Reality shock Present by : Dr.Amira Yahia

Outline Phases of reality shock Differences between the novice nurse and the expert professional nurse Strategies to ease the transition from novice to professional nurse

What Is Reality Shock? Reaction experienced when entering work force after years of preparation Recent graduates are expected to be competent, capable nurses—without the experience Increased acuity, combined with the nursing shortage, may leave you feeling depressed, insecure, and powerless

Reality Shock Inconsistency between the academic world and the work world Occurs in novice nurses when they discover a work environment for which they have prepared for several years and suddenly feel that they are not prepared

Phases of Reality Shock Honeymoon Shock or Rejection Recovery Resolution

Honeymoon Phase Everything in the work world is just as the new graduate imagined Most often occurs during the orientation period

Shock (Rejection) Phase Realization of conflicting viewpoints and different ways of performing skills Lack of an expert available as a resource Common questions: “What must I do to become the kind of nurse I want to be?” “What must I do so that my nursing contributes to humankind and society?”

Inappropriate Reactions to the Shock Phase Native Adopts ways of least resistance; simulators other nurses Run away Leave nursing; return to graduate school Rutter Bottles up conflict and becomes burned out

Appropriate Response to Shock Change agent Welfare of patient is foremost Care enough to elicit change

Recovery Phase Novice nurse begins to understand the new culture Novice nurse experiences less anxiety and healing begins

Resolution Phase Novice nurse adjusts to the new environment Work expectations are more easily met The nurse has developed the ability to elicit change

Degree of Reality Shock Less for graduates who begin their career in the same institution where clinical rotations were performed Higher for graduates who choose to work in institutions in which they did not train Reality shock inventory will be helpful to assess oneself and the situation

Causes of Reality Shock Culture shock Work culture is different and unfamiliar Providing “wholistic care” may not be reality Methods of evaluation Work world evaluates on quantity of care Academic world evaluates on correct steps Incongruent school and work values

From Novice to Expert Stage 1: few clinical experiences; skills learned by rote rule governed behavior Stage 2: advanced beginners; able to perform adequately; make some judgment calls aspects, based on prior experience Stage 3: competent nurses; able to foresee long range goals & master new skills some mastery and coping ability, not speed

Stage 4: proficient nurses; holistic view; able to develop effective solutions sees whole, not aspects speed Stage 5: expert nurses; intuition & decision making instantaneous does not rely on rules or aspects quickly zero in on problem

Strategies to Ease Transition Participate in orientation programs Biculturalism Role models and mentors Preceptorships Self mentoring Improve self-confidence and self- esteem Know keys to survival

Ways to Build Self-Esteem Become future-oriented; do not focus on mistakes List areas in which to improve List personal qualities that you like about yourself Take time to treat yourself Engage in positive self-talk

Set goals and mark them off when complete Maintain a positive attitude Become active in professional organizations Offer to mentor students Keep personal and professional life in balance

Keys to Survival Never fail to ask for help Use available facility resources Re-energize with professional associations Stay in contact with friends Evaluate your growth realistically Stay focused on your goals

Meeting Special Needs of the Novice Nurse Organizational skills Clinical skills Interpersonal skills Delegation skills Priority setting skills Balance with personal life

Improve Organizational Skills Use report sheets Contact former nursing instructors to discuss challenges Learn to delegate appropriately

Improve Clinical Skills Observe experienced nurses Provide mentor with list of skills needing refinement Use policy & procedure book

Improve Interpersonal Skills Attend unit meetings Volunteer for committees Take an active interest in the nursing unit Participate in professional organizations Make rounds with physicians Assist with procedures

Improve Delegation Skills Communicate face to face; be aware of body language Follow-up by putting tasks in writing Be pleasant and open to suggestions Offer help Provide sincere, positive reinforcement

Improve Prioritization Skills What are the patient needs? How much time is required for a task? What tasks can be delegated?

Improve Your Social Life Reintroduce yourself to spouse, family & friends Participate in children’s activities Read a novel Try new recipes Participate in exercise Enjoy the nursing profession!