Week 5; Reality shock & Nurse residency Flashcards
define reality shock:
Unsettling or jarring experience resulting from wide disparity between what was expected and what the real situation turns out to be, such as the firstdayon a newjob.
When does reality shock occur?
This reality shock occurs with the transition from the educational to the service setting where there are different priorities and pressures.
When does reality shock resolve?
This conflict resolves when the new nurse is able to see ways that he/she can influence the work environment.
What are the 4 phases of reality shock?
- honeymoon phase
- shock phase
- recovery phase
- resolution phase
What is the honeymoon phase of reality shock?
New Grads are happy to be done with nursing schooland excited to start their first job.
What is the focus of the honeymoon phase?
The focus of this stage is learning the unit routine, being introduced to new people, and developing new skills.
What is the shock phase?
New Grads begin to recognize there are flaws in the system. There may be discrepancies/inconsistencies in the workplace.
What are 5 examples of discrepancies or inconsistencies in the workplace with shock phase?
- Discovering their Preceptor does not know everything or follow policies
- Realizing they do not have the tools and equipment to do their job.
- Experiencing communication breakdowns
- Identifying poor professional behaviors in their fellow nurses
- Having felt humiliated by a physician, bullied by a nurse, or embarrassed by a colleague.
What is the recovery phase?
See the balance between what works well and what needs improvement.
What do you establish during the recovery phase?
expectations that are consistent for all their co-workers.
What is important to realize during the recovery phase?
it is important to realize every nurse defines their own practice, and it is their job to be the nurse who they want to be.
What are 3 things to keep in mind with the recovery phase?
- Reflect on what is going well and what can be improved.
- Treat your patients and the nurses with whom you work with respect
- Keep your sense of humor.
Why is there caution in the resolution phase?
There is some caution in this stage as this is when theNew Grad may consider adoptingvalues and beliefs that are less than ideal in order to fitinwiththeir co-workers.
What does the new grad have the opportunity to do during the resolution phase?
The new grad has the opportunity to define the nurse they want to be and become that nurse.
What are 5 things to keep in mind during the resolution phase?
- Identify and manage conflicts as they arise.
- Problem solve
- Focus on what is working well
- Celebrate smallsuccesses along the way!
- Seek supportfrom a trusted professional- preceptor, manager or nurse educator.
What are examples of academic values? with nursing?
Concise, thorough Theorists models Complete total care Supervised Competency –SILC Limited skills
What are examples of real life values? with nursing?
Expertise Efficiency, speed Skill competence Organization Prioritization Delegate Accountable Flexible
What are intrinsic factors that lead to reality shock?
Lack of confidence/expertise
Inability to make decisions, prioritize and time management.
Uncertain when to call the physician and what to say.
Delegating others.
Increase stress
Feelings of being alone
What are extrinsic factors that lead to reality shock?
Increase workload, high acuity of patients.
Conflicting values and beliefs
Working 12 hour shifts days/nights
Decrease lack of time for family, friends and self.
Demands of the work setting-competency, cbts, etc.
What themes emerged from 2004 study of new grads with reality shock?
- Lack of confidence to perform skills; difficulty with critical thinking and gaining knowledge
- Developing relationships with peers and preceptors
- Struggling with wanting to be independent right out of the gate
- Frustrations with the work environment
- Organization and priority setting
- Communication with Physicians
What is transition shock?
the initial stage of role adaptation for the newly graduated RN
What does transition shock model consist of?
- Loss
- Doubt
- Confusion
- Disorientation
What happens in the loss stage of the transition shock model?
leadership and collaboration skills, peer support, social maturity, life changes
What happens in the doubt stage of the transition shock model?
skills tasks, professional culture, roles 7 responsibilities
What happens in the confusion stage of the transition shock model?
interdisciplinary/intradisciplinary, changing roles and tasks, practice
What happens in the disorientation stage of the transition shock model?
role stress, practice autonomy, developing professional identity.
What are nursing strategies for transition from SN to RN?
- Organization
- gathering supplies
- Prioritize patients
- Using the SBAR
- proper rest, nutrition, immunizations
- role models –latch on!!
What are characteristics of a professional RN?
Have a positive attitude Be proactive Be flexible Ask for help when needed Ask questions Open communication with co-workers Accept Positive and Negative criticism Continue education-newest evidence based practice Learn the culture of the unit and staff Coming prepared for clinical
What are some coping strategies for coping?
- Have a Mentor/Preceptor
- Organizational skills- using a Nursing tool (brain sheet)
- Come prepared if you are on a Med/surg floor know your medications/patho for different diagnosis for that particular unit.
- Plenty of rest prior to shift, nutrition/exercise
- Know the expectations of the unit/self
- Networking with fellow class mates/instructors
- Carry medication cards, quick look nursing books either on you or in locker
- Know where to look for resources e.g. Pharmacy, RT, polices etc.
- At end of shift reflect with the Mentor/Preceptor on how the day went. Whether it is neg/pos criticism.
What is a nurse residency program?
Planned comprehensive program
When would you do a nurse residency program?
< 12 months experience
What do you acquire with nurse residency?
Acquires knowledge, skills, and professional behaviors to deliver safe, quality care that meets defined standards of practice
How long is a Nurse residency program?
a minimum of 6 months in length
When would you do an RN Fellowship Or Post Bac Nurse Residency?
Registered Nurses with 12 or more months experience
What is the goal of an RN Fellowship Or Post Bac Nurse Residency?
Acquires knowledge, skills, and professional behaviors to deliver safe quality care that meets defined standards of practice
What is the purpose of an orientation?
introduce new individuals to the organization
What is practiced based learning?
preceptor/mentor learning
What does practiced based learning promote?
Promotes the process of investigating and evaluating healthcare practices
What 2 things does practiced based learning improve?
- Improve patient care
2. Improve patient outcomes
Who is a preceptor?
Experienced competent staff nurse
What are the 4 NRP Accreditation Elements?
1) Organizational Orientation
2) Practiced-based experience
3) Activities promote professional development
4) Minimum 6 months
How do YOU benefit from a nurse residency program?
- Competence
- Confidence
- Stronger Leadership
- Improved critical thinking
How do PATIENTS benefit from a nurse residency program?
- Quality Care
2. More engaged & committed caregivers
How do STAFF benefit from a nurse residency program?
- Improved team dynamics
- Efficiency & safety on unit
- increase Morale
- decrease Stress
How do ORGANIZATION benefit from a nurse residency program?
- Improves overall fiscal health of organization
2. Decrease cost with recruitment & training
What is a huge benefit of a nurse residency program?
retention rate
What are the 3 E’s of a nurse residency program?
- Engage
- Educate
- Empower
What is unique about a versant nurse residency program?
shorter length
What is unique about a viziant nurse residency program?
12 months
Besides versant and visitant nurse residency program, what are the 2 other types?
- home grown
2. AACN Post Baccalaureate Nurse Residency Program
What does a residency nurse program emphasize?
- leadership abilities
- critical thinking skills
- communication skills (written & verbal)
- research-based practice
- patient safety
- professional career development
Upon Completion of the Residency, the Resident will have:
- Transitioned from advanced beginner toward competent professional RN.
- Developed effective decision-making skills r/t clinical judgment & performance.
- Provide clinical nursing leadership at the bedside.
