Abstract
In an effort to deal with the critical nursing shortage, new graduate nurses are entering highly specialized areas that once were available only to experienced nurses. A critical challenge exists for the new graduate when faced with the application of intensive theoretical knowledge in practice, and implementation of high-technology interventions, to meet the needs of patients and families. Innovative strategies are required to prepare the new graduate for this high-acuity practice environment and lessen the impact of reality shock. This article describes the implementation of medical-surgical nurse extern and student nurse aide programs that expanded to critical care. Program outcomes included positive feedback from participants about increased clinical experience, RN role perception, and comfort in the clinical practice setting. Program components are detailed, outcomes discussed, and implications for practice presented.