New Nurse Tips: Reality Shock and Strategies to Adjust

  1. As many of you finish up your new hire orientation - I’d like to personally congratulate you for making it through the trials and tribulations of nursing school, the NCLEX, the application and interviewing process, and now your new hire orientation – I understand the hard work, pain and sacrifice you’ve endured! Now let's get you through this reality shock!

    New Nurse Tips: Reality Shock and Strategies to Adjust

    As a new graduate nurse just eight years ago, I specifically remember thinking upon my graduation - "Nursing school was the hardest thing I've ever experienced!" It was a mutual feeling among all of my peers. Let's just say that it only took a few weeks into working as professional nurses for our opinions to drastically change. The reality was that working as a nurse was much more challenging than school could ever be!

    MY REALITY SHOCK

    My first job was a charge nurse position for a sub-acute rehab facility, day shift 7 am until 3:30 pm, Monday through Friday. I was very excited to begin my new career as a Registered Nurse and was eager to please my nursing management - to show them what I was really made of.

    Well, let's just say that I quickly found out that working as an RN did not turn out to be fashionable. In fact, the majority of the time it was downright scary! During my first shift at my facility, I was supposed to have a unit orientation with a preceptor, and the goal of the day was to shadow her and perform a few hands-on skills so I could get comfortable in the new setting. Instead, I was thrown onto the floor with a full patient assignment of 15 patients, and my assigned preceptor also had 15 of her own patients. I was so upset and taken back that I could not leave without discussing my first shift with the director of nursing (DON). In our discussion, I made sure to focus on Patient Safety, Staffing Ratios", and Structured Training to emphasize my level of concern and the sincerity of my intent to do a good job. My feelings were acknowledged, and I was commended for bringing my concerns to her.

    During her feedback, a lot of things were said in regards to me being "new" and that it will take "time" for me to adjust to my new role as an RN, all of which I thought was fluff to get me out of her office. Frustrated and uncertain if this was a right fit for me, I informed her that I wasn't sure I'd want to continue working at the facility. She grabbed my hand and then uttered these following words:

    "Nursing is a commitment to doing whatever it takes to provide safe and effective care for our patients regardless of personal gain, and it is unfortunate that the people who are in charge of signing our checks use our compassion against us."

    Although at that time that statement did nothing other than add to my frustration and concern regarding working in my new position, it has since then stuck with me and has been proven to be true in every single position I've held as an RN.

    Reality shock hit me HARD! For the first 6 months working as a new nurse, I constantly struggled with the idea of leaving nursing altogether and going back to the food and hospitality industry. I sought out advice and guidance from prior nursing school professors and friends who were in established nursing positions. I cried nearly every shift. I found myself desperately working on building a positive reputation for myself because my nursing management viewed me as "a complainer", even though I tried my best to bring ideas for resolve to the table. Regardless of my many frantic attempts to bring some form of stability to my crazy shifts, I felt like each shift was an uphill battle. For every problem that was resolved, 10 new problems surfaced. I had to do something or I was going to lose my mind and throw in the towel for good!

    FINDING A WAY TO DEAL

    Firstly, I focused on mastering nursing skills (i.e. effective and timely patient assessments, safe medication administration, evaluating the effectiveness of nursing interventions, establishing nurse-patient relationships, enhancing interdisciplinary communications and healthcare team collaboration efforts, etc.), which helped me gain the first level of comfort within my new position as an RN. Secondly, I became quite vocal in sharing my concerns with management, which provided an additional level of stress within my new role, but in the long run, helped me establish a working relationship with the team. Thirdly, I began holding my colleagues accountable for their performance - an extremely difficult task as a new graduate RN, but a necessary feat nonetheless. Finally, I began analyzing my overall level of satisfaction within my new role and started identifying things that I could personally change, rather than obsessing about the things in which I could not.

    For many of the issues that needed to be addressed, I found myself outnumbered by a nursing staff that was "set in their ways", so I decided that the best thing I could do was continue my education. With the numerous needs identified within my clinical setting during my first 6 months as an RN, I eagerly enrolled in an online RN to MSN program and my nursing career greatly improved! I was able to find my passion within the realm of nursing, and I began working towards earning an MSN in Nursing Education. As I worked through the MSN program over a three year period, I became empowered with insight and understanding of nursing, and I was able to see how I could make a difference on a larger scale. I became the change agent that I so desperately sought out as a new nurse, and my nursing career has never been better!

    To help you cope with reality shock and adjust to your new role as a nurse, here are three coping strategies that you can effectively utilize in your practice so you can too move towards becoming a confident and satisfied member of the nursing profession:

    #1 FOCUS ON MASTERING YOUR SKILLS

    One of the first coping strategies new grad nurses should utilize is simply making sure that nursing skills are being performed in a way that follows facility and state regulations. Focusing on mastering your skills from day one can drastically reduce the negative effects of reality shock later on.

    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 nursing skills independently, thus boosting your confidence and satisfaction within your new role.

    #2 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 nurses to help you when you need it.

    With the ever-changing regulations, treatments, and care plans of today's healthcare system, we all rely on one another to ensure that we are delivering the safest and most effective client care possible. Be sure to identify and communicate your learning needs as they arise, and be sure to seek out expert guidance so you can feel confident in your tasks and responsibilities.

    #3 FIND A NURSING SPECIALTY THAT FITS YOU BEST

    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, and the same goes for an operating suite versus a subacute rehabilitation center. In many cases, new graduate nurses are eager to begin working and accept the first specialty that was offered.

    In the event that you find yourself really struggling with specialty area you are working in, be sure to discuss your concerns with the nursing management before deciding to quit. They may be able to personally relate to you and your struggles and will be able to 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 onboard.

    Just know that reality shock is a normal phase that every new nurse goes through, and that you are never alone in dealing with it. I hope that you find my journey inspiring and that you can utilize the coping strategies to help you swiftly move from reality shock to that of career satisfaction!

    Best Wishes!
    -Damion
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    About Damion Jenkins, ADN, MSN

    Hi! I am Damion - a Registered Nurse, Educator, Tutor and Writer! I am the owner and operator of TheNurseSpeak.com - a nursing education and consulting company & blog. I love to help nursing students, new graduates and nursing professionals alike to develop strategies for success!

    Joined: Nov '17; Posts: 51; Likes: 111
    Nurse Education Consultant, Tutor and Writer; from MD , US
    Specialty: 7 year(s) of experience in Individualized Tutoring

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    14 Comments

  3. by   dialysisnurseLC
    This very timely article as I will be taking on the role of charge nurse at a dialysis unit. I start in 12 days. I'm excited and nervous.
  4. by   Chrispy11
    I'll be starting my first nursing job in dialysis too. Very happy to have secured a position. I had a few to choose from and was lucky enough to get to shadow with different potential employers so I had an idea of expectations. I think I chose the best fit.
  5. by   masonicusRN
    From a new grad having trouble trying to choose specialties during orientation... THANK YOU !! This reaffirmed what my priorities are and made me feel like it's ok not to know everything. As others have said, timely and great information.
  6. by   TriciaJ
    This is very pertinent and timely advice for struggling new grads. I very much enjoyed this article. Thank you!
  7. by   Damion Jenkins
    Quote from dialysisnurseLC
    This very timely article as I will be taking on the role of charge nurse at a dialysis unit. I start in 12 days. I'm excited and nervous.

    Thank you dialysisnurseLC, LPN, RN for that positive feedback! Congratulations on your new position - you'll do great!

    Best,

    Damion
  8. by   Damion Jenkins
    Quote from Chrispy11
    I'll be starting my first nursing job in dialysis too. Very happy to have secured a position. I had a few to choose from and was lucky enough to get to shadow with different potential employers so I had an idea of expectations. I think I chose the best fit.

    Thank you Chrispy11, RN for your contribution to this discussion. Congratulations on your new position in dialysis. From what I hear - Dialysis Nurses love their jobs. You'll do great!

    Best,

    Damion
  9. by   Damion Jenkins
    Quote from masonicus
    From a new grad having trouble trying to choose specialties during orientation... THANK YOU !! This reaffirmed what my priorities are and made me feel like it's ok not to know everything. As others have said, timely and great information.
    masonicus, ADN, RN - you are very welcome! Truth be told - you'll never know everything! Don't let other nurses convince you of anything different. The goal is to learn every day, and to learn from mistakes. Seek clarification from experienced members of the healthcare team, and work hard in building your skill set. Before you know it, you'll start feeling more confident within your new role.

    Congrats, and welcome to an exciting career!

    Best,

    Damion
  10. by   Damion Jenkins
    Quote from TriciaJ
    This is very pertinent and timely advice for struggling new grads. I very much enjoyed this article. Thank you!
    Thank you TriciaJ for your kind words.

    Best,

    Damion
  11. by   SisterofMary
    This is more than applicable at the moment. I worked sub-acute before moving to a acute-care hospital on a medical-surgical unit. Although I have a basic understanding/foundation, I am finding the move difficult to adjust to.

    Heavier patient load with staffing minimums and upper management constantly on our tail to perform better. Meanwhile we don't have basic supplies like working vitals machines. It seems that everything I learned in nursing school sugar coated the reality and most days I feel like a well paid servant than a critical thinking health care professional.

    Although my heart is in caring for my patients and promoting the best health care outcomes for them, it can be difficult when many other pieces are not in place.

    Hoping that it gets better.
  12. by   Damion Jenkins
    SisterofMary, thank you for contributing to this discussion. We all feel your struggle. Please know that excellent nursing care arrives with effective teamwork and flexibility. It is true that we should not accept broken equipment and limited resources/staffing as the norm, however the best way to push through these challenges is to form a strong team.

    Keep your spirits high, and be sure to present these issues to nursing leadership in an objective and meaningful way that emphasizes on suboptimal patient care and poor staff retention.

    Take care and keep fighting the good fight.

    Best,

    Damion
  13. by   SisterofMary
    Quote from Damion Jenkins
    Take care and keep fighting the good fight.
    Thank you....it helps to know that this is not forever and I am not the first nurse to be in this position. I appreciate your transparency and honesty. <3
  14. by   Damion Jenkins
    My pleasure - we're all in this together!

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