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Reality Shock in Nursing

reality shock in nursing

Reality Shock in Hospital Nursing


reality shock in nursing

Lisa was amped to start her new job. She had prepared for the top ten interview questions and carefully crafted a winning resume learned from reading the popular “Your Last Nursing Class: How to Land Your First Nursing Job…and your next!”

She landed a job straight out of school in a magnet hospital only 20 minutes away from her home. She bought new Gray’s Anatomy scrubs and laminated cheat sheets for her clipboard. She was ready.

What she wasn’t prepared for was the  emotional roller coaster ride. In nursing school she was confident and comfortable. Made decent grades. Rode the wave. Now she was unbalanced and shaky. Out of her element. Alone.

Daily Laura experienced fatigue, self-doubt, fear, vulnerability…..what happened?? Reality shock in nursing is what happened.

Reality Shock in Nursing: Being the Newbie

Starting a new  job places you squarely at the bottom of the food chain. In school you may have been the top student, or class president, or most popular, but none of that counts for much in a busy MedSurg unit or chaotic ED. You have to establish your credibility, and that takes time.

You are joining an existing  group and you will be evaluated by the group to see if you are safe and to see if you fit in.

Initially you are in the honeymoon phase. During the honeymoon phase, you feel positive and open.

Take advantage of this phase and introduce yourself to others, including providers. “Hi, I’m Carlos. I’m a registered nurse, and new to the hospital.” Extend your hand and smile.

Ask questions. Show learnability. Be humble and be helpful. Jump in and help out. Learn people’s names and call them by their name (pro tip: everyone loves to hear their own name).

Reality Shock in Nursing: Losing the Rose-Colored Glasses 

At first everything was rosy. Lisa could  see only the good in everyone and pinched herself at her good luck in landing a job in such a progressive, supportive setting.

But then Lisa began to notice some things that were not so wonderful. 

Constant Interruptions.

Stethoscope in ears, Lisa was bent over and straining to hear breath sounds on one of her patients while doing a head-to-toe assessment.  The  phone in her pocket rang over three times. First the unit secretary: ”They’re coming to take your patient in 4102 to surgery. Is everything ready?”

Then Lab: “The potassium level of your patient room in 4140 is 3.2”.

Then a family member: “Hello, I’m calling to see how my mother did last night. ”


Lisa watched her preceptor manage six patients and wondered how she could ever measure up. No one had ever told her about Nursing’s Dirty Little Secret. Shouldn’t there be nurse:patient ratios?


Later in the staff lounge, two nurses chatted away while ignoring her. As Lisa listened, they ripped into a nurse from night shift.

“He always leaves such a mess! Can you believe he left my patient soiled? Almost makes me believe in bedside report!”

“I know, right?! Bedside report? You mean we have to do it when the manager’s not here, too?” Loud laughter.

Reality Shock in Nursing: Practice Drift

In another unit on night shift, Laura was shocked to see the phlebotomists in the ICU go from patient to patient drawing am labs without changing their gloves.

“What kind of place am I working in ?” She was shocked but reluctant to rock the boat as she was new and unsure. In the end she discussed it with her residency manager who talked to Lab and the phlebotomists started changing their gloves between patients. She didn’t yet know about practice drift, where employees know the right thing to do but grow lax and take shortcuts.

When you encounter problems on the unit, be a part of the change. Many units have unit based councils where issues are addressed. Maintain your standards of practice acquired in training while learning to work in the real world. This is reconciling two sets of values.

Reality Shock in Nursing: Experienced Nurse

Even an experienced nurse changing specialties will go through Reality Shock. In MedSurg, Alexa was quite comfortable and confident. Others looked to her for guidance.

When she transferred to Endoscopy Lab she encountered a tight group of seasoned nurses who had worked together as a team for a long time. Socially, she was the outsider.

She felt conspicuously slow as the other nurses ran circles around her. They all could do everything so fast-prepping  patients, assisting in cases, turning over rooms, anticipating what each doctor wanted..discharging. Alexa felt awkward and all thumbs.

Alexa was experiencing Reality Shock just like a new grad all over again.

Reality Shock in Nursing: Recovery

One day after a long shift Lisa belly laughed at her husband’s silly attempt at humor. He smiled happily and said “I was starting to think you didn’t find me funny anymore.” Lisa realized she was regaining her sense of humor back at the exact same time she realized she had lost it. When was the last time she laughed?

She was learning to reconcile the reality of working as a nurse in the hospital setting with maintaing her ideals. Sometimes she felt like she was connecting the dots. She felt accomplishment and pride.

Benefits of Being Uncomfortable

Being comfortable can make you complacent and dull. If you are growing, you’re uncomfortable. If you are constantly comfortable, you’re not practicing new skills or pushing yourself. Push yourself and grow- it’s rejuvenating and you won’t have regrets. 

Reality Shock in Nursing: Resolution

It’s a Tuesday and Lisa sees the community college nursing students report in at change of shift, all bright-eyed and nervous, well, scared. But optimistic. They look at Lisa like she’s a celebrity on a pedestal. When Lisa answers their questions, some of them take notes. All of a sudden she realizes she’s not one of them.  She’s no longer new. Jessica, another nurse passes her in the hallway. “Hey Lisa don’t forget the potluck on Thursday! But you have to bring your guacamole and salsa, OK?”

At some point you move into recovery and resolution. You feel that you make a difference.  Your sense of humor returns. Things are not perfect, coworkers are not perfect, and you’re not perfect- but you’re able to roll with it and you’re developing resiliency.  You learn to pick your battles. One morning you wake up and realize you slept all night before your shift and didn’t have the heavy dread. You’re in Resolution Phase.

You’ve survived and you’ve arrived! Congratulations.

Best wishes,

Nurse Beth

Author “Your Last Nursing Class: How to Land Your First Nursing Job..and your next!” 

Come visit me at Ask Nurse Beth  career column at for all kinds of  entertaining and informative career questions and answers, and to submit your own question :) 


All concepts of Reality Shock are credited to Marlene Kramer. Marlene Kramer wrote a 1974 book, Reality Shock: Why Nurses Leave Nursing, which examined burnout in the nursing profession. Her book has been widely cited in subsequent studies on retention and satisfaction within nursing.


About Beth Hawkes (146 Articles)
Nice to meet you! I'm a Nursing Professional Development Specialist in acute care, a writer, speaker and career columnist.

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