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The following case study sheds light on several pivotal areas for reflection: Anna's progression through the stages of reality shock, the importance of resilience skills, and the exemplary leadership demonstrated by the Scrub Nurse, and the emotional and professional dilemmas that affect career choices. This essay aims to delve into these critical aspects and furnish insights into how graduate nurses can successfully adapt to demanding clinical environments. By examining Anna's journey, we provide valuable guidance for healthcare professionals and new nurses navigating the intricacies of clinical practice. This reflection encompasses a comprehensive exploration of the challenges and growth opportunities that arise in the early stages of a nursing career, offering a deeper understanding of these significant areas.

Registered Nurse Reflection

First and foremost, the RN exhibited an extraordinary degree of empathy. A crucial soft skill, particularly in the healthcare industry, is the capacity to understand and express the feelings of others (Morrell et al., 2020). The RN promptly recognised Anna's emotional state when she became distressed after an unfortunate incident and was a fellow team member. This acute awareness of a teammate's well-being demonstrates a sincere concern for the psychological well-being of teammates.

Secondly, in a neurosurgical theatre, the capacity to remain calm under pressure is an essential complex skill (Huotarinen et al., 2018). The RN exemplified this by intervening when the neurosurgeon reacted less than favourably. They not only asked the surgeon to calm down but also took charge of organising a replacement instrument tray, enlisting Anna's assistance. This demonstrates not only composure but also assertiveness. The RN's ability to stay composed in a high-stress situation reassured the entire team, contributing to maintaining a safe and effective working atmosphere.

Moreover, the RN took on the role of a mentor and guide when privately sat down with Anna to discuss the incident. This demonstrates a thorough comprehension of the value of mentoring in the healthcare domain. By offering guidance and creating a safe space for reflection and discussion, the RN enabled Anna to understand the situation better and learn from the experience. Effective mentorship is a hallmark of outstanding leadership as it not only aids in professional development but also fosters a culture of continuous learning and improvement within the team (Hashimy et al., 2023).

Effective communication is another indispensable soft skill, especially in emotionally charged situations (Song & McCreary, 2020). The RN displayed their communication skills by engaging Anna privately and gently in a conversation about the incident. This open and empathetic dialogue allowed Anna to express her feelings and concerns. The RN's willingness to listen and offer guidance in a supportive manner encourages a positive learning environment and helps build trust among team members.

Lastly, the RNs demonstrated their leadership prowess in conflict resolution. In the face of the neurosurgeon's outburst, the RN skillfully defused the situation by asking for calm and then proactively seeking a solution – in this case, organising a replacement instrument tray. Conflict resolution is critical in healthcare, ensuring a harmonious and efficient team environment (Tuncay et al., 2018). The RN's intervention prevented further escalation and maintained a focus on patient care and the task at hand.

Reflection on Anna’s response

Anna's response to the situation in the neurosurgical theatre can be aptly analysed through Kramer’s framework of reality shock, which describes the stages of adjustment individuals undergo when transitioning into new and challenging work environments (Graf et al., 2020). This framework allows us to understand Anna's emotional journey and professional growth as she grapples with the unfamiliar and high-pressure setting of the neurosurgical theatre.

The first stage of reality shock, often called the honeymoon phase, typically involves a rosy view of the new environment. During this phase, individuals tend to have a positive and idealised perspective, often driven by excitement and optimism (Gaundan & Mohammadnezhad, 2018). In Anna's case, her honeymoon phase most likely occurred during her initial placement in the general surgical unit. Her tasks there primarily involved postoperative patient care, which aligned with her prior experiences and training, thus generating a sense of familiarity and comfort.

However, reality shock's second stage, characterised by shock and rejection, represents the tipping point when individuals encounter unanticipated difficulties and experience a sense of disillusionment (Gaundan & Mohammadnezhad, 2018). During Anna's time in the neurosurgical theatre, her path changed significantly. Her transition into this stage was accelerated by accidentally contaminating the sterile instrument tray. She was already experiencing emotional difficulty, and the neurosurgeon's abrupt response overwhelmed her even more. Her observable shakiness, physical withdrawal to the corner of the theatre, and reluctance to participate in subsequent activities all provide substantial evidence of her shock and rejection phase. The literature on reality shock confirms that reactions like Anna's are typical during this stage, as individuals grapple with unexpected challenges and a departure from their comfort zones (Gaundan & Mohammadnezhad, 2018).

The recovery and resolution phase of reality shock marks a critical turning point. Nurses start to adjust, get over the initial shock, and get their bearings during this period (Gaundan & Mohammadnezhad, 2018). When Anna made the decision to finish her shift, her road to recovery began. She showed drive to find a solution and adjust to the new, challenging setting by offering to help organise a replacement instrument tray and gather materials as needed. In this stage, people actively participate in problem-solving and seek ways to reclaim their sense of competence, which is a usual progression in the adjustment process (Gaundan & Mohammadnezhad, 2018).

The third step of reality shock, comprehension and acceptance, helps people realise the requirements and realities of their new work or surroundings (Gaundan & Mohammadnezhad, 2018). Anna is getting close to this point when she questions if she wants to keep on in this strange and new theatre environment. This reflection is crucial to the adjustment process since it frequently helps people choose their career routes with knowledge (Swanson, 1986).


The transition from nursing school to the demanding world of clinical practice is often marked by a phenomenon known as reality shock, a challenging period for new graduate nurses (Graf et al., 2020). Anna's experience in the neurosurgical theatre serves as a compelling case study of this phenomenon, where the stark contrast between the structured educational environment and the complex, high-pressure clinical setting can lead to stress, self-doubt, and disillusionment. In navigating reality shock, new nurses like Anna can develop foundational resilience skills to bridge the gap between theory and practice successfully.

For newly graduated nurses, effective communication is essential to resilience (Parker, 2022). Anna's narrative highlights the significance of transparent and sympathetic communication with the medical staff. A helpful and cooperative work atmosphere can be created by communicating worries, asking for clarification, and encouraging open communication (Hassmiller & Wakefield, 2022). The importance of empathic communication is demonstrated by Anna's meeting with the Scrub Nurse, who understood her emotional state and offered a private conversation.

Mentoring and assistance can partially mitigate reality shock (Ponchitra et al., 2022). The Scrub Nurse provided Anna with direction and support, demonstrating the importance of mentoring in assisting recent grads with their transition. Insights, expertise, and emotional support from seasoned nurses can help overcome the difficulties of clinical practice (Molina-Mula & Gallo-Estrada, 2020).

Self-reflection is another crucial skill for managing reality shock. Encouraging graduate nurses to engage in regular self-reflection and self-awareness can foster personal and professional growth. Learning from challenging experiences and adapting one's practice is a hallmark of resilience (Matahela & van Rensburg, 2023). Anna's contemplation about her future in the neurosurgical theatre underscores the importance of this introspective process. Self-awareness empowers new nurses to build resilience and thrive in their roles.

Time management and stress reduction techniques are additional components of a nurse's resilience toolkit. Efficient time management and stress reduction strategies are essential for managing the rigours of nursing practice and preventing burnout. Mindfulness, organisation, and prioritisation enhance resilience by maintaining well-being and emotional balance (Cooper et al., 2021). Lastly, embracing adaptability and a learning orientation is critical for new nurses. Cultivating a growth mindset is vital. Recognising that errors are a natural part of the learning process, not failures, allows nurses to navigate the ups and downs of their early careers (O'Flynn-Magee et al., 2018). Anna's uncertainty about her future in the neurosurgical theatre emphasises the need for a growth-oriented perspective.

Strategies for practice

One of the most impactful strategies is seeking mentorship and finding role models within her clinical setting. Mentorship plays a vital role in leadership development, as demonstrated in research by Roth & Whitehead (2019). Anna's relevance and importance in seeking a mentor lie in the guidance, expertise, and emotional support mentors can provide. Mentors can provide insight into the nuances of the field, support her in navigating challenging situations, and provide encouragement in a new clinical setting like the neurosurgery theatre, which brings unique obstacles. Through developing a mentoring relationship, Anna can strengthen her leadership abilities and find the drive and resiliency needed to handle the challenges of her position (Crogan et al., 2019).

Another key tactic for Anna's development as a nurse leader involves continuing education and professional development. According to a study by Bianchi et al. (2018), clinical professionals must stay informed on the most recent developments and best practices. The information, skills, and critical thinking abilities that Anna will get from implementing this plan will help her make wise judgments and effectively manage her team. By committing to ongoing professional development, Anna can gain a competitive edge in her clinical area and inspire and motivate her colleagues through her knowledge and expertise, thereby strengthening her leadership capacity (Hashimy et al., 2023).

Practising self-reflection and cultivating emotional intelligence is a third strategy that can significantly benefit Anna's leadership journey. Self-reflection allows her to assess her actions, decisions, and interactions with her team and patients, contributing to her leadership growth (Matahela & van Rensburg, 2023). On the other hand, emotional intelligence empowers her to manage the stress and emotional challenges that may arise in her new clinical setting (Majeed & Jamshed, 2021). White & Grason (2019) shed light on the importance of emotional intelligence in nursing leadership in their research. Anna's relevance and importance in embracing self-reflection and emotional intelligence lie in her ability to lead effectively in a demanding clinical environment.


The case study of the RN and Anna's experience in the neurosurgical theatre provides a compelling glimpse into the challenges new graduate nurses face during their transition into clinical practice. Anna's journey through the stages of reality shock underscores the pivotal role of communication, mentorship, self-reflection, time management, and adaptability in a nurse's resilience toolkit. By actively seeking mentorship, engaging in continuous professional development, and cultivating emotional intelligence, nurses like Anna can adapt and thrive in high-pressure healthcare settings, ultimately emerging as effective leaders. This study reinforces the significance of robust support systems and skills development for nurses, contributing to enhanced patient care and the nursing profession's continued growth and success.


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