Reality shock

Associate professor: Dr. Shahnaz Ayasrah

 Reality shock
O Reality shock theorizes that those new to
the nursing profession go through a learning
and growing transition. This process is
characterized by four phases: honeymoon,
shock, recovery, and resolution.
 Honeymoon Phase

O The honeymoon phase is a period of

excitement and seeing the world through
‘rose colored glasses,’ new graduates are
very excited to be joining the profession and
eager to learn as much as possible.
O TIP: It is important to develop initial bonds of
trust and respect between new nurses and
their preceptors during the honeymoon
phase, as this will be the foundation for
coping with future phases.
 shock phase
O TIP: Critical strategies to ease through the
shock phase include: finding a mentor for
guidance, taking care of yourself physically
and emotionally (be sure to get enough
sleep, eat properly, and laugh frequently),
and developing a support network, which
usually includes fellow nurses.
 shock phase
O The new nurse is the most vulnerable when
in the second phase, the shock phase, as
this is when negative feelings towards their
new profession surfaces. This is often when
the new nurse realizes the expectation of
the new role is inconsistent with the day-to-
day responsibilities and new job
responsibilities sink in. When the nurse is in
a negative state, they are at risk to quit,
leave their unit, or burn out.
 Recovery Phase
O Next is the recovery phase; new nurses
begin an upward climb back to the positive
side. They are able to look at all sides and
see the job realities with a more open
perspective.
O TIP: To ensure nurses stay in the recovery
phase and move to the next phase, it is
important they receive constructive criticism,
are eased into their roles and
responsibilities, and provided with strong
mentors.
 Resolution Phase

O The fourth and final stage, which is usually

around a year, is the resolution phase. This
is when the nurse can see the role in
perspective and fully contributes to the
profession.
O TIP: Even though a nurse makes it through
the resolution phase, it is important to
continually help them retain the positive
aspects of their job in order to maintain
ongoing happiness and career success.
Issue of Nursing Retention
Approximately 30%
and up to 50% of new
graduate nurses will
quit within the first
year of employment. High staff turnover is
expensive – costs
(Hillman & Foster, 2011)
anywhere from
$22,000 to over
$64,000 per nurse.
(Finkelman, 2012, p.285)
Problematic Cycle of High
Turnover or Poor Retention
 Turnover/ $$$, disrupts
 Retention work teams 
 productivity

Stress  Staffing
Burn Out Shortage
 Experienced RNs may
compromise patient safety

Excessive Increased
Overtime Workload
The Crucial Two Years
The first two years…Phase 1
Anticipatory Socialization
 Pre-work experience
O Education: BSN vs. ADN
O Other experiences r/t age, race,
sex, marital status and personality

 All of these determine the expectations nursing

students may have about life after graduation.
realistic expectations
vs.
unrealistic expectations  reality shock
The first two years…Phase 2
Organizational Socialization
 Actual work experience
O Orientation – The amount of time and depth
of training greatly impacts the new graduate’s
perception of work stress and satisfaction.

O Working conditions and environment

• Stress level r/t work demands
• Relationship with supervisors and other staff
The first two years…Phase 3
Socialization Outcomes
Positive work Conflict in the work
experience environment
✚
✚ Inadequate transition
Effective program/period
orientation/transition ✚
program Unrealistic
________________ expectations of nursing
role
Work satisfaction ________________
and retention Dissatisfaction and
Turnover rates
Patricia Benner’s
From Novice to Expert
Expert
Proficient
Competent A nurse with
intuitive
Advanced A nurse in understandin
Beginner A nurse in the same
Novice setting for g of clinical
the same
A nurse more than situations;
setting for
A nursing 2-3 years; able to
who has 2-3 years;
student or able to anticipate
some able to understand
any nurse potential
experience, anticipate situations
transitioning including problems; can
& plan long- as a whole
be a mentor
to a new term goals and makes
mere to other
specialty for specific decisions
observation patient based on nurses
population previous
experiences
(Potter & Perry, 2009, p.9)
Role Transition
O Survey of 270 graduate
nurses working in 6 acute care hospitals in
metropolitan area of Denver, Colorado in 1999.
O Data collected at specific intervals: at
baseline, after 3, 6 and 12 months, additional
follow-up for groups employed >1 year.
O Survey included open-ended questions asking
nurses to identify any difficulties during their
role transition from student to staff nurse
(Casey, Fink, Krugman, & Propst, 2004)
 Factors Affecting Role Transition
O Lack of confidence
• anxiety, insecurity & feeling incompetent during the 1st
year of employment
• Difficulty with making critical decisions about patient
care, setting priorities and time management

O Tension among peers & preceptors

• New nurses did not feel welcomed
& respected by experienced nurses
• Some preceptors were less patient
and sympathetic –
 They forgot how it was like to be
the inexperienced nurse.
 Factors Affecting Role Transition
O Struggle with dependence & independence
• Lack of a guiding figure or mentor r/t absence of consistent
preceptors during orientation period
• Others were overwhelmed with responsibilities yet were
uncomfortable delegating work to unlicensed personnel.
• Others felt “babied” which hindered their
ability to grow & develop professionally.
O Stressful work environment
• nurse-to-patient ratio r/t shortage
• A few of the new nurses had to assume the role of charge
nurse or preceptor after only 9 months of experience and
training  stress r/t responsibility
What can Nurse
Leaders do?
Nurse leaders can help address
the issues of nursing shortage and
staff retention by supporting new graduate nurses by:
O Advocating for transition or residency programs to
competency, confidence & satisfaction of new RNs
O Maintaining a healthy working environment
 Not using novice RNs to cover for staffing shortage before
the end of orientation period
 Zero tolerance for lateral violence or bullying
O Supporting experienced RNs who are serving as preceptors
and mentors for novice RNs
Shaping our Future Nurse Leaders
O New graduate nurses are the future employee pool
O Job satisfaction & retention are greatly influenced by
the quality of orientation and support received by the
new graduate nurse.
O A positive experience will encourage the now proficient
nurse to mentor novice nurses & give them the same
positive experience he/she had during the transition
period.
The mediocre teacher tells. The good
teacher explains. The superior teacher
demonstrates. The great teacher inspires.
- William Arthur Ward
Thank You