France’s transition to academic nursing: the theory–practice gap

Abstract

Nursing education’s shift from vocational settings to academic institutions is a trend that has accelerated recently in Europe with the advent of the Bologna accords. France has adopted this model using a centralized, policy-driven approach. This article describes the background to this change and explores the process and impact of this shift in the lives of practicing nurses in clinical units. Between April 2011 and June 2013 nurses and students were observed using the shadowing method and were interviewed in a nursing school and four hospital units where students had clinical placements. The key interviewer elicited descriptions of the process as seen by the nurse mentors and generated themes and summary statements that encapsulated the phenomena of policy change at the individual level. The nurses expressed a broad understanding of the process, but were required to adapt the changes to their everyday professional needs under difficult time pressures. Nursing students found little sympathy and support from their mentors during the process and perceived a general lack of understanding of the goals of the reform. Three significant types of reactions were noted from new graduates: the exploitation of the hospital setting to find more rewarding work; a renewed interest in developing nursing activities traditionally undervalued; and finally, withdrawl from the profession. These factors point to the difficult future for nursing in France and globally, as systems try to reform toward greater perceived efficiency and restructuring of professional roles without providing adequate time or ressources to implement adopted policies.