chapter 13 | Work-Related Stress and Burnout 201shocks of bad experiences, the affirmations of good
experiences, constructive evaluation, knowledge of
the unit routine, and priorities of school versus work
(Godinez, Schweiger, Gruver, & Ryan, 1999;
Heslop, 2001).
Well-supervised orientation programs are very
helpful for newly licensed nurses. In this era of the
nursing shortage, the orientation program may be
cut short and the new nurse required to function on
his or her own very quickly. One way to minimize
initial work stress is to ask questions about the ori-
entation program: How long will it be? Whom will
I be working with? When will I be on my own?
What happens if at the end of the orientation I still
need more assistance?
Differences in Expectations
The enthusiasm and eagerness of the first new job
quickly disappear as reality sets in. Regardless of
the career one chooses, there is no perfect job. The
problem begins when reality and expectations col-
lide. After 2 or 3 months, the new nurse begins to
experience a formal separation from being a stu-
dent and embraces the professional reality of the
nursing role. To cope with reality, several facts of
work life need to be recognized (Goliszek, 1992,
pp. 36, 46):
1.Expectations are usually distortions of reality.
Unless you accept this and react positively, you
will go through life experiencing disappoint-
ment.As a student, you had only two or three
patients to care for, and you are very surprised to
hear on your f irst full day of orientation that you
have f ive patients. Although you did hear the nurses
talking about their caseload while you were a stu-
dent, you expected to continue to have two or three
patients for at least the next 4 months.
2.To some extent, you need to fit yourself into
your work, not fit the work to suit your needs
or demands. Having a positive attitude helps to
maintain flexibility and a sense of humor.Your
f irst position is at a physician’s off ice. The physi-
cian is ready to retire, and his patient load is
dwindling. You wanted to apply for a position in
acute care, but you have a very active social life
and did not want to work weekends. The current
position is not very challenging, and you are con-
cerned that you might be unemployed soon. You
are starting to miss the acute care environment.
Go back to your SWOT analysis. Evaluate your
current strengths, weaknesses, opportunities, and
threats. Where do you see yourself in 1 year? 5
years? How will you f it yourself into your work to
meet your goals?
3.The way you perceive events on the job will
influence how you feel about your work. Your
attitude will affect whether work is a pleasant or
unpleasant experience. Health care is not easy.
Sick people can be cranky and demanding. Health-
care agencies continue to want to do more with less.
How you perceive your contribution to the health-
care system will def initely influence your reality.
4.Feelings of helplessness and powerlessness at
work cause frustration and unrelieved job
stress. If you go to work every day feeling that
you do not make a difference, it is time to
reevaluate your position and your goals.
What are these differences in expectations?
Kramer (1981), who studied reality shock for
many years, found a number of them, which are
listed in Table 13-3.
Ideally, health care should be comprehensive. It
should meet not only all of a patient’s needs but
also be delivered in a way that considers the patient
as a whole person, a member of a particular family
that has certain unique characteristics and needs,
and a member of a particular community. Most
health-care professionals, however, are not
employed to provide comprehensive, holistic care.
Instead, they are asked to give medications, provide
counseling, make home visits, or prepare someone
for surgery, but rarely to do all these things. These
tasks are divided among different people, each a
specialist, for the sake of efficiency rather than con-
tinuity or effectiveness.table 13-3
Professional Ideals and Work Realities
Professional Ideals Work Realities
Comprehensive, holistic Mechanistic, fragmented care
care
Emphasis on quality of Emphasis on efficiency
care
Explicit expectations Implicit (unstated) expectations
Balanced, frequent Intermittent, often negative
feedback feedback
Assignments that
“make sense”
Adapted from Kramer, M. (January 27–28, 1981). Coping with reality
shock.Workshop presented at Jackson Memorial Hospital, Miami, Fla.