Chapter 30 1. Examine proactive approaches to reality shock, the transition from student to graduate 2. Identify three competencies for achieving life balance 3. Identify strategies for renewal 4. Discuss the importance of commitment to nursing to continue to build communication skills As you become more comfortable with your ability to communicate, you will soon become increasingly aware of how complex a venture it is. Beyond the technique comes the art, the intuitive application of what you know. This concluding chapter asks you to consider the commitments necessary to move on in your chosen profession: to remain open and sensitive to the human condition, to renew your energy, and to embrace change. To do these, you must find balance in life as you explore the challenges of moving from the role of student to graduate: from transitioning from the clear expectations of school to the ambiguity of nursing practice; from a low nurse-to-client ratio to the conflicting needs of many patients; from, perhaps, a focused role as student to stressors from additional life changes such as marriage, having children, moving, and adjusting to a new, perhaps first, job (Tingle, 2001). Marlene Kramer conducted a classic study of the problem of “reality shock,” when young graduates find themselves in a work situation, thinking they were going to be prepared and finding that they were not (Kramer, 1974). Understanding these findings provides you with an opportunity to be more proactive in your approach to the work world, although it may not make it easier to deal with the emotions encountered in this transition toward personal and professional development. Although this may not be the exact situation in which you will find yourself, it is useful to examine her findings and the research that has followed. As a student you learn how to be successful in the role of student, moving from novice to expert in that role by the time you graduate. In a new work setting, you again become the novice. Kramer describes the development of the professional–bureaucratic conflict, in which the nurse faces the challenge of not being able to give the desired amount of time to an individual client. Kramer identified four phases of this culture shock (Box 30-1). Emotions you may experience during this transition include “exhilaration, anger, grief, excitement, resentment, nervousness, euphoria, self-doubt, or satisfaction” (Tingle, 2001). Understand that a range of feelings is normal. To deal with stress at this time, self-care is important. For example, take a break during your shift and eat your meal off the unit if possible, making sure that your clients’ immediate needs are met before you leave them in someone else’s care. Your confidence will grow over time. Be patient with yourself. Tingle (2001) summarizes transition strategies through the mnemonic, NURSES: Use available facility resources! Reenergize with professional associations! Evaluate your own growth realistically! A study of 612 newly licensed registered nurses in New York identified several themes in these nurses’ experience: colliding expectations between nurses’ personal view of nursing and their lived experience; the need for speed and not enough time to get everything done and get to know the patients; high expectations and too much work and responsibility; mistreatment by physicians, rudeness, and criticism; and yet, a theme of hope, that after the first 6 months of difficult transition, things were better and the nurses were more resilient (Pellico et al, 2009). A study in Norway of job satisfaction and job values among new nurses found that the transition from school to work was less dramatic than initially assumed (Daehlen, 2008). Kramer (1974) offers the following suggestions to achieve Bicultural Adaptation: evaluate situations in the workplace by looking at all sides to the issue, consider how your behavior will affect other colleagues, and identify appropriate and attainable goals. Other proactive strategies include the following: when interviewing for a job, inquire about the length of the orientation and internships or preceptor programs for new graduates (Dyess and Sherman, 2009); do your homework about the organization’s philosophy and mission statement, available online; when you accept a position, ask questions about the history of the organization; focus on gaining a reputation for competence in skills and interpersonal relationships; identify someone who will understand what you are experiencing, and let you express your feelings, not someone with whom you work, and someone you trust to keep a confidence; expect to be tested as the “new kid on the block,” and avoid being defensive; understand that other staff members also feel pressure and experience stress; keep a journal to record the thoughts, feelings, reflections, and ideas you have about how things could be changed, ideas you might share when you have earned the respect of your colleagues. Guterman (1994) proposes a model he calls generative balancing, which focuses on three competencies: “creating success, finding meaning, and renewal.” “All three competencies are necessary for balancing, and the real thrill, the excitement of the ride—just as in life—comes from the movement, not from finding a steady-point” but from balance. To create success is to set goals, to see the station or the destination. Guzzetta (1998) compares her own journey toward holistic nursing practice to the weaving of a tapestry: “master weavers of a tapestry have described the weaving of a tapestry as a calling, as transformation, as healing, or as a sacred work.” What would your tapestry of success as a nurse contain? How would you embellish and color it to reflect your unique contribution? To find meaning is essential for the nurse. Arnold (1989) sees this process as crucial for the nurse to prevent burnout, which she proposes is an existential crisis, and for the patient, who needs the nurse in the role of “meaning maker.” Arnold’s work confirms what many career nurses have come to view as the essence of nursing. Arnold (1989) suggests that many nursing students grow up with a set of values and beliefs that translate into rules and regulations. Faith may be seen as a gift that is tied to good behavior. Do the right things and all will be well. When nurses are faced with seemingly meaningless tragedies, “or an accumulation of stressors, the nurse’s spiritual perspective is thrown off balance. Beliefs previously used no longer provide an accurate internal guide on which to base decisions.” It may become hard to pray or attend religious services. Traditional passive beliefs in a higher power may “not necessarily lend any understandable meaning to life experience. If one thinks of spirituality in such narrow terms, the essence of spirituality as a relationship with a higher power is lost.” Through the resolution of this existential crisis comes “a total acceptance and commitment to stewardship, anchored by a reasoned loyalty and trust in a higher purpose. What is needed is a broader perspective, a transcendent level of meaning that reorders the incomprehensible circumstances of pain and suffering that a nurse experiences on a daily basis.” An examination of nurses’ stories from their work with disenfranchised people, clients who frighten us or who are afraid, revealed four dimensions of meaning: the reward of meaning as overcoming challenges through facing our own fears and prejudices, the reward of meaning from a sense of having been called to the work, the reward of meaning as a legacy of caring connected with family experience or tragedy, and the reward of meaning from the experience of common humanity, the belief that each person has a right to care and respect (Zerwekh, 2000). Kushner (2001) faced just such an existential crisis when his own child died of progeria, a disease of premature aging. He questioned his own beliefs: how could he, a rabbi, a good person, have such a senseless tragedy occur in his life? In his book When Bad Things Happen to Good People, he concludes that you cannot control the events in your life, only the attitude that you take toward life. Kushner discusses three ways that he found to give meaning to life: belong to people, accept pain as a part of life, and know that you have made a difference. These are all a part of your life as a nurse if you remain open and sensitive to the human condition (Kushner, 2002).
Continuing the commitment
Putting it all together
Reality shock: the transition to nursing practice
Proactive approaches to reality shock: the transition from student to nurse
Achieving generative balance
Creating success
Finding meaning
Meaning for the nurse
Continuing the commitment
Moments of Connection . . .
