Revisiting Reality Shock – What’s Changed for New Nurses?

julie kertesz/ via flickr creative common

julie kertesz/ via flickr creative common

By Maureen Shawn Kennedy, AJN editor-in-chief

Last month, we highlighted on Facebook a blog post I had written in 2010, “New Nurses Face Reality Shock in Hospital Settings – So What Else is New?” (It seemed timely in terms of all the June graduations.)

I wrote that original post in response to a study that had just been published in Nursing Outlook (here’s the abstract) describing the experiences of new nurses. Generally, these newbies felt harried, unprepared, overworked, and unsupported—all similar concerns voiced by nurses in Marlene Kramer’s 1974 book, Reality Shock: Why Nurses Leave Nursing. (Here’s AJN’s 1975 review of the book. It will be free for a month; note that you have to click the PDF link at the article landing page to read it.)

My post back in 2009 noted how nothing much seemed to have changed since the publication of Kramer’s book. Now, once again, this post has generated many comments, a number of them on our Facebook page as well as on the original blog post.

Here are a few. I’ll start with Facebook:

I’m almost a 20yr RN and have experienced

[this] in a new job. I’ve developed skills to deal with this over the course of my career, so it doesn’t impact me like it did as a new nurse…but to new nurses out there: just know that bullies have some personality disorder that extend[s] beyond the workplace (even if you never get to see it). Learn, be happy, and go on your way. It’s them, not you.

It’s up to nursing leaders at all levels to set the expectations and role model professional behavior.

The real problem is that we will no longer want to work as nurses . . . it has become so difficult for so many reasons. So at the end of a long shift you wonder, “Is it worth it? Is it?”

And some comments from the blog:

Nurses represent the largest group in the medical profession. Just think about the things we could change (for the better), if WE ALL stood together!?

I left my first nursing job at the 8-month mark due to bullying and lack of support. The stress was so severe I would dry heave in my car before my shift. After [I’d voiced] my concerns about job stress, many of my co-workers stated this was the norm . . . either ride it out or take anti-depressants (many of the nurses I worked with did).

I had great clinical and no unrealistic expectations leaving my BSN program in 1981 . . . by senior year, no one should be unaware of the work load and clinical experiences should be adjusted to help with this expectation. We worked 32 hours a week side by side with a nurse our last semester . . . with gradually increasing responsibility. The transition to work was no shock. If you don’t want to work hard, miss some meals, work weekends and holidays . . . then do not pick nursing as your career. Its damn hard work but incredibly rewarding and often quite fun.

It is the responsibility of experienced nurses to prepare the nurses of the future. We should all remember that we were new grads at one point and welcome the opportunity to build excellence in the profession.

So what do you think? There’s been a lot of research and recent attention given to bullying and health work environments—is it making a difference? What do you see where you work?

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Editor-in-chief, AJN


  1. Pam May 22, 2016 at 8:36 am

    So what is the answer? As a CNO who is trying everything to retain nurses, I am well aware of the issues described here. But what is the solution? I myself believe a huge piece of this is the 12hour shift. The pace, the acuity and shortage of staff make a 12 hour shift almost unsustainable. Who does we eliminate that as a method to retain staff?

  2. Bonnie Schuyler August 15, 2014 at 1:14 pm

    At the risk of sounding like one of the “bully” nurses (and I truly think I am known as a caring, patient preceptor in real life), while there are definitely problems and I especially agree with Gina who says we lack the staffing to truly support new grads, I do sometimes feel like some new grads don’t take responsibility for their own learning experiences. The people who don’t thrive are not the ones I see asking for feedback, making concrete learning plans, listening and asking questions (after making a sincere effort to think it through on their own). They seem more interested in being spoonfed an orientation, or perhaps showing off what they know (their egos are not used to being new and not knowing what to do–they’ve been at the top of their classes for years in an effort to get into and then get through nursing school!). I know this doesn’t apply 100%, but it is something I feel like I have observed.

    Management is also not always that kind and thoughtful in dealing with new grads. They often seem to talk about nurturing, etc, and will tell a new hire “If you need extra time we’ll give it to you, we want you to succeed,” but do they follow through with that? What I’ve found is much more of a “if you’re not cutting it…” attitude. And then new nurses who have been successful in orientation are treated like they ought to have the knowledge and speed of nurses a year or two out. That’s when THEIR stress level starts to build.

  3. Angie August 1, 2014 at 6:43 pm

    Thank you so much for sharing your experiences. I find them very helpful and inspiring. The healthcare Industry is a great place to work , but it can be ruthless. Survival of the fitiest and you always have to watch your back. Youth has strenght and beauty , therefore we have to, as we get older collect as much education and credentials as we can to survive.

  4. Cindy Taylor August 1, 2014 at 1:57 pm

    I have been an RN for 39 years, have never been without at least one job, usually a full-time plus a part-time job. This past May I was laid off from my job in a hospital ER, with several very poor excuses, and the comment that I was “not able to keep up” and coworkers were frustrated with me. (I had experienced some bullying but did not expect to be terminated!) Also, I did not want to work 12 hr. shifts, although I was working them every third weekend, like everyone else. There was no warning of this lay-off, and I was the only one. Now, on unemployment, I cannot find a job even in a store. At age 60, I am finding out that many people in various careers are being laid off. There must be a reason, but I haven’t found it yet. We are not eligible for social security yet, and retirement is not advisable. What do we do? The Midwest has no nursing shortage–I believe the 2 year ADNs are getting the jobs, as well as CNAs and other less educated workers. Going back to school is no guarantee of getting a job, as is relocating. I never expected to see this kind of change and sadness.

  5. angie vogel July 29, 2014 at 6:19 pm

    I feel for Rudy, sadly, her situation is a becoming a very common. Hospitals are finding ways to cut costs by using call backs and travel nurses instead of hiring new grads. Also, I have noticed a trend that, like most professions in earth, aesthetics, gender and fitness level play a pivotal role in the hiring process. I am not saying that is the only decisive factor, but if the recruiter has two candidates with similar credentials, most likely the strongest, more fit candidate will be successful.

  6. Moira Speed July 29, 2014 at 3:56 am

    I think bullying is still there, but the nature of that bullying has changed a little. We still have traditional bullies, who, for their own reasons, go on a power trip with others. This can happen be they new RNs , or just an individual with whom the bully can see a crack. Also, I think now, we are attracting into the profession, people with a different set of pesonality traits, several o which may not necessarily be compatible with the traditional view of nurses’ traits. They are competitive and ready to stand on colleagues in order to achieve their own ends. It is a bit more akin to a business model rather than a caring one. I think we also have third category, one which was alluded to in a previous comment–that some nurses are simply ill-prepared for the workload, and are not prepared to do what is necessary. This creates a situation with the rest of the team whereby that individual almost needs to be forced into working, i.e., they are almost bullied into doing what is necessary just to fulfill their requirements of the job. When they are told about a falling short, they then regard this criticism by peers or line managers as bullying.

  7. Rachel July 28, 2014 at 5:29 pm

    I am a new nurse about to be off of orientation in 2 weeks. There is definite brushing off of concerns and worries with “thats what its like for everyone” “it takes a year to adjust” and “youll be fine”. I have cried myself to sleep many a night because ive left work not feeling like i learned anything and feeling chewed up and spit out. Add that with eyerolls and snide side glances from nurses who themselves are only a year out and it is an intimidating, scary environment as a new nurse just trying to make it through some days. The work load is not hard, or shocking, it is the nonchalantness of how people treat you and your worry that is what is a struggle. And the phone haha 🙂

  8. Gina Humphries July 28, 2014 at 4:42 pm

    What I see is a constant lack of adequate staffing to sufficiently support our new nurses and often they get thrown in the fire way too soon. When staffing is so short and acuity high, it’s often difficult to really be present.

  9. Melissa Rudy July 28, 2014 at 4:33 pm

    That’s my quote! “Nurses represent the largest group in the medical profession. Just think about the things we could change (for the better), if WE ALL stood together!?”

    FINALLY, this situation is getting noticed.

    I have been discussing this exact problem since the economy tanked in 2008! My letter to Health Affairs was quoted and can be seen at

    It read as follows….:

    I have experienced some new caveats to our current situation that I believe may be of interest. I graduated May 2008 with my BSN in Northern California and did everything by the book (hundreds of apps, spoke with managers, thank you notes, ACLS, BLS, professional resume, LTC, SNF, etc.) and was unable to locate employment. When an offer was made, my children and I relocated to a rural town four hours away. Sadly, after four months of orientation, I was told I “failed orientation” and they needed an experienced RN. My children and I moved again. Recently I applied to a Versant New Grad Residency. I made it through their first round of interviews but was told that I was no longer a “New Grad” due to my previous four months of experience!

    So, not only am I not experienced enough to work as a staff nurse, but I am no longer considered a New Grad! So, where do I fit in? I feel that if I cannot get into a New Grad program I will have the same unstructured learning demands and unrealistic expectations placed on me similar to my first failed hospital experience. It also appears that the longer it takes for me to find employment, the more reservations the employers have towards me.

    I have researched my situation. It appears my peers from nursing school are experiencing similar situations…all over the U.S.

    Melissa Rudy, RN, BSN, PHN [editor’s note: this comment has been very slightly shortened for readability and to avoid repetition]

  10. Barbara Finkenbine July 28, 2014 at 2:45 pm

    In the 30 years since I graduated, nursing has changed a lot. We worked a lot more hours of overtime to get al the paperwork done. The staff now has to deal with a higher acuity level of patient population so their workload is higher. We were able to take the charts and go sit is the charting room or at the nurses station but most hospitals now have commuter drop downs on the hall or computer stations on wheels, therefore they are standing constantly. This is much more tiring and is not physically good for the body.

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