Bridging the theory-practice gap in nurse education

"Nursing academics are often viewed as being out of touch with clinical practice and preoccupied with research, while clinical nurses are viewed as too busy to educate or research.”

To tackle this concern, noted by the authors of an article on closing the theory-practice gap in nursing education, La Trobe University researchers established the role of the lecturer-practitioner.

Sam Miller, an Intensive Care Unit lecturer-practitioner and postgraduate course coordinator, unpacked the appointment in the Australian Nursing and Midwifery Journal.

“The vision for this role is a clinician endorsed as an expert nurse within a speciality area and recognised by the academic environment as a professor.

However, in reality, appointments are commonly made to nurses who are experts in their fields and working towards achieving nurse practitioner and professor titles,” Miller and her co-authors wrote.

“This dual accreditation across both academia and advanced clinical practice places the individual in a unique position to move seamlessly between practice, education and associated research activities.”

Nursing Review sat down with Miller to find out more about the lecturer-practitioner role and the impact of the model on the theory-practice gap.

NR: What does the lecturer-practitioner role entail? Who would be an ideal candidate?

SM: An ideal candidate for the lecturer-practitioner position is someone who wants to work in nursing education, but also someone who wants to maintain a strong clinical practice portfolio. So, usually someone who’s quite advanced in the nursing practice – either a nurse consulting position or nurse practitioner, that sort of level of practice within a specialty.

We’re also looking to design a curriculum and deliver that teaching. And because of the integration between theory and practice, it’s someone who’s able to move between the two areas. So, someone who’s keen to deliver the education but also have strong links with practice and maintain their own clinical caseload.

What does research tell us about the impact this role can have on postgraduate education?

There’s not a huge amount of research on the topic, which is something the team here at the Alfred Clinical School are working on. We’re going to look at how that works for the students and the educators, and what we call industry partners – the nurse managers and clinical educators that work in these sites that we integrate with.

The research comes from undergrad – it’s moved from nursing education coming out of the bedside, as it was 40, 50 years ago, to universities. That created the theory-practice gap, so that’s what you were taught in university, in a separate building. And then you would go on placement and you would be expected to move that knowledge across, even though the two settings were very different.

So, as that has evolved, we then tried to bridge that theory-practice gap. And the lecturer-practitioner positions allow us to be visible in the clinical area as well as in teaching. So even if there’s a teaching session I’m not delivering, I’m always visible to the students.

And they know that I’ve quality-assured the teaching that’s been delivered by other practitioners, and they also see me in a senior position in Intensive Care, so that helps assure them I am a clinical expert and also dedicated to their education.

Why else do you think the addition of this role makes a difference to how students view their education?

I think it helps with transparency, and speaking to some students that study at universities that don’t have these positions, I think they still feel that the university and its clinical area are very separate. There’s no communication between the two.

Undertaking postgraduate studies is very separate to the clinical practice. It’s very difficult for them to align the two. So even if they just see me walking around the unit in a senior position, they’re able to relate the understanding that they have from the theory into clinical practice. And they can see that these are not two distinct bodies of their professional development.

Any academic learning that they do does immediately transfer over to their clinical practice. And that’s the purpose of us delivering the postgraduate education. It’s not a purely academic qualification that they get. It’s something that’s recognised clinically to ensure that they are in fact practitioners.

What challenges does this role bring about for the professional? You know, having a foot in both camps?

You have dual lines of reporting, both academically to the head of school, to your professor, and to the nurse student manager, and for me that’s Intensive Care. And that means keeping both lines happy. Usually there is an agreement between whatever I’m undertaking in terms of specific tasks. I will be well supported by both sides. But if there was to be any discrepancy between the academic viewpoint and the clinical viewpoint, that would then sit with me and I would have to resolve that between the two areas.

In terms of what roles, it can be quite difficult. I don’t have designated days with the university and designated days in clinical practice. I work from an office in the university. If I’m needed in the clinical area, I’ll walk over there where I physically can. And in terms of teaching, I have a teaching commitment both to postgrad and to undergraduate teaching as well. So, it’s very difficult to juggle all of that workload. It’s a case of being proactive when you know you’ve got lots of marking to do. But sometimes you need to be reactive, especially for the demands from the clinical area.

If I’m required to go over there to help them, that needs to happen there and then. You need to plan your workload where you can and know your personal limitations. And try not to take too much work home in the evening.

What does it take to ensure the position is as beneficial as possible? What advice would you give to anyone setting up a new lecturer-practitioner position?

The most important thing is that there is understanding and transparency from both partners – the university and the healthcare providers – on the terms of the agreement that will underpin the lecturer-practitioner appointment.

For me, that ensures that I’m paid by the healthcare organisation because that gets me better conditions, rather than if I moved over to the academic pay scale. So, transparency in discussion at that high level before you create a lecturer-practitioner position.

And just continually review to make sure that both partners are happy with what they get from the position, and that the position is working well for the individual that’s there. For me, that’s very frequent catch-ups with both lines of reporting that I have, so both the professor in the clinical skills and the nurse manager over in Intensive Care. Anything they want to discuss, I’m very accessible to them. So we have conversations around the development and the projects that are ongoing, rather than having me in an office and nobody knows what’s happening between the two interfaces.

You mentioned earlier that the team will be looking to address the lack of research in terms of this role in postgraduate education. What will the team be looking into?

At the moment, we don’t have a narrow research question, but we’re really interested in how this role works.

Anecdotally, everyone from the university and the clinical practice areas are very happy with the role. No one has had any negative feedback that we’re aware of. But we need to quantify that by producing research. So we will be looking at the opinions of students. At the moment, the group of students I manage come from the hospital that I’m in a partnership with and also from other hospitals. The other hospitals don’t see the full benefit of the lecturer-practitioner role. For them, I just act as a student coordinator for their academic programs.

It’d be really interesting to survey both groups of students to find out whether the students that view me as a lecturer-practitioner have any difference of opinion in terms of bridging the theory-practice gap. As for the other students, they follow more traditional routes where they have academic teaching with me and then go back to their clinical areas, which I’m not related to. It’d be good to follow that.

It would also be good to investigate how other partners or senior nurses feel the lecturer-practitioner role benefits them, in terms of accessibility and understanding of the course in comparison to if they’re accessing any courses that don’t have a lecturer-practitioner. So, they just send their students off to university one day a month for their workshop days and they don’t have any other interaction.

It would be good to evaluate that link and that relationship we have and see if there are any gaps we could work towards improving.

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