Nurse education is founded on a clear and compelling promise that graduates will deliver safe, ethical and evidence-informed care. Across undergraduate and postgraduate programmes, nursing students are taught the principles of patient safety, clinical reasoning, professional accountability and compassionate practice. Yet, when students enter clinical environments, this promise is not always realised. Instead, many students encounter a dissonance between what they have been taught and what they observe in practice. This gap between theory and practice is not a benign or inevitable feature of professional learning but does represent a significant threat to patient safety, undermines professional standards and raises important questions about the integrity of current nursing education systems. Clinical learning environments are complex, pressured and often under-resourced. Students frequently witness staffing shortages, high workloads, limited access to equipment and variable standards of communication and teamwork (Palese et al. 2023). Within such contexts, the idealised models of care presented in the classroom can appear distant from the realities of practice. More concerning, however, is not simply the existence of this gap, but the behaviours that students may observe and, over time, internalise. These can include medication administration errors, lapses in patient identification protocols or documentation practices that do not always reflect care delivery. Such observations are not isolated anomalies but can form part of a broader pattern of compromised practice that becomes normalised within certain clinical cultures (Tambunan 2024). For students, these experiences are formative. Clinical placements are not merely sites for skill acquisition; they are also environments in which professional identities are shaped. When students repeatedly observe practices that contradict their formal education, they are placed in a position of cognitive and ethical tension. Ideally, such tensions would prompt critical reflection and discussion. In reality, however, many students feel unable to challenge what they see. Hierarchical structures, concerns about assessment outcomes and a desire to ‘fit in’ can discourage speaking up. As a result, a powerful hidden curriculum emerges; a curriculum that prioritizes conformity over critical thinking and silence over advocacy (Hoffmann et al. 2022). The consequences of this hidden curriculum are profound. Rather than reinforcing safe and evidence-informed care, clinical placements may inadvertently socialise students into accepting suboptimal or unsafe practices. Over time, this can erode the very principles that nursing education seeks to instil. Students learn not only how care should be delivered, but also what is tolerated, overlooked or implicitly endorsed within clinical settings. In this way, the gap between theory and practice is not simply a matter of inconsistency; it becomes a mechanism through which unsafe norms are reproduced. It is important to recognize that this issue cannot be attributed solely to individual students or practitioners. The theory–practice gap reflects wider structural and organisational challenges. Research suggests that students often struggle to transfer theoretical knowledge into complex, real-world situations, particularly when working under pressure or within hierarchical environments (Carvello et al. 2024). Effective integration of theory and practice requires strong partnerships between academic institutions and clinical providers. However, such collaboration is often constrained by competing priorities, limited resources and insufficient protected time for joint working. Academic staff may have limited opportunities to engage directly with practice environments, while clinical mentors may be overstretched and unable to provide the level of guidance and support that students require. The role of clinical mentors is particularly critical. Mentors are expected to facilitate learning, model professional behaviour, and support students in translating theoretical knowledge into practice. However, mentors themselves operate within the same challenging environments and may lack formal preparation or ongoing support for their educational role. When mentorship is driven primarily by availability rather than expertise or aptitude, the quality of student learning can be compromised. This creates a fragmented educational experience in which students are expected to demonstrate safe and competent practice without consistently observing it in action. Assessment practices further compound this issue. In many settings, clinical assessments may not fully capture a student's ability to deliver safe care. There can be a reluctance to fail students, particularly when doing so may have implications for workforce supply or reflect negatively on placement areas (Tambunan 2024). Consequently, students who meet basic behavioural expectations, such as punctuality and professionalism, may progress despite inconsistencies in their clinical practice. This creates a concerning disconnect between assessment outcomes and actual competence. The implications for patient safety are clear. Newly qualified nurses entering the workforce may feel ill-prepared for the realities of practice, particularly in high-pressure or understaffed environments. Some may adopt the unsafe practices they have observed, perceiving them as necessary adaptations to clinical realities. Others may attempt to adhere strictly to professional standards, only to experience frustration, moral distress, or burnout when these standards appear incompatible with the demands of the workplace. In both cases, the risk to patients is significant. Addressing the theory–practice gap requires a shift in how responsibility is understood and enacted across the system. It is not sufficient to expect individual students to bridge this gap through resilience or personal commitment alone. Instead, there must be shared accountability across academic institutions, clinical organisations and regulatory bodies (Kirwan et al. 2019). Educational programmes must ensure that curricula are not only evidence-informed but also aligned with the realities of contemporary practice. Clinical environments, in turn, must provide conditions that enable safe and effective care to be delivered and observed. This raises important, and at times uncomfortable, questions. To what extent should educational institutions be accountable for the clinical experiences of their students? How should organisations respond when unsafe practices are observed within placement settings? What mechanisms are needed to ensure that mentors are both supported and held to appropriate standards? While there are no simple answers, it is clear that a more explicit and coordinated approach to accountability is required. Reframing the relationship between education and practice is central to this effort. Clinical placements should not be viewed as transactional arrangements in which students provide additional workforce capacity in exchange for learning opportunities. Instead, they should be understood as genuine pedagogical partnerships, with shared responsibility for the quality of student learning and patient care. This requires investment in mentorship, recognition of teaching roles within clinical settings, and the development of structures that facilitate ongoing collaboration between academic and practice partners. Cultural change is equally important. Students must feel empowered to raise concerns about patient safety without fear of negative consequences. This requires the creation of psychologically safe environments in which questioning and critical reflection are actively encouraged. At the same time, organisations must demonstrate that concerns are taken seriously and lead to meaningful action. Without this, efforts to promote speaking up will remain rhetorical rather than substantive (Hoffmann et al. 2022). Educational strategies also have a role to play. Approaches such as simulation-based learning, interprofessional education and structured reflective practice can support students in developing the skills and confidence needed to navigate complex clinical situations. However, these approaches must be embedded within a broader system that values and supports their application in practice. Without alignment between educational innovation and clinical reality, their impact will be limited (Palese et al. 2023; Tambunan 2024). Ultimately, the persistence of the theory–practice gap reflects deeper questions about the values and priorities of the nursing profession. A profession that is genuinely committed to patient-centred care cannot accept a situation in which educational ideals are routinely compromised in practice. Nor can it tolerate systems that place students in environments where unsafe practices are normalised or unchallenged. The challenge, therefore, is not simply to acknowledge the existence of the gap, but to address the conditions that sustain it. This requires leadership at multiple levels, from educators and clinicians to organisational leaders and policymakers. It also requires a willingness to confront uncomfortable truths about the realities of practice and the limitations of current approaches to education and training. For nursing students, the transition from theory to practice should be a process of integration, not disillusionment. For patients, it should provide assurance that the care they receive is grounded in the best available evidence and delivered by competent, confident professionals. Bridging the gap between theory and practice is therefore not an optional aspiration but is an ethical imperative. If nursing is to maintain public trust and uphold its professional standards, it must move beyond accepting the theory–practice gap as an inevitable feature of education. Instead, it must be recognised for what it is: a systemic failure with direct implications for patient safety. Addressing this failure will require sustained commitment, collaboration and cultural change. The alternative, continuing to prepare students for a reality that contradicts their education, is no longer defensible. Our students, and the patients they will care for, deserve better. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Kohanová et al. (Sun,) studied this question.