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Reality Shock For New Nurses

Written by kimmel52

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

So now you are close to graduating from nursing school or you have graduated recently. Whichever the case, you will be in for a reality shock when you begin your career as a Registered Nurse. What do we mean by the term, “reality shock”? Well, like the term says, it is the reality that shocks us. For second-career nurses, the transition from nursing school to working with real patients can range from somewhat uncomfortable to highly shocking. These rookies often have given up secure, well-established careers, only to discover on-the-job demands never mentioned in the textbooks.

However, the right attitude can help you weather your first few months on the nursing unit. For those who overcome the challenges of transitioning to nursing, the rewards outweigh the costs of starting over. Education of nurses is thought to lack reality orientation, which is reflected in the difficulty graduate nurses experience in their transition from an educational to a work situation. The phenomenon of “reality shock” is defined by Kramer (1974) as this lack of reality orientation. On graduation, “neophyte” nurses are confronted with conflicting roles of professional (from education) and bureaucratic (from work environment). Adopting a particular role is part of the socialisation process graduates undergo. Methods of adjusting and improving the experience of “reality shock” have been suggested by Kramer (1974) and developed using a theoretical model, by Neuman (1982). The quality of care provided by graduate nurses needs to be examined as this is the ultimate role of the nurse. (1)The question you may ask is, “so there is a difference in the reality of being a student or graduate nurse”? The answer is an emphatic, YES! First of all, as a student nurse you were given assignments that were not beyond the scope of your practice or ability. In addition to that, you were working under your instructor’s license and whether or not you were aware, they kept a very close watch on you. Therefore, there was a safety net that always hovered beneath you in case you were to fall.

This is not the case as you take on the title, Registered Nurse. There is no safety net. You are out there by yourself, free to make decisions and make mistakes. With those decisions and mistakes you are also, FULLY ACCOUNTABLE. Now imagine yourself with eight or more patients. You may be asking yourself, “What do you mean eight or MORE patients?” Most student nurses never have more than six or seven patients and that is only at the very end of the program. Even then, the student nurses can delegate tasks to assistive personnel thereby lessening their work load. However, there will be time that you will be on a floor, without any assistive personnel, with more than eight patients and no one to rely on except yourself. To compound this scenario, there may be patients that have very critical care pathways that you must follow, incoming calls from patient’s families, doctor’s, operating room staff, and other collaborative care departments requesting information. Now, let’s stop this scenario in its tracks. You probably feel the stress building by just reading the previous passage. If so, don’t worry, it is a perfectly normal reaction. So, relax, and know that there are ways to ease this inevitable right of passage. Let’s take a look at some of the ways to help ease and deal with reality shock.

1. First of all, it is important to understand that, “reality shock” does indeed exist and you will come face to face with it. Knowing what you will face is most of the battle. The task at hand then becomes, knowing what steps to take and resources to use, and how to use them.

2. Learn as much as you can during your in-service training program, which usually lasts up to eight weeks or more. This means familiarizing yourself with every inch of your floor. Know where everything is located, from safety pins to I.V. tubing. You may never know when you may need it, NOW, and the worst thing that can happen is that you spend precious time looking for something as small as a safety pin.

3. Know, who the assisted personnel are, and know them by name and face. Find out who will be the ones that you will be working with during your shift. What usually happens during in-service training is that graduate nurses train on the main shift, which is most frequently days, before transferring to the shift that they have been hired to work. Therefore it is very important to know who you will be working with during your shift. Try also to develop a working relationship with the assistive personnel. Remember, it is not a popularity game, you are not out to make best friends. Your goal is quality patient care, and the patient comes first. Let your intentions be known that your number one goal is to give the best patient care that you have respect for the care team assistive personnel and are a willing and helpful body to them as well. In doing this, you will have disabled the invisible wall that exists between nurses and assistive personnel. That wall is the one entitled, I am a NURSE and you are ONLY an aide. One thing that you must strive for is to use an even tone of voice, and fairness when delegating. You must also remember the rights of delegation, which are as follows, a. the right task, b. the right person, c. the right communication, (must be clear and concise), d. the right feedback, (the person who is delegated the task must comprehend what it is that is asked of them and let the nurse know that they comprehend). By doing this you are ensuring that patient care will not suffer do to a personality glitch, which could have been avoided.

4. Know, know and KNOW where the Policy and Procedure manual is located on the floor. Part of your hospital in-service will include the introduction of the Policy and Procedure Manual. This is the manual that you will have to refer to many times for protocol from everything from changing out a Foley Catheter to transporting a patient to another floor. The final analysis will be in any investigation, “did the nurse use and follow the Policy and Procedure Manual?” You want to always be sure that you follow the rules and protocols contained in your institutions manual. Therefore, you should know where it is located and be familiar with how to look up various procedures and policies, particularly

5. The policy regarding medication errors. Most everyone makes them and it is crucial that you know what paperwork is required to be filled out. It will come in handy. You cannot just, “wing it”, when making a decision, you have to follow protocol.

6. Use assertive communication when interacting with doctors’. Assertive communication indicates that you are aware of yourself and your limitations as well as your liability to the patients that you care for. Using this form of communication with over assertive medical personnel will help you function to your maximum capability and earn respect as an independent care professional. {For more information on the uses and strategies concerning assertive communication, please refer to the text entitled, Nursing Today, Transition and Trends, by JoAnn Zerwekh, Jo Carol Claborn, 5th edition, Co. 2006, Saunders, Philadelphia.}

7. Ask questions. You will have time during your in-service training to ask questions and get answers. It is your right to do so. Remember, not knowing is not an excuse, and you do not want to be in a situation where there will be no-one to ask. This is not to say that you will know everything, but a least you are giving yourself a head start and a good solid foundation by knowing what you can. So don’t be afraid to ask. Also, know who your resources are, for questions that you may have on the shift that you will be working.

8. Find a mentor with whom you can relate. Try to find someone not only on the shift during training, but also on the shift that you will be working. It is nice to find someone who has the experience and understanding as well as someone that you can get along. There might be a time that you will want to call them in the middle of the night and vent your concerns, or just to have them give you positive input in your performance. Mentors are essential to the growth of a new nurse.

9. Lastly, Know, Know and Know, what your State Nurse Practice Act states. This Act, is your guideline for most all that you do as a Registered Nurse. Know it well.

Hopefully these tips will help to ease the reality shock that you will face during your transition from student nurse to full time graduate nurse. Remember, you can’t do it all. You are a welcome asset to your employer, but first and foremost an embodiment of all that Florence Nightingale stood for. Best wishes on your journey.
Mirella Pancia

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