1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 22 Making the Transition from Student to Professional Nurse

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Reality Shock  Definition  Inconsistency between the academic world and the world of work  Occurs in novice nurses when they discover a work environment toward which they worked for several years and suddenly realize that they are not prepared

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Phases of Reality Shock Honeymoon phase Honeymoon phase Shock or rejection phase Shock or rejection phase Recovery phase Recovery phase Resolution phase Resolution phase

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Honeymoon phase  Everything in the work world is just as the new graduate imagined.  Most often occurs during the orientation period. Reality Shock

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Shock (rejection) phase  New nurse comes into contact with the following: Conflicting viewpoints Conflicting viewpoints Different ways of performing skills Different ways of performing skills Lack of security of an expert available as a resource Lack of security of an expert available as a resource  Nurse may feel frightened or may react by forming a cold, hard shell. Reality Shock

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Inappropriate Approaches for Dealing With the Shock Phase Native—adopts ways of least resistance and mimics other nurses Native—adopts ways of least resistance and mimics other nurses Runaway—finds the real world too difficult and leaves the profession or returns to graduate school with a goal to teach nursing Runaway—finds the real world too difficult and leaves the profession or returns to graduate school with a goal to teach nursing Rutter—considers nursing just a job Rutter—considers nursing just a job Burned out—bottles up conflict; fatigued, depressed, angry Burned out—bottles up conflict; fatigued, depressed, angry Compassion fatigue—gradual decline in compassion over time; this results from exposure to events that have traumatized patients. Compassion fatigue—gradual decline in compassion over time; this results from exposure to events that have traumatized patients. Loner—adopts the attitude to “just do the job and keep your mouth shut” Loner—adopts the attitude to “just do the job and keep your mouth shut” New nurse on the block—changes jobs frequently and is always the “new” nurse who has to be taught New nurse on the block—changes jobs frequently and is always the “new” nurse who has to be taught

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Recovery Phase  Novice nurse begins to understand the new culture.  Novice nurse experiences less anxiety, and healing begins.

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Resolution Phase  Novice nurse adjusts to the new environment.  Work expectations are more easily met.  The nurse has developed the ability to elicit change.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Degree of Reality Shock  May be less for new graduates who begin their career in the same institution where clinical rotations were performed.  May be higher for students who choose to work in institutions in which they did not train.  Reality shock inventory will be helpful for assessment of oneself and the situation.

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Causes of Reality Shock  Culture shock Occurs when people are immersed into a culture different from that with which they are familiar and comfortable Occurs when people are immersed into a culture different from that with which they are familiar and comfortable

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Students Are Taught to Provide “Wholistic” Care but the Work Reality May Be Different  Partial task system in the work world: Nurse ensures that tasks are carried out but is not the sole provider of care.  Whole task system in the academic world requires complete knowledge, encourages loyalty to the profession, and is consistent with what is taught in school.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. From Novice to Expert  Stage One Nurses with few clinical experiences Nurses with few clinical experiences Skills are learned by rote. Skills are learned by rote. Occurs when nursing education is completed Occurs when nursing education is completed  Stage Two Advanced beginners able to perform adequately Advanced beginners able to perform adequately Able to make some judgment calls on the basis of experiences Able to make some judgment calls on the basis of experiences Occurs upon entry into the workforce Occurs upon entry into the workforce

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. From Novice to Expert  Stage Three Competent nurses Competent nurses Able to foresee long-range goals Able to foresee long-range goals Mastering skills Mastering skills  Stage Four Proficient nurses Proficient nurses Able to view whole situations rather than parts Able to view whole situations rather than parts Able to develop effective solutions Able to develop effective solutions

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. From Novice to Expert  Stage Five Expert nurses Expert nurses Intuition and decision making are instantaneous. Intuition and decision making are instantaneous.

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Interpersonal skills: Lack of comfort with interpersonal skills (e.g., making rounds, clarifying orders, participating in team conferences) is common.  Clinical skills: Doubt in ability to perform skills without supervision is common.  Organizational skills: Feeling disorganized is common.  May be based on being overwhelmed by the new environment Special Needs of Novice Nurses

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Delegation skills  Uncertainty with delegation is common.  Related to Limited exposure to delegation activities Limited exposure to delegation activities Characteristics of the personnel to whom one is delegating Characteristics of the personnel to whom one is delegating  Priority-setting skills  Important in the work world when ineffective priority setting may have serious consequences  Assertiveness skills Special Needs of Novice Nurses

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Questions to Ask to Determine Priorities Is this task a priority because of time deadlines? Is this task a priority because of time deadlines? What other personnel can perform this task? What other personnel can perform this task? Do safety concerns make this task a priority? Do safety concerns make this task a priority? What will be the consequences if this task is postponed? What will be the consequences if this task is postponed? What legal issues are related to the priority of the task? What legal issues are related to the priority of the task?

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Strategies to Ease Transition  Orientation programs in the work setting  Biculturalism Joining of school values with workplace values Joining of school values with workplace values Allows the new nurse to introduce ideas or values from nursing school and integrate them into the work environment Allows the new nurse to introduce ideas or values from nursing school and integrate them into the work environment

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Strategies to Ease Transition Activities of biculturalism programs Activities of biculturalism programs  Learn to integrate theory into practice.  Complete classes focused on making assignments and developing organizational skills  Work on alternative shifts.  Participate in role playing to learn conflict resolution.

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Strategies to Ease Transition  Role models and mentors Experienced professional nurses who provide guidance to the novice nurse regarding goal setting Experienced professional nurses who provide guidance to the novice nurse regarding goal setting Attributes of good role models Attributes of good role models  Enjoys nursing  Compatible professional goals or values  Sincere desire to assist the new nurse  Trustworthy

21. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Strategies to Ease Transition  Preceptorships During the final semester of school, the student is assigned to an experienced nurse, who serves as a preceptor with whom the student experiences everyday practice. During the final semester of school, the student is assigned to an experienced nurse, who serves as a preceptor with whom the student experiences everyday practice. One-to-one relationship between preceptor and novice nurse provides security and an environment in which to grow. One-to-one relationship between preceptor and novice nurse provides security and an environment in which to grow.

22. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Strategies to Ease Transition  Self-mentoring Learn appropriate references. Learn appropriate references. Develop problem-solving skills. Develop problem-solving skills. Willing to ask questions Willing to ask questions  Preprofessional and professional organizations

23. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Self-Confidence and Self-Esteem  Self-confidence and self-esteem  Important predictors of positive transition from student to nurse  Self-esteem questionnaire can predict an increased chance for stress-related illness and decreased job effectiveness.

24. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Suggestions to Improve Self- Confidence and Self-Esteem Become future-oriented—Do not focus on past mistakes. Become future-oriented—Do not focus on past mistakes. List areas in which to improve. List areas in which to improve. List personal qualities that you like about yourself. List personal qualities that you like about yourself. Take time to treat yourself. Take time to treat yourself. Engage in positive self-talk. Engage in positive self-talk. Set goals and mark them off when complete. Set goals and mark them off when complete. Maintain a positive attitude. Maintain a positive attitude. Remember, you made it through nursing school! Remember, you made it through nursing school! Become active in professional organizations. Become active in professional organizations. Offer to mentor students. Offer to mentor students. Keep balance. Keep balance.

25. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Keys to Survival During Transition  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.

26. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Meeting Special Needs of the Novice Nurse  Organization skills  Use report sheets.  Contact former nursing instructors to discuss challenges.  Learn to delegate appropriately.

27. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Meeting Special Needs of the Novice Nurse  Clinical skills  Observe experienced nurses as they perform skills.  Provide the nurse manager and mentor with a list of skills that need further practice.  Use the policy and procedure manual.

28. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Meeting Special Needs of the Novice Nurse  Interpersonal skills  Attend unit meetings and volunteer for committees.  Take an active interest in the nursing unit.  Participate in professional organizations at the local, regional, state, and national levels.  Make rounds with physicians and assist with procedures.

29. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Delegation skills  Communicate face to face—Body language is important.  Follow up by putting tasks in writing.  Be pleasant and open to suggestions.  Be willing to change task assignments, if indicated.  Offer help.  Provide sincere, positive reinforcement. Meeting Special Needs of the Novice Nurse

30. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Priority-setting skills  What are the patient needs?  How much time is required for a task?  What tasks can be delegated? Meeting Special Needs of the Novice Nurse

31. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Take time to remember what is important to you:  Reintroduce yourself to spouse, family, and close friends.  Participate in children’s activities.  Read a novel.  Try new recipes.  Call old friends.  Participate in a health club or aerobic exercise, or just walk.  Enjoy the nursing profession! Meeting Special Needs of the Novice Nurse