Award Date


Degree Type


Degree Name

Doctor of Nursing Practice (DNP)



First Committee Member

Angela Silvestri-Elmore

Second Committee Member

Roseann Colosimo

Third Committee Member

Howard Gordon

Number of Pages



Newly licensed nurses are at incredibly high risk for reality shock leading to early burnout which results in many of them resigning their positions or leaving nursing altogether. Common feelings leading to reality shock often involve exhaustion, cynicism, depersonalization, decreased self-efficacy, and decreased job satisfaction. The result of early burnout presents significant financial strain and quality concerns for our already struggling healthcare systems. In the 1960s and early 1970s, Marlene Kramer brought her research regarding newly licensed nurses and their experience of “reality shock” to publication. Kramer felt strongly that reality shock was a key factor that led newly licensed nurses to leave the profession. More than 40 years later, newly licensed nurses continue to experience the same problems when trying to transition into their roles.The purpose of this project was to examine whether participation in a nurse residency program that actively addressed reality shock and early burnout reduced the incidence of emotional exhaustion, cynicism, depersonalization, and increased newly licensed nurse’s sense of personal accomplishment and self-efficacy within the first year of practice. Kramer’s “Reality Shock” theory (1974) and Boychuk-Dunscher’s “Process of Becoming” theory (2008) was the theoretical framework used as a basis for the educational intervention content. The Maslach Burnout Inventory Human Services Survey for Medical Personnel was utilized to assess exhaustion, cynicism, depersonalization, and personal accomplishment among newly licensed nurses. Demographic questions were asked at the beginning of the survey. Questions related to the COVID-19 pandemic were also included as it was recognized that participation in the care of patients during the COVID-19 crisis may have added stressors that would not have been otherwise present. The setting was an education and training center located in Las Vegas, Nevada, that provides centralized education services and a nurse residency program for newly licensed nurses in a seven-hospital system. Forty-five newly licensed nurses completed the initial online demographic survey, COVID-19 survey, and MBI survey. Descriptive statistics using frequency distributions were used to characterize sampled demographics and participant’s perception of providing care to patients with COVID-19 during the pandemic. Twenty-six newly licensed nurses completed the educational intervention discussing reality shock and early burnout via a digital learning management system. The educational intervention and surveys were available for 4 months. Twenty-six participants completed the same online MBI survey following completion of the educational intervention. A paired samples t-test was used to analyze data obtained from the pre- and post-intervention surveys. The educational intervention was successful in achieving its overall objectives, but the incidence of burnout did not improve as much as hoped, perhaps due to the unexpected added stress of a nationwide pandemic. Increasing organizational awareness of new nurse reality shock and early burnout through the project contributed positively to development of initiatives to assess and address burnout within the healthcare organization. A system wide retention committee was formed to address engagement and assess and address early burnout of newly licensed nurses within the first year of practice. Raising the awareness of organizational leadership regarding reality shock and early burnout will help support ongoing retention efforts. It is suggested that in the future, in person educational sessions be added to supplement the presentation which will enhance ongoing efforts to assist newly licensed nurses to feel understood and supported through their transition to practice. When they feel they are well supported in their respective clinical work settings, retention occurs.


Burnout; Cynicism; Depersonalization; Emotional Exhaustion; MBI Survey; Reality Shock


Health and Medical Administration | Medicine and Health Sciences | Nursing

File Format


File Size

861 KB

Degree Grantor

University of Nevada, Las Vegas




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