202 unit 3 | Professional Issues
When efficiency is the goal, the speed and
amount of work done are rewarded rather than the
quality of the work. This creates a conflict for the
new graduate, who while in school was allowed to
take as much time as needed to provide good care.
Expectations are also communicated in different
ways. In school, an effort is made to provide explicit
directions so that students know what they are
expected to accomplish. In many work settings, how-
ever, instructions on the job are brief, and many
expectations are left unspoken. New graduates who
are not aware of these expectations may find that they
have unknowingly left tasks undone or are considered
inept by coworkers. The following is an example:
Brenda, a new graduate, was assigned to give med-
ications to all her team’s patients. Because this was a
fairly light assignment, she spent some time looking
up the medications and explaining their actions to the
patients receiving them. Brenda also straightened up
the medicine room and f illed out the order forms,
which she thought would please the task-oriented
team leader. At the end of the day, Brenda reported
these activities with some satisfaction to the team
leader. She expected the team leader to be pleased with
the way she used the time. Instead, the team leader
looked annoyed and told her that whoever passes out
medications always does the blood pressures as well
and that the other nurse on the team, who had a
heavier assignment, had to do them. Also, because
supplies were always ordered on Fridays for the
weekend, it would have to be done again tomorrow,
so Brenda had in fact wasted her time.Additional Pressures on the New Graduate
The first job a person takes after finishing school is
often considered a proving ground where newly
gained knowledge and skills are tested. Many peo-
ple set up mental tests for themselves that they feel
must be passed before they can be confident of
their ability to function. Passing these self-tests also
confirms achievement of identity as a practitioner
rather than a student.
At the same time, new graduates are undergoing
testing by their coworkers, who are also interested
in finding out whether the new graduate can han-
dle the job. The new graduate is entering a new
group, and the group will decide whether to accept
this new member. The group is usually reasonable,
but sometimes new graduates are given tasks they
are not ready to handle. If this happens, Kramer
(1981) recommended that new graduates refuse to
take the test rather than fail it. Another opportuni-
ty for proving themselves will soon come along.
Additional problems, such as dealing with
resistant staff members, cultural differences, and
age differences, may also occur. Above all, the expe-
rience of loss is frequently described by new grad-
uates. Losses are described as the following
(Boychuk, 2001):
■The ideal world of caring and curing they had
come to know through their education
■Their innocence
■The familiarity of academia
■The protection of clinical supervision by nursing
instructors
■Externally set boundaries of care and safety
■A sense of collegiality and trusted relationships
with peers
■Grounded feedbackResolving the Problem
Before considering ways to resolve these problems,
some less successful ways of coping with these
problems are listed.
■Abandon professional goals.When faced with
reality shock, some new graduates abandon their
professional goals and adopt the organization’s
operative goals as their own. This eliminates
their conflict but leaves them less effective care-
givers. It also puts the needs of the organization
before their needs or the needs of the patient
and reinforces operative goals that might better
be challenged and changed.
■Give up professional ideals.Others give up
their professional ideals but do not adopt the
organization’s goals or any others to replace
them. This has a deadening effect; they become
automatons, believing in nothing related to their
work except doing what is necessary to earn a
day’s pay.
■Leave the profession.Those who do not give
up their professional ideals try to find an organi-
zation that will support them. Unfortunately, a
significant proportion of those who do not want
to give up their professional ideals escape these
conflicts by leaving their jobs and abandoning
their profession. Kramer and Schmalenberg
(1993) stated that there would be fewer short-
ages of nurses if more health-care organizations
met these ideals.