New Nurses Face Reality Shock in Hospital Settings – So What Else is New?July 27, 2009
A new report in Nursing Outlook (here’s the abstract) analyzes the experiences of new nurses. The news is not good. Actually, it’s really pretty awful when you think that much of what theses nurses complain about was documented in a book published in 1974 by nurse and researcher Marlene Kramer, Reality Shock: Why Nurses Leave Nursing.
The current report analyzes the nurses’ answers to an open-ended question that was part of a larger study of newly licensed registered nurses who’ve been employed less than 18 months. Researchers identified five themes among the 612 comments:
• Colliding expectations – The nurses expected the workplace to be more in keeping with what they were taught in nursing school; “high patient-to-nurse ratios were a particularly dominant source of stress.”
• The need for speed – The nurses felt there should have been more time for them to transition to carrying full responsibilities for patient care.
• You want too much – There were many complaints about the heavy workload, with little time to do it and little time to spend with patients.
• How dare you? – The nurses felt they were mistreated by nurse and physician colleagues and management.
• Change is on the horizon – Despite the many complaints about the workplace and the workload, the nurses described a hopefulness that things would improve.
The authors note that these are long-standing issues and that it makes one wonder “how seriously leaders have considered the concern of nurses at the bedside.”
While most of these nurses (75%) worked in non-Magnet facilities, that leaves 25% who were employed at Magnet facilities, showing that achieving Magnet certification does not guarantee a workplace free of angst (and that’s an unreal expectation, anyway).
One thing that’s changed. I was a new graduate when Kramer’s book came out and could identify with much of it. My initial job was in a city-run hospital where resources were limited (one of the first things you learned was to find out where your colleagues hid their secret stashes of linens) and the workload was tough (in working as an LPN in my senior year, I was the only nurse with two aides on a 24-bed medical/surgical ward – yes, ward).
So yes, the workload was tough and yes, we dealt with unappreciative physicians and department heads, and yes, I wished I had more time to “learn the ropes.” As new nurses, we had one week of orientation and then we were assigned to the units where we would work.
The difference I see between my early experience as a new nurse and what seems to be the experience of many new nurses today is the support I and other new nurses received from more senior colleagues. Perhaps that is what made the workplace problems bearable.
The nurses on the unit where I was to work (Bellevue Hospital’s emergency ward) took pride in the reputation of the unit and wanted newcomers to continue what they had built. They were invested in our success. I spent the first few days working with an experienced nurse who watched and coached me in performing interventions I didn’t feel comfortable with or had never performed. She cheered my success and always ended our experience by saying, “See? You can do it.” The head nurse would frequently check in with me, asking “How’s it going?” and then really listening to my responses. The support of colleagues outweighed the problems—we were all in it together. My classmates at neighboring facilities echoed the same sense of becoming part of a team all working together; it was how we were socialized into the profession.
It seems that this is a far cry from what most new nurses experience—there are too many reports of bullying behavior to dismiss it. So how is it that this sense of nurturing the next generation seems to have disappeared from so many workplaces? What are we going to do about it? What is it like at your workplace?