Making the Transition from Student to Professional Nurse

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Making the Transition from Student to Professional Nurse


Key Concepts

• Phases of reality shock• Differences between the

novice nurse and the expert professional nurse

• Strategies to ease the transition from novice to professional nurse


Overview

• Inconsistency between the expectations as a student and those of the profession creates conflict for the new nurse

• Transition, often referred to as reality shock, is a complicated process that can be overwhelming for the new nurse


Reality Shock

• Inconsistency between the academic world and the work world

• Occurs in novice nurses when they discover a work environment for which they have prepared for several years and suddenly feel that they are not prepared



Phases of Reality Shock

• Honeymoon• Shock or Rejection• Recovery• Resolution



Honeymoon Phase

• Everything in the work world is just as the new graduate imagined

• Most often occurs during the orientation period


Shock (Rejection) Phase• Realization of conflicting viewpoints

and different ways of performing skills

• Lack of an expert available as a resource

• Common questions:– “What must I do to become the kind

of nurse I want to be?”– “What must I do so that my nursing

contributes to humankind and society?”


Inappropriate Reactions to the Shock Phase

• Native– Adopts ways of least resistance; mimics other

nurses • Run away

– Leave nursing; return to graduate school• Rutter

– Bottles up conflict and becomes burned outContinued…


• Loners– Adopts the attitude just do the job and “keep your

mouth shut” • New nurse on the block

– Change jobs frequently; use the excuse: “I am new here”


Appropriate Response to Shock

• Change agent– Welfare of patient is foremost– Care enough to elicit change

• May be called a troublemaker


Recovery Phase

• Novice nurse begins to understand the new culture

• Novice nurse experiences less anxiety and healing begins


Resolution Phase

• Novice nurse adjusts to the new environment• Work expectations are more easily met• The nurse has developed the ability to elicit

change


Degree of Reality Shock

• Less for graduates who begin their career in the same institution where clinical rotations were performed

• Higher for graduates who choose to work in institutions in which they did not train

• Reality shock inventory will be helpful to assess oneself and the situation


Causes of Reality Shock• Culture shock

– Work culture is different and unfamiliar– Providing “wholistic care” may not be reality

• Methods of evaluation– Work world evaluates on quantity of care – Academic world evaluates on correct steps

• Incongruent school and work values


From Novice to Expert (Benner, 1984)

• Stage 1: few clinical experiences; skills learned by roterule governed behavior

• Stage 2: advanced beginners; able to perform adequately; make some judgment calls

aspects, based on prior experience

• Stage 3: competent nurses; able to foresee long range goals & master new skills

some mastery and coping ability, not speed

Continued…


• Stage 4: proficient nurses; holistic view; able to develop effective solutions

sees whole, not aspectsspeed

• Stage 5: expert nurses; intuition & decision making instantaneous

does not rely on rules or aspectsquickly zero in on problem


Strategies to Ease Transition

• Participate in orientation programs– Biculturalism– Role models and mentors– Preceptorships– Self mentoring

• Improve self-confidence and self-esteem• Know keys to survival


Ways to Build Self-Esteem

• Become future-oriented; do not focus on mistakes

• List areas in which to improve• List personal qualities that you like about

yourself• Take time to treat yourself• Engage in positive self-talk

Continued…


• Set goals and mark them off when complete• Maintain a positive attitude• Become active in professional organizations• Offer to mentor students• Keep personal and professional life in

balance


Keys to Survival

• 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


Meeting Special Needs of the Novice Nurse

• Organizational skills• Clinical skills• Interpersonal skills• Delegation skills• Priority setting skills• Balance with personal life


Improve Organizational Skills

• Use report sheets• Contact former nursing instructors to discuss

challenges• Learn to delegate appropriately


Improve Clinical Skills

• Observe experienced nurses• Provide mentor with list of skills needing

refinement• Use policy & procedure book


Improve Interpersonal Skills

• Attend unit meetings• Volunteer for committees• Take an active interest in the nursing unit• Participate in professional organizations• Make rounds with physicians• Assist with procedures


Improve Delegation Skills

• Communicate face to face; be aware of body language

• Follow-up by putting tasks in writing

• Be pleasant and open to suggestions

• Offer help• Provide sincere, positive

reinforcement


Improve Prioritization Skills

• What are the patient needs?• How much time is required for a task?• What tasks can be delegated?


Improve Your Social Life

• Reintroduce yourself to spouse, family & friends

• Participate in children’s activities• Read a novel• Try new recipes• Participate in exercise• Enjoy the nursing profession!


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Making the Transition from Student to Professional Nurse

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