Reality Shock: What They Didn’t Teach You in Nursing School

Reality shock is something that you may have heard about in nursing school, but know very little about. Most nursing programs do not adequately prepare their students with coping mechanisms to effectively manage each phase of reality shock. 

Once you start your new job as a nurse, having straight A’s or being the most popular student among your professors won’t matter. You’ll have to establish credibility among all your new colleagues and that’s not an easy task. In fact, it can be shocking and quite intimidating.

Let’s discuss what reality shock is, and tips for managing each phase.

The Four Phases of Reality Shock In Nursing

The idea of reality shock is applied to those who are new to the nursing profession or new to a nursing speciality, where they go through a learning and growing transition. This process has four phases: honeymoon, shock, recovery, and resolution.

 

Honeymoon Phase

The honeymoon phase is a period of excitement for new graduates. You may be very excited to be joining the profession and find yourself eager to learn as much as possible. You will be guided by your desire to do your very best and become confident in your new roles and responsibilities. 

Tip: It is important to establish working relationships where trust and respect are demonstrated between you and your preceptors during this phase. This will help to minimize complications in the following phases of reality shock.

 

Shock Phase

The new nurse is the most vulnerable in the second phase – the shock phase, as this is when negative feelings towards your new role may surface. This is often when the new nurse realizes that the expectation of their new role is inconsistent with the day-to-day responsibilities and work flow. When nurses find themselves in the shock phase, they are at risk to quit, leave their unit, or experience burn out.

Tip: Critical strategies to ease through the shock phase include: finding a mentor for guidance, taking care of yourself physically and emotionally, being sure to get adequate sleep, eating a balanced diet, exercising regularly and having fun with family and friends. It is also essential that you develop a strong support network, and workplace buddies that have your back.

 

Recovery Phase

During the recovery phase, new nurses begin an upward climb back to the positive side. Now able to  consider all sides of your new role as a nurse, you will begin to see the job realities with a more open perspective. You can begin to accept the challenges of your day-to-day responsibilities, and find creative solutions to barriers in providing safe and effective nursing care. 

Tip: To ensure that you do not move back to the shock phase, it is important to seek out constructive criticism, and let your preceptors and mentors know where you are having trouble adjusting. Seek out clarification, and be sure to always work within your limitations. Don’t be afraid to admit that you don’t know. Once you become confident in your roles and responsibilities, you will move to the resolution phase. 

 

Resolution Phase

The fourth and final stage, which is typically after one year of nursing experience, is the resolution phase. During the resolution phase the nurse fully understands their role and fully contributes to the delivery of safe and effective patient care. 

Tip: It is important that you continue to focus on the positive aspects of your job in order to maintain ongoing satisfaction and career success. Engage in continuing education by earning an advanced degree, or becoming certified. When you remain engaged in your own professional development, you are sure to find fulfillment within the nursing profession. 

 

Here are some additional coping skills that you may find helpful as you transition into your new role as a nurse:

Focus on mastering your skills

Making sure that your nursing skills are being performed in the way that follows facility and state regulations will help you to avoid mistakes and help to build confidence. The first six months to a year is an important time for you to work on improving your ability to perform all client care and administrative skills independently, thus boosting your confidence and satisfaction within your new role.

Seek Guidance from experienced nurses 

Just because you finished orientation at your new job does not mean that you are all alone in providing client care. In fact, nursing is always a team effort, and you are encouraged to seek guidance and resource experienced nursing staff to help you when you need it.

When juggling the complex treatments, and patient care of today’s healthcare system, we all rely on one another to deliver the safest and most effective client care possible. Be sure to identify your learning needs as they arise and seek the expert guidance you will need to feel confident in your roles and responsibilities.

Find a nursing specialty that fits 

Not all nursing specialty areas are created equal. The expectations and responsibilities of nurses in an emergency department are very different than those of a medical-surgical unit. In many cases, new graduate nurses are eager to begin working and accept the first specialty that they are offered.

In the event that you find yourself really struggling with the specialty you are working in, be sure to discuss your concerns with your supervisor before deciding to quit. They will be able to identify your struggles and may offer effective coping strategies and/or specialty alternatives accordingly. Switching specialties within the first six months to a year is quite common, and many times healthcare facilities will accommodate your requests to keep you on staff.

We hope that these tips for managing reality shock help you as you transition from student nurse to professional nurse. If you have any additional tips you’d like to share, please leave your thoughts in the comments section below!

5 Tips for NCLEX Success!

Congrats for getting through the many trials and tribulations of what we like to call Nursing School – you rock! Now that you have proven your competency in the classroom and clinical setting, you must now focus on getting past the final academic hurdle to becoming a licensed, practicing nurse – the NCLEX.

In order to begin your professional journey in nursing, you must be able to pass the NCLEX. This standardized, computerized adaptive test (CAT) is offered year-round, and is administered by Pearson Vue, and governed by the state board of nursing in which you choose to practice in.

With the right preparation and study plan, passing the NCLEX is absolutely attainable. Although passing the NCLEX is attainable for everyone who takes it seriously, it is important to understand that the NCLEX does not measure your intelligence, nor does it predict how successful you will be within your nursing career. In fact, the NCLEX only measures your ability to critically think through the questions and answer choices to arrive to the best answer. Typically the best answer is the safest, most patient-centered, most therapeutic, and within the scope of nursing practice.

Whether you are preparing to take the NCLEX for the first time, or you are repeating the exam, here are five tips for NCLEX success:

 

Understand what the NCLEX is and how it is formatted

Remember us mentioning computerized adaptive test (CAT) earlier? It means that no single exam is identical, and that questions provided are based on how you are answering previous questions. For example, if you answer the very first question on the test correctly, you will receive a question that is a little bit harder. If you answer the first question incorrectly, then you will receive a test question that is a little bit easier. The computer will select questions based on areas of strength and weakness throughout the exam. 

 

The test will ask you a minimum of 75 questions, and a maximum of 265 questions. The test determines if you pass when you stay above the passing line with a 95% confidence interval. This does not mean that you have to answer 95% of the questions correctly. What it does mean though is that the computer must be 95% confident that you have remained above the passing threshold. The candidate will fail the test when they do not rise above the passing line with 95% confidence.

 

To help you better understand, think of it this way – there is a horizontal line on an axis and we will call it the “pass line.” Anything above it is passing, and anything below it is not passing. You start exactly on the line at question one, and with each correct and incorrect answer, you get bumped up a notch or down a notch. With each correct answer, the computer will provide progressively more difficult questions. To pass, you must ultimately rise to a point above the pass line that demonstrates competency with marginal doubt. It is important to know that the test can end at any number between 75 and 265 when this determination is made, or when you have met the maximum time allowed – which is six hours.

 

Find ways to reduce your Stress Levels

For all of the anxious test-takers out there – don’t fret. We know of many ways to manage your stress. Test-anxiety is a very real, very common thing. It is important that you understand that you are not alone when it comes to feeling nervous and even doubtful when testing. Even if you don’t typically have test anxiety, there is a chance that you will be nervous just from the pressure of passing the NCLEX.

Let’s take a look at some ways you can reduce your stress levels and stay focused on becoming a licensed nurse:

 

Find test-taking strategies that work for you

There are many helpful tools and methods that can assist you in choosing the correct answer choice on the NCLEX. Mastering individualized test-taking strategies and applying them to every single test question can help reduce distractions caused by your racing mind. Using a systematic approach rather than relying on your memory may prove to be very helpful in reducing your anxieties.

Get plenty of rest before the exam
It is important that you refrain from staying up all night studying before the NCLEX. Knowing that NCLEX questions are written in a way that requires critical thinking and a great deal of focus. Being tired only inhibits your brain’s ability to make clear decisions. Be sure to engage in the number one preferred self-care activity of all time – adequate sleep and rest. 

Eat a healthy breakfast and avoid too much caffeine

For a week or more leading up to the day of the exam, it’s important that your body and mind are well-nourished. That’s why it’s important to eat a healthy diet. On the day of the exam, you will want to eat a brain powering breakfast such as egg whites, fresh fruit, and water or herbal tea. Having one cup of coffee in the morning is fine, but overdoing the caffeine can cause you to feel jittery and could make your test anxiety worse. 

Close your eyes, take a deep breath and regain your focus!
At times you may feel your nerves starting to get the best of you during the exam, so it’s important to regain control. Closing your eyes and taking a deep breath is a simple and effective way to calm your nerves and regain your focus.

Don’t fixate on not knowing the answer – Just take an educated guess and move on

Sometimes we get to a point to where our best test-taking strategy doesn’t help us choose the right answer on the NCLEX exam. If you find yourself in this situation, don’t freak out – it happens to us all. Just take an educated guess and move on. Dwelling on the fact that you do not know the answer will provide unnecessary distractions that could send you down the wrong path. Simply accept that you don’t know, select the answer that makes the most sense, and move to the next question.

Don’t let real-world experience or past clinical experiences trick you

It is very important to understand that the creators of the NCLEX write questions and answer choices in a way that will make you immediately react. This reaction is generally the cause of real-world experiences that you are familiar with. Selecting an answer choice based off of this gut feeling is typically a grave mistake. Borrowing from your past experiences as a nursing assistant or during your clinical rotations in school will set you up for failure.

When considering the NCLEX world versus the real world, you should understand that the NCLEX world is 100% perfect. You only have one patient at a time. You have an LPN and a nursing assistant that you can delegate tasks to. You are well-staffed, with all the working equipment you need to provide the BEST care possible. The NCLEX world operates in black and white – textbook standards at all times. There are no cutting corners, or taking shortcuts. Unless the question offers select all that apply answer choices, there is only one correct answer.  

As you move through each NCLEX question, you should remind yourself that the creators of the NCLEX want you to use textbook nursing standards as your guide for action. Nurses assess before they implement. Nurses always consider what is most therapeutic for the patient. Nurses always consider the least invasive treatment option first. Nurses always advocate for patient-centered care practices. The nurse can always do something before relying on other members of the healthcare team. Before you answer each question, you should ask yourself – “Is this textbook nursing practice?” 

 

Practice, Practice, Practice 

By answering at least 25 NCLEX questions per day, and completing weekly practice exams leading up to sitting for the NCLEX is one of the most important ways to prepare for NCLEX success. It is important to note that simply answering questions and taking the practice exams is only half of the process.

You must also: 

Look up questions that you answered incorrectly, and review that nursing topic or content. Every practice question bank provides rationales as to why each answer choice is correct or incorrect.

Jot down notes of which concepts you want to revisit, so with your next study session, you can focus on problem areas.

It is especially useful to take at least 1 or 2 full online mock NCLEX exams so you are used to the experience of computer testing. Go through as much of the question bank as you can before exam day and you will be miles ahead.

Practice applying test-taking strategies learned to every single question. This will help you to master the strategies so that you have a systematic process of approaching each question. This is especially helpful when you may not remember certain topics or content.

 

Most importantly – BELIEVE IN YOURSELF!

Everyone who graduates nursing school deserves to pass the NCLEX and you are no exception! You have already proven your potential as a nurse by graduating nursing school. You did more than complete your coursework. You have proven that you are resilient, creative, caring, and intelligent. Your flexibility, dedication and desire to successfully complete nursing school is far more impressive than passing the NCLEX. Now, you must transition from nursing student to nurse. The NCLEX is your final academic hurdle to earning the right to practice as a licensed, professional nurse – so get out there and rock it – You got this!

If you have any additional recommendations or tips for NCLEX success, please leave your thoughts in the comments section below!