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Reality Shock and New Grads. It's Real.

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New grads entering into the nursing profession experience a widely-documented phenomena known as Reality Shock. This article talks about how to help them navigate through the four phases of Reality Shock.

by Nurse Beth Nurse Beth, MSN (Columnist)

Specializes in Med Surg, Tele, ICU, Ortho. Has 30 years experience.

How do you deal with reality shock?

Reality Shock and New Grads. It's Real.

Honeymoon Phase

The Honeymoon Phase happens when you start a new job and basically have a positivity bias. Everything is wonderful and exciting. The Honeymoon Phase is described as viewing everything you see through rose-colored lenses.

The smart preceptor takes advantage of this time by introducing the positive new employee to colleagues and the providers on the unit. The new grads may be starry-eyed, but don’t pop their bubble-it will happen soon enough. Just support them. It’s a perfect time to begin to develop a trusting relationship with your preceptee.

Effective preceptors know that a successful precepting experience is relational. We all learn more readily when we feel safe, not judged, and supported. New grads are very receptive during the Honeymoon Phase and readily soak up new information.

Shock Phase

The Shock Phase is when the reality of the work situation sets in. New grads are idealistic and try to make sense of their fast-paced and scary new world and responsibilities through black and white rules and based on their foundation of textbook learning. They struggle with ambivalence, such as “Sometimes PVCs perfuse, but sometimes they don’t”.  They may be disappointed to notice cliques on the unit, or be confused and frustrated when individual preceptors instruct them differently or even contradict one another. 

For example, new grads are taught in Orientation to do bedside report and to include the patient and family, but quickly notice that on the floor, some nurses do give handoff report at the bedside while others give handoff report standing over their COWs in the hallway.

They were sternly informed that syringes with meds that are not immediately administered should be labeled, but often syringes are carried down the hall and are not labeled.

As a preceptor and educator, it’s really important to listen to their concerns. Try to differentiate expected and predictable new RN role stress from serious issues that must be addressed. Feeling overwhelmed and inadequate is normal and expected. But being pressured by providers (and colleagues!) to take orders via text messaging when hospital policy and CMS clearly state not to is an issue that must be addressed.

If your new resident is overwhelmed, try to help them regain perspective. Remind them of when they were recently in school and have them recall a time when they were overwhelmed. Remind them that they did gain more proficiency in the Sim Lab over time, and they did successfully meet many challenges. The same thing will happen on the job. Make sure they understand that every nurse has gone through this phase, that it’s uncomfortable, and that they will get through it.

If your new resident is feeling pressured to do something not in alignment with policy, chances are that it’s an organizational accountability/culture problem. An organizational accountabilty/culture problem is when policy and practice contradict one another, and admin/leadership does not hold providers and each other accountable. Report these incidents and let your resident know that incident reports are taken seriously.

If your organization has a nursing Shared Governance, such practice issues can also be addressed and escalated there. 

Recovery Phase

During the Recovery Phase, perspective improves. New grads are able to see both the positive and negative sides and they begin to tolerate ambivalence a bit more. They recover their sense of humour. Encourage your new grad to write down his/her concerns and also to write down their suggestions for improvement.

Resolution Phase

The ultimate challenge is integrating the values and ideals of school with the values and ideals of the workplace without sacrificing integrity. In school, new grads were taught to perform comprehensive, 20 minute long patient assessments. In the work setting, they must perform focused assessments in 5 minutes tops.

In school, new grads passed meds on one or two patients without a phone or a pager constantly interrupting them. In the work setting, they must learn to safely manage distractions during med pass. These are just a couple of examples of successful integration of school and work ideals and values.


What experience do you have with the stages of Reality Shock, and what helped you through? Also read 10 Essential Tips for New Preceptors

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.

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7 Comment(s)

"An organizational accountability/culture problem is when policy and practice contradict one another, and admin/leadership does not hold providers and each other accountable. Report these incidents and let your resident know that incident reports are taken seriously". 

Sadly, these incident reports are NOT taken seriously and nobody is held accountable (unless maybe a patient dies?). If we told this to our residents, we would be lying.

Mrs.D., BSN

Specializes in Medical cardiology. Has 3 years experience.

Thank you for this, it was a helpful reminder as someone who is about to precept her first new grad. I had an amazing preceptor, and I want to be that lifeline for my new grad who is due to meet me in a week or two. Do you have any other resources that I might use to set her up for success? I train many others, just not new grads. I literally have no idea what I’m doing in this department.

I’ve avoided it until now because I think of it as such a big deal. I know I have a lot to offer—I enjoy where I work, continue to learn every day, and I have a good work ethic—but I don’t know what to teach...

Thanks. 

JBMmom, MSN

Specializes in Long term care; med-surg; critical care. Has 9 years experience.

39 minutes ago, Mrs.D. said:

I’ve avoided it until now because I think of it as such a big deal.

The fact that you're putting the time and effort into planning for this new grad means that you're going to be a great preceptor no matter what. I think that attitude of the preceptor is really one of the most important things. I know that in my unit, they've put new grads with the newest, least experienced nurses. Initially I thought it was crazy because these nurses haven't fully developed their own practice in critical care and now they're teaching new grads. But I realized that they are new and enthusiastic and maybe even if they don't do everything exactly right they will at least be a positive outlook for these new nurses. The nuances of practice will come with time, but a bad experience is more difficult to overcome. Good luck with your new nurse!

bitter_betsy, BSN

Specializes in Emergency / Disaster. Has 2 years experience.

@Mrs.D.

As a relatively new grad who had a tremendously terrible experience that still affects me - the best thing you can do for your new person is to support them and answer their questions and teach them.  Ask if they want you over their shoulder and give them a little space when they need it.  My preceptor made me figure things out - which is fine - but there are easier / more efficient ways to do things and I didn't learn any of those. Tricks for pulling blood off an existing line when it doesn't want to pull, how to find finger veins when there are literally no veins left in the human. Which meds you can push faster than 2 minutes and for goodness sakes - how to document things in the shortest way possible.  I do everything the long and hard way.  It gets done, but it takes me longer, makes me slower and much more frustrated.  I'm figuring it out but I hate her more every day for the knowledge and experience that she preventing me from having in those precious few weeks.  I was SO excited to start my job and starting on day 3, I threw up every day until I cracked in a residency class (about week 😎 and told the course coordinator what had been going on. I had a new preceptor the next day.  I found out later one of the reasons that they gave me a new preceptor was because 2 of the nurses that I work with now complained on my behalf.

For the most part, I could do the tasks when I started on the floor. What I couldn't do is figure out a system to be time efficient or any of the short cuts to make things easier (trendelenburg for a foley or double tourniquets for a hard stick or even heat).  I also didn't know what I had to have orders for and what I could do myself - I still don't know most of them.  It isn't the nursing that's hard - its the "things" that are required that are hard... and the documentation... oh the documentation.

I wish I had heard "you are doing a great job" or even you suck rocks. Feedback of any kind would have been appreciated - when the feedback did come it was after a correction of some sort and didn't seem genuine at all.  Oh - and don't sit on your butt at the nursing station and let me struggle with 4 patients on week 1.  Be a teammate, teach me how to get caught up and how to organize and how to get out of the weeds - not just say - you have another patient in room 4 and take another drink of your coffee and eat some more of your egg McMuffin. I like to be told where I'm struggling so I can work on that, but I also don't want to feel alone while doing it.  Tell me where I am weak and help me get stronger there.  After all - I am on your team and someday I may be your code partner.  Make me the nurse you want to work with.  Lift me up and help make me strong.

The fact that you care - already puts you ahead of so many others!

Being a first year nursing student, I found this article to be super helpful and relatable. It will be good to know some of the ups and downs of first getting into nursing!

"When the Charge Nurse sees you and your preceptee as two fully functioning nurses instead of one unit" This! One week into my orientation on a new unit and I was being asked to float to cover vacations!