When participants were asked to relate their initial workplace experiences, their responses were suggestive of reality shock. This is a multi-faceted phenomenon, and participants expressed differing aspects of their new roles for which they did not feel prepared. They highlighted how the increased responsibilities of being an autonomous professional made them anxious; how frustrated they were due to being undermined; and how the workload overwhelmed them. Such negative sentiments made some participants feel that attrition from the profession was the best way forward.
Participants were aware that once they started working as qualified radiographers, they would assume more responsibility. However, the experience of being immersed in this responsibility brought about reality shock. They expressed the idea of increased responsibilities in a negative way, focusing more on the repercussions of what could happen if they made an error that affected a patient, as opposed to embracing their professional independence.
Study respondents highlighted accepting their own radiographic images as the most significant indicator of their increased level of responsibility. Harvey-Lloyd, Stew and Morris [14] state that the level of responsibility given to practitioners at the outset of their careers is a concern that is acknowledged across the different healthcare professions. Phenomenological research from as early as 1950 describes the anxiety radiographers felt due to the sudden responsibility of accepting their own radiographs [14]. This anxiety may indeed be justified, as radiographer error may have very serious implications for the patient. In one instance in Grimsby in the United Kingdom, a radiographer committed suicide after a barium enema examination he was performing proved fatal for the patient. He had incorrectly inserted a catheter, which perforated the patient’s bowel. Barium from the procedure leaked into the blood stream, and the patient died shortly after the procedure from pulmonary barium micro-embolisation [15].
Naylor [16] documented how repeated studies unanimously found that newly-qualified nurses were unprepared for their increased responsibilities. However, in one study, although surveyed nurses were anxious about their newly acquired responsibility, they felt it gave them ownership of their practice, which is a positive psychological coping mechanism that may be useful to healthcare practitioners in any discipline [16].
Participants in this study felt taken advantage of, because they were viewed as having less personal responsibility due to their young age, as well as being unmarried. As autonomous practitioners, participants expected to be regarded as equal members of staff by their colleagues, but the reality they encountered was that they were undermined in various aspects, which resulted in reality shock. Their colleagues were older, and many were married, or had family responsibilities. These responsibilities would sometimes require them to be absent from work, and the newly-qualified radiographers would be required to take over the duties of the absent staff members. This made participants feel undervalued, and they perceived that they were regarded as substitute staff.
In addition to this, the allocation of duties and rotations were unfavourable to the participants. They were assigned to work during hours that no one else wanted, and to perform duties that the older, qualified staff members preferred not to do. Participants perceived that they were at the very bottom tier in the departmental hierarchy, and they felt they could not protest such treatment as it was never expressly communicated, but rather, subtly implied. Within the nursing profession, such behaviour by qualified staff is described as oppressive, and it is known as horizontal, or lateral violence [16]. This is defined as destructive behaviours of co-workers against one another [17]. Embree and White [18] explain horizontal violence as peer-to-peer aggression, which includes non-verbal innuendo, and undermining activities. Such behaviours are found in what are now termed toxic workplaces. Horizontal violence discourages staff retention, and so the affected newly-graduated radiographers are likely to seek employment elsewhere due to such experiences [17].
Respondents detailed feeling overwhelmed by high workloads upon exposure to their work environments. During clinical rotations as students, there was always supervision, and assistance in dealing with the workload. Now, as unassisted practitioners, they were responsible for ensuring that all patients within the Imaging Department were attended to. They now had to work regularly, for longer hours, and attend to more patients. Additionally, they were short-staffed, further increasing the work pressure. In a separate study, newly-qualified occupational therapists reported being overwhelmed by their schedules, with limited time to complete their professional duties [19]. Naylor echoes this, noting that high patient volumes, heavy workloads, and staff shortages have been cited as the most prevalent sources of work pressure amongst diagnostic radiographers [16]. Continued feelings of being overwhelmed in the workplace can lead to depersonalisation, and this is associated with feelings of detachment, and dehumanisation [20]. Taking time to relax in relaxation rooms and shorter working hours may help radiographers alleviate the overwhelming feelings associated with increased workloads [21].
In this study, most respondents performed their student clinical rotations in the private healthcare sector, but commenced professional practice in public hospitals. In South Africa, there exists a large discrepancy between these two types of institution. Public hospitals generally have longer patient waiting times; shortages of consumables; and compromised patient care due to a high demand for services, and limited healthcare staff. Conversely, private hospitals generally offer better quality patient care, shorter waiting times, and better quality equipment [22]. Participants exposed to the private healthcare system as students reported experiencing reality shock when they were exposed to public hospitals as qualified radiographers. Some of them had almost no exposure to the analogue equipment used in most public hospitals, only being familiar with modern digital equipment. They were unprepared for the shortages staff and consumables, and the bureaucratic, unsupportive management style. Public hospitals within South Africa are reported to be generally in a dysfunctional state, due to bureaucratic bottlenecks [23]. Being immersed in this environment resulted in reality shock for participants.
Respondents in this study experienced reality shock from varying factors, and some of them expressed a desire to leave the radiography profession. Attrition from the radiography profession remains a serious concern in South Africa. The number of radiographers registered by the Health Professions Council of South Africa has been steadily declining over the past few years, underscoring that the attrition rate within radiography in South Africa is alarmingly high [24]. When new healthcare practitioners are exposed to pressure, and adverse events in the working environment, this negatively influences their attitude, satisfaction, and ultimately, increases the likelihood of attrition from the workplace and professional workforce [25]. Research suggests that about 30% of new nurses either change jobs, or leave the profession within their first year of employment due to reality shock [10]. In this study, although some participants were still deliberating on leaving radiography, one participant had already taken action to this end, and was awaiting admission into university to study a programme in a different field.
However, the findings of this research are not without pitfalls. The results of this study may have limited transferability, as is true for all qualitative studies. Another limitation is that the interviews were conducted by a radiographer, and thus interpretations may be biased towards the interviewer’s own experiences within the radiography field, as opposed to reflecting the participants’ true sentiments.
