Nurse Managers and the Four Phases of Work Acclimation

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nurse smiling

For freshly graduated nurses, entering the working world can be a challenge. New nurses face an all-new set of coworkers and a novel environment that operates by its own set of rules and assumptions, all of which nurses must learn and adapt to quickly.

At the same time, they must manage the task of putting a huge volume of theoretical learning into real-life practice. The adjustment period can prove so stressful that up to 30 percent of new nurses leave the profession within their first year of employment, according to a study cited in the Sage Journal article, Faculty’s Role in Assisting New Graduate Nurses’ Adjustment to Practice.

Nurse managers can guide young nurses through this transition by helping them understand and prepare for the issues they may face in their new jobs. Doing so not only makes new nurses more resilient, it also lowers the attrition rate, helps departments run more smoothly, and improves delivery of care to patients.

A good educational background can help nurse managers do the important work of preparing the next generation of nurses. Academic programs such as Duquesne University’s Nurse Education & Faculty Role MSN teach nurse manager candidates the theories and techniques that help new staff acclimate, as well as how to cope with their own new nurse manager challenges. Also offering Post-Master’s Certificate programs to meet the needs of all healthcare providers, Duquesne’s online master’s in nursing prepares students to be effective nurse managers or enter a variety of other MSN careers.

Culture Shock

The first issue for new nurses—and, indeed, for new workers in any profession—is a phenomenon called culture shock. Most often applied to people who travel to or live in foreign countries for extended periods, culture shock can also apply to anyone who needs to adjust to an unfamiliar professional or social environment.

In an article on the website Medium, the organization Participate Learning describes the four stages of culture shock. Although the article discusses world travelers, the stages are equally relevant to new nurses:

  1. Honeymoon stage: At first, everything about the new professional environment seems exciting. The nurses enjoy their jobs and get along well with their coworkers. The work itself is fascinating and nurses enjoy caring for patients.
  2. Frustration stage: After a while, new nurses begin to see their situation differently. Their friendly coworkers now have annoying habits and patients seem demanding. Many nurses start to question their career choice.
  3. Adjustment stage: Finally, the frustration fades and nurses start to feel that they fit in. Coworkers are friends now, not strangers, and the environment is familiar and easy to navigate.
  4. Acceptance stage: The final phase of culture shock is achieved when new nurses are fully acclimated to their environment. Not everything is perfect, but nurses feel that they can handle the reality of their workplace and they prepare to settle in for the long haul.

Reality Shock

While culture shock can affect anyone, anywhere, in any profession, a related term called “reality shock” has been coined specifically to describe the nursing profession.

Described by Marlene Kramer in her 1974 book Reality Shock: Why Nurses Leave Nursing, reality shock has stages nearly identical to culture shock—but the concept recognizes that new nurses face uniquely difficult professional challenges. It incorporates these challenges into four parts:

  1. Honeymoon stage: New nurses feel confident in their academically acquired knowledge. They take a rose-colored view of the nursing profession. They are excited to learn as much as possible.
  2. Shock stage (equivalent to but more pronounced than frustration stage): New nurses start to understand the incredible demands they now face. They have too much work, not enough time, and their knowledge is insufficient. They despair of ever being good enough. They think they might have chosen the wrong profession.
  3. Recovery stage: If new nurses experience enough on-the-job wins, they progress to the recovery stage. They may be still drowning, but they are starting to feel slightly better and more confident. Their job performance improves and they see a glimmer of light at the end of the tunnel.
  4. Resolution stage: In this phase, new nurses have developed some much-needed perspective. They see that there are both positive and negative aspects to nursing, and they decide that the positives outweigh the negatives. Most nurses need about a year to arrive at this point. Once they get here, they become fully functioning, contributing members of the profession.

How Nurse Managers Can Help

New nurses can’t completely avoid culture shock and reality shock, but nurse managers can be a big help in easing the transition. Although there are endless ways to do this, limited only by the nurse manager’s creativity, the website Ausmed explains that four strategies are proven to be especially effective:

  • Preceptor programs and mentoring. In preceptor programs, each new nurse works closely with an experienced colleague. In mentoring relationships, new nurses are assigned to a higher-up person who can answer questions and address concerns. Both types of programs offer effective support.
  • A supportive environment. Many factors go into creating a supportive environment. New nurses should have ample opportunities to practice their skills and see positive outcomes. They should also feel welcomed, valued, and encouraged to ask questions.
  • Nurse managers can help new nurses to create plans for their transition periods. When new nurses are prepared for the challenges and stressors they are likely to face, they are less likely to reach a place of career-ending discouragement.
  • Self-care. Self-care is crucial during a new nurse’s turbulent settling-in period. Nurse managers should emphasize this fact early on and support their staff in developing ongoing self-care efforts.

Along with these major strategies, a good nurse manager can support staff through other behaviors such as open communication, effective organization, emotional support during difficult cases, constructive feedback, and much more. Any or all of these factors can result in a happier staff and a more effective medical team.

About Duquesne University’s Master of Science in Nursing Program

Duquesnes University offers several online master’s nursing programs including: Family Nurse Practitioner, Psychiatric-Mental Health Nurse Practitioner, Adult-Gerontology Nurse Practitioner, Forensic Nursing, Nursing Education, Executive Nurse Leadership to prepare RNs in all stages of their careers.  The university offers both MSN and Post-Master’s Certificate degree programs in all three concentrations and provides one-on-one faculty support to encourage academic success.

The university’s MSN in Nursing Education and Faculty Role prepares graduates for the Certification for Nurse Educators (CNE) exam. For more information, contact Duquesne University today.




Transition from student to nurse and role of nurse managers – Ausmed

Nurses leaving profession within first year – Sage Journals

Culture shock – Medium

Reality shock – Sage Journals

How nurse managers can help – Ausmed