Significant Challenges in the Contemporary Workplace

A nurse knows that her peer is using substances and tries to convince the peer to voluntarily report the abuse to the state board of nursing. However, the peer is too scared. What does the nurse say to the peer to convince the peer that voluntary reporting is the best scenario?

"If they catch you before you turn yourself in, you could lose your nursing license." State boards of nursing are more inclined to instill harsher penalties for nurses who do not self-report, including instituting fines or revoking licensure.

A nurse is working with a new nurse in a hospital. The nurse notices that the new nurse has been volunteering to be assigned to more patients and has been volunteering for extra shifts as well. After a month, the new nurse appears tired and moody. Which statement made by the nurse can help the new nurse cope with reality shock?

"You should take care of yourself and make sure you are getting plenty of sleep." Self-care, such as getting enough sleep, is important for reducing the feelings of reality shock.

What is reality shock?

A feeling of powerlessness that leads to an inability to cope with the demands of the profession. Reality shock occurs when new graduates experience powerlessness as they enter the workforce. Reality shock puts psychological stress on new nurses, reducing their ability to cope effectively with the demands of their new role.

Which scenario demonstrates horizontal violence?

A new nurse is being bullied by her coworkers because of the nurse's religious beliefs. Horizontal violence is incivility that occurs between peers in the workplace.

Place the scenarios in order from lowest risk to highest risk of the incivility continuum.

A nurse rolls his eyes at his coworker. A nurse makes sarcastic jokes about a peer's clothes. A nurse calls the new nurse a "goody two shoes." A nurse insults a colleague's religion. A nurse jumps on top of her colleague in the heat of an argument and chokes her.

Which scenario represents the beginning stages of incivility along the continuum?

A nurse uses her cell phone for texting while at the nurses' station. During the beginning stage of the continuum of incivility, common behaviors are distracting and may annoy or irritate others, such as talking on the cell phone loudly or texting while at the nurses' station.

What can a nurse expect to do while participating in a rehabilitative program through the state board of nursing due to opiate addiction?

Attend rehabilitation meetings. Nurses with past substance abuse problems and who participate in the rehabilitative programs may need to attend rehabilitation meetings to show commitment to the program and to recovering from the substance abuse. Participate in workplace evaluations. Nurses with past substance abuse problems and who participate in the rehabilitative programs may need to participate in workplace evaluations so that they can be monitored for their progress as they reenter the work setting. Comply with blood and urine testing. Nurses with past substance abuse problems and who participate in the rehabilitative programs may need to have their blood and/or urine tested to check for use of substances. Be restricted from administering controlled substances. A nurse in a rehabilitative program can expect to be restricted from administering and handling controlled substances.

Why is self-care an important factor for coping with reality shock?

Getting plenty of rest gives nurses the energy to care for patients. Sleeping regularly is a way to cope with reality shock, because it gives energy to the nurses to care for others Being mentally and physically strong helps nurses face the demands of the nursing profession. Being mentally and physically strong prepares the nurse to face the demands of the profession, so it is a way of coping with reality shock. Having a healthy social life with friends and family gives nurses an outlet to unwind and have fun. Spending time with friends and family outside of work is a way to cope with reality shock, because it lets the nurse have an outlet to have fun, which keeps spirits high and adds positivity to the nurse's life. Maintaining good nutrition helps nurses stay healthy and nourished to meet the demands of long shifts. Eating nutritious meals on a regular basis can keep nurses going strong throughout their shifts and stay healthy overall.

Which nurses are at risk for substance abuse?

Patrick has worked for two weeks straight without a day off. When nurses are overworked (often caused by nursing shortages) and have long and tiring shifts with early or late hours, they may be inclined to take substances to stay awake and alert. Gabriela works in the trauma center, which she does not like. Working in high stress environments like trauma centers puts nurses at risk of wanting to abuse substances to find relief or a sense of calm. Kari has a terribly sore back and is caring for a patient who is prescribed pain killers. Having easy access to patient medication can be tempting for nurses who want to abuse substances. Diversion is the act of taking patient medication for personal use and is common among health care workers.

The nurses who work on unit 3D at the hospital are all friends on a social media site. One day, one of the nurses posts a bullying comment about a new nurse who joined their team. What is the appropriate action by the other nurses?

Point out the bullying behavior and standing up for the new nurse. Nurses are encouraged to intervene when they witness incivility. Therefore, the nurses should call out the nurse who is at fault and stand up for the new nurse to send a message that this behavior is not tolerated.

The nurse observes a coworker who arrives late to her shift. As she explains why she is late, the nurse observes that the coworker's speech is slightly slurred and her eyes appear droopy. How should the nurse proceed in this situation?

Report what you have observed. Reporting what was observed is the appropriate action to take in this scenario, since this is possible substance abuse as evidenced by the signs of tardiness and slurred speech.

What is an appropriate scenario for making it known that incivility is not tolerated at a health care organization?

Requiring the wrongdoer to collaborate with the nurse manager to develop goals and a performance improvement plan. Collaboration encourages self-responsibility and ownership of the plan.

In what way is the Health care industry as a whole impacted by reality shock?

Resources such as time and money are spent on hiring and training nurses to replace those who leave. Lack of retention of nurses plagues the health care industry.

Samantha and Elise are both nurses who work on the pediatric unit of a hospital, and they have become friends outside of work as well. Samantha knows that Elise has been struggling with depression after separating from her spouse, but she recently found out that Elise drinks an entire bottle of wine each night to cope with the depression, which is unusual for Elise. During one of their shifts, Elise shows up to work wearing the same clothes she had on the day before and smells of alcohol. What action should Samantha take in this scenario?

Talk to Elise privately and convince her to self-report the substance abuse to the manager. Convincing Elise to self-report the substance abuse is the best option in this scenario. This keeps patients safe, and self-reporting is more respected than getting caught abusing substances.

How do shadowing programs help reduce reality shock?

They give students a chance to work closely with preceptors. Shadowing programs give students a chance to work closely with preceptors to gain clinical experience to get a sense for what the work environment is like. A preceptor is a practicing nurse.