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Theory to practice gap in the nursing practice

The transitional phase in nursing practice is considered to be the remarkable changes which is faced by the newly graduate nurses in providing proper care. The primary reason for facing the challenges by the nurses includes lack of proper theory to practice knowledge. It is also stated that the new graduate nurses face challenges due to lack of proper knowledge which influences the superiority of life of the patient and the new graduate nurses fails in providing proper which impacts the thinking process (Robeano et al., 2019). One of the challenges which is faced by the nurses includes lack of proper knowledge which increases the stress by developing psychological burnouts by increasing the treatment error. The lack of proper practice knowledge impacts the patient’s condition and increases the level of frustration including tiredness due to lack of proper work life balance. Hence, in this case, the major challenges faced by the nurses working in the environment includes lack of proper confidence, role expectation, workload, orientation issues and fear (Chicca & Bindon, 2019). The factors which can cause dissatisfaction includes lack of support, physical environment and lack of responsibility. The following paper will discuss about the importance of planning and organising shift workload and improving the quality of care.

It has been determined that the new graduate nurses face difficulties in managing the patient care due to lack of proper knowledge and practice. The new graduate nurses face difficulty in managing proper work or to handle more than 1 patient at the same time which impact the patient’s condition and increases the chance of developing treatment error. The new graduate nurses face difficulty in managing time due to business and unpredictable nature of the hospital unit. Poor time management increases the workload of the new graduate nurses which results in increasing the waiting time, increasing the stress, lack of proper work-life balance, lowering self-esteemed, lowering the job satisfaction which reduces the turnover rate. Hence, effective time management and proper coordination helps in supporting the new graduate nurses in managing work (Labrague & McEnroe-Petitte, 2018). Effective time management helps in increasing the productivity and providing better care to the patients. The time management helps the nurses in organising and prioritising the patient care, managing proper administration task and lowering personal obligations. The nurses with proper knowledge and techniques to manage the time effectively faces less limitation and challenges. Similarly, the nurse faces difficulty in managing the critical patients due to lack of proper clinical care knowledge in providing proper care. The new graduate nurses have lack of proper theory to gap knowledge which impacts the patient’s condition. DeGrande et al., (2018) performed a study for determining the determining the challenges faced by the new graduate nurses employed in the adult intensive car units. The study stated that the new graduate nurses face difficulty in the entry level in to the practice due to gap in the readiness between the actual clinical practise and nursing curricula which increases the chance of developing challenges by enhancing the negative consequences. The result of the study stated that the overall meaning of the experience includes uncomfortable in the setting which impacts the turnover rate. The study result also states that the reason for uncomforting situation includes- lack of proper confidence, uncertainty of the situation, lack of proper experience in managing the situation of the patient, lack of proper learning, difficulty in handling situation and lack of proper team support or cooperation within the nursing team which increases the challenges and lowers the self-confidence of the nurses. Ghiasvand et al., (2017) completed a study for understanding the relationship amongst the anxiety and time management assistances among the new graduate nurses. The result of the research stated that most of the participants had a reasonable level of time administration skills which was almost 49%. The state of anxiety was also 58%, the academic motivation was 58% and that of trait anxiety was 60%. The study stated that there exists an undesirable association amongst time management state and anxiety level. Hence, a proper motivational plan and time management skills training must be provided which will help in improving the knowledge of the nurses and lowering anxiety. Hussein et al., (2017) stated that cumulative difficulty of acute care wards, high patient insight and challenging capacities the new graduate nurses endure to necessitate advance levels of provision to accomplish intensifying patient clinical care requirements. The result of the study stated that no change in the level of nurse satisfaction after implementation of the clinical supervision was observed in the setting. The result also highlighted that the negative responses include increase workload, advance clinical demands, lack of proper expectations and increase clinical demands impacts the condition and thereby a proper clinical support helps in improving the competency of new graduate nurses and lowering the challenges by addressing the unmet need (Kaihlanen et al., 2018).

New nurses' challenges in time management and clinical care knowledge

Two reasons for effecting the nursing experiences

Theory to practice gap in the nursing practice

The new graduate nurses face difficulty in managing the patient condition during the initial phase of preparation due to lack of proper understanding and theory to practice gap. The primary reason for the theory to practice gap include lack of proper opportunity of the student nurses in providing proper care. Safazadeh et al., (2018) stated that nursing is a technical occupation which is based upon art and theory of care. Presently, the theory to practice gap had a biggest jeopardy in delivering proper care. The result of the study stated that the theory-practice gap can be divided in to 13 categories and the main factor which increases the gap includes organisational barrier, lack of proper training and cultural difference in the care process. Hence, the study stated that proper education can be provided to the student nurses apart from the nursing curriculum which will help in preventing the challenges and improving the self-confidence and esteemed among the new graduate nurses.  The lack of proper preparation experience impacts the care process and increasing the workload of the new graduate nurses.

Murray et al., (2019) performed a study to explore the transition experience of recently graduate nurses in providing proper attention to the patient safety issues. The study highlighted that the new graduate nurses face challenges in the clinical setting which is accompanied by the degree of shock and the primary reason for developing such condition is due to lack of proper theory to practice gap. The study stated that the inadequate experience to medical locations and practices leaves the newly graduate nurses at risk of producing mistakes and failure to recognise the deterioration sign of the patient, prioritising the time management of all the patient and understanding about the completion of task for improving the patient safety and care. The result of the study stated that the lack in knowledge and theory to practice gap impacts the patient’s safety, insights, time management and the incidence increases the chance of developing medication error, transitional issues and lack of proper time management increases the stress among the newly graduate nurses (Rush et al., 2019).

The newly graduate faces challenges due to discrimination and lack of cooperation within the team. Jack et al., (2017) performed a study for determining the perceived unfairness and the experiences faced by the student’s nurses during their undergraduate clinical placements. The study stated that the nursing students needs proper support by the practice staffs during their clinical placement and the students feels ignore, bullied and unsupported which impacts the clinical experience and increases the job dissatisfaction. The result of the study stated that the newly graduate nurses or the student nurses often feels ignored or unfairness which increases the challenges. Hence, proper support is essential for the patient in order to recover the quality of care.

The time management skill is essential in nursing practice which helps in lowering stress among the newly graduate nurses and recovers the superiority of care provided to the patients. Time management also helps in lowering issues in critical care unit. Mohammed et al., (2019) stated performed a study for determining the relation between the stress level and skills among the nursing students. The result of the study highlighted the fact that the nursing students has reasonable level of time organization skill which is 75.3% and it is related with the stress which is related with 54.5%. Hence, in this case a proper time management skill needs to be delivered to the nursing students which will help in improving the quality of care provided to the patient.

Importance of planning and time management

According to the NMBA standard 6, the nurses must provide a safe, appropriate and quality care. The sub-standard 6.1, the registered nurses must provide the patients with proper comprehensive safe and quality care in order to provide the patient with safe practice. Standard 6.5, highlights that the nurses must provide the patient with care in relation to the guidelines, policies and standards. Hence, in this case proper support and practice guidelines must be provided to the newly graduate nurses for improving the quality of care and preventing the treatment error.

Conclusion

The above paper deliberated about the difficulty faced by the new graduate nurses. The major challenges faced by the nurses working in the environment includes lack of proper confidence, role expectation, workload, orientation issues and fear. The factors which can cause dissatisfaction includes lack of support, physical environment and lack of responsibility. The lack of proper time management occurs due to theory to practice gap. The time management skill is essential in nursing practice which helps in lowering stress among the newly graduate nurses and advances the quality of care provided to the patients. Time management also helps in lowering issues in critical care unit. The studies highlighted that the main factor which increases the gap includes organisational barrier, lack of proper training and cultural difference in the care process. The lack of proper time management develops due to gap or lack of opportunities in the nursing curriculum. The nursing students has reasonable level of time management skill which is 75.3% and it is related with the stress which is related with 54.5% according to one of the studies. The sub-standard 6.1, the registered nurses must provide the patients with proper comprehensive safe and quality care in order to provide the patient with safe practice. Standard 6.5, highlights that the nurses must provide the patient with care in relation to the guidelines, policies and standards. Lastly, the study stated that proper clinical simulation and time management skills helps in supporting the newly graduate nurses and improving their care service.

The two actions which can be taken by the nurses in order to recover the quality of care, practice and helping in the transitional period includes- time management skill training and clinical simulation programs by the organisation in order to deal with the critical patient.

Time management is one of the most common approaches which needs to be addressed by the newly graduate nurses in managing the work-life balance and lowering stress and frustration. The nurses must be involved in the care process which will help in improving the quality of care and maintaining a successful transition (Sanaie et al., 2019). The real-time management planning helps in improving the identified challenges and lowering the chance of developing complications and challenges.  The clinical supervisor in this case can provide the newly graduate nurses with proper time management planning and skills which will help in lowering the challenges. The training must be provided via online programs such as planning and prioritising the need of the patient and recovering from the challenges (Labrague et al., 2017).

Challenges for new nurses in managing critical patients

The organisational changes which need to be implemented include proper leadership or supervision plan which needs to be provided for improving the skills and enhancing the knowledge or improving the skills in managing the critical patients (Linn et al., 2019). The clinical simulation program must be implemented within the organisation by the supervisors which will help in increasing the understanding and knowledge in handling real patient and understanding the signs and symptoms. The program must be implemented for 2months which will help in lowering the theory to practice gap (Shin et al., 2019).

References

Chicca, J., & Bindon, S. (2019). New-to-setting nurse transitions: A concept analysis. Journal for nurses in professional development, 35(2), 66-75. doi: 10.1097/NND.0000000000000530

DeGrande, H., Liu, F., Greene, P., & Stankus, J. A. (2018). The experiences of new graduate nurses hired and retained in adult intensive care units. Intensive and Critical Care Nursing, 49, 72-78. DOI:10.1016/j.iccn.2018.08.005

Ghiasvand, A. M., Naderi, M., Tafreshi, M. Z., Ahmadi, F., & Hosseini, M. (2017). Relationship between time management skills and anxiety and academic motivation of nursing students in Tehran. Electronic physician, 9(1), 3678–3684. https://doi.org/10.19082/3678

Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017). New graduate nurses' experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support. BMC nursing, 16, 42. https://doi.org/10.1186/s12912-017-0236-0

Jack, K., Hamshire, C., Harris, W. E., Langan, M., Barrett, N., & Wibberley, C. (2018). “My mentor didn't speak to me for the first four weeks”: Perceived unfairness experienced by nursing students in clinical practice settings. Journal of clinical nursing, 27(5-6), 929-938. https://doi.org/10.1111/jocn.14015

Kaihlanen, A. M., Haavisto, E., Strandell?Laine, C., & Salminen, L. (2018). Facilitating the transition from a nursing student to a Registered Nurse in the final clinical practicum: A scoping literature review. Scandinavian Journal of Caring Sciences, 32(2), 466-477.

https://doi.org/10.1111/scs.12494

Labrague, L. J., & McEnroe?Petitte, D. (2018). Job stress in new nurses during the transition period: an integrative review. International nursing review, 65(4), 491-504.

https://doi.org/10.1111/inr.12425

Labrague, L. J., McEnroe-Petitte, D. M., Gloe, D., Thomas, L., Papathanasiou, I. V., & Tsaras, K. (2017). A literature review on stress and coping strategies in nursing students. Journal of Mental Health, 26(5), 471-480. https://doi.org/10.1080/09638237.2016.1244721

Linn, A. C., Caregnato, R. C. A., & Souza, E. N. D. (2019). Clinical simulation in nursing education in intensive therapy: an integrative review. Revista Brasileira de Enfermagem, 72, 1061-1070. https://doi.org/10.1590/0034-7167-2018-0217  

Mohammed, S. R., Aref, S. M., & Mohammed, E. A. (2019). Relation between Time Management Skills and Stress Level among Fourth Year Students at Faculty of Nursing. ResearchAuthers Pages 1. Inter Parental Conflict and Its Effect on Adolescent's Behavior in Selected Schools at Minia City. DOI: 10.21608/MSNJ.2019.187805

Murray, M., Sundin, D., & Cope, V. (2019). New graduate nurses’ understanding and attitudes about patient safety upon transition to practice. Journal of clinical nursing, 28(13-14), 2543-2552.

https://doi.org/10.1111/jocn.14839

Robeano, K., Delong, D., & Taylor, H. A. (2019). Optimizing transitional support for novice nurse practitioners. Nurse Leader, 17(4), 303-307.

https://doi.org/10.1016/j.mnl.2019.03.020

Rush, K. L., Janke, R., Duchscher, J. E., Phillips, R., & Kaur, S. (2019). Best practices of formal new graduate transition programs: An integrative review. International Journal of Nursing Studies, 94, 139-158.

https://doi.org/10.1016/j.ijnurstu.2019.02.010

Safazadeh, S., Irajpour, A., Alimohammadi, N., & Haghani, F. (2018). Exploring the reasons for theory-practice gap in emergency nursing education: A qualitative research. Journal of education and health promotion, 7, 132.

https://doi.org/10.4103/jehp.jehp_25_18

Sanaie, N., Vasli, P., Sedighi, L., & Sadeghi, B. (2019). Comparing the effect of lecture and Jigsaw teaching strategies on the nursing students' self-regulated learning and academic motivation: A quasi-experimental study. Nurse education today, 79, 35-40.

https://doi.org/10.1016/j.nedt.2019.05.022

Shin, H., Rim, D., Kim, H., Park, S., & Shon, S. (2019). Educational characteristics of virtual simulation in nursing: An integrative review. Clinical Simulation in Nursing, 37, 18-28. https://doi.org/10.1016/j.ecns.2019.08.002

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