Chapter 25

What is the difference between a novice nurse and an expert nurse?

A novice nurse has no experience, follows rules strictly, and needs support. An expert nurse acts with intuition, responds fluidly, and draws from deep understanding in complex situations.

What is transition shock and who coined the term?

Transition shock is the emotional, physical, and mental stress new nurses feel when entering real-world practice. It was coined by Duchscher in 2009.

What is reality shock and how is it different from transition shock?

Reality shock, introduced by Kramer, is when new nurses realize the gap between school and practice. Transition shock (Duchscher) expands on this, describing the multiple dimensions of this stress in today’s healthcare environment.

What are the 4 phases of reality shock (Kramer)?

Honeymoon → Shock (Rejection) → Recovery → Resolution.

What happens during the Honeymoon Phase?

New nurses feel excited and optimistic. Everything seems ideal, and they look forward to getting paid to do what they trained for.

What happens during the Shock (Rejection) Phase?

The nurse feels overwhelmed, unsure, and lost without instructors. They face conflicting values and often ask, "Am I cut out for this?"

What are the different reactions nurses may have to reality shock?

• Natives

• Runaways

• Rutters

• Burned Out

• Loners

• New Nurse on the Block

• Change Agents

What is a Native nurse?

A nurse who “goes along” with the culture—even if it means taking shortcuts or unsafe practices—to avoid conflict.

What is a Runaway nurse?

A nurse who leaves the profession or changes roles because the real-world job is too overwhelming.

What is a Rutter nurse?

A nurse who treats nursing like “just a job” and puts in minimal effort while waiting for something better.

What is a Burned-Out nurse?

A nurse who internalizes stress and eventually becomes emotionally drained, tired, and withdrawn.

What is a Loner nurse?

A nurse who isolates themselves and prefers to be left alone, often choosing night shifts to avoid interaction.

What is a New Nurse on the Block?

A nurse who frequently changes jobs and never really settles into one role or team.

What is a Change Agent nurse?

A nurse who actively seeks to improve the system and speaks up for better patient care and safer practices.

What happens during the Recovery Phase?

The nurse starts to adjust, regains confidence, and begins to see humor and joy in their role again.

What happens during the Resolution Phase?

The nurse has fully adapted, feels competent, and is able to grow professionally and personally.

What is the difference between burnout and compassion fatigue?

Burnout builds slowly due to ongoing stress. Compassion fatigue comes on suddenly and is caused by emotional overload from caring for others.

What are symptoms of compassion fatigue?

Emotional exhaustion, hopelessness, physical fatigue, and disconnection from work.

What are the ABCs of preventing compassion fatigue?

• Awareness

• Balance

• Connections

What are four elements of transition shock identified by Duchscher?

• Stability: Steadiness of the work environment (e.g., low staff turnover).

• Predictability: Knowing what to expect (e.g., patient types, routines).

• Familiarity: Comfort with the unit, staff, and layout.

• Consistency: Regular patterns in patients, team, and workload.
  ➡ Lack of these increases stress for new nurses.

What are some skills novice nurses often need to improve?

• Communication

• Clinical judgment

• Delegation

• Prioritization

• Organization

• Assertiveness

What is the whole-task vs. partial-task system?

• Whole-task means providing total patient care (preferred by novice nurses)

• Partial-task divides care among staff and is more common in today’s healthcare settings.

What is the purpose of nurse residency programs?

To help new nurses transition into practice with support, education, mentorship, and longer orientation (often 12 months).

What is self-mentoring and why is it important?

It means taking responsibility for your own growth by asking questions, reflecting, and finding resources—especially when mentors are unavailable.

What is horizontal violence in nursing?

Bullying or aggression between coworkers (e.g., eye-rolling, refusing help, belittling), which creates a toxic work environment.

What are the 4 types of workplace violence according to the CDC?

1. Stranger with criminal intent

2. Client/patient violence

3. Coworker (horizontal or vertical violence)

4. Personal relationship violence

What is assertive communication and why is it important?

It allows nurses to speak up respectfully, say no when needed, and advocate for safety without guilt or fear.

What are examples of coping strategies for new nurses?

• Get sleep

• Ask questions

• Have a mentor

• Use SBAR

• Manage time

• Practice self-care

• Reflect

• Use support tools like checklists or apps

How can nurses improve communication with doctors and staff?

• Practice conversations

• Use clear language

• Write down what to say

• Listen actively

• Ask clarifying questions when needed

What’s one tip for prioritizing tasks as a new nurse?

Write down all tasks, assign levels of urgency, and ask, “What can I delegate?” or “What must I do first for safety?”

How can a novice nurse delegate effectively?

• Know what each team member is allowed to do

• Communicate clearly

• Stay respectful

• Follow up to ensure the task is done right

What’s one way to build interpersonal skills as a new nurse?

• Attend unit meetings

• Ask questions during rounds

• Volunteer for committees

• Seek feedback from your peers and preceptors