Chapter 1: Role Transitions
A nursing student is nearing the end of his/her clinical experience. The student would like to care for patients who are typically challenging for students in the first year of practice. Which patient would be the best choice for this student? a. A 62-year-old man with diabetes who needs outpatient care set up b. A 30-year old woman with a kidney stone requiring IV pain medications c. A 45-year old man with chest tubes recovering from a car accident d. A 25-year old woman who received blood yesterday
ANS: C The skills that nursing students have identified as the most challenging include code blues, chest tubes, intravenous skills, central lines, blood administration, and patient-controlled analgesia. The most appropriate patient for the student to increase his/her skill level would be the 45-year old man with chest tubes. The other patients are not considered to be a "challenging patients" for most nursing students.
A graduate nurse has been out of school for 3 months and working in a staff nurse position for the past 2 months. What type of transition is the nurse experiencing? a. A developmental transition b. An organizational transition c. A health-oriented transition d. A situational transition
ANS: D A situational transition is a lifestyle change that occurs because of a new situation. Most often the changes are by choice—for instance, graduations, marriages, and new jobs. Developmental transitions include becoming a parent or going through a midlife crises. An organizational transition involves a change in leadership. A health-oriented transition involves dealing with an illness or health issue, such as coping with a chronic illness.
Which of the following statements by the graduate nurse shows an understanding of reality shock as it applies to nursing? a. " Reality shock is the period when a person moves from school into the workforce. b. "Reality shock is the realization that practice and education are not the same." c. "Reality shock is the period from graduation to becoming an experienced nurse." d. "Reality shock is a transition phase that new graduates go through before changing jobs."
ANS: A "Reality shock" is a term often used to describe the reaction experienced when one moves into the workforce after several years of educational preparation. The new graduate is caught in the situation of moving from a familiar, comfortable educational environment into a new role in the workforce where the expectations are not clearly defined or may not even be realistic. The realization that practice and nursing school are not the same is often associated with "going native." When nurses move from one position to another, they have already experienced reality shock. Becoming an experienced nurse takes time and is not part of the definition of reality shock.
A student in the last semester of nursing school has established a goal of making a successful role transition to graduate nurse. Which statement by the student indicates his/her understanding of how to achieve this goal? a. "I should care for increased numbers of patients to enhance work organization skills." b. "I will observe staff nurses as they perform nursing procedures to refine technique." c. "I should seek increasingly close guidance from the nursing instructor to reduce errors." d. "I will evaluate my progress every 7 weeks or more to allow time for growth."
ANS: A It is important for the student to start taking care of increased numbers of patients to help with time management and work organization. The student should also be able to function without close guidance from the nursing instructor. Although it is good for students to observe staff, a student in the final semester should be able to perform tasks with minimal observation and should instead focus on implementing care and time management. Waiting 7 weeks to evaluate progress would not be helpful to the student. Although regular self-evaluation is an important process, it is the actual experience of taking realistic patient assignments and working typical shift hours that assists with successful role transition
A nurse is trying to avoid burnout. Which of the following actions is a valid way to achieve this? a. Refusing to constantly work extra shifts b. Withdrawing from peer support group c. "Going native" d. Changing jobs every 6 to 12 months
ANS: A One of the quickest ways to experience burnout is to "overwork the overtime." Set priorities with your mental and physical health being the highest priority. Learning to say "no" to extra shifts is a positive means of coping of avoiding burnout. "Going native" is the term that describes how recent graduates begin to copy and identify the reality of their role transition experience by rejecting the values from nursing school and functioning more like a team member at their place of employment. Withdrawing from peer support groups, "going native," and changing jobs every 6 to 12 months would increase the chance of the nurse experiencing burnout. The nurse should instead focus on his/her practice and seek out support from other nurses.
A student nurse is in the last semester of nursing school. Which action by the nursing student indicates appropriate preparation for the transition experience? a. The nursing student requests additional experiences in performing skills and procedures. b. The nursing student maintains close contact with a nursing instructor to observe nursing procedures. c. The nursing student practices nursing assessments and care on one or two patients to become more competent. d. The nursing student increases communication with a nursing instructor to maintain a resource person after graduation.
ANS: A Students should get all the experience, not just observation, you can before graduation. Ask to perform procedures and skills and request feedback from staff nurses and instructors. Students should also begin to build resources that will be available after graduation. It is during the last semester that students begin to care for more complex patients (and more patient numbers) to gain experience in the "real world" of nursing management, as well as less begin to have less reliance on the nursing instructor as a resource person.
A student nurse is interested in improving his/her nursing skills. What action would be the best for the student nurse to take? a. Ask his/her instructor for extra skills practice during clinical hours. b. Watch videos on how to perform the nursing skills that he/she needs to practice. c. Review his/her nursing textbooks. d. Observe nurses perform skills in his/her clinical setting.
ANS: A The best way for the nursing student to improve skills is to get hands-on practice. The student would benefit most from requesting extra skills practice during clinical hours, where skills can be performed on real patients, with the guidance of a clinical instructor. Therefore, watching skills videos, reviewing nursing textbooks, and observing other nurses would not help the student obtain hands-on practice.
The graduate nurse understands that transitions occur throughout life. What major factor does the nurse identify as influential in a successful transition from school to practice? a. Level of new knowledge and skills required in the new environment b. Amount of classwork required to obtain a degree c. Personal history of previous developmental transitions d. Influence of classmates and their transitional experiences
ANS: A The transition from student to practice reflects a situational transition that is most often affected by the anticipation of changes in the new work environment. Classwork no longer affects this transition. A personal history of previous developmental transitions and the influence of classmates are not as prominent as the anticipated requirements to function in the new environment of work.
A student in the last semester of nursing school wants to be sure of adequate preparation for the transition experience. Which patient should be added on to the clinical assignment to assist in this process? a. A 48-year-old man with heart failure who has oral and IV medications due and needs a new IV started b. A 38-year-old woman who cares for herself independently and is going home later today c. A 25-year-old man who is leaving the hospital against medical advice d. A 40-year-old man who needs education on diabetes management
ANS: A To adequately prepare for role transition, the student nurse needs realistic assignments and real-life experiences. It would be most appropriate for the student to accept the "busy" patient, who requires oral and IV medications and needs to have his IV restarted. The patient who can care for themselves independently and the one who is leaving the hospital against medical advice would not provide as much skill experience. Diabetic teaching is important but does not require the time management and work organization skills of a "busy" patient.
Which action would greatly help the graduate nurse when seeking out employment? (Select all that apply.) a. Plan out interviews. b. Ask to speak to nurses who work on the unit. c. Wait until the interview to gather all of the information. d. Find out what type of nursing care is delivered. e. Determine the length of orientation.
ANS: A, B, D, E It is important for the graduate nurse to be prepared when seeking out employment. Planning out interviews, speaking to nurses who work on the units, finding out what type of nursing care is provided, and determining the length of orientation are all actions the graduate nurse can take to prepare for employment. Waiting to gather information at the interview can leave the graduate nurse feeling frazzled and disorganized.
A new nurse wants to make personal lifestyle changes to become a healthier individual. Which actions would help with reaching this goal? (Select all that apply.) a. Begin an exercise routine. b. Eat snacks late at night. c. Incorporate relaxation into his/her schedule. d. Begin eating nutritious meals and snacks.
ANS: A, C, D To maintain health and wellness, the new nurse should begin an exercise routine, incorporate relaxation into his/her schedule, and begin eating nutritious meals and snacks. The nurse should consider cutting out snacks late at night.
Which action by the graduate nurse shows that a successful transition to nursing has been made? a. The nurse begins to work with the nursing team and functions as others expect. b. The nurse begins to objectively evaluate work experiences and enjoy the humor of clinical situations. c. The nurse believes everything is great, patients are wonderful, and the new unit is so nice. d. The nurse meets regularly with other new graduates to compare and discuss problems.
ANS: B Objectivity and humor are two of the characteristics of a successful transition. "Going native" occurs when the graduate begins to provide care in the manner that the team or group wants it done, not necessarily the correct way. The "honeymoon phase" is when everything is going great. Meeting with other new graduates can be productive, but it is a part of the transition, not an indication of successful transition.
Which statement by the nursing student indicates an understanding of the importance of constructive feedback? a. "I will wait until my clinical evaluation and then make any changes to my practice that are needed." b. "I will request routine feedback from my instructor so I can make any changes needed to improve my skills." c. "My instructor will let me know if I need to change anything." d. "I will ask my colleagues if I needed to make any changes to my practice."
ANS: B Students are responsible for their skills and growth as health care providers. To ensure that their nursing skills are adequate, students should request periodic feedback from their clinical instructors. Waiting for feedback or asking colleagues would be not an effective way for nursing students to obtain feedback in a timely manner.
A new graduate has worked on a busy unit for 6 months since graduating from nursing school. The graduate tells a friend, "I've never been so upset in all my life! The care that some of the staff give our patients is outrageously bad. There's practically no attention to the principles of asepsis the way I learned them! The staff tells me that we have to cut corners if we're going to get all the work done. I can't stand it!" What phase of reality shock is this graduate experiencing? a. Honeymoon b. Shock and rejection c. Recovery d. Role transformation
ANS: B The honeymoon phase for the new graduate nurse is short lived when the graduate identifies the conflicts between the way she or he was taught and the reality of what is done. Shock and rejection cause mental and emotional withdrawal, moral outrage, and a hypercritical attitude, which are just some of the symptoms of the realization that the honeymoon is over. Excessive mistrust, frequent pains and illness, a decrease in energy and fatigue, feeling like a failure and blaming oneself for every mistake, a hypercritical attitude, and feeling morally outraged are characteristics of the shock and rejection phase. The recovery phase is characterized by a beginning sense of humor (usually the first sigh), a decrease in tension, and an increase in the ability to cope with the situations that he/she is faced with. Role transformation is the process of transforming from student to nurse.
A nurse manager is giving a presentation at a local community college. The nurse manager understands the job expectations of a new graduate when making which of the following statements? a. "A graduate nurse should be able to perform as independently as was demonstrated the last semester of nursing." b. "A graduate nurse should be able to function competently as a registered nurse at the entry level." c. "A graduate nurse should be able to function in the role that was described in the curriculum for the school of nursing." d. "A graduate nurse should be able to be able to function independently with ability to make clinical nursing judgments."
ANS: B The job expectations of a new graduate nurse are those of an entry-level new employee. This frequently includes an extended orientation to assist the new graduate to transition into the independent role of the nurse. The new graduate nurse is not expected to function independently with the ability to make clinical nursing judgments. School curriculum and how one functioned the last semester of school are usually not considered in the job expectations of a new graduate.
A nurse manager is preparing a group of newly hired nurses to work on the unit. After educating them on reality shock, a student raises their hand and asks what physical and psychological symptoms the nurse may experience? The nurse manager replies: (Select all that apply.) a. "It is not possible to experience any physical or psychological symptoms from reality shock." b. "You may experience headaches." c. "It is possible that you will experience gastrointestinal upset." d. "You could experience insomnia." e. "Women may experience menorrhagia."
ANS: B, C, D Reality shock can cause physical and psychological symptoms that are important for the nurse to be aware of. These can include headache, insomnia, feeling stressed out, gastrointestinal upset, and post-student blues. Menorrhagia (excessive menstrual bleeding) is not a typical physical symptom of reality shock but is caused by uterine fibroids, endometriosis, or uterine polyps. Amenorrhea (absent menstrual flow) may be experienced because of stress associated with reality shock.
The nurse has an adequate understanding of transitions when making which statement about situational transitions? a. "This type of transition can occur with leadership change." b. "This type of transition occurs only when one is dealing with a chronic illness." c. "This type of transition can occur when one has a career change." d. "This type of transition occurs during a midlife crises."
ANS: C A situational transition occurs from change to from one situation to another, such as a career change. Dealing with a chronic illness would be characteristic of a health-illness transition, a leadership change would be an organizational transition, and a midlife crises would be a developmental transition.
A new nurse is caring for five patients on a busy surgical floor. While hanging blood for a patient, the nurse receives notice that another assigned patient is being taken for surgery. The nurse has not obtained informed consent from the patient. What action should the new nurse take? a. Immediately leave the room he/she is in and obtain informed consent from the patient. b. Allow the patient to go to surgery without obtaining informed consent. c. Delegate obtaining informed consent to another nurse while staying with the patient who is receiving blood. d. Ask the transporter to obtain informed consent from the patient.
ANS: C Although the nurse must stay with the patient while hanging blood, it is important that informed consent is obtained from the other patient before going to surgery. The best action for the nurse to take would be to compromise and delegate obtaining informed consent to another nurse. The other actions would be inappropriate and possibly dangerous to the patients involved.
A new graduate of less than 1 year describes his/her perception of a staff nurse position, stating: "It feels great to be a nurse! In fact, it's a snap! I can hardly believe there's no instructor looking over my shoulder." What phase of reality shock is the graduate experiencing? a. Recovery b. Shock and rejection c. Honeymoon d. Transition
ANS: C In the first phase of the role transition process (the honeymoon phase), the graduate nurse is thrilled with completing school and accepting the first job. Life is a bed of roses because everyone knows nursing school is much harder than nursing practice. Shock and rejection occur as the nurse tries to understand how nursing school and the "real world" come together. Transition occurs as the nurse begins the move from student to nurse and refers to the entire process, not just a particular phase. The recovery phase is when the nurse can laugh at situations that he/she is in and is able to cope with the situations that are being faced.
The new graduate has an understanding of the nursing journey ahead when stating: a. "It is not acceptable for me to make any mistakes at all." b. "I am not worried about issues with transition. I am tough. I will do just fine!" c. "I know that I will make some mistakes, but I will learn and grow from them." d. "I am going to keep studying so that I am always right."
ANS: C It is important for the graduate nurses to know that they will make mistakes in their nursing careers but that it is important that they learn and grow from them. It is not realistic for graduate nurses to believe that they will not make any mistakes or will not struggle with transition.
A nurse has worked the past 5 days in a row to make some extra money. Today is a scheduled day off. Which of the following actions would be the best for this nurse to take? a. Call the unit to see if they need the nurse to work. b. Read nursing articles and take practice quizzes to stay up to date. c. Take his/her small children to the zoo. d. Work on a continuing education requirement.
ANS: C It is important that the nurse take time to relax and have fun. Taking his/her small children to the zoo is a non-work-related activity that would ease stress and be enjoyable.
A graduate nurse has been reviewing the NCSBN's Transition to Practice model. The graduate nurse understands the intention of the model when making which of the following statements? a. "The intention of the model is to mandate that all state boards of nursing provide a regulatory model for transition to practice." b. "The intention of the model is to provide educational modules so that the new graduate does not need to work with a preceptor." c. "The intention of the model is to have the new graduate take and pass the NCLEX® Exam, obtain employment, and then enter a transition program." d. "The intention of the model is to complete the formalized transition program within 6 weeks."
ANS: C The NCSBN's Transition to Practice model is a regulatory model that is designed to promote public safety by supporting the role transition experience of newly licensed nurses. The new graduate would first take and pass the NCLEX® Exam, obtain employment, and then enter the transition program. There are 5 transition modules with content focused on communication and teamwork, patient-centered care, evidence-based practice, quality improvement, and informatics. The time period for completion of the program is 6 months with an expected additional 6 months of ongoing support. Because of individual state's rights, the NCSBN encourages states to adopt this model; however, they does not have the authority to mandate adoption of the model. This model does not act in replacement of a preceptor in the clinical practice area.
A graduate nurse has clocked in for his/her second shift on a busy orthopedic unit. After accepting the assignment, the graduate nurse notices a fellow nurse complaining loudly at the nurse's station to other staff members. This fellow nurse is typically upset with floor assignments and thinks that the "new nurses get all the easy assignments." Which action would be best for the graduate nurse to take? a. Join the conversation and tell the fellow nurse that he/she does not care for the assignment either. b. Begin a conversation with another staff member about the fellow nurse who is complaining. c. Steer clear of the nurse who is complaining and try to focus on the positive. d. Begin complaining about his/her own assignment.
ANS: C The graduate nurse would have the most success by steering clear of the complaining nurse and focus on the positive. Joining the conversation and focusing on the negative will not help the graduate nurse adjust to his/her new job.
Which of the following actions by the graduate nurse is an inappropriate methodology to recover from reality shock? a. Networking b. Obtaining a mentor c. Returning to school d. Joining a support group
ANS: C The transition period is successfully managed when the graduate is able to evaluate the work situation objectively and predict effectively the actions and reactions of other staff. Nurturing the ability to see humor in a situation may be a first step. Returning to school is a positive step after the graduate has worked through role transition, has some clinical experience, and is ready to focus on a new career objective. Networking, obtaining a mentor, and joining a support group would give the graduate nurse an opportunity to talk to others experiencing the stress associated with reality shock. The nurse would benefit from 'talking through' issues and learning how to cope.
A graduate nurse has been hired as a nurse at a local hospital. The new nurse is in the honeymoon phase of role transition when making which of the following statements? a. "I am so nervous about being on my own as a nurse." b. "This will be a great learning experience." c. "I can't wait to have a steady paycheck." d. "This job is perfect. I can finally do things my own way."
ANS: D The honeymoon phase is when the student nurse sees the world of nursing as quite rosy. Often, the new graduate is fascinated with the thrill of arriving in the profession. Reality shock occurs when one moves into the workforce after several years of educational preparation. Recovery and resolution occur when the graduate nurse is able to laugh at encountered situations. During this time, tension decreases, perception increases, and the nurse is able to grow as a person.