NUR 6340 Module 1 Transition Shock Paper: A New Graduate's First Four Months in an Emergency Department Example

The Supply Room in Week Three: Precepting a New Graduate Through Transition Shock in a Newark Emergency Department

Student Name

M.S. in Nursing, Nurse Educator, Thomas Edison State University

NUR-6340: Healthcare Professional Precepting: Ensuring Career Success

Mentor Name

Month Day, Year

The Supply Room in Week Three: Precepting a New Graduate Through Transition Shock in a Newark Emergency Department

Week Three

Every person in this paper is invented, as is the hospital. The emergency department at a hospital in Newark sees about 95,000 visits a year and hires four to six new graduates each spring. The writer has worked there for eleven years and has precepted a dozen nurses. This spring she was assigned Dana, who graduated with honors, passed her licensing examination on the first attempt and asked specifically for emergency nursing.

In the third week, after a shift in which a patient in the hallway deteriorated while Dana was starting an intravenous line on another patient, the preceptor found her crying in the supply room. Dana said she felt she knew nothing, that everyone else moved twice as fast and that she was afraid she would hurt someone. She was not sure she could do this job.

The preceptor's first instinct was reassurance: you are doing fine, everyone feels this way. On reflection, she decided that reassurance was not enough and that she needed to understand what Dana was going through.

Reality Shock

Kramer (1974) studied new nurses moving from school into hospital work and described reality shock: the reaction of new workers who find that the work world does not hold the values they were prepared for. Nursing school taught comprehensive, individualized care; the hospital asked for speed, efficiency and many patients at once. Kramer described phases of honeymoon, shock, recovery and resolution and found that new nurses who could not reconcile school and work values often left nursing or became cynical. She argued that preparation should begin in school and that hospitals should help new nurses integrate their professional ideals with the realities of the workplace.

Transition Shock

Duchscher (2009) studied newly graduated nurses through their first months and described transition shock as the immediate and dramatic experience of moving from student to professional practitioner. New graduates experienced shifts in their relationships, roles, responsibilities and knowledge all at once. They described doubt, confusion, disorientation and loss: loss of the support structures of school, of the identity of a good student and of the confidence they had built. Duchscher found that this period was most intense in the first months and that new nurses needed a supportive work environment, realistic expectations and help understanding that their reactions were part of a recognizable transition rather than evidence of failure.

Dana's words matched Duchscher's account closely. She had moved from being a successful student to being the least competent person on the unit, from caring for one patient with an instructor nearby to carrying three patients and a hallway, and from knowing the answers on tests to not knowing what she did not know.

Why It Matters

Kovner et al. (2014) examined how nurse turnover is defined and measured and used national survey data to estimate turnover among newly licensed registered nurses. By their estimate, a substantial share of newly licensed nurses changed jobs before their first anniversary, and roughly a third had gone by the end of year two. They noted that turnover rates vary with how they are calculated and that the costs to hospitals and patients are substantial.

Naming the Experience

The next day, the preceptor took Dana to coffee during their break and described transition shock in plain words: a normal, intense period that most new nurses go through, worst in the first months and not a sign that she had chosen the wrong career. She shared her own first months, when she had cried in her car after shifts. Dana said that hearing it had a name made her feel less alone.

Pacing the First Four Months

The preceptor and the unit educator revised Dana's orientation plan. For weeks four through eight, Dana carries two patients in the lower-acuity area, with the preceptor nearby, and takes a third patient only when she and the preceptor agree she is ready. From weeks nine through twelve, she moves to the main treatment area with a full assignment of three patients, still with the preceptor. For the last four weeks, each nurse carries a separate full assignment, with the preceptor nearby for questions. The plan sets goals for each phase, such as prioritizing among three patients and calling the physician with a clear report.

Protected Conversations

Every Friday, preceptor and orientee spend fifteen minutes after the shift reviewing what went well, what was hard and what Dana wants to focus on. The preceptor asks about Dana's sleep and life outside work, because Duchscher describes how the transition spills into every part of a new nurse's life. Dana keeps a short list of situations she found confusing, which they discuss together.

Connecting With Peers

The preceptor asked the unit educator to bring the spring's new graduates together for an hour every two weeks. Hearing that others felt the same way helped each of them, and Dana later said these meetings were where she first laughed about her mistakes.

The Preceptor's Limits

Precepting someone in distress takes energy. The preceptor told the nurse manager that she would need a lighter assignment on days she precepted in the first month and a colleague to cover when she needed a break. She also recognized that some of Dana's distress might call for more than a preceptor can offer and gave her information about the employee assistance program.

Limits

Kramer's work is more than fifty years old, and nursing education has changed. Duchscher's studies involved small groups of new graduates. A plan built for one orientee may need adjusting for another.

Conclusion

Dana's crisis in the supply room was transition shock, not failure. Kramer explained the clash between school and work, Duchscher described the shock of the first months and turnover figures showed what is at stake. Naming the experience, pacing the orientation, protecting time for conversation, connecting Dana with peers and protecting the preceptor's own energy make it more likely that Dana will still be an emergency nurse a year from now.

References

Duchscher, J. E. B. (2009). Transition shock: The initial stage of role adaptation for newly graduated registered nurses. Journal of Advanced Nursing, 65(5), 1103-1113. https://doi.org/10.1111/j.1365-2648.2008.04898.x

Kovner, C. T., Brewer, C. S., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15(3-4), 64-71. https://doi.org/10.1177/1527154414547953

Kramer, M. (1974). Reality shock: Why nurses leave nursing. Mosby.