Keynote paper given by Gary Rolfe at the Portuguese Nurses Association Conference, Lisbon, Portugal, 24-26 November 2010 

The theory-practice gap
I have spent the last 30 years working as a nurse in the United Kingdom (UK), firstly as an untrained nursing assistant, then as a qualified staff nurse, then as a university lecturer, and finally as a professor of nursing. During this time I have seen many changes in the UK in the relationship between those nurses who deliver care to patients and those who work primarily in colleges and universities, and whose job it is to support front-line nurses in various ways. When I first started out in nursing in 1980, nurse teachers in the UK were employed by the health service and worked alongside practising clinical nurses as equal colleagues. Nurse teachers regarded themselves first and foremost as nurses, and only secondarily as teachers. They had more or less the same aims, objectives and values as their clinically-based colleagues and saw their primary purpose as the improvement of patient care. They achieved this aim in a number of ways: through the education of qualified and unqualified staff in the classroom and clinical areas, at a strategic level through influencing practice at meetings and on committees, and to a lesser extent through research projects aimed at providing answers to specific nursing problems.

A number of factors and events have contributed to a change in this partnership between clinically-based nurses and nurse educators, particularly over the past 15 years in the UK. In particular, two events in the nineteen nineties, which occurred almost simultaneously, have resulted in a dangerous and perhaps irreparable split between the practice of nursing and the practice of nurse education. Firstly, a new curriculum for nurse education was introduced. This new curriculum, called Project 2000, emphasised theory over practice by structuring the timetable so that students spent the first six months in the classroom learning theory before being allowed on placements in clinical areas. It also introduced a range of new theoretical subjects such as sociology, psychology and philosophy into the timetable which meant that, for the first time in the UK, nurses were being taught by lecturers who were not themselves registered nurses.

The second big change, which happened at roughly the same time, is that nurse education moved from health into the higher education sector. This move was both geographical and professional. Many schools of nursing, which had previously been situated in hospitals, moved physically into university premises. At the same time, nurse teachers found themselves re-employed as lecturers on university contracts. They were no longer employed by the health service, and their new employers had quite different expectations of them.

This morning, I want to explore what it means to me to work as a professor of nursing in an institution that has little regard for nurses and nursing; an institution that values theory over practice, theorists over practitioners and researchers over teachers. I want to examine a number of conflicts between the aims of higher education and the aims of nursing, particularly in relation to research. And I want to offer some suggestions for how lecturers and professors of nursing might rethink their views about the purpose and practice of research for the benefit of patients and nurses.  

The rise of research 

It is no coincidence that the transition of nurse education from the hospital to the university was accompanied by an enormous growth in nursing research and nursing journals. Whereas the former schools of nursing regarded teaching as their primary activity, almost all universities, and certainly those in the UK and the USA, consider research to be their number one mission. The top universities in the world: Oxford, Cambridge, Harvard, Yale, M.I.T., are famous not for their teaching but for their world-leading research. The mission statement of my own university states firstly that: 
Swansea University will provide an environment of research excellence, with research being undertaken that is internationally recognised and that informs all other activities at the University.
And only secondly that: 
Swansea University will deliver an outstanding student experience, with teaching of the highest quality, that produces graduates equipped for distinguished personal and professional achievement. 
Promotion in most universities, including my own, depends to a large extent on the number of research grants I win and the number of papers I publish in the top research journals. Promotion to higher grades such as professor, require me to have a PhD, which is first and foremost a training in research. 
Too much research 
This emphasis on academic research has resulted in a number of unfortunate consequences for nursing. Firstly, research has become an end in itself. That is to say, more and more nurse academics are applying for research grants and doing research projects not because the findings will improve practice in some way, but merely because they realise that, in order to please their employers and to gain promotion, they have to do research. Too often I have seen colleagues make decisions about what research projects to bid for based on the size of the grant and the prestige of the funding organization rather than on the relevance or usefulness of the project to nursing practice. And even in cases where these researchers assure me that their main reason for doing a project is to inform nursing practice, they still usually publish their findings in academic journals which are read only by other academics. As a result of this pressure to ‘publish or perish’, as we say in the UK, I believe that there are far too many research reports in far too many journals, and that most of it is 
unnecessary, unhelpful, and increasingly unread. This phenomenon is not recent, and it is not restricted to nursing. As long ago as 1963, the American bio-scientist Bernard Forscher wrote a letter to the journal Science in the form of a parable in which he compared researchers to brick makers and theorists to builders. His complaint was that too many people are busy making too many bricks and no one is bothering to build with them. In other words, we have too many research papers and no one is using them to build theory or develop practice. 


  The jargon wheel and the total library: The problem of reliability in qualitative research (2010) 

  Validity, trustworthiness and rigour: Quality and the idea of qualitative research (2006)

  Research truth and authority (2000)

  Expanding nursing knowledge (1998) 

  The theory-practice gap in nursing: from research-based practice to practitioner-based research (1998)

  Going to extremes: action research, grounded practice and the theory-practice gap (1996) 


    contact: praxis@garyrolfe.net