Connecting nursing education and practice: a focus on shared goals for quality and safety.

The gap between the worlds of nursing education and nurses in practice has been highlighted over the past four decades. Cyclical eff orts to bridge this gap have met with varying degrees of success. A recent a.. empt to unite nursing education and practice is the Quality and Safety Education for Nurses (QSEN) initiative, generously funded by the Robert Wood Johnson Foundation (Cronenwe.. et al., ..007). The major goal of QSEN is to prepare future nurses with the knowledge, skills, and a.. itudes necessary to continuously improve the quality and safety of care delivery in health care systems. This article summarizes and discusses QSEN's accomplishments and upcoming activities within a framework of the factors contributing to the separation of the education and practice worlds and makes recommendations for building on the progress derived from QSEN activities. HISTORICAL PERSPECTIVES The early days of nursing education relied on an apprentice model of education. Diploma nursing programs were created by hospitals, with instructors selected for their excellent performance and clinical skills. Most instructors continued to practice, thus ensuring the currency of their knowledge. Nursing students received limited formal instruction and spent many hours working in the wards. Close supervision of new students (o.. en called "probies," short for "probationers") was a serious undertaking to protect patients and to instill the necessary values related to nursing practice. As students progressed, they assumed more responsibilities and eventually served as charge nurses. As new graduate registered nurses, these individuals were fully prepared and had in fact "practiced" in the role for some period of time. For be.. er or worse, there were few surprises in the demands and expectations of the workplace. Several factors led to the migration of nursing programs into colleges in the United States. Support for Florence Nightingale's vision of nursing as a true profession grew steadily, along with the body of knowledge associated with the practice of medicine. The amount and variety of knowledge required by nurses expanded signifi cantly. In 1923 the Goldmark Report recommended that nursing education should reside within institutions of higher education. Over time, many U.S. diploma programs transitioned into colleges or were closed in response to professional nursing organizations' position statements and goals. However, the fi nancial contribution that hospital-based nursing schools made to their institutions (a factor that continues today) was a signifi cant disincentive to closing these programs. ORIGIN OF THE EDUCATION-PRACTICE GAP The movement of nursing education into college se.. ings accomplished many goals established by nurse leaders and other stakeholders. Nursing education incorporated liberal arts, science, and social science knowledge taught by experts in those fi elds, providing a fi rm foundation for professional nursing practice. Exposure to other professional disciplines and the value of generating and applying new knowledge to improve practice were emphasized. Nurse faculties strengthened their educational credentials and methods to enhance the academic experience and to produce professional nurses with a commitment to lifelong learning and to expanding scientifi c knowledge within the discipline. The unanticipated consequences of nursing education's transition into colleges are at the core of the education-practice gap. With most nursing faculty no longer employed in health care facilities, access to appropriate practice experiences to maintain current knowledge and skills was lost. The nature of nursing practice makes it diffi cult to be involved intermi.. ently. Increasing technology, complex health care systems and practices, cost implications, and risk management considerations further complicate faculty practice arrangements. Many nursing instructors fi nd it challenging to balance their full-time roles as academicians with the need for ongoing clinical exposure; some have described this challenge as having two full-time positions! …