Since nursing education was transferred to universities in Iran, the public and health administrators have criticized Iranian nurses because of poor-quality patient care. It seems that nurses are not able to transfer the taught theoretical knowledge in academia into practice. This paper attempts to provide an insider view of why the taught theoretical knowledge in academia might be difficult to enact in the clinical setting. Using the grounded theory approach, individual in-depth interviews and participant observation were undertaken with a purposive and theoretical sample of 26 participants in Tehran University of Medical Sciences. The data were analyzed using the constant comparative method. The findings showed that, in spite of increased academic input into nursing education, clinical behaviors in both the education and practice settings were perceived as "traditional routine-based".