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!

New Grad Nurse Tips: How to Safely and Effectively Delegate Tasks

When we ask new graduate nurses what they find to be most difficult as they are transitioning from student nurse to professional nurse, the majority say that it is delegation. This is because the artful skill of nursing delegation is one that can take years of experience to master. It involves transferring responsibility from one individual to another, while retaining accountability for the outcomes. This is a completely different role for the new grad nurse to get used to, especially since the opportunities to practice delegation are very limited during nursing school.

Since new graduate nurses are often hesitant in giving the responsibility of carrying out patient care tasks to others, this brings on additional stress to the transitioning nurse, which can result in poor time management and overwhelming workloads.

Let’s face it – nursing is not a one person show. It takes a team to safely and effectively care for patients. Since nursing is a team effort, it is vial that the new nurse master strategies for safe and effective delegation. To help new grad nurses better manage their roles and responsibilities,  we’re dropping gems on strategies for safe and effective delegation below. 

Decide when delegation is appropriate

Okay new nurses, here’s the scoop – You should NEVER delegate what you can E.A.T. The nurse is responsible for Evaluating, Assessing and Teaching. These are specific responsibilities of the Registered Nurse and should always be carried out by the RN. Delegation can begin after the RN has assessed the patient, and the condition and needs of the patient have been considered. The RN will prioritize the patient’s needs based on their condition, and differentiate between nursing and non-nursing tasks. Let’s not forget that initial assessment (including vital signs) are to be done by the RN, and therefore should not be delegated to the nursing assistant. Once you have assessed your patients and have considered their needs, now you can begin to think about whom you may delegate to.

Determine adequate skill levels 

It’s up to the RN to choose the appropriate person for the task. It is essential to know the skill level of each team member to match the task assignment appropriately. One easy way to accomplish his task is by getting to know your co-workers. Here are some questions you may want to ask to help you feel more confident about your decision in choosing:

Is this person licensed or unlicensed?
How long has this person worked within their role?
Has this person been validated for competence in performing the task?
Does the person feel confident that they can safely and effectively perform the task?
Does the person need additional training or instruction to complete the task independently?

Once you have asked yourself these questions, you will be able to move into the next phase of safely and effectively delegating.

Use clear communication when delegating tasks

In order for any task to be effectively delegated, nurses must give clear, concise and detailed instructions. This includes the purpose, any identified limits, and expected outcomes of the task. Also, the nurse must ensure that the person to assume the task can complete it within the expected time frame established. Nurses should consider that the person you are delegating to will be working with several other patients, so be mindful and set realistic, attainable goals. Finally, the nurse must always ask if there are any questions or concerns which promotes clarification and opportunity for the supportive personnel to disclose concerns related to the tasks.

Supervise the delegated work and provide feedback

To ensure the delegated work has been completed appropriately, nurses must offer direct supervision and feedback as needed. They must also be available in case an unexpected outcome occurs. You should never assume that the task was completed without validating it by checking that all components of the task have been accurately carried out. Be sure to build strong relationships with your nursing support staff by identifying areas of success and offering suggestions for improvement. And don’t forget to say “thank you”—it goes a long way!

Evaluate task outcomes

To ensure that the patient received the care needed and that the team worked together efficiently, RNs must evaluate the delegation process upon task completion. If an unexpected outcome occurs, it is essential that RNs develop a plan to correct the deficiencies if possible.

As you hit the floor running, please remember that learning to delegate effectively takes time and practice. Reflecting on the process of delegation and identifying areas for improvement will help you develop this important skill. Good luck —we know you got this!

If you have any further tips or suggestions to promote safe and effective delegation, please share your thoughts in the comments section!