Nurses across the nation recognize the gap between nursing education and nursing practice. Nurse historians believe this phenomenon began about 40 years ago during World War II. Nursing education during that time began to move seriously from apprenticeship learning in hospitals to learning in the university setting. The rapid increase of baccalaureate nursing programs brought about a movement of nurses from the hospitals to the university campus as students and as educators (Chaisson, 1980). This has generally divided nursing into two camps: education and practice. The nursing literature relates the problems which have arisen from this division. The negative outcome frequently identified is the limited communication and collaboration between nursing education and nursing practice (Martin, 1980, Spero, 1980). Other problems have also been identified. Nursing practice views nurse educators as lacking in clinical expertise and in understanding the "real" world of nursing (Curtis, 1980, Spero, 1980). Nursing students often have difficulty viewing their instructors as competent practitioners and therefore the nurse educator may become an ineffective role model (Diers, 1980). On the other hand, nurses in practice often fail to recognize their roles as educators and scholars. The development of the body of nursing knowledge suffers when nurses are not prepared to identify and study nursing questions. New knowledge developed by nurse educators, which is often not clinically oriented, may benefit those in practice minimally (Williamson, 1980). To bridge the gap between nursing practice and education, nurse educators are moving back into nursing practice. Nursing faculty, individually and collectively are seeking effective methods of incorporating practice and teaching. Different modes of faculty practice have been identified such as: dual appointments in practice and education, private practice, development of a practice within a nursing college, assuming patient care while supervising students, joint faculty ,oractice positions, and others. Nursing faculty are seeking methods to address the gap between nursing education and practice.
The term unification frequently appears in nursing literature. The term implies the unifying and strengthening of the expected roles of nurses as practitioners, educators and scholars. The goal of unification is to provide high quality care, achieve academic excellence and conduct research (Nayer, 1980). Several authors, however, caution that when roles are combined, some aspect of nursing may suffer (McCarthy, 1981; Spero, 1980). These authors believe that the energy needed to function effectively in all areas would be prohibitive for the individual nurse. However through the combined efforts of several nurses, pooling their resources, nursing could be demonstrated in the fullest sense, without excessively taxing the individual nurse.
With this background, a joint faculty/ practice position was initiated. Following is a description of the experiences of the author, a nurse educator, demonstrating a joint faculty/practice position. The planning, implementation and evaluation are presented.
Planning a Joint Faculty/Practice Position
A proposal for a joint faculty/practice position was developed and presented to a clinical committee which represented the educational and service institutions involved. A collaborative relationship had already been developed between a private midwestern medical center and a nursing department in a university setting. The objectives for the joint position included the increasing communication and collaboration between the institutions, the demonstration of the combined nursing roles of practice, education and research, bringing to the practice setting education and research skills, and the enhancement of the nurse educators role as practitioner. If these goals could be demonstrated successfully, similar positions could be developed with participation of nurses from both nursing faculty and nursing service. Thus nursing practice and education would be working side by side with common goals. The combined efforts of nurses from both areas would further develop and enhance the profession of nursing.
Further negotiations with the clinical committee, administrations from both institutions and the selected nursing area, the proposal was approved for a twosemester period. Immediate objectives were set to orient to the pediatric unit, the selected clinical unit, and begin working as a primary nurse. Involvement with students on the clinical areas was minimal during the initial period. How the joint position was to develop in this setting was yet to be seen. The pediatric staff received the position well and already had many suggestions for help in various projects.
The First Semester: An assignment was presented to the author early in this semester. A committee with representation from nursing and the medical community requested that I develop a parent education program on the pediatric unit. A second suggestion came from the intensive care nurses requesting a parent support group for parents with children in intensive care. Thirdly, several nurses expressed a desire to begin a research study on the pediatric area. The opportunities were overwhelming and exciting.
The pediatric head nurses and educational coordinator provided the direction and support for these endeavors. The study of a parent education program was begun. The gathering of data, the testing of ideas, and the seeking of support and approval within the hospital system were initiated during the first semester. The potential of assigning selected students (honor students) to the parent education program was soon recognized and tested. An objective for the second semester became evident. Honor students would be involved in implementing the parent education activities under the supervision of the author. The educator and practitioner roles would thus be combined.
The support group for the parents with children in intensive care was also begun. Objectives for these support meetings were developed by intensive care nurses, an intern chaplain and the author. Meetings with parents were planned each week. After involving nursing students in these support group sessions, it was decided that nursing students would be involved during the second semester to learn more about crisis intervention. Nursing students and nursing staff were all provided with classes on crisis theory and strategies for intervention. Relating the theory with the actual experiences of parents has been a "here and now" learning experience.
The involvement in a research project began when the staff developed a home instruction tool to be given to parents upon dismissal. Since several nurses had requested a desire to be involved in a study, the author suggested that the tool be tested. An enthusiastic response resulted. A group was formed to develop a proposal. By the beginning of the second semester, a proposal to test the home instruction tool had been approved and funded by the medical center. The nursing staff was particularly pleased since this was the first nursing research study supported financially by the medical center. The role of researcher had now been added to the joint faculty/ practice position.
The Second Semester: The first semester became the planning and testing period for the joint position. The second semester became the implementation of the role. The activities already described were implemented and nursing students were involved in these activities during their clinical experience. They participated in a variety of parent education activities, the parent support groups and also assisted with research activities, such as collection and compiling of data.
The nursing staff were involved in all activities, according to interest and by assignment. Their input and participation were sought in the parent education activities. Nurses were involved in the research project, assisting with the literature review and data collection. The nursing staff was aware of all the activities related to the joint position and demonstrated their support and interest through their cooperation.
By the end of the second semester a final report was developed and presented to the clinical committee which had originally endorsed the joint position and to the head nurses of the pediatric department. The goals, the activities and the data collected throughout this period were presented. The responses from parents and nursing staff involved in the parent education activities were overwhelmingly positive. The outcome of parents' behaviors as observed by nursing staff as a result of the support group were also positive. They observed that parents were frequently more "open" after participating in a support session. Nursing staff responded that they themselves, had become more sensitive to parents' needs with the development of the support group. The implementation of the research project was evaluated highly by staff. The guidance received was well taken and appreciated. An outcome of the study was the presentation of the study by one of the pediatric nurses at a national pediatric convention and by the author at a national nursing meeting. The author and a staff nurse have co-authored an article on this study and have submitted it for publication. The pediatric staff is proud of their accomplishments.
The nursing students responded favorably to their experience with an instructor in a joint position. As stated by one nursing student, "It is very valuable to have someone who is very familiar with the medical center and I think we (students) are accepted more readily." Another wrote, "She (the author) has developed a close communication with staff members as well as with families, in this way these individuals relate more closely to me which facilitates my learning."
The overall goal of the joint position was to enhance communication and collaboration between nursing education and nursing practice. The author believes that this was demonstrated. One head nurse wrote this evaluative statement, "This has truly been a collaborative effort."
When the final report was presented at the end of the second semester, suggestions were made to continue the position and also to expand it to other clinical areas. The decision was made to continue the position for a third semester and to seek a reciprocal arrangement by a nurse in practice. In such a position, a nurse in practice would take a leadership role in bringing strengths from practice to nursing education. Ideally joint positions will occur in other clinical areas. Each nurse in a joint position would strive to provide high quality of care, achieve academic excellence and conduct research.
Although the author is no longer in the joint position, the results of this experience have been rewarding. Both institutions seek to develop similar positions. Communication and collaboration between practice and education have improved as each group recognizes the strengths of the other. An increase of sharing of skills and knowledge is observed. The author continues to provide support for activities which were begun during this experience. Many benefits have been realized from this experience; a parent education program continues to expand through the efforts of the nursing staff, the support group is on going under the supervision of the Head Nurse. A warm welcome awaits the author when she arrives on the pediatric unit for a visit!
The author's overall goal to demonstrate a mechanism to improve communication and collaboration between nursing education and practice has been realized. Nurses have grown from this experience, patients have received improved nursing care and nursing knowledge has been augmented. This has been a vital experience in nursing.
- Chaisson, G.M. (1980). Faculty clinical practice: The strategy for reconciliation. Arizona Nurse, 33(3), 1-6.
- Curtis, M. (1980). Evaluating the clinical performance of faculty fact or fantasy? NLN Publication No. 15-1831, 27-32.
- Diers, D. (1980). Faculty practice: Models, methods and madness. NLN Publication No. 15-1831, 7-13.
- Martin, RJ. (1980). One meter stick-the nursing audit. Journal of Advanced Nursing, 5, 199-208.
- McCarthy, P.A. (1981). Will practice make perfect? Nursing Outlook, 29(3), 163.
- Nayer, D.D. (1980). Unification. American Journal of Nursing, 80(6), 1110-1114.
- Spero, J.R. Nursing: A professional practice discipline in academia. Nursing and Health Care, 1(1), 22-25.
- Williamson, J.A. (1980). Faculty practice in a nursing center: An integrated model. NLN Publication No. 15-1831, 17-20.