Managing Reality Shock in New Employees: A Preceptor's Guide

Chapter 3 Reality Shock

Reality Shock Reality shock is defined as the shocklike reaction that new staff experience when they find the new job for which they have just been hired does not operate within their expected values and ideals. The discrepancy may exist between their former employer and their new employer. The 4 stages of reality shock that preceptors should anticipate include the following:

Honeymoon Perceives virtually all aspects of the new employment as being great. Engages in mastering skills and routines and integration with other staff. Shock Personal or organizational obstacles become apparent and prevent the new employee from meeting needs and goals. May experience outrage, fatigue, perceptual distortions related to anger and frustrations, rejection of work values.

Recovery Onset is heralded by return of a sense of humor and perspective. Begins to recognize that not everything about the current work situation is bad or substandard compared with previous experiences and expectations. Begins to see both positive and negative aspects of the current situation. Resolution Conflict between work values and practices may resolve in one of the following ways: o Rejects work values (may change employer). o Continues to fight discrepancies (stays, but complains frequently). o Attempts to retain the best values and practices from both the past (past employer) and the present.

Try to recall your own passage through reality shock. Think of any discrepancies that you may have experienced in a new job. Which of these conflicts were most difficult to resolve? Do you remember going through the 4 stages of reality shock? What would have been helpful to you at each stage of reality shock? How much time did you need to resolve these conflicts? Were you ever dissatisfied, disappointed, or shocked by any comparisons between your past and new employers? Think of applying these strategies when working with new employees. Alspach, JoAnn. "Chapter 5." From Staff Nurse to Preceptor: A Preceptor Development Program. Aliso Viejo, CA: AACN Critical Care Publication, 2000. N. pag. Print.

Reality Shock Phase Ways to Assist Preceptee 1. Honeymoon Harness their enthusiasm for learning new skills and routines. Be realistic, but do not stifle their enthusiasm. Introduce them to other staff and coworkers. Anticipate that preceptees may experience some dissatisfactions with new position or employer. Be a good listener. Provide opportunities to vent frustrations in a constructive manner. Help them view situations realistically. Ask preceptees to keep a written record of improvements they would like to suggest. Help them to recognize positive aspects of their current work setting as well as areas where improvements could be made. Identify and deal with any conflicts that persist. Assist preceptees in constructive problem solving. Describe the mechanisms and processes available to resolve perceived problems. Help them combine the best aspects of their prior school or work expectations with their current work situation. 2. Shock 3. Recovery 4. Resolution Alspach, JoAnn. "Chapter 5." From Staff Nurse to Preceptor: A Preceptor Development Program. Aliso Viejo, CA: AACN Critical Care Publication, 2000. N. pag. Print.

Reality Shock HONEYMOON Phase You have a new job and you perceive your preceptor as all-knowing and the agency as just perfect. Your exuberance makes you eager to learn everything so that you can hit the ground running within a few days. You do not see any problems and love everything about the agency and its staff.

1. Recognize that some aspects of a new staffs exuberance may not always be helpful in making the transition in a new job. Unrealistically high expectations may set the stage for deep disappointments later as the realities of daily work become more apparent. 2. Preceptors can help prevent this emotional roller coaster by reminding orientees that all healthcare facilities/agencies have room for improvement and may have their share of problems and that preceptors will not always have all the answers.

3. Perhaps once each week, preceptors could ask their orientees to identify 2 things they have encountered that they really like and 2 things that they would like to help improve. These strategies may assist preceptees to view both strengths and weaknesses of the agency in a more realistic light. 4. Try to direct preceptees enthusiasm by having them begin to plan their preceptorship with you. By helping to distinguish and prioritize their learning needs, preceptees will also see that their learning and development will be a gradual process. Alspach, JoAnn. "Chapter 5." From Staff Nurse to Preceptor: A Preceptor Development Program. Aliso Viejo, CA: AACN Critical Care Publication, 2000. N. pag. Print.

Reality Shock SHOCK Phase You are a newly hired clinician who has worked in this position at another agency for 7 years. You did not work for 18 months immediately before starting your new job because you had 24- hour responsibility caring for a parent in declining health. After your first week on the job, you tell your preceptor that you must speak with him or her about the deplorable circumstances you have observed in your team: staff responds lethargically to you, no one seems to know where anything is, patient orders are often missing, and staffing is never adequate for the workload. You tell your preceptor that you do not think you can take much more of this situation.

1. Listen fully and openly to the preceptees concerns. 2. Avoid being defensive about the situation. Try to maintain an open mind toward necessary improvements. 3. If the issues identified are truly problems, let the preceptees know that you share his or her concerns. Try to consider each problem one at a time and to relate any progress that has been made in resolving it. Ask the preceptees for suggestions to address each problem. Explain the mechanisms available within the department for making those suggested changes, and specify the first few steps for implementing the change process.

4. If the issues identified are not rally problems (perhaps they merely represent differences in practice from what orientees are accustomed to or changes that have transpired in the healthcare system since they were last employed), help the preceptees to understand the situation more fully or offer explanations (not excuses) for why things are as they are. If the preceptees still views the situation as a problem, explore how the issue might be raised for discussion among other staff without the preceptees seeming overly critical of his or her new coworkers. 5. Remind preceptors that they can avoid the need for this type of discussion if they had mentioned the problem to the preceptees first and asked the preceptees for suggestions at that time. Another way to prevent this form of bottle-up frustration is by giving preceptees numerous opportunities to share their reactions and impressions on a daily or weekly basis. If preceptees do not mention any flaws in the system, ask them about this, encourage recognition of areas needing attention, and speak candidly in response. Alspach, JoAnn. "Chapter 5." From Staff Nurse to Preceptor: A Preceptor Development Program. Aliso Viejo, CA: AACN Critical Care Publication, 2000. N. pag. Print.

Reality Shock RECOVERY Phase You are an extremely diligent and somewhat compulsive worker with 15 years of experience in real estate and 3 years of experience in a staff position at a nearby health care agency. You lost your last job to downsizing and are terrified of losing your job again because of heavy financial pressures in your family circumstances. You take your orientation program very seriously and want to impress your supervisor and coworkers with the quality of your work. At the end of your second week of orientation, you spend more than 1 hour teaching cardiac risk factor modification to a patient. Only after your preceptor inquires about why your patient needs to learn this instruction, do you discover that you have taught this skill to the wrong patient. You feel foolish and embarrassed, and fear that your peers and supervisor will perceive you as irresponsible and incompetent.

1. Help the preceptee to keep things in perspective. The worst outcome of this situation is that the preceptee will need to repeat the instruction to the right patient. 2. Suggest that the preceptee lightenup so that the stress associated with wanting to do well or to impress others does not overshadow his or her effectiveness. 3. Use your sense of humor to allay the preceptee s fears and embarrassment. You might relate some of your own more memorable clinical blunders so that the preceptee no longer views you as perfect. As long as patients suffer no harm, laughing at yourself can help reduce unnecessary tensions. Alspach, JoAnn. "Chapter 5." From Staff Nurse to Preceptor: A Preceptor Development Program. Aliso Viejo, CA: AACN Critical Care Publication, 2000. N. pag. Print.

Reality Shock RESOLUTION Phase You are a staff nurse who recently worked in a small inpatient facility. You took a new job with a large home care agency. Your patient populations differ, your workload is heavier, you feel isolated from other staff, and you must adjust to working in a managed care environment. Now that your orientation is nearing completion, you realize that much of your former professional decisions seems to be lost because many decisions are more or less determined by clinical pathways, care maps, or other dictates of managed care. Although you have reconciled many other differences between your former and present positions, this issue is affecting your professional identity and job satisfaction negatively.

1. This scenario affords a good opportunity to teach constructive problem solving to preceptees. 2. Explain some of the inevitable changes that have and will continue to affect how healthcare services are provided to clients and how to not only survive but to thrive professionally in a managed care setting. 3. Rather than viewing protocols such as care maps or critical pathways as immutable dictates, explain to employees new to these mechanisms how, why, and by whom these devices are constructed, how they are evaluated, and how they can be modified. If staff believe that improvements to these established practices are warranted, they can learn how to initiate and follow through with making necessary changes. Rather than perceiving professional decisions at a personal level, staff can be helped to view this discretionary capability as a team-oriented process.

4. Describe how changes in these documents have been made in the past and what the preceptee s role can be within a team-oriented change process. 5. Suggest that the preceptee review the professional literature in the area to determine how other facilities have implemented changes in their programs that not only optimize patient outcomes, but promote professional autonomy in the process. Alspach, JoAnn. "Chapter 5." From Staff Nurse to Preceptor: A Preceptor Development Program. Aliso Viejo, CA: AACN Critical Care Publication, 2000. N. pag. Print.