National survey shows the majority of nurses use very little research in the first 2 years after their graduation, highlighting a gap between research and clinical practice
- Center for the Advancement of Evidence-based Practice, Arizona State University College of Nursing & Health Innovation, Phoenix, Arizona, USA
- Correspondence to Susan B Stillwell
Center for the Advancement of Evidence-based Practice, Arizona State University College of Nursing & Health Innovation, 500 North, 3rd Street, AZ 85004, USA;
This study may be of interest to nurse educators who have wondered but were afraid to ask, “Do our graduates use research to inform their practice?” The findings of this study would be of particular interest to nurses in Sweden, as the nursing graduates in Sweden were the focus group for this national longitudinal study.
The authors relate the research practice gap to the concept of ‘reality shock’ and ‘transition shock’, illustrating the disconnect between nursing education and clinical practice. Their review of literature addresses problems which the new nurses encounter when they attempt to use research in practice, their attitudes towards research and the organisational challenges they face to establish an evidence-based practice (EBP).
In response to a call for research to investigate the course of nurses' research use (RU) postgraduation, this data was collected as part of Sweden's Longitudinal Analysis of Nursing Education study. A total of 26 out of the 28 Swedish universities and colleges with nursing programmes participated. Patterns and changes in RU, measured as instrumental, conceptual and persuasive research, as well as changes in working conditions, were examined. The authors found that instrumental RU was reported most frequently, seven different RU profiles became evident and there was no association between change in RU and changes in working conditions. Additionally, nurses sustained their RU profile over time, and more than half of the nurses reported low RU at year 2. More important, a disturbing finding was that nurses with a low RU profile typically became ‘lower users’.
Although this research was a descriptive survey, which cannot support cause and effect relationships, it provides the nursing community in Sweden with important information about their newly graduated nurses' use of research over time. RU scores were categorised as high and low; however, we do not know the ‘acceptable’ RU score that reflects adequate RU. The nurses self-reported the extent of RU during their past 4 working weeks, and as with all self-reporting methods, under- or over-reporting may occur. No reliability of the Swedish version of the RU items was reported, but the authors point out that the questionnaire was reviewed by clinical nurses, ‘scrutinised’ for face validity and feasibility, and supported by the consistency found in the participants' scores.
Identifying the nurses' actual research behaviours may add value to understanding nurses' RU. Interventions can be tailored to improve RU. Despite the shortcomings of a self-report, nurse faculty may find the questionnaire helpful as an adjunct to monitor for unplanned curricular change. Obtaining RU scores at the end of the nursing programme as baseline data and comparing them with scores achieved at postgraduation would strengthen the current study.
Readers who find the data analysis challenging may find it helpful to read the authors' prior study. Although operational definitions of the types of research were provided, listing questionnaire items may add clarity for the reader. The use of the terms ‘EBP’ and ‘RU’ interspersed throughout the article may be confusing for some readers, as EBP includes external and internal evidences, patient preferences and clinician expertise in clinical decision making. The authors did note this distinction.
The uncertainty in content and the manner in which nursing students acquired the skills for EBP was pointed out by the authors. A comparison of the programme outcomes and nursing curricula with RU scores of the graduates of their respective school may provide further insight into the knowledge gap. With the reference to EBP and RU, it would be interesting to study newly graduated nurses' RU in those who attended programmes that were fully integrated with EBP, compared to programmes with only a stand-alone traditional research course.
This study further epitomises the well-recognised gap between research and practice. It also uncovered a worrisome finding that nurse RU may decline over time. This has been observed in the medical profession,1 and we have found a decrease in EBP implementation scores in our students during their transition from junior to senior semesters. Informing practice with evidence improves treatment outcomes, and it is imperative that nurses from academic and clinical settings collaborate and take action to investigate educational approaches and other interventions to sustain EBP and seal the gap.
Competing interests None.