support transition into the NQN role but has evolved to provide numerous learning experiences to all student nurses at all points in their development. In 2019, it was a huge honour for the partnership between BWC and BCU to be recognised nationally: it won the Student Nursing Times Award for Partnership of the Year. This award has been fundamental in sustaining the continuing growth and development of the programme, enabling TiP to be recognised by other BCU departments and external institutions.
Due to TiP’s success, other departments and practice partners approached us and the education programme has been rolled out to other trusts and services. This means it is being made available to an increasing number of students across fields outside of children’s nursing, including mental health.
The future
The core values of BCU align with those of BWC and the two institutions share a joint vision for student nurses – to provide high-quality care to children, young people and their families. As TiP continues to grow, the team will continue to take an innovative approach to teaching. It is pivotal to give students a contextualised, authentic experience that enables them to take learning directly from the classroom to the bedside. Ongoing support and pastoral care will be vital in preparing them for the transition to NQN.
TiP will need to be carefully considered in relation to the NMC’s (2018) standards for education; it will need to be aligned into the new curriculum and there will be opportunities for change.
Key points
- There is a gap between theory and practice for student nurses and those who are newly qualified
- This causes anxiety and stress during the transition, and there is an issue with retaining newly qualified nurses
- A trust and university collaborated to produce the Theory into Practice programme, which gives student nurses additional training
- It provides sessions on topics such as self-reflection and physiology, as well as clinical competencies
- Student nurse feedback showed that the training programme improved their confidence and competency, resulting in it being rolled out to other trusts
Ajani K, Moez S (2011) Gap between knowledge and practice in nursing. Procedia - Social and Behavioral Sciences; 15: 1, 3927-3931.
Bryan S (2018) Switching from practice to teaching opened my eyes. Nursing Standard;
32: 24, 35.
Corlett J (2000) The perceptions of nurse teachers, student nurses and preceptors of the theory-practice gap in nurse education. Nurse Education Today; 20: 6, 499-505.
Frankel A (2009) Nurses’ learning styles: promoting better integration of theory into practice. Nursing Times; 105: 2, 24-27.
Health Education England (2018) RePAIR: Reducing Pre-Registration Attrition and Improving Retention Report. HEE.
Henderson S (2002) Factors impacting on nurses’ transference of the theoretical knowledge of holistic care into clinical practice. Nurse Education in Practice; 2: 4, 244-250.
Maben J et al (2006) The theory-practice gap: impact of professional-bureaucratic work conflict on newly qualified nurses. Journal of Advanced Nursing; 55: 4, 465-477.
Monaghan T (2015) A critical analysis of the literature and theoretical perspectives on theory-practice gap amongst newly qualified nurses within the United Kingdom. Nurse Education Today; 35: 8, e1-e7.
Nursing and Midwifery Council (2018) Realising Professionalism: Standards for Education and Training. Part 2: Standards for Student Supervision and Assessment. NMC.
Pressick I, Taylor L (2018) Theory into Practice [abstract]. In: Partners in Practice: Nurses Working Together Through Change – Conference and exhibition hosted by the RCN Education Forum, Book of Abstracts. RCN.
Sharif F, Masoumi S (2005) A qualitative study of nursing student experiences of clinical practice. BMC Nursing; 4: 6.
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