Nursing professor calls for steps to close the reality gap between education and practice

January 18, 2006

The nursing profession should be deeply concerned that the reality gap between education and practice identified three decades ago still remains today, according to a commentary in the latest Journal of Advanced Nursing.

Professor Jill Macleod Clark from Southampton University says that despite considerable efforts by the profession to bring about change, the basic problems identified in a 1976 paper by Eve Bendall continue to cause concern.

Dr Bendall's paper, which is reprinted in the 30th Anniversary Issue of the Journal, had warned that there was a danger of producing nurses who were "increasingly proficient on paper and decreasingly proficient in practice."

She believed that what nurses were learning in theory was becoming increasingly divorced from what they were actually doing in practice.

In an up-to-date commentary, Professor Macleod Clark, who is head of the University's School of Nursing and Midwifery, says that a total review of the nursing education system is called for and tough policy measures need to be introduced.

"We also need sufficient funding to resource and radically modernise the practice learning requirements and outcomes of nursing students in the 21st century" adds the Professor, who is also Chair of the Council of Deans and Heads of UK Faculties for Nursing and Health Professions.

Dr Bendall's paper, written when she was Registrar of the General Nursing Council for England and Wales, looked at the behaviour of 321 student and pupil nurses from 19 hospitals. 22 real-life nursing situations were selected and examined, to explore the gap between what they had been trained to do and what they did in reality.

She compared their written descriptions of what they should do in practice with what they actually did and discovered that these differed in 84 per cent of cases. Bendall concluded that, on many occasions, nurses did not follow the ideal behaviour they have been taught when they were faced with the real situations they encountered on hospital wards.

"I suspect that if my research study was replicated today, the result would be similar" Dr Bendall writes in the Anniversary Issue, which focuses on how many of concerns raised in the last 30 years are still relevant today.

Although she acknowledges that much has changed in the last 30 years she maintains that "the conflict between the ideal and the real inevitably remains."

Professor Macleod Clark adds that the profession has made considerable efforts to bring about change, but that the pressures on today's nurses are a key factor in the continuing "reality gap" identified by Eve Bendall.

The Professor also feels that there is a need to provide good role models and fewer, but higher quality, practice placements.

"Until the fundamental issue of an over-stretched nursing workforce is resolved, the gap between theoretically sound practice and actual care delivery will remain with us" she says.

"Students should be exposed to extensive simulated learning opportunities. This would, at a stroke, reduce some of the pressures on practising nurses.

"As a profession we should be deeply concerned, indeed embarrassed, that the problems identified by Eve Bendall 30 years ago still persist in today's nurse education system, in spite of everyone's best efforts to change.

The original paper and the commentaries are featured in the 30th Anniversary Issue of the Journal of Advanced Nursing. The special issue also features another 11 papers from the last three decades, together with commentaries from 2006.
These reflect how the journal has worked with authors from all over the world to improve standards of nursing and healthcare worldwide.

The Bendall paper and commentaries are now available free online at

Further information: Annette Whibley, Wizard Communications,

Notes to editors

Blackwell Publishing Ltd.

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