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Reality Shock in Nursing

New Graduate Nurses enter their first job as a Professional Nurse eager to being their new role! Many New Grads will orient to their new role with ease while some will struggle.  New Grads work with Nurse Preceptors to smooth the transition from Student Nurse to Professional Nurse.  In the beginning of this transition, excitement takes over as the New Grad meets new colleagues  and accepts new challenges.

It is natural to feel overwhelmed and disillusioned as a New Grad.  These feelings typical start about 6 months to a year after getting off of orientation when the New Grad realizes the healthcare environment is flawed.

Four Stages of Reality Shock:

1.The Honeymoon Phase: 

New Grads are happy to be done with nursing school and excited to start their first job.  In this stage, the New Grad perceives their work environment and their new colleagues in a positive light, often as they are looking through rose colored glasses.  A typical response to how they are doing will be “I am great!  This is wonderful.  I am learning so much?  This is fun!”  The focus of this stage is learning the unit routine, being introduced to new people, and developing new skills to provide excellent nursing care to those entrusted to them.

2- The Shock Phase :  

New Grads begin to recognize there are flaws in the system.  They may encounter discrepancies and inconsistencies in the work environment.  Moreover, the New Grad may begin to discover concerns with the practices of other nurses.  A few examples of these discrepancies and inconsistencies are:
*  Discovering their Preceptor does not know everything or follow policies
*  Realizing they do not have the tools and equipment to do their job.
*  Experiencing communication breakdowns
*  Identifying poor professional behaviors in their fellow nurses
*  Having felt humiliated by a physician, bullied by a nurse, or embarrassed by a colleague.

3- The Recovery Phase :

New Grads begin to see the balance between what works well and what needs improvement.  The New Grad begins to establish expectations that are consistent for all their co-workers.  During this phase, it is important that the New Grad realize every nurse defines their own practice and it is their job to be the nurse who they want to be.  Once the New Grad redefines the nurse they want to be then their sense of humor and good feelings about nursing will return.
4.  The Resolution Phase:
New Grads have the opportunity to define the nurse they want to be.  There is come caution in this stage as this is when the New Grad may consider adopting values and beliefs that are less than ideal in order to fit in with their co-workers.

  • Strategies to Overcome Reality Shock:

Honeymoon Phase
*  Develop relationships with your preceptor and new co-workers.  Find a best friend at work
*  Be encouraged about your new excitement.  Celebrate the successes you have along the way!
*  While celebrating your success, be realistic about your accomplishments.

Shock Phase
*  Understand and accept that you may experience some dissatisfaction with your new role and work environment.  This is a natural feeling and it is very common among New Grads.
*  Share your feelings with a trusted professional … like your Nurse Educator or Nurse Manager
*  Take all the good skills, knowledge, and attitudes from all the nurses with whom you work while weeding out the rest.

Recovery Phase
*  Reflect on what is going well and what can be improved
*  Find your sense of humor
*  Treat your patients and the nurses with whom you work with respect
Resolution Phase
*  Identify and manage conflicts as they arise
*  Problem solve
*  Focus on what is working well
*  Celebrate small successes along the way!
*  Seek support from a trusted professional … like your Nurse Educator or Nurse Manager

Transitioning From Student Nurse to Professional Nurse :

new grads were asked “what difficulties are you experiencing with the transition from student role to the RN role?  There were several themes that emerged from this study.

 Here they are:

* Lack of confidence to perform skills; difficulty with critical     thinking and gaining knowledge

* Developing relationships with peers and preceptors

* Struggling with wanting to be independent right out of the gate

* Frustrations with the work environment

* Organization and priority setting

* Communication with Physicians


Assistant teacher Bashar Rasheed

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