Precepting/Orienting Nurses

A couple of years ago, I was asked to orient a new hire on my floor and was excited as she was a grad from my alma mater, so we had the same frame of reference. She was excited because she had always wanted to work in psych. I felt great knowing she was going to be on a somewhat quiet unit, instead of an acute one, like I did.

So, I began to orient her to the unit, citing procedures, treatments, and daily practices at nauseam. She caught on very quickly, and was doing so well. On our last day together, I turned her loose to do it on her own, and she was excellent!

However.....(you knew there would be something) two days off of orientation, she gets pulled to another unit. Not only does she get pulled, they require her to be a nurse's aid. Not only does she have to be a nurse's aid, they place her with a very psychotic patient. Not good. She begins to cry. They place her with another patient, it does not make her happy.

I guess my spidey-sense went off, even though I had not seen her since orientation. My co-workers began to tell me some troubling things: she is not on the floor very much,  and is seen constantly on her phone. She won't take off orders, help with treatments, or basic patient care. "Hmmmmm," I thought, "maybe she's quitting?" In my typical fashion, I just asked her, "Are you going to keep working here?"  She mumbled an answer about not being a psych nurse the rest of her life, and averted my eyes. Yep, she's a goner. The next day I had asked someone who knows everything at the facility and they confirmed my suspicion that she had turned in her notice.  I took it kind of personally. "Maybe I didn't give her enough training or support?". I found out later that she went to another job and stayed there only 3 weeks before she turned in her notice, too. I felt a lot better after knowing that.

After that experience, I took a precepting course offered by my facility so I would get a little more per hour for training new hires. Over the course of two years, I've probably oriented 10 different people. Some were straight out of school, others just picking up for extra money. I've had a few that were lazy, and some that were very ambitious, wanting to try their hand at every skill, gross or not. My alma mater also has brought me some about to be grads who need to precept their 120 hours with a nurse before taking NCLEX. Those are my favorites! I just love seeing a new nurse with all that positivity in their eyes. And they think you know EVERYTHING! Ha!

If you ever get the chance to precept/orient, take it! I used to think that having a student would be an awful burden and experience, but you learn things from them, too! (I had an orientee that showed me a trick changing ostomies that has keep me from making a horrible mess that I'm forever grateful for.)

The best motivation to help you study for NCLEX

 is to set the date. How true it is! Nothing puts the fear of GOD into you like knowing you could possibly waste $200 if you are not prepared enough.

Our school required we buy this online tutoring program. It is supposed to run you through the 7 areas: fundamentals, pharmacology, pediatrics, mental health, medical-surgical, maternity, and nursing management. This company places you with a tutor, and you do an initial assessment. You go through the books and after each one, you take a test. If you don't score 60% or better, you must do homework to help you improve your score. Then you take it again. It gives you a read out of areas you missed and what you need to work on. I got through fundamentals just fine but pharmacology....I fell short. Again and again, so close but not 60%. The tutor wouldn't let me advance. Really? I paid you $400 to teach me, but you can't advance me until I reach the exact benchmark? I just gave up trying to use them. Besides the aforementioned scenario, their questions were not formatted to helping me with NCLEX. When I started nursing school in the fall of '11, we were required to buy Saunders Comprehensive Review for NCLEX-PN. I had listened to my dean at my school when she said, "if you really want to pass NCLEX-PN, then after lecture every day, use the Saunders book and reinforce it." So, I went through the entire book, and accompanying disc with chapter questions on it. However, I still did not feel adequately prepared. I began to search online for alternatives. Kaplan was good, I had heard, but very expensive. I had less than 4 weeks before I tested and their program was more involved than I had time or money for. NCSBN.org  is the organization which I took my jurisprudence test for state licensure and I was told they were the people who came up with the NCLEX questions. So I signed up for the 3 week PN review.
It did the same as the other companies, but was affordable ($50) and I went through the test questions as many times as I needed to, which really helped. I would highly recommend them if you need lots of repetition to grasp a concept.
I planned on taking NCLEX-PN Saturday, March 23, 2013. Every spare minute I had, I was going through questions. I added up over 4,000 questions and rationales that I had done. Finally, the day came. I showed up early and they decided to go ahead and take me early! Holy cow! My nerves took over and I headed for the bathroom!  So, I still started at the time I was supposed to. ;)
There were many checks of identity, and finally I was sitting down. "Don't stress: you studied, God is with you...." I kept saying in my head over and over again. Then came the first question. I looked at the screen and thought, " I am so in trouble! I wonder how long it will take me to save up to take this again?" I literally prayed through each question. When I got to question 84, I got nervous again. You see, you can fabulously fail with 85 questions or spectacularly pass with the same amount of questions. The minimum questions for NCLEX-PN is 85. The computer will keep asking questions until you get at least 50% correct. 15 of the questions are "experimental" and if you miss those, it's no big deal. But you don't get credit if they are right, either. You have up to 205 questions unless the computer deems that you are not going to pass based on the amount of high level questions you got right.
After question 85, the screen went blue."Oh, no..." My breathing went shallow. I raised my hand and the attendant escorted me to the office. I called Hunnybunny who was very surprised to hear from me. "It's over?" Yes, it's over, I told him. I felt the way I was supposed to after NCLEX: exactly like I failed. No tears or boo-hooing for me, though. It was what it was. I had spent over 300 hours studying. If I wasn't ready by then, I didn't think anything would help.
I had heard about the Pearson Vue trick a year or so ago. After the results are transmitted, you can try to register again for the exam. If it takes your credit card, it means you failed. If you get this pop-up, ( see below) it means you have passed.
            

  

That is exactly what happened to me! I found out that I passed NCLEX-PN by using this PVT (Pearson Vue trick). On Monday, March 25, it posted to my Board of Nursing website, with my name plus LPN! Thank you, God!

On to the NCLEX

So, it's down to this. This one little test. Well, not really "little". It can be as "few" as 85 questions, or as many as 205 on the NCLEX-PN. Am I terrified? Is the pope stepping down? Terrified doesn't quite cover it.
I've been working at a private duty nursing place since May of last year, and now that I'm not in school, I've been working full-time.  When my patient is taking a nap, I catch a few pages.   Also studying at night when I get home. Our school had us purchase a review package from a "nameless" company. It was very expensive, and not very worth it as far as I can tell. I'm getting more out of my Saunders Comprehensive Review for the NCLEX PN Examination-4th-edition, Mosby's NCLEX- RN Review Cards,  and some old ATI books a friend who passed NCLEX gave me. It's weird, now that I'm out of school, I don't feel so stupid when I do these assessments and practice tests.
I've read every "plan" out there, but I'm hoping I picked the right combination of resources. You might be wondering when I'm taking it. Well, keep wondering. That's setting myself up for pressure I don't need. How about I just let you know WHEN I PASS?

Adventures in Nursing School

I know, I know, you think I don't love you, but I do.....just been busy trying to pass stuff, get through clinicals, ect. To say it's been crazy has been putting it mildly. My first week of school we were required to do two days of skills to be checked off on. I made it through the foley cath check off just fine. The trach care and suctioning...not so much. I ended up redoing that one. I also missed one on my med calculation test that we had to do for Pharmacology, so I repeated that one, too. But it's all good. That stress is over. Last Friday, I completed my IV check off skills, and that was successful. We had to do 5 skills: initiate the IV, insert a bolus medication, add a piggy back IV,  convert it to a saline lock, and then...discontinue the IV. All within 30 minutes. It wouldn't have been so bad, but they always teach you the old fashioned way to do it, manually getting a drip rate. That wasn't near as much fun, but I got through it. Check out my make shift IV pole! Hey, you have to use what you have or what you can get to learn on. It's really a pole to put in your yard and hang flowers or a birdfeeder on. That's what I told Hunnybunny we could use it for, anyway, after I purchased it from Hobby Lobby. And maybe you can see the "fake arm" I made. I got tired of waiting to use the manikins at school as there are so many of us, and not as many of them. So, I took a candle, width of my wrist; some modeling clay-rolling it out super thin to make the veins to lie on top of it. And then I put some spongy paper-like material on top for the "skin" Can you see the "veins" under the "skin"? Well, it worked for me so I guess that's all that counts. At least it smelled good from the candle.
As far as the other classes go, I'm doing fine. Intro to Med-Surg may kill me, but I'm still there. It's a 6 hour class and a 12-hour clinical. The clinical is going .....okay. Definitely need to bare in mind that you have to be more flexible than you ever thought you would be. I managed to get points taken off the first day! I had this patient with 20 meds to give and completely blew it. Not to mention that our instructor takes off points for diary-type nursing notes that we had to write. I know she wants us to be clear and concise, and I guarantee you, I will be by the time our last clinical is over.
What I've noticed most is that I don't have the "what if I don't make it" attitude that I had last semester. Don't misunderstand, I work HARD! I feel like I have to study twice as much as my under 25-year-old classmates. But I guess I've gotten to the point where I know I'm trying my best, and that's all anyone can ask. Even of myself.

So....my last post was a little tense....

so, I apologize. And I deleted it.  Stress was getting to me. Still is. A friend told me that she benefited the most from putting lots of time into notes. And I have to admit, she's right. Only I can dig through that text and totally understand what notes I've written. So, if I sounded judgmental, I think I was just feeling unappreciated by those I had shared notes with. They don't want to pitch in, it's really about them.
I had another test today and patiently waiting for her to post the grades.I'm feeling pretty good about it.

Next week, I have vital signs check off and injection check off...both on the same day! As far as being nervous, sure, I'm nervous, but not terrified. I probably should be. But I'm trying not to psych myself out.

I have been really enjoying most of my classes, especially Pharmacology. The teacher is passionate about teaching us the right way, and I appreciate her for that.

We received our new schedule for next semester. Here it is as follows:


Mental Health
Health Deviations
Peds
Pharm II

We hit the ground running with 12-hour clinicals. Thankfully, I got the new Timberland Pros. Aren't they positively "Ooogle-ly"?? But so far, they are very comfortable. I've been breaking them in every chance I get. Clinicals for this semester start very soon, and I'll be getting my assignment for them Monday. Sounds crazy, but this semester has really flown by.

The more you learn, the more you realize how much more you have to learn

And I've never felt this was true as much as this week! My first day was this past Wednesday,  August 17th, and no, I didn't sleep at all! I kept having that dream of being late so, I checked my clock on the half hour.

We made our way in, 60 of us in this particular class; all ages, shapes, colors, nationalities were accepted.  I had gathered all the paperwork we had to present for admission for months, terrified I had forgotten something important. All three semesters met in an auditorium and we were welcomed by our upper classmen.
Our main speaker was very enthusiastic and it was the first time I had seen her smile since my journey began. It was great knowing that others had sat where I was sitting and were about to graduate.

First, we began to go over syllabi, exam dates, and how to use the online resources. Then we started talking about clinical dates, uniforms, back up plans for transportation, etc.

Monday was the LONGEST DAY EVER! I was there from 8 am until 4pm. My brain hurt when I got home, and then the headache started. I was very glad to have the following Tuesday off as it's a future clinical day. Wednesday was almost just as long...just til 2:00. Thursday is lab/lecture, so its an abbreviated pharmacology day, 8:00 til 10:00. I was off today, but spent most of it working on my required online class.

Sticker shock!

  

No, these aren't all my books, but pretty close. Fact is, I'm still buying them. Wow, they told me I'd have to sell a kidney to pay for school, but I don't guess I fully believed them. So far, I am up to $206. That amount was six books I found on Amazon. I still have $500 more to come up with in books and supplies. I hope the subsequent semesters aren't this expensive.

    Thankfully, I had the foresight to get my laptop when I started prerequisites, and even got one of these: 


It's been pretty handy on this traveling thing I've done this year. And it looks like it will spare my back.

That butterfly feeling

"When you find your path, you must not be afraid. You need to have sufficient courage to make mistakes. Disappointment, defeat, and despair are the tools God uses to show us the way."

Paulo Coelho

Every time I start thinking about what this August is going to hold, I get physically sick on my stomach. Seriously. Like I did when I was pregnant with all three boys. I'm trying to figure out if this is normal or not. In my heart of hearts, I think I believe it is normal, but it's really freaking me out.

In a former life, I was an on-air personality at a well-respected, top 40 radio station. When I first started, I was really nervous, but eventually I got to the place that I could be talking to you in my studio, ask you to "hold that thought" , and go into my spiel. When the weather, or commercial was over, I could pick up exactly where I left off. My oldest brother was in the control room when I did this once, and he was amazed. My question is: is it like that in nursing school where you can get over the butterflies and do what you need to do without being scared to death?
Have any of you nursing students felt that way? And when did it get easier?

Happiness is Getting Your First Nursing Book!

I'll admit it....I'm a planner. I hate last minute ANYTHING. Am I a control freak? No, I'm thinking I'm not. Most control freaks like to control EVERYTHING and EVERYBODY. I am way too flawed for that. But, being that everything hinges on Pharmacology in nursing school, I felt the need to investigate the HOW. How do you "study" ahead for a course you haven't had yet and will determine whether or not you have the moxie to see it through the end? Here's what I've discovered, anyway, on how to study for Pharm:
1. Learn starting from category of drugs. (Seems logical)
a. side effects
b. toxicity
c. action
d. contra
e. endings names of drugs

2. Mnemonics is a good way to study, too. I found a cool site to start with: Medical Mnemonics.

3. I have found that doing a simple search on Google can be a great asset. Apparently, real teachers don't care who they teach as long as someone out there learns. You can find Power Points for lectures on any subject under the sun. And teachers love to have students learn at home, so do some research. If you want to dig into Pharmacology, this teacher, Jerry Carley, RN, MSN, MA, CNE, has this great nursing info site, including pharm. Click on his name and check it out. He's brilliant!

4. Allnurses.com is a great tool to find tips on how to study pharm, vent or just about anything else nurse related.

5. Networking. Don't underestimate the power of networking. I have found that most people have knowledge and experience that they are willing to share if you just ask. This past semester, I became friends with the most wonderful lady who just happened to be an LPN. (She had to take A & P again because of a technicality) And she was a wealth of information and mostly, inspiration. She made me believe I had a shot at being a nurse. I will forever be grateful to her. We studied our hearts out for that demanding class. A study partner is going to be your ACE in the hole.

Orientation of Sorts

I was ill prepared for the "orientation" segment of my nursing journey. Since I was an alternate, I had missed the first round of orientation. There were only 4 of us at this meeting. The administrator passed out the material, and we began to go over over everything. 
  I knew the shot record requirement was going to be a problem. In Florida, there is no centralized office of immunizations, and mine were done in the docs office over 40 years ago. It doesn't help the the doctor is dead as well.  So, I went to the health clinic and had them draw MMR titers. Also got the Hep B that was recommended. My arm had a huge knot from that shot.  Cool. Got that done.
Getting there early afforded me the "privilege" of going first to get my classes. I will be in class on Mondays from 8:00-4:30PM, with  the "How to be a nurse", essentially. (Lecture and lab are back to back). Tuesday is a clinical day which starts at 1:30 through 7:30. (Hey, I was an alternate: beggars can't be choosers.)  Wednesday is Pharmacy I , and the second lecture for the "How to be a nurse". Thursday is the Pharm lab. And Fridays...I collapse;)  Not really, but initially, I probably will.

Surviving A & P II

 So, finals are done and we all survived them. Anatomy and physiology just about killed me. Half the test was over endocrine and reproduction, and then the rest was cumulative. It's fairly sadistic to do that to students. But they do it. I felt like the class is what I would call a "weeding out" class as it started with 34 students and we ended up with 22. If you don't pass with at least a C, you have to repeat the course. So, a lot of people decided to end it before they choked on a bad grade. My crowd did pretty well, and my study partner, an LPN herself, kicked butt and took names. Afterward, we all felt like we had been prisoners in a war who were finally released. It appears I  got a C, which is fine with me.   I have a Russian friend I've been in school with for awhile who pulled straight A's. She had a 32 on the ACT, so she was rolling admission for the RN program. She's really a sweet lady, and has taught me so much about her culture. Hard to be envious of anybody that works that hard.

I'm taking the summer off to ride bikes with my kid and generally goof off. I have a few notebooks from my friend the LPN as she graduated from the program where I am headed. I also got some textbooks from a local trade in store in dosage, pharmacy, medsurge, and the actual NCLEX-PN book from Saunders. So far, I've noticed that the A & P is rehashed throughout the courses. Really, really, really glad I passed.

I'm in !!!!!!!

Despite the whole world going to hell in a hand basket around me with war, weather woes, and political mayhem, I received a call from my school. They offered me a shot at this fall's LPN class!!! So, I went today to fill out my intent form. The Pickle had to go with me as Hunnybunny was on a job. Could have rolled over and died when I was talking to the administrator, a very no-nonsense chick, and my 7 year old is removing the lid to the evaluation bin! She got on to him, and I wanted to die. Of all days, why did it have to be today that he acted like a 7 year old??
Anyway, I am stoked, scared, and very, very tired of studying for finals this week. I wrote a paper on JFK the movie for my humanities class and I have back to back finals on Sunday in anatomy and physiology plus a lab final. Joy, joy......
but still- I'm "walking on sunshine"!

Contained Joy

Well, I thought I would update you all on the school situation. They told us to check our information network at school by April 1st to see if we've been accepted, letter to follow. I did, and I was not considered for the RN program at all but I am an alternate (3) for the LPN program this fall! Personally, I am very excited, but you'd think I'd lost the showcase on The Price is Right the way the info has been assimilated. One person told me to consider other options. And some have been very ... "Aw, that's too bad. But I give you kudos for even trying." Huh? Did I miss something? I'm an alternate, for crying out loud, for a nursing program! I am in my late 40's and being considered to study with others to become a nurse. What more do these people want? No, I'm not a brain, most of the people I know that didn't get in sported a 3.8. I'm nowhere in that vicinity. But, hey, I MIGHT get to be an LPN! That would be so cool! Why is that not good enough for these people?
Done ranting. Thanks for listening.