Exploration of Disorienting Dilemmas New Registered Nurses Experience in Clinical Situations

The transition new graduate registered nurses (RNs) experience is difficult. New graduates feel pressure related to job expectations and high workload responsibilities. As nurses begin working in clinical practice, some experience a disorienting dilemma—a disconnect between what was learned in school and what is experienced in clinical practice. According to Mezirow (1981), this is the first step in a transformative experience. Yet, there is a gap in knowledge regarding disorienting dilemmas new RNs with less than two years of experience encounter. The purpose of this study was to explore disorienting dilemmas new graduate registered nurses (NGRNs) experience in the clinical setting to help nurse educators decrease the preparation-practice gap. The following research questions guided this study: Q1 What are examples of disorienting dilemmas new registered nurses experience? Q2 How do new registered nurses interpret and respond to disorienting dilemmas? Q3 How were new registered nurses prepared to manage disorienting dilemmas in their education and training? A grounded theory study was conducted to explore disorienting dilemmas NGRNs experienced in the clinical setting to help nurse educators decrease the preparation-practice gap. Focus was placed on the participant’s description and feelings during the dilemma. Additionally, resources the NGRNs used to resolve the dilemma, reflections after the dilemma, and discovery of the impact of the dilemma had upon the new RN were all explored. Constructivist grounded theory that acknowledged the prior knowledge and experience of the researcher was used for this study. Eighteen NGRNs from the United States with greater than six months and less than two years of experience were interviewed. During initial and focused coding, five main concepts were identified: communication, experience, confidence, advocacy, and individual. A theoretical model was developed and revealed a path new RNs walked with experiences along the way. Findings indicated that disorienting dilemmas were red stop light experiences for each of these new RNs. The experience caused them to stop, assess the situation, and then decide how to proceed. When NGRNs perceived they were able to successfully navigate the disorienting dilemma and resolve the situation, they were able to see it as a growth process. However, some were unable to resolve the disorienting dilemma fully and chose a different path after their experience. The new path for those in this research did not involve leaving the nursing profession, but it did cause changes including leaving a clinical practice area as well as changing shifts. The disorienting dilemma was a catalyst for change. Nurse educators could guide nursing students to handle dilemmas as new RNs by giving additional feedback and teaching regarding communication and advocacy. New RNs need to be prepared to handle these difficult situations and nurse educators play a key role in this preparation.