`Reality shock refers to the transition to a graduate nurse from a student. It involves the emotional, social and physical response to the unwanted, undesired, unexpected or intolerable. The reality shock involves a non-linear journey that moves the novel practitioner through role-relationship, skill, emotive, intellectual, professional and developmental changes. Furthermore, it carries with it expectations, meanings and experiences. It is presumed that reality shock is influenced by experiential and developmental histories, as well as situational contexts which cultivate and, prescribe culture, work ethic, professional responsibilities and roles’ expectations. The role transition experience is felt with various intensities. In addition, it is based on predictable fundamental issues. It exists within personally fluctuating and motivated physical well-being, emotional and intellectual states. This paper is aimed at discussing why reality shock is a problematic period and how the transition can be made easier. Challenges during the transition
During the first stages of the transition, students express a range of, overwhelming intensity and labile nature emotions. Terms such as scared to death and terrified are used to express the emotions. During the first weeks, there is a routine of relentless anxieties. The predictability, stability, consistency and familiarity of individuals and introductory clinical experiences with which student interact significantly influences the responses to prevailing role transition stress. Students are usually anxious, overwhelmed and express psychologically and physically debilitating stress levels (Chang and Hancock, 2003, 157). This is more prevalent during the first four months post- orientation. This traumatic adjustment is as a result of insufficient and inadequate emotional and functional support, communication insecurities, lack of confidence and practice experience, and linked to control loss, new colleagues and failure of support. This results to inadequate anticipated roles, professional practice values, intellectual, emotional and physical exhaustion, as well as unrealistic performance expectations from colleagues, the institution and graduates themselves.
Dominant nurses who are supposed to interact with the graduates and teach them, often challenge the practice content and process. It is aperceived that the challenges intentionally seek to diminish the negligible confidence level. It is worth noting that acceptance displays and supportive statements from senior colleagues go a long way in encouraging the student nurses. There is an experience of lack of control and consequently powerlessness that is linked to transition shock experience.
Students consume a lot of energy trying to stabilize their emotions, which leaves them, exhausted, by the fourth month. New graduates have the fear of being viewed as clinically incompetent, being inadequate in offering safe care to patients and hurting them inadvertently, and inability to cope with designated responsibilities and roles. Consequently, graduates are rejected by peers who think they are not valuable and do not add value to the professional community. Sometimes, new graduates disguise the inadequacy feelings for the reverently and new-found esteemed colleagues (Wilson and Startup, 1991, 396).
Considering that new graduate nurses do not have immediate access to peers and educators who can offer emotional support, feedback, practice consultation and intellectual counsel, they often have self-doubt and feel isolated. Graduate nurses report struggles with upholding practice standards and intentions consolidated during course work. Students express guilt and frustration about the inability to endorse practice principles they believe are a basic requirement in the professional role.
Immense all-encompassing energy is wasted while trying to perform the new roles at the expected level without revealing how hard it was for them. Established life-pattern routines such as debt acquisitions living arrangements and advancing intimate relationships are changed. Being young professionals, the graduates are still experiencing developmental and personal changes. In addition, they are required to make advanced practice decisions and clinical judgments for which they feel minimally competent but at the same time, completely responsible. The novel professional accountability level is complicated by practice expectations from colleagues and managers which are unclear. In addition, there are inaccurate assumptions on how a successful transition should be like, physical demands of shift work, unanticipated role-relationship struggles and lack of a normalizing feedback that can evaluate role transition and experience progress. Surrounded by insecurities and doubts, new practitioners are unable to control relentless debriefs of practice decisions and actions. Majority of graduates spend most of their time reflecting about what took place on the previous shift, and preparing for the next. Sleep time is occupied with dreams about work. This brings about a perpetual work state that substantially contributes to growing exhaustion (Griffiths, Winstanley and Gabriel, 2005, 292).
The introduction to the professional practice environment begins with orientation to the nursing role, practice context and workplace. During this period, there is a high energy level, inspiration and eagerness to finally practice independently. They are aware that they are in a learning role, and there is an inquisitive fascination of all that lies ahead. After some time however, the experience is abruptly and rapidly transformed from one having wonder and excitement to one of all-consuming stress, doubt and fear (Chang and Hancock, 2003, 155).
Recommendations to ensure the transition is bearable
New graduate nurses should have an access to support networks of colleagues and peers. The support network is recognized a vital link to ongoing professional development among graduates who could not access it.
As a result of the criticality of the training received, many nurses urge for a more balance between practical on the job learning and theoretical learning. Many nurses are frustrated as a result of the conflict between the goal to assist patients, the organizations’ priorities, procedures and structures. A course intended for student nurses is therefore, essential so that they acquire the necessary skills. In the course, student nurses are presented with problems; they act on them and try to come up with solutions. As a result, they learn how their solutions relate with the experienced staff nurses’. Such training programs impacts significantly on performance, motivation and attitudes of nurses when on reality shock (Nayak, 1991, 65).
On arrival at the new health institutions, training graduate nurses should begin with work place raining. If assisted to do excellent work, job satisfaction results automatically. In-service setting educators should handle the responsibility of orienting new graduate nurses with keenness so that students experience an easy time during their practice. Student nurses should be assisted so that they develop suitable interpersonal strategies. As a result, graduate nurses are capacitated to nurse inside the system and become a positive change influencer in the care system. Nursing colleges’ philosophy ignores learning of technical skills and emphasizes clinical judgment and problem-solving capabilities. This enables student nurses to continue learning and solving problems. However, if graduates feel inadequate and are unable to demonstrate competence concerning the basic skills, it is particularly likely that their effectiveness in every area suffers. It is agreeable that basic skills are the easiest to observe and assess. The basic skills therefore may be used as the overall capability’s indicator.
It is notable that the head nurse or a hospital educator conducts a learning assessment on graduate nurses. Apart from equipping graduate nurses with information that brings positive influence to the hospital, conducting a learning assessment on them; shows accountability. There should be courses that cater for all graduates needs and individual needs.
In- service educators should work together with the management. Head nurses should be aware of the socialization process and symptoms and signs in various reality shock stages. She should be aware of her reactions towards conflict that young graduates experience. Consequently, she should formulate ways through which to manage how she reacts in every situation. Research indicates that supervisors have a solid impact on motivation and stress levels in new professionals. Graduates who experience the paramount career adjustment have supervisors who set clear and timely goals, offer direction, coaching and technical advice to assist the graduate nurses grow and learn. In addition, supervisors need to give performance feedback frequently and timely.
In the nursing profession, reality shock is considered a uncommonly critical period. Graduate nurses experience physical, emotional and intellectual challenges. Measures should be put in place to ensure that the students pass through the stages successfully. Industry employers and educational institutions have a responsibility of offering preparatory theory on role transition for graduate nurses, facilitate clinical placements that are educative, and that equip graduates for the highly intense, dynamic and conflict-laden professional practice context. In addition, the workplace orientations should be extended and expanded to provide a balance between clinical skill practice and theoretical knowledge.
Chang E. & Hancock K. (2003) “Role stress and role ambiguity in new nursing graduates in Australia.”Nursing and Health Sciences. Vol. 5, 155–163.
Griffiths, D. S., Winstanley, D. and Gabriel, Y. (2005)“Learning shock: the trauma of return to formal learning.” Management Learning. Vol. 36, iss.3, 275-297.
Nayak, S. (1991)“Strategies to support the new nurse in practice.Journal of Nursing Staff Development. Vol.7, iss. 2, 64- 66.
Wilson, A. & Startup, R. (1991)“Nurse Socialization: issues and problems.”Journal of Advanced Nursing. Vol.16, iss.7, 391-397.
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