Strategies to Prevent or Alleviate Reality Shock for a new nurse
The lack of reality orientation among many nursing students or neophyte nurses often lead to what professionals have tagged as “reality shock.” This is usually mirrored in the problems new nurses experience during the transition that happens from their educational to work situation. This so-called “reality shock” is defined by Marlene Kramer (1974) as “.
.. the reactions of new workers when they find themselves in a work situation for which they have spent several years preparing and for which they thought they were going to be prepared, and then suddenly find they are not.”ExpectationsAccording to role delineation studies conducted by the National Council of State Boards of Nursing (NCBSN), expected competencies of new graduates include (Joel 2002):The ability to practice safely while protecting themselves and their patients. Examples of this is being able to use universal precautions and perform CPR, having the ability to identify medical emergencies and to intercede appropriately until more qualified professional help arrives.The capacity to manage care and administer assistive personnelThe facility to communicate effectively with patient and family involved in the care of the patientExpertise in basic technical skillsThe capability to complete a work assignment within an suitable time frame.
However, many new nurses may become disheartened and upset after finding that real life practice could be quite different from the training they got in school. This may prevent them from meeting the expectations mentioned above, and may even prod them to leave the nursing practice altogether.Problems they may encounterOne of the primary difficulties encountered by new nurses in moving into the workforce is their prior perception of their role in the health care industry. Corwin and Taves’ studied the nurses’ role in relation to bureaucratic and professional conceptions. Here, they define the professional nursing role as having attention directed at maintaining educational and professional standards (Corwin and Travis 1962).Role models also affect new nurses’ perception of their new world.
In 1968, Kramer found out that a few weeks into the hospital transition, neophyte nurses’ role models changed from that of an instructor to that of a staff nurse. Kramer states that neophyte nurses may express a feeling of betrayal, blaming their educational facility for their inability to cope, thus changing efforts to fitting into the new system (1974).Neophyte nurses likewise reported some differences between the stressed continuity of care they received during their education, and the difficulty of this in actual practice. Different patient assignment load and time constraints were causes cited. New nurses’ values were compromised because minimal opportunities were present to follow through care. Because of this dissatisfaction resulted, and most felt as if they were helpless to alter their situation (Horsburg 1989).
A general inability to fit in was also stated, as neophyte nurses found it difficult to function as workers. They find it tedious to rely on self-evaluation rather than colleague feedback on their clinical skills. In relation to this, some new nurses are unable to function as members of a multi-discipline team.Another stressful situation when new nurses are expected to react to unplanned and unexpected events without further ado. Often they fail this test that only enforces their role as a beginning nurse, and which distinguish them from being “experts” in their field.StrategiesKramer formulated the concept of reality shock.
She explained the difficulties encountered by new nurses as they go through the progression of attempting to merge the professional ideals and values with which they were instilled in nursing school with the abrasive, less lofty actualities of the workplace.In dealing with reality shock, it has been studied that much of the stress arises from conflict of roles and values. The term shock itself implies physical symptoms, even if these breeds strictly psychological stressors. These may emerge as extreme tiredness when adjusting to shift work. It could also be developing anxiety to such an extent that physical signs of nausea, headaches and tremors materialize and the new nurse would rarely be able to utilize normal lines of defense to regain equilibrium (Fitzpatrick and Whall, 1983: 209).In the Neuman model, primary, secondary and tertiary prevention strategies are applied to reduce factors causing reality shock among new nurses (George, 1980: 262).
First, an issue that should be raised by educational institutions is called the primary intervention. For example, during a nursing student’s final year, his education should involve training on reality shock (Bennett, 1988). Faraburgh (1984) also suggests that by reading Kramer’s book on reality shock (1974) as introduction to this phase will help new nurses cope with reality shock.On the other hand, the use of actual mentors to educate new graduates and to conduct orientation programs may also be able to combat stress. This is the so-called secondary prevention.Tertiary prevention to shock may involved a method by which graduates several months into their working frame are made to compare the present to their past experiences.
The awareness that time management skills, giving adequate care to patients and finally being able to successfully communicate as a member of a multi-discipline team are only some encouraging results that may be recognized in this workshop (Bennett, 1988).Some more strategies that could be used to mitigate reality shock for new nurses is to attend career forums, job fairs, and open houses. They could join and become active in professional associations by attending meetings. It must be remembered that networking is a highly effective method of finding and getting jobs.New nurses who lack confidence should also consider part time and less desirable shifts, if only to get their foot in the door and gain some experience. Once they acquire even a small amount of experience, they will definitely have more options available to them.
In fact, it would be wise to consider volunteering to gain experience, confidence and to make contacts.With perseverance and a concerted effort, the reality shock these neophyte nurses may initially feel may dwindle down. Indeed, the journey may be difficult but the destination is worth the trip.