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Although the phenomenon of reality shock has been acknowledged as part of the new graduate nurse transition for decades, there is evidence to suggest that the problems with the transition into practice are more serious today. This article presents findings about the new graduate nurse transition and learning needs from qualitative research conducted in a community-based novice nurse transition program. The new graduate nurse transition and learning needs are examined through the eyes of new graduates and the nursing leaders and preceptors who work with them. Recommendations are offered for continuing education initiatives that can be designed to meet these needs.
J Contin Educ Nurs 2009;40(9):403-410.
The practice readiness of new graduates is a topic that generates lively conversation and divergent viewpoints among nurse educators in academic and practice settings. Although the phenomenon of reality shock has been acknowledged as part of the new graduate nurse transition for decades (Kramer, 1974), there is evidence to suggest that the problems with the transition into practice are more serious today. Prior to the initiation of computerized licensure testing in 1994, new graduates entered practice with provisional licenses, working with seasoned nurses for a number of months. New graduates in today's environment can take the licensure examination within weeks of graduation and enter practice as fully licensed registered nurses almost immediately. An unintended consequence of this change has been the rapid deployment of new graduates into clinical settings where they assume professional responsibilities that potentially are beyond their capabilities (Burns & Poster, 2008; Del Bueno, 2005; Li & Kenward, 2006; Spector & Li, 2007). This change has been made even more problematic by the rising acuity of today's hospital patients, reduced lengths of stay, staffing shortages, and complex new technologies. In this era of cost containment, there have been greater demands on nurse leaders in practice settings to shorten new employee orientations and move new staff into patient care assignments more rapidly.
Health care agencies and the American Association of Colleges of Nursing (AACN) now realize the effect of the influx of new graduates, and many efforts are being made to improve the orientation of novice nurses (AACN, 2005; Salt, Cummings, & Profetto-McGrath, 2008; Williams, Goode, Krsek, Bednash, & Lynn, 2007). The National Council of State...