Professional Documents
Culture Documents
Reality Shock
Reality Shock
Reality Shock
The Experience of Transition from Student Nurse to Registered Nurse
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Prepared by: Jr Brian Hogan Paulus (matric no: 20570) Lecturer: Mr Rekaya Vincent Balang
Assignment Topic
Transition is a complicated process whereby many changes might occur at once. The newly graduated nurse tries to juggle all the changes which may cause him or her to face reality shock. Discuss this issue. What are the strategies that could ease this issue?
Presentation Overview
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3 4 5 6
What is Reality Shock How Reality Shock Emerges
Definition of Terms
Reality = The state of being real Shock = A disturbance in the equilibrium or permanence of something (Merriam-Webster, 2012)
Hence generally,
Reality Shock = The disturbance in the equilibrium of reality
In nursing perspective: Reality shock is the shocking experience of new graduate nurses when they realise that the work situation for which they have prepared for DOES NOT exactly operate within the values and ideals that they had anticipated. (Meleis, 2010)
This phenomenon emerges as the experience of transition from being a nursing student to a registered nurse. (Duchscher, 2008)
REALITY SHOCK!!!
Reality
Expectations
-Family/friends/intimates -Practice -Critical decision making and clinical judgement expectations -Home/Work balance -Financial management -Changing roles and task -Leadership/Delegation -Sociocultural assimilation
-Personal/professional relationships -Intergenerational dynamics -Intradisciplinary/ interdisciplinary relations -Social -Life changes
maturity
Responsibilities
-Interdisciplinary/Intra-disciplinary -Performance expectations -Roles and responsibilities -Personal/professional self -Professional culture
Relationships
-Professional culture; peer support -Developmental task -Leadership and collaboration skills
-Organisational structure -Role blurring
Knowledge
-Nursing as a profession -Relational dynamics -Transition experience -Intellectual/Practical/ Theoretical/Tacit
-Professional roles
Roles
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Unfamiliar environment
Emotional Distress
Increased accountability
Stressful.
Increased Accountability
Unclear practice expectation
Professional accountability
Stressful
(Duchscher, 2008)
Subject and assessment are different from what was learnt / out of date
Inadequate Experience
Emotional Distress
New environment
Increased accountability
Lack of experience
Lack of knowledge
(OShea & Kelly, 2006)
Negative Consequences
High level of stress
Leave profession
Frustration and guilt Subsequent powerlessness; fatigued, debilitating Detrimental effects on nursing care; technical, task-driven, largely unsatisfying
(Ambler, 1995; Banks & Bailey, 2010; Bowles & Candela, 2005; Cowan & HengstbergerSims, 2006; Bueno, 1995; Duchscher, 2008; Hodges et al., 2008; Horsburgh, 1989; Kelly, 1998; Kilstoff & Rochester, 2004; Stacey & Hardy, 2011; Walker, 1998)
Positive Consequences
Motivation of nurses
Job satisfaction
Evolution of a more mature, professional sense of self
Banks & Bailey, 2010; Duchsher, 2008; Halfer & Graf, 2006
Transition Modules
Integrating key components in real practical setting in the final modules of training. Developed by clinical education team of hospital and tutors in university. Initially implemented by universities in Canada with collaboration from local hospitals. Aimed to support new staff nurses during their first 6 months following qualification
Source: Broad, Walker, Boden & Barnes (2011)
Successful transition
Basic life support
Employees more likely to remain in profession - more cost effective Better contribution to patients care
Nurse Residency Program Nurse Residency Program... why hospitals are starting it?
Increase level of new graduate nurses preparedness to become staff nurse
47%
41%
Source: National Council of State Board of Nursing 2003 Employer Survey, 2004.
Percentage of new graduate reporting education adequately preparing them to... Statement Provide direct care to 6 or more patients Know when and how to call a physician Synthesize data from multiple source in making decision Delegate to other RNs and assistive personnel Manage time, organize workload and prioritize tasks Appropriately utilizing research finding in providing care Percentage 22% 42% 50% 32% 47% 48%
Source: National Council of State Board of Nursing, Practice and Professional Issues Survey, Fall 2004 & 2006.
12 month 24 month
36% 7% 56% 12.6%
Mentorship
Mentor can share their experience about some real life problem and stress mgmt with the new graduates such as how to promote effective when working a night schedule . Is a win-win relationship where senior staff nurse also improve leadership skills, professional relationship, learn problem solving skills which lead to job satisfaction Includes:
i. ii. introduction to practice environment overt and covert culture
Source: Alspach, 2006; Morrow, 2008
Mentorship includes...
Practice environment Reflection
Method that bring mentor back in time to their novice stage are helpful for the new graduates
Experience nurses need to demonstrate maturity with conflict management. Exp: teachable moment vs. talking behind graduate nurses back Inside joke may lead to unintended misinterpretation by the graduates
Prior to the arrival of new graduates on the unit, manager can engage front line nurses in a discussion about their own lived experiences as new graduate. Was this a positive experience? Has eating our young ever been acceptable? If so, why and how can it be change?
Conclusion
New nurses face great challenges when they undergo the transition from student nurse to registered nurse. The challenges arise due to the reality which differs from the new graduate nurses expectation. When the reality is different, the situation demands adaptation. The adaptation is seen as the new graduate nurses orientation to the reality.
Different nurses have different level of ability to adapt, which requires time varying from a nurse to another.
Successful adaptation could produce positive outcome to the nurses whilst failure to adapt causes negative impacts to nurses and nursing profession. To solve the negative impact caused by reality shock, new graduate nurses needs to prepare themselves physically, intellectually, emotionally, and socioculturally.
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References Ambler, N. (1995). The beginning practitioner: 1st year RN adaptation to the workplace. Paper read at Conference Proceedings Research for Practice, at Newcastle University. Banks, Z. M., & Bailey, J. H. (2010). Career motivation in newly licensed registered nurses: What makes them remain. The Qualitative Report, 15(6), 1489-1503. Retrieved from http://www.nova.edu/ssss/QR/QR15-6/banks.pdf Bowles C. & Candela L. (2005). First job experiences of recent RN graduates. Journal of Nursing Administration, 35(3), 130137. Broad, P., Walker, J., Boden, R., & Barnes, A. (2011). Developing a model of transition prior to preceptorship. British Journal of Nursing, 20, 20. Bueno, D. (1995). Ready, willing, able? Staff competence in workplace design. Journal of Nursing Administration, 22, 14-16. Cowan, L. S. & Hengstberger-Sims, C. (2006). New graduate nurse self-concept and retention: a longitudinal study. International journal of nursing studies, 46, 59-70 doi: 10.1016/j.inurstu.2005.03.004. Duchscher, J. B. (2008). Transition shock: The initial stage of role adaptation for newly graduated Registered Nurses. Journal of Advanced Nursing, 65(5), 1-11. doi: 10.1111/j.13652648.2008.04898.x Halfer, D. & Graf, E. (2006). Graduate nurse perceptions of the work experience. Nursing economics, 24(3), 150-155.
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References Harwood, M. (2011). Transition shock: Hitting the ground running. Nuritinga, 10(10), 1-11. Retrieved from http://www.utas.edu.au/__data/assets/pdf_file/0007/156661/M_ Harwood.pdf Hodges, H. F., Keeley, A. C. & Troyan, P.J. (2008). Professional resilience in Baccalaureateprepared acute care nurses: First steps. Nursing Ethics, 14 (6), 716-740. Horsburgh, M. (1989). Graduate nurses adjustment to initial employment: Natural field work. Journal of Advanced Nursing, 14, 610-617. Kelly, B. (1998). Preserving moral integrity: A follow-up study with new graduate nurses. Journal of Advanced Nursing, 28, 1134-45. Kilstoff, K., & Rochester, S. F. (2004). Hitting the floor running: Transitional experiences of graduates previously trained as enrolled nurses. Australian Journal of Advanced Nursing, 22(I), 13-17. Morrow, S. (2009). New graduate transitions: leaving the nest, joining the flight. Journal of Nursing Management, 17, 278-287. Stacey, G. & Hardy, P. (2011). Challenging the shock of reality through digital storytelling. Nursing education in practice, 11, 159-164 doi:10.1016/j.nepr.2010.08.003. Thrall, T. H. (2007). Shock absorbers. Hospitals & Health Networks, 81(6), 60. Walker, W. (1998). The transition to registered nurse: The experience of a group of New Zealand graduates. Nursing Praxis in New Zealand, 13(2), 36-43.
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