Reference no: EM133593240

Matt is a new nursing graduate and has just completed a 3-week orientation to a medical-surgical unit in a small rural hospital. After orientation ended, he switched to the night shift as his regular shift, working 7 pm to 7 am. After 1 week on night shift, his assignment is to care for 10 patients because one of the scheduled nurses has called in sick. Matt is concerned about being responsible for this many patients because he has only had six patients during orientation with his preceptor. The charge nurse assures him that she will be available to help if he should have questions. In addition to Matt and the charge nurse, the floor is staffed with two unlicensed assistive personnel (UAP) for the census of 20 patients.

Matt receives orders for a patient to receive 2 units of packed red blood cells at 10 pm. The charge nurse has received an admission from the emergency department but helps Matt with the process of checking the blood. While the first unit is infusing, one of Matt's patients is experiencing increased confusion and is calling out loudly. The patient is also trying to get out of bed. The UAP working with Matt is attempting to calm the patient and keep her safe but is having difficulty. Matt administers a PRN sedative for the confused patient, and then obtains the second unit of blood. After starting the second unit of blood at 2 am, Matt makes rounds on his other patients. He finds the UAP assisting the confused patient back to bed after finding her on the floor crying and holding her leg. He calls for the charge nurse, but she responds that she is unable to help at this time. Matt performs an assessment on the patient and asks the UAP to stay with the patient while he calls the health care provider. An x-ray is ordered for the patient, so Matt makes arrangements for this and then checks on his transfusion patient.

When Matt's preceptor arrives for the day shift, he tells her, "This is more than I can handle. I need to rethink nursing because this isn't anything like it was in school. I didn't have any help, and I've never had to care for this many patients. I don't want to work like this. I'm going to try to get my charting done and get out of here. Maybe I need to work somewhere else."

Question 1. What phase of reality shock is Matt experiencing?

Question 2. What could the preceptor do to help Matt through this phase?

Question 3. What special needs can you identify that Matt may have difficulty with and what strategies would you suggest to help him?