Reality Shock
Exhaustion
Reality shock calls for professional accountability from graduate students. Several factors lead
to heightened strain during this critical period. There are unclear practice requirements from colleagues
and managers, unexpected relationship-role struggles with colleagues, inaccurate assumptions of what
an effective transition is like, physical demands to adjust to shift work, and the lack of a normalizing
feedback that can assess the role transition progress and experience (Duchsher, 2009). Students narrate
of how they spent their time reflecting about what had happened in the previous shift, and preparing for
the next one. During the time students are supposed to sleep, they are occupied with dreams about the
work. This contributes to a ‘perpetual work’ state that extremely contributes to exhaustion.
Professional Support
With adequate professional support, a smooth transition can be made possible. For instance, if
clinical teaching staff are available and approachable, positive outcomes are achieved during the
period. Moreover, student graduates should be motivated to ask questions to increase their knowledge,
and should never be put down. Another approach to ensure a smooth transition is prompting graduate
students to involve in best practices with benevolent surveillance. Students can be allocated to a certain
ward and monitored by the experienced staff. Graduate students should receive feedback in a
constructive and timely manner, be praised and reassured. According to Johnstone, Kanitsaki & Currie
(2008), graduate students should be given support when experiencing problems, and debriefed after
undergoing through a difficult situation.
Offering graduate nurses support in a timely and appropriate manner bears a positive and direct
result on competence and confidence for beginning practitioners. Johnstone, Kanitsaki &Currie (2008)
argues that support also involves guiding the student so that they do not make mistakes. Graduate
students comment that the dominant nurses with which they interacted with challenged both the content
and process of the practice foundation. According to Duchsher (2009), these challenges are intentional
and aim at diminishing the already negligible confidence level at work. Graduate students consume a
lot of energy trying to stabilize their emotions during the transition, which leads to remarkable
exhaustion by the 3 rd to 4 th month (Duchsher, 2009).
Strategic Directions
There are several recommendations that can be put into place to ensure graduate nurses survive
the transitional problems. The strategies include standardizing the orientation phase, being introduced
to the workload responsibility gradually, standardization and provision of preceptors and mentors, work
hours restriction, patient load restriction, monitoring the students closely during the first eight weeks
through clinical supervision sessions and excluding particular responsibilities during the first rotation.
It is essential that clinical supervision sessions include transition coordinators as well as esteem
enhancement and self-concept assessment throughout the first transition year. Implementing these
strategies ensures that students apply nursing knowledge to their practice though decision making and
critical thinking. According to Morrow (2009), this facilitates the transition to advanced beginner from
novice, and beyond.
Expectations and Work Load
Graduates find it hard to switch to full responsibility as a result of the orientation approach
used by nurse managers, clinical educators and senior nurses. On many occasions, students never
address their issues to the senior counterparts as a result of their demanding workloads (Duchsher
2009). Moreover, students express their concern of being placed in practice situations that are beyond
their experiential and cognitive comfort level. Pellico, Brewer and Kovner (2009) support the notion
that nursing schools are viewed as insufficient in training clinical skills. Anticipatory guidance,
conflict resolution and delegation classes are thought to contain curricular content that should be
excluded from educational programs.
Hospital nursing is associated with a lot of stress in new graduates. This is as a result of
constant competence testing in a technological environment that is ever-changing, novel
responsibilities and the necessity to adapt to new roles, and avoid pressure by following ritualistic
routines. Inadequate confidence, high self expectations, role ambiguity and conflict, unrealistic
expectations from the clinical staff, lack of support, conflict of values and tension make it hard to
maintain professional standards.
The developmental and sociocultural tasks during the first 4 months basically involve getting
and trusting their professional being, differentiating their self from those around, acceptance from the
larger community and balancing professional and personal life (Duchsher, 2009). According to Maben,
Latter and Clark (2006), time pressure results from poor skill mix, limited staffing, extra demands and
high patient turnover. Students claim that some nursing staff treat them rudely, are hostile, resentful and
dismiss them moreover, there is verbal abuse, humiliation and psychological harassment.
Providing appropriate support to graduates ensures an effective transition which is achieved
within four months. Support from senior staffs ensures that new graduates quickly become functional
members in the institution. It is worth noting that different students require varying orientation time
periods to ensure they are incorporated in to the new environment. Rotations within a period of four
months is essential as it helps students acquire different skills. Adequate support is necessary during the
integration and early transition phase since this is the time when graduates feel lost most.