Reality Shock

1. Reality Shock Ask the participants: �What are your expectations of ambulatory (clinic) nursing?� Write their responses on the board Do you think it is easier than bedside nursing? Why? Transition: We�ll explore the phases of reality shock and how your transition into the Ambulatory Care setting will fall into these phases.Ask the participants: �What are your expectations of ambulatory (clinic) nursing?� Write their responses on the board Do you think it is easier than bedside nursing? Why? Transition: We�ll explore the phases of reality shock and how your transition into the Ambulatory Care setting will fall into these phases.

2. Reality Shock : ObjectivesAfter the discussion, the participant should be able to: Define �Reality Shock� Identify the four phases of reality shock Identify the common behaviors exhibited in each phase Identify what the preceptor can do to help the new staff member Can do this at the beginning or the end.Can do this at the beginning or the end.

3. Reality Shock The shock-like reaction of new employees when they find that the work situation for which they have prepared for DOES NOT exactly operate within the values and ideals they had anticipated. This is a mismatch of their expectations and reality. This is a normal occurrence. We all go through some degree of shock reality whenever we encounter a new environment or a new situation. Remember when you were first married? Everything was wonderful. How long did it take before you realized that your spouse was human?This is a mismatch of their expectations and reality. This is a normal occurrence. We all go through some degree of shock reality whenever we encounter a new environment or a new situation. Remember when you were first married? Everything was wonderful. How long did it take before you realized that your spouse was human?

4. Reality Shock It is the total social, physical and emotional response of a person to the unexpected, unwanted or undesired, and even to the intolerable� (Marlene Kramer, 1974) There is actually a physical component to this shock. It is not just limited to emotional and psychological manifestations.There is actually a physical component to this shock. It is not just limited to emotional and psychological manifestations.

5. Reality Shock Four Phases of Reality Shock Honeymoon Shock Recovery Resolution

6. Reality Shock:  Honeymoon Phase Your Behaviors High-energy euphoria Perceives everything as being wonderful Fascinated by the newness of the experience Focused on mastery of skills, routine and integration with staff Mentor�s Role Harnesses new employee�s energy and enthusiasm for learning new skills and routines Be realistic, but not negative Assists in the integration of the new employee into the work culture Use college roommate experience I love everybody and everything I don�t know why everybody else is frustrated/unhappy The whole world is just rightUse college roommate experience I love everybody and everything I don�t know why everybody else is frustrated/unhappy The whole world is just right

7. Reality Shock:  Shock Phase Your Behaviors Experiences outrage and frustration Experiences conflicting values and practice Pre-occupied with the past Generally negative Mentor�s Role Offers support Be a good listener Encourages new staff to record suggestions for improvement Offers an objective point of view: acknowledge negative highlight positives Slap on the face. Aha! �Wake up and smell the coffee that�s three days old!� This isn�t how I was taught to do this This shouldn�t be done this way Slap on the face. Aha! �Wake up and smell the coffee that�s three days old!� This isn�t how I was taught to do this This shouldn�t be done this way

8. Reality Shock: Recovery Phase Your Behaviors Sense of humor returns Lessened tension and anxiety Objectively evaluates the situation Differentiates between effective/ineffective behavior Mentor�s Role Acknowledgement Assists in seeing the positives Talks about ways to improve work environment Supports improvement efforts/participation Views how things really areViews how things really are

9. Reality Shock:  Resolution Phase Your Behaviors Conflicts resolved Understands/accepts role in the work environment/culture Acts appropriately Mentor�s Role Assists with constructive problem-solving Assists new employee in using new and helpful coping mechanisms Assists in acknowledging and managing conflicts that still persist Integration is successful May take time, depending on the level of experience of the preceptee and the culture that he/she is enteringIntegration is successful May take time, depending on the level of experience of the preceptee and the culture that he/she is entering

10. Reality Shock Causes Fear, lack of confidence, total responsibility Unrealistic expectations of self and co-workers; Fatigue Role conflict and undefined expectations Lack of resources and lack of support Dealing with physicians and other health care workers Lack of organizational skills/new situation Heavy workload, frequent interruptions Capture on flipchart and compare with overheadCapture on flipchart and compare with overhead

11. Reality Shock Helpful attitudes for the Preceptor/Preceptee �If at first you don�t succeed, try and try again� People are unpredictable Conflict is healthy, if dealt with creatively There are at least two good solutions to every problem Work that is meaningful is important to you and your co-workers Develop a tolerance for your own uncertainty and conflicts Refer to handout, �Points to Remember�Refer to handout, �Points to Remember�

12. Reality Shock Helpful attitudes (continue)� Develop interpersonal competency for maximum effectiveness Learn to recognize that occasionally, outside support is necessary

13. Reality Shock Possible Outcome Adaptation: to become effective, assimilated, accepted and aware Rejection: dissatisfaction, depression, anger, frustration, surrender

14. Reality Shock: �I�m an expert, and always will be.� Myths: Working in the Clinic is a piece of cake This will be much easier than bedside nursing I was an expert in the hospital and definitely be an expert in the clinic Truth: Different kind of �hard� Not easier � instead of one patient you�ll have sixty in one day You�ll be a novice once again. Use it!

15. Reality Shock �If only dreams and realities were not so far apart.� (Cervantes)