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!

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!

5 Reasons You Didn’t Get Into Nursing School

You’ve received that dreaded letter from your nursing school informing you that you will not be starting your nursing program next semester and there are one million things running through your mind.  Where did I go wrong? How did I overlook that? What I am going to do now…?

Here are a few common mistakes pre-nursing students make when applying to nursing school and a guide on how to improve your next nursing school application. 

 

1.You Put All Your Eggs in One Basket                                                                                                                                          While attending your university’s nursing program is ideal, it may not be likely. Nursing is highly competitive and most programs have very limited seats. Applying  solely to your university could be a critical mistake and cost you a semester’s wait -or more.  

Play it safe and begin preparing your application to multiple schools in your immediate and surrounding areas to make the most of your investment. All nursing programs aren’t created equal so your application may vary from program to program. The first step is scoping out your potential transfer school for accreditation, credit transferability, and tuition costs. 

After you have found a good match,  a general admission application to your potential transfer school of choice is usually necessary. Additionally, some schools require additional courses that are only specific to their school and require completion of said course(s) by program admission deadline. Iron out all of the details by scheduling or attending an information session with a nursing school advisor. Once you’ve been accepted to the university! Apply! Apply! Apply!  Casting a wider net always equates to better results.

 

2. Your Application Wasn’t Competitive                                                                                                                                      You’ve done the hard part of getting all the many criteria of the application together- but does your application stand out? The highly competitive nature of nursing school makes it imperative that you have a standout application in areas outside of your coursework. 

Volunteer hours and great letters of recommendation are a necessity; however, there are ways to take it even further. Step your application game up by getting a job as a CNA or nurse tech. Hands on experience is invaluable and is sure to make you stand out among the rest. Also, get your application in as soon as possible to show your dedication, timeliness and commitment to the process.

 

3. Your Science GPA Wasn’t Strong Enough                                                                                                                                There are many aspects of the nursing application that are considered during the admission process; however, the science GPA holds major weight in most programs. These classes (Anatomy & Physiology l & ll, Microbiology, Chemistry and  Bio sequence) are literally the foundation of nursing curriculum and scoring high in these courses are a surefire way to get the attention of the admission committee. It shows that you are not only serious about these courses but sets the tone that you’ve got what it takes to succeed in the nursing courses ahead. If you got an average grade in one of these courses it might not be a bad idea to repeat it and shoot for an A!

 

4.Your Entrance Test Score Was Too Low
Nursing entrance tests are hard work. They can be expensive, confusing and time consuming. Nonetheless, a good score could change the dynamics of your application and catapult you into a front row seat in your program of choice.

If your score didn’t make the cut or improve your application, a retest may be your only option. Avoid frustrating yourself by creating a strategy for success. Even the worse test takers have found ways to ace these exams and continue their nursing journey. More appropriate study-guides and test quizzes may help your score improve drastically. Preparing using the test taker’s materials are efficient way of understanding the test requirements. Additionally, don’t wait until the last minute to complete this exam. Give yourself time to retest in the event you aren’t pleased with your initial score. 

 

5.You Got Waitlisted                                                                                                                                                                         While getting waitlisted isn’t the “yes” you were hoping for, lets face it, it’s better than “no.” As aforementioned, most nursing programs have limited seats; however, the applicant pool plays a major part in the chance of a seat opening up. 

If you’ve found yourself in this tricky middle-ground, remain hopeful. Some accepted applicants won’t choose to attend your program while life circumstances may happen to others, thus delaying their attendance. If things don’t work out in your favor, be sure to check out numbers 1-4 to make sure you’ve given yourself the absolute best chance of getting an absolute YES! next time. 

 

We know that denial to the nursing program can be devastating, disappointing and can often come with a ton of embarrassment. Don’t allow negative thoughts to distract you from your calling or  goal to become a nurse. The true test of this minor setback is how you respond. 

 

Becoming a Military Nurse

Military nursing shares many similarities to civilian nursing, in which the common goal is to treat patients and promote their well-being. Military nurses may work either at home or in foreign countries and in a variety of setting to include, but not limited to, military bases, military hospitals, and clinics. Military nurses may also work in hospitals or global response centers alongside deployed military personnel during natural disasters or times of war. Military nurses can work in potentially dangerous environments, like foreign war zones, and work under extremely stressful conditions. The benefits of becoming a Nurse in the military are numerous! You are provided with the tools you need to develop your career and continued training and leadership opportunities within your field. In addition to opportunities for continuing education and clinical specialization, you will receive low-cost or no-cost medical, dental and life insurance, generous retirement plan options, housing allowances, food stipends, and paid vacation earned at a rate of 2.5 days a month which you are eligible to take anytime.

In order to become a military nurse, you must earn a Bachelor of Science in Nursing (BSN) or an advanced nursing degree from an accredited school. Military nurses are commissioned officers; therefore, an associate degree will not be accepted. After graduating from nursing school, successfully passing the NCLEX would be the next step. Once you are licensed RN or advanced practice provider you can start your journey into the military with or without work experience. You will want to begin to talk to a Health Professions Recruiter, when you are ready to start this journey! Once you decide on a branch, make sure you meet all eligibility requirements determined by your recruiting branch, and complete the application packet. This process will take about a year from initial onset to final approval from the commissioning board. If you find out your application has been accepted the next major step is the completion of Commissioned Officer Training (COT). You are required to complete this 5-week commissioned officer course which helps you learn the ropes of military life as an Officer in the military. After successful completion of this course, you will graduate and go on to the duty station that you have been assigned to!

The main certifications you will need are a Bachelor’s degree and an active RN license from a non-compact state. You will also need to be certified in Basic Life Support (BLS).

If Acute Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications are required for a particular nursing specialty, you should also have these completed as well. Any other specific certifications relative to your nursing specialty are helpful but not required (i.e. CCRN).

There are many things to consider before making the choice to become a military nurse. There is a huge commitment involved with such a decision. You are not just a nurse, but you are also an active member of the Armed Forces. You will have to be deployed, many times for lengths varying 6 months to a year. Other things to consider before joining the military are your future plans. For example:

  • How will the military benefit you?
  • Do you have plans to further your education?
  • Are you able to live a structured life, taking orders from higher ranking individuals around you?
  • Are you able to be an active member of team and step up to leadership positions?

All these are great questions to think about and consider in your decision to join the military. The field of military nursing is fast-paced and can be emotionally, physically, and intellectually demanding. For the right candidate, it is an excellent opportunity for travel and personal and professional growth.

Jay Nichols known by her audience as Jay Quinn is a Critical Care Nurse in the US Air Force. Jay is currently an Acute Care NP student and also the owner and founder of Nurse Jay Boutique. Jay graduated from the University of South Carolina Mary Black School in Dec 2015 and started her nursing career as a new graduate on the Medical/Surgical ICU unit at the Mayo Clinic in Rochester, MN.