The Dreaded NCLEX

August 31, 2009

The countdown has begun, folks.  One more semester until I place my career, my future, and my livelihood in the hands of a computerized, adaptive, multiple choice test. Intimidating, much?

But never fear, for Nurse Teeny has a plan.  I am not taking any chances on this puppy and have come up with a study plan that should prepare me well…

  1. September: Read through Kaplan’s NCLEX review book.  This one is more focused on strategy and breaking down the style of the test questions, so I thought it would be a good place to start, and then build from there.  Also, I plan to review my ATI subject test results and identify the content areas where I need to focus.
  2. October: Start Hurst Review’s online NCLEX test prep.  Hurst was started by a nursing school professor and has a fabulous track record.  By using their online version, I can view the lectures on my own time and read the book according to my own needs.  Their in-person class is four days straight of intensive review, but I think I’d get more out of it (and pay less) if I have 90 days to focus on the content that’s really giving me trouble, and get instruction from the comfort of my own living room.
  3. November: Start Saunders‘ NCLEX review books.  These has thousands of practice questions and will be a good way to train my brain for the “Big One.”
  4. Ongoing: Flash cards galore!  I bought a lifetime subscription to The Flashcard Exchange for $19.95 and downloaded the free app Mental Case to my iTouch.  This allowed me to download electronic NCLEX review flash cards directly from Flashcard Exchange to my iTouch – now I can sit on the bus and quiz myself.  I also have a copy of Kaplan’s little book on meds you need for the NCLEX, which I will carry with me and review at my leisure.
  5. November 20: Take the ATI Comprehensive Predictor…180 questions covering all of the subjects and content reviewed in previous classes.  ATI people claim that your performance on this effectively indicates how you will do on the NCLEX (hence the “predictor” label). My school appears to agree…we have to pass this for the school to submit our names to the state Board of Nursing as eligible to take the NCLEX.
  6. December: Take as many practice tests as I can get my little hands on.  (Hopefully) take the NCLEX before Christmas.  If Santa brought me an RN license, I would be greatly pleased! :)

So, there you have it.  I’m sure that other strategies will emerge as I begin reviewing.  The important thing is NOT to cram.  And to walk into that testing center knowing that I did everything I could to prepare.

How will or did you prepare for the NCLEX?  What worked and what didn’t work?  I’d love to get your feedback…


Nursing Student Socialization

August 25, 2009

So here I am, two weeks from the start of school and mute on the evidence-based blogging front.  Sorry, folks!  My time off this month has been a bit of a roller roaster.  But then again, what better time to discuss research about the nursing school experience than when thousands of students are returning for another year, and thousands more are just beginning the journey?

I thought I’d initiate this blogging experiment by addressing an article that caused quite a stir within my own cohort.  Just ‘cuz I like to rock the boat. :)

The study in question (Utley-Smith, Phillips, & Turner, 2007) discusses the “returning to school syndrome model,” which was first identified among RNs returning to academia to earn their BSN degrees.  The model is applied this time to accelerated nursing degree students, who have professional/academic backgrounds in something besides nursing and have decided to enter the nursing profession.

The reason this led to controversy among my classmates was that the article identifies “hostility” as one potential pitfall of being a second-degre nursing student.  Because the article was sent to us by a not-so-favorite faculty member, some people interpreted her distribution of the article as a passive aggressive way of calling us “hostile” and took immediate offense.

Reading the article, however, I believe that this knee-jerk reaction has way more to do with our own cohort’s baggage related to this particular professor, and very little to do with what the article actually says…

The returning to school syndrome model lists three phases in the socialization of second-degree students into the nursing profession.  Although the boundaries between these phases are fuzzy, there are definitely hallmarks of each:

  • Honeymoon – This period often coincides with the first semester of nursing school.  You’re excited about being a student again, you’re confident that you’ve made the right choice and you’re optimistic at the first signs that you might actually be able to figure this stuff out.  I remember turning to a friend halfway through one of our first clinical rotations and exclaiming, “I might really be able to do this!!!”  It was invigorating and I was in love with nursing.  The honeymoon phase is all about the romance of nursing and is critical to success because it makes you believe that this experience is worth all the challenges to come.
  • Conflict – The conflict phase is tricky.  Utley-Smith et al. noticed that this period often occurs during the second semester, when clinicals get more intense and classroom material gets harder.  The skills you knew well in your life B.N. (“Before Nursing”) don’t get you as far, and the expectations are higher.  Our second semester featured part two of our Med-Surg nursing course, during which we were expected to build on the skills learned in part one and really take off.  And I did notice A LOT more conflict during this time.  More fatigue, more anxiety and much more complaining, often about issues that were out of our control.
  • Reintegration – Reintegration actually begins with hostility, in many cases.  External factors are blamed when students don’t live up to their own standards of success.  I believe that in our cohort’s case, we’re still muddling through this part.  We’re all used to being really good at things – we succeeded in school and previous jobs, and we got into a very difficult nursing program.  So when the grades are less than expected and the G.P.A. doesn’t glow as we think it should, we look for culprits, whether they be administration, faculty, the program itself, or sometimes a peer.  Hence the “obnoxious” remark about my finishing exams quickly.  Hostility hopefully (and usually) evolves into positive resolution, when you figure out how to integrate “self B.N.” with “self R.N.”, and understand how you have been transformed into a nurse.

Returning to school is difficult.  Returning to school to study nursing is even harder, especially when you have been successful in your life before nursing.  Not only do you learn extremely difficult material at a rapid, break-neck pace, but you also are thrown into a completely new culture.  And to top it all off, learning in the classroom is very different from learning to think on your feet, and in nursing school, you have to do both.

I’m not intending to scare anyone off from nursing, or from second-degree programs.  If you’ve read through any of this blog, you know how intensely rewarding and exhilarating my own experience has been.  But I do propose that you be aware of some of the emotional and mental responses you may have to the experience, responses that may surprise and shock you. I hope that your nursing programs include some of these issues of adjustment in your orientation and nursing foundations class – if they don’t, ask for it!

I also advise that you cut yourselves a little slack and realize that no matter how many A’s you got in your prereqs or how many stellar references you got from your former boss, you are starting from Square One.  The skills, the language and the culture will be foreign concepts, and you don’t have to master them right away.  But your interpersonal qualities, work ethic, and passion for providing care to others – which undoubtedly got you in to begin with – are important to hold onto.

And when you start to doubt whether you can do this, you can.

Reference*

Utley-Smith, Q., Phillips, B., & Turner, K. (2007). Avoiding socialization pitfalls in accelerated second-degree nursing education: The returning-to-school syndrome model. Journal of Nursing Education, 46(9), 423-426.

NOTE: I will always include reference(s) at the end of these research-based posts, in case you wish to read the original articles.  Happy researching!


Nursing Brain Sheet – Another Option

August 20, 2009

So I’ve been a slacker about my “evidence-based blogging” thus far.  I blame the tonsillitis I contracted last week, which has kept me from working, having fun or being at all useful. (Note: That is the THIRD case I’ve had in about a year…ugh).

But I did want to post another version of a nursing brain sheet that I have been toying with since my Family Nursing class.  I’ve noticed a lot of downloading traffic of the previous brain, which is awesome!! I’m glad folks are finding it useful.  The important thing is finding something that works for you…

This one is a wee bit different – the first page is a “time management” brain.  On it, you list all of your clients (or up to 3), plus a few critical details about each one/space for making notes, and then use the time columns to indicate when each client has meds due, procedures, consults, etc.  That way you can visualize who-has-what-when, and plan ahead, especially for those times when ALL of your patients have something due (0900 meds anyone????).

Pages 2 and 3 are meant to be printed double-sided.  You can fit information about 3 clients at once, including vitals, CBGs, I&Os, etc.  The backside has a space to jot down lab results you need to know, plus a hopefully useful “SBAR” section for each client.  SBAR is the gold standard in nursing (and much of health care) for giving and receiving report.  It stands for Situation, Background, Assessment, Recommendation.  You can use this section when getting report at the beginning of shift, and it has handy information that you can use when giving report as well.

Give it a shot and see what you think.  And please let me know how the brains are working for you once you start clinical!  I love tinkering with these and coming up with new layouts where you can fit as much useful information into as little space as possible.  Hmm, maybe I should copyright these… :)


Hometown Hero…

August 18, 2009

carter post transplant

…And he’s only two years old.  My aunt was telling me last week about her friend/neighbor’s grandson Carter, who was diagnosed in April with hepatoblastoma (an extremely rare form of pediatric liver cancer that affects about 100 kids per year).  Carter’s mom grew up in my hometown, so I feel a special connection with this family.  Carter’s mom and dad have been keeping a daily blog about their journey, which my aunt forwarded to me and I sat transfixed for four hours, reading every single entry in one sitting.

This family amazes me – not only is their youngest facing a serious disease with the spirit that only a toddler can, but Mom is also pregnant and due in September!  Their story is the reason I want to go into pediatric nursing – because it’s family nursing.  Reading about  how they are treated by a variety of doctors, nurses, CNAs and so many other health care workers, has sometimes made me proud of my profession and sometimes made me very frustrated.  I can only hope that someday I am one of those nurses that they hold up as a positive example.

Needless to say, this family is also facing an uphill financial battle.  The location of the tumors necessitated a liver transplant last week.  Carter is recovering very well, but cancer treatment ain’t cheap, nor is a major transplant (nor the anti-rejection meds and follow-up care that Carter will need for the rest of his life).  The family’s friends have set up a “Carter’s Fight Fund” to help defray some of the costs.  If you’d be interested in donating even a few dollars in support of Carter and his family, download the contribution form here and read more.

I encourage you also to read the family’s blog.  You will be inspired.


Are You Oinking Kidding Me?

August 14, 2009

My little sister is a grad student in Public Health and Social Work, and a world traveler extraordinaire! She was most recently in India for 6 weeks on a water sanitation project and returned home safely on Wednesday.

She came back with a stowaway, however.  And not just any stowaway.

H1-freaking-N1.  Aka the “swine flu.”

The emergency department didn’t even try to type it.  Based on her symptoms and recent travel history, they’re pretty confident in their diagnosis (although India has had its share of cases, it’s apparently nothing worthy of the panic it’s receiving).  They did do a chest x-ray and draw blood to check for parasites and other creepy crawly things that could make her sick.  But in the meantime, it’s the usual treatment regimen: rest and fluids.

The good news is, the mass hysteria that accompanied the original swine flu outbreak last spring has died down. Those of us who have been exposed can go about our business as long as we don’t exhibit any symptoms.  The bad news is, the next couple weeks were supposed to be a whirlwind for my poor sister – moving back to school, coming back home for our ladies’ wine trip, starting her second year of classes, and then traveling to a friend’s wedding.  Hopefully the disease will run its course in time for her to do some of it, and hopefully none of the rest of us will get sick either.

Oh dear.


Putting Research Into Practice

August 13, 2009

Into practicing research, that is.  The free medical clinic where I worked for a year before starting nursing school has hired me back as a consultant during my break from school.  And wouldn’t you know it, my primary project is to help develop evidence-based guidelines! 

The clinic has been using the model of group medical visits for women’s health, and they want to put this model to work for their diabetes patients, who use 80% of the clinic’s resources.  But they also want to formalize the process of group visits so that they can use the model in the future for other types of groups.

My task: to develop policies and procedures/standard work orders for group medical visits in general, as well as to draft a research-based ”vision statement” about the need for a diabetes-specific group. 

So it’s not exactly a relaxing break.  But I’m making money!  And I’m using the research skills we honed this summer.  Not a bad deal…


He’s Ba-ack (Again)!

August 9, 2009

Fake Doctor has returned! Although posts about his residency have been few and far-between lately (see his musings on why here), he has now decided to tackle an issue to which we all should be paying more attention…

Health care reform.

My leadership class this fall will be focusing heavily on this issue.  As will this blog, I’m sure.  I’m already poised to get on my soap box about the recent town hall meetings that have featured congresspeople hanging in effigy.  Seriously, people? Get a grip.

But my typing abilities are somewhat hampered these days, so for now I simply encourage you all to see what Fake Doctor has to say in his new blog, Ah Yes, Health Policy.


Palliative Care Resources

August 8, 2009

Nurse Teeny got a shout out in the latest edition of Palliative Care Grand Rounds, a monthly post by a palliative care nurse practitioner about blogs discussing palliative care issues.

If you want to read oodles of perspectives on palliative care, this is a great place to start!


Take These Broken Wings…

August 3, 2009

Or at least this broken wrist. Radiology called today with the news – I have a small scaphoid fracture after all, which the urgent care doc missed.  My first fracture ever, at the ripe ol’ age of 28.  No change in the treatment plan, except I now need to get a follow-up x-ray in a couple weeks to make sure it’s healing.  At least it’s my left hand, or I’d be up a creek.

As my friend said, “That’s some dog!” I’m just glad she’s a dog with enough sense to do this AFTER school gets out!


Evidence-Based Blogging

August 2, 2009

The next few weeks will hopefully be quiet, barring any future klutzy moves by yours truly (or any sudden moves by the dog). So I thought I’d take advantage of this downtime by addressing one component of nursing that my nerdy self just eats up: research.

I’ve blogged previously about the possibility of pursuing my Ph.D. in addition to/instead of my DNP. And my Master’s degree as a Clinical Nurse Leader will also lend itself to utilizing nursing research to improve and enhance health care. One of the things we learned in our Research class this summer was the importance of synthesizing current literature (“evidence-based”), rather than relying on a single article (“research utilization”) to change practice.

As someone who actually enjoys doing CINAHL database searches and making evidence tables (fine, groan if you want to), I thought I’d use this blog as a forum for exploring a topic that has fascinated and flustered me all year: the culture of nursing school, particularly the experiences of second-degree nursing students.

I’ll be taking a look at and blogging about some articles over the next few weeks that address this issue, and I welcome your comments and feedback. Whether you’re a second-degree student, a BSN or ADN student, a student-to-be or already a nurse, I’d love to hear about your experiences and expectations of nursing school. Hopefully the research addressed will be fodder for some good conversation…