12.5 Transitioning to the PN Role
Reality Shock
As a new graduate transitions into the role of being a practical nurse, it is very common to experience something called “reality shock.” Although Kramer’s “Reality Shock” theory is several decades old, it continues to apply to new nurses transitioning to their new role through a process of learning and growing. Kramer’s Reality Shock theory characterizes four phases of transitioning into a new role referred to as the honeymoon, shock, recovery, and resolution phases[1]:
- Honeymoon phase: The first phase occurs when the newly graduated nurse is excited to join the nursing profession and it is everything they imagined. During this phase, the new nurse is typically paired up with a preceptor nurse to orient them to the new role.
- Shock phase: The second phase is when the new nurse is the most vulnerable. They are moved off orientation and independently perform tasks without the guidance of their preceptor. The nurse role is often more difficult than the new nurse previously imagined. The new nurse realizes their expectations associated with the nursing role may be inconsistent with the actual responsibilities. During this phase, negative feelings regarding their new profession may arise, and the new nurse is at greatest risk for leaving the unit or quitting.
- Recovery phase: The third phase is when new nurses begin to have positive feelings towards their profession again. During this phase, the new nurse is able to reflect on their experiences and develop a clear understanding of their responsibilities and role expectations. The novice nurse typically experiences decreased tension and anxiety and begins to assist other nurses as needed.
- Resolution phase: The fourth and final phase is usually at the end of the first year of the new position. The new nurse can visualize how the role contributes to the profession, and work expectations are easily met.
Transitioning Into Practice
Over the years, the National Council of State Boards of Nursing (NCSBN) has researched the complex issue of retaining new nursing graduates and found the inability of new nurses to properly transition into practice can have grave consequences. New nurses care for sicker clients in increasingly complex health settings and feel increased stress levels. As a result, new nurses are involved in more client safety and practice errors than experienced nurses. It has been reported by the NCSBN that within the first year of employment, 25% of novice nurses leave their nursing positions.[2]
There are several potential strategies for helping new nurses transition into practice. The first step of the transition is being aware of “reality shock” and the phases of the transition process. A thorough orientation process with an experienced preceptor is a traditional strategy for transitioning into a new nursing position. A newer strategy being implemented in some agencies is a nurse residency program.
Orientation may last anywhere from one