Cognitive Dissonance Theory (CDT), introduced by Leon Festinger in 1957, explains the psychological discomfort experienced when individuals hold two or more conflicting beliefs, attitudes, or values. This discomfort often motivates individuals to reduce dissonance by altering their beliefs or behaviors. While extensively studied in areas such as smoking cessation, weight management, political ideologies, and more recently in the context of the COVID-19 pandemic and artificial intelligence (AI), limited literature addresses how cognitive dissonance (CD) affects nurses, nursing students, and nursing professional development (NPD) practitioners. (Zang & Duaso, 2021; Meaney & Rieger, 2021; Montemarano et al., 2025; Seran et al., 2025; Ren et al., 2025; Clark et al., 2004).

One study conducted by Schrepel et al. (2019) identified the importance of understanding medical students’ CD in order to accurately cultivate the entrance to clinical practice. This article explores how applying CDT in medical education and orientation can illuminate the challenges healthcare providers can face. NPD practitioners can utilize this information to reshape educational strategies for novice nurses as well as enhance transition to practice.

When CDT is applied to nursing, it exposes a significant disconnect between academic instruction and clinical practice. This gap highlights the persistent divide between what nursing students learn in the classroom and in textbooks versus the realities of hands-on patient care. This disconnect is not unique to nursing students and novice nurses but reflects a broader issue across the health care field. The literature extensively documents these challenges, particularly during the transition from student to practicing nurse. (Hampton, Smeltzer & Ross, 2021; Hallaran et al., 2023; Eckerson, 2018).

This gap between what is taught and what is practiced often causes confusion and CD for novice nurses, who struggle to reconcile theoretical knowledge with real-world expectations and experiences. Swain et al. (2019) illustrated a similar pattern in chiropractic education, where students’ perceptions of professional identity and future roles conflicted with the core principles of practice, an issue also interpreted through the lens of CDT.

Therefore, would like to pose the following questions: What is the impact of CD on novice nurses and what can NPD practitioners do to support novice nurses? What barriers can the NPD department overcome when theory and practice do not match? How can knowledge learned from understanding the factors of CD impact the ability to provide high quality education to our colleagues, students, and patients? These questions aim to examine how CD awareness can serve as a catalyst for reflective practice, professional growth, and the advancement of high-quality, evidence-informed education across healthcare settings.

For NPD practitioners, understanding CD is not just theoretical—it’s a tool. When used effectively, it can improve engagement, strengthen evidence-based practice, and ultimately support the delivery of high-quality education to colleagues, students, and patients. One transformative approach to addressing the persistent disconnect between nursing education and clinical practice involves a fundamental shift in mindset, guided by the principles of CDT. Rather than accepting the gap as inevitable, educators and professional development leaders might ask: What if theory and practice could be aligned more authentically?

For instance, what if high-stakes assessments were not limited to textbook-based scenarios, but instead reflected the complexity and unpredictability of real-world patient care? What if nursing students were taught to believe—and consistently experienced—that classroom learning directly translates to bedside practice? Such a paradigm would challenge traditional educational structures and demand a more integrated, practice-informed pedagogy.

Simulation-based learning, both in academic and NPD settings, presents a unique opportunity to bridge this divide. Emerging technologies, including AI, offer the potential to create highly realistic clinical scenarios that more accurately reflect the emotional, physical, and cognitive demands of nursing practice. Imagine simulations involving distressed patients and families, high-acuity emergencies, and dynamic environmental stressors—scenarios that more closely mirror the realities of contemporary healthcare.

In the meantime, NPD practitioners can create a culture of learning safety for novice nurses, developing and utilizing innovative teaching strategies, such as incorporating AI to foster critical thinking, aligning with organizational goals, and, most importantly, have compassion and understanding for the CD among novice nurses.  

To answer the above addressed thought provoking questions There are several strategies that can be implemented for NPD practitioners to decrease the dichotomy between theory and practice.

1. Develop Structured Nurse Residency Programs
   1. Include an American Association of Colleges of Nursing (AACN) nurse residency program to provide a lengthy supportive environment to foster growth, confidence, and competency.
2. Initiate Planned and Deliberate Preceptorship Programs
   1. Intentionally match the preceptee and preceptor by mutual goals, personality, and nursing specialty.
3. Unit Specific Debriefing Sessions
   1. Provide opportunities to increase communication, provide constructive feedback, and address challenges and concerns of the novice nurse.
   2. Develop of trusting relationships between NPD practitioners and novice nurses.
4. Simulation
   1. Provides opportunities to develop real life situations and bridge the gap between theory and practice.
   2. Demonstrates skills and protocols specific to the organization.
   3. Using AI: Aligning theoretical instruction with practice-based realities is not only a pedagogical imperative, but a moral one—ensuring that nurses are equipped to deliver safe, compassionate, and effective care from day one.

NPD practitioners and specialists are leaders for the novice nurses, therefore recognizing, addressing and implementing strategies to break down the barriers of CD are essential. Creating a culture of understanding that CD exists while providing tangible methods to decrease or even eliminate the misconceptions will allow for professional growth, increased novice nurse confidence and competency, and ultimately impact patient care.

References 

American Association of Colleges of Nursing. (2025). Nurse Residency Programs. https://www.aacnnursing.org/our-initiatives/education-practice/nurse-residency-program

Eckerson, C. (2018). The impact of nurse residency programs in the United States on improving retention and satisfaction of new nurse hires: An evidence based literature review. Nurse Education Today. 7184-90.

Clark, E., McCann, T. V., Rowe, K., & Lazenbatt, A. (2004). Cognitive dissonance and undergraduate nursing students' knowledge of, and attitudes about, smoking. Journal of advanced nursing, 46(6), 586–594. https://doi.org/10.1111/j.1365-2648.2004.03049.x

Festinger. L. (1957). A theory of cognitive dissonance. Stanford University Press.

Hallaran, A., Edge, D., Almost, J & Tregunno, D. ( 2023). New Nurses Perceptions to Practice: A Thematic Analysis. Canadian journal of nursing research. 55(1). 126-136.

Hampton, K. B., Smeltzer, S. C., & Ross, J. G. (2021). The transition from nursing student to practicing nurse: An integrative review of transition to practice programs. Nurse education in practice, 52, 103031. https://doi.org/10.1016/j.nepr.2021.103031

Meaney, T., & Rieger, E. (2021). Integrating cognitive dissonance and social consensus to reduce weight stigma. Body image, 37, 117–126. https://doi.org/10.1016/j.bodyim.2021.02.003

Montemarano V, Firasta L, Deska J, Cassin SE. (2025). Cognitive dissonance for weight stigma reduction: The development and effect of a counter-attitudinal advocacy intervention. Clinical Obesity. 2025;e70024. doi:10.1111/cob.70024

Swain, M. S., Gliedt, J. A., de Luca, K., Newell, D., & Holmes, M. (2021). Chiropractic students' cognitive dissonance to statements about professional identity, role, setting and future:

international perspectives from a secondary analysis of pooled data. Chiropractic & manual therapies, 29(1), 5. https://doi.org/10.1186/s12998-021-00365-6

Zhang S, Jose Duaso M. The delivery of smoking cessation interventions by nurses who smoke: A meta-ethnographic synthesis. J Adv Nurs. 2021; 77: 2957–2970. https://doi.org/10.1111/jan.14783

Seran, C. E., Tan, M. J. T., Abdul Karim, H., & AlDahoul, N. (2025). A conceptual exploration of generative AI-induced cognitive dissonance and its emergence in university-level academic writing. Frontiers in artificial intelligence, 8, 1573368. https://doi.org/10.3389/frai.2025.1573368

Schrepel, C., Jauregui, J., Brown, A., Shandro, J., & Strote, J. (2019). Navigating Cognitive Dissonance: A Qualitative Content Analysis Exploring Medical Students' Experiences of Moral Distress in the Emergency Department. AEM education and training, 3(4), 331–339. https://doi.org/10.1002/aet2.10380

Ren, X., Zheng, W., & Zhang, M. (2025). Navigating cognitive dissonance: master's students' experiences with ChatGPT in dissertation writing. Frontiers in psychology, 16, 1542559. https://doi.org/10.3389/fpsyg.2025.1542559