200 unit 3 | Professional Issues
5.Bad stress leaves feelings of exhaustion and
avoidance.
6.Good stress helps growth; bad stress is limiting.
Good stress improves interpersonal relation-
ships; bad stress makes these relationships
worse.
7.Processing all stress requires human action.
The Real World
Today’s health-care system has adopted the cor-
porate mindset. Both the new graduate and the
seasoned professional continue to experience
redesigning, changing staffing models, complex
documentation requirements, continued nursing
shortages, and the expectation that work does not
end when the employee goes home (Trossman,
1999). Most agencies expect new graduates to
come to the work setting able to organize their
work, set priorities, and provide leadership to
ancillary personnel. New graduates often say, “I
had no idea that nursing would be this demand-
ing.” Even though nursing programs of study are
designed to help students prepare for the
demands of the work setting, new nurses still need
to continue to learn on the job. In fact, experi-
enced nurses say that what they learned in school
is only the beginning; school provided them with
the fundamental knowledge and skills needed to
continue to grow and develop as they practice
nursing in various capacities and work settings.
Graduation signals not the end of learning but the
beginning of a journey toward becoming an expert
nurse (Benner, 1984).
Right now you are probably thinking,
“Nothing can be more stressful than going to
school. I can’t wait to go to work and not have to
study for tests, go to the clinical agency for my
assignment, do patient care plans,” and so forth.
In most associate degree programs, students are
assigned to care for one to three patients a day,
working up to six or seven patients under a
preceptor’s supervision by the end of their pro-
gram. Compare this with your “next clinical rota-
tion,” your first real job as a nurse. You may work
7–10 days in a row on 8- to 12-hour shifts, car-
ing for 10 or more patients. You may also have to
supervise several technicians or licensed practical
nurses. These drastic changes from school to
employment cause many to experience reality
shock(Kraeger & Walker, 1993; Kramer, 1981).
Initial Concerns
The first few weeks on a new job are the “honey-
moon” phase. The new employee is excited and
enthusiastic about the new position. Coworkers
usually go out of their way to make the new person
feel welcome and overlook any problems that arise.
But honeymoons do not last forever. The new
graduate is soon expected to behave like everyone
else and discovers that expectations for a profes-
sional employed in an organization are quite differ-
ent from expectations for a student in school.
Those behaviors that brought rewards in school are
not necessarily valued by the organization. In fact,
some of them are criticized. The new graduate who
is not prepared for this change feels confused,
shocked, angry, and disillusioned. The tension of
the situation can become almost unbearable if it is
not resolved. Table 13-2 provides a list of ongoing
and newer workplace stresses
Graduate nurses in the first 3 months of employ-
ment identified concerns related to skills, personal
and professional roles, patient care management, thetable 13-2
Stress in the Workplace
Ongoing Sources Newer Sources
Conflict with physicians Terrorism
Work overload/ Changes in technology
work devalued
Role conflict Downsizing
Ineffective, hostile, Constant changes in nursing
incompetent supervisors care delivery
and/or peers Work/home conflicts
Lack of personal job fit; Elder and child care issues
inadequate preparation, Workplace violence
recognition, or clear job
description
Poor work control, fear Lawsuits related to job stress
and uncertainty related
to career progress
Age, gender, racial, Demands of accreditation/
religious discrimination compliance issues
Dealing with death Pressure for immediate results
and dying patients/
families
Salary Colleagues’ inexperience
Adapted from DeFrank, R., & Ivancevich, J. (1998). Stress on the job: An
executive update.Academy of Management Executives, 12(3), 55;
McVicar, A. (2003). Workplace stress in nursing: A literature review.
Journal of Advanced Nursing, 44(6), 633–642; and Hall, D. (2004).
Work-related stress of registered nurses in a hospital setting.Journal
for Nurses in Staff Development, 20(1), 6–14.