I have new nurses on my unit, and know reality shock can be tough. How can I help them overcome reality shock and be successful in their new position?

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New nurses enter their assigned practice settings eager to begin their new jobs, to meet their new colleagues, and to accept their new challenges. They complete orientation and their initial competency verifications without difficulty. Their preceptors ease the transition into practice and teach them everything they need to be successful. Then, six months to a year later, disillusionment sets in. The preceptee realizes that the reality of the new healthcare environment is flawed.

There are four phases to reality shock:

  • Honeymoon phase: Preceptees are happy to be in their clinical rotations and may say "everything is wonderful."
  • Shock phase: Preceptees begin to encounter weaknesses, discrepancies, and inconsistencies in the work environment and their new colleagues.
  • Recovery phase: Preceptees begin to perceive the realities of the professional practice environment with a balanced view of both negative and positive aspects.
  • Resolution phase: Preceptees may adopt less than ideal values or beliefs to resolve the conflicts of values and find ways to "fit in" with their coworkers.

With the four phases to reality shock, there are different ways to help preceptees overcome reality shock. Here are a few suggestions for each of the different phases.

  • Honeymoon phase: Develop the initial bonds between preceptors and preceptees, created by a mutual sense of trust, respect, and honor. Be realistic, but do not stifle their enthusiasm.
  • Shock phase: Anticipate that preceptees may experience some dissatisfaction with new positions, peers, or employers. Help preceptees to vent frustrations in a constructive manner.
  • Recovery phase: Always treat preceptees kindly, help them view the situation realistically, and ease them into their roles and responsibilities. Do not release preceptees to take full patient assignments until they are ready.
  • Resolution phase: Identify and manage any conflicts and confusions that persist, give simple, easy-to-follow directions for tasks, and help preceptees retain the positive aspects of their nursing values/beliefs systems from school and from the practicing nurses.

Diana Swihart, PhD, DMin, MSN, CS, RN-BC

(February 2010)