My CPNE Journal~St Mary's 11/4/2011

[LoopsRN2]

Hi All

Most of my buddies have heard about it already, but I wanted to put it out there for my cyper-friends!

I passed the CPNE the weekend of November 4th, 2011 at St Mary's in Madison Wisconsin under the new 18th edition changes.

Background~

I have been an LPN since 1991, and started with a couple of years in long term health, moving to a telemetry/icu/er float position for a few years. I then worked night shift in OB-Peds, and then moved to clinic nursing. I began assisting the surgeons I worked for in the clinic in surgery in 1998 and I fell in love with the OR, and became a certified surgical first assistant a few years ago. I have wanted to continue my nursing education for a long time, but it was not possible with the amount of call I need to take, and I feel blessed with this opportunity Excelsior has given me.

The week before~

I was really hoping for a quiet week, but I never know what I will be doing day to day and sure enough, I was working day and night hours the 3 days prior to our leaving for Madison, Wisconsin. I will say that it cuts down on the time you have to obsess about the upcoming exam, lol! I was exhausted when I finally was finished with my call rotation Thursday morning- they day we were to leave. My 20 year old son came with me, and hubby stayed back to run our daughter to her activities. We drove 6 hours to Madison, Wisconsin from Northern MN, arriving at the Quality Inn and Suites at around 1 am (yup, not the best plan, but surely we can sleep in?! NOT....) Housekeeping was outside our room, banging in the next room's bathroom, slamming doors, vacuuming by 0800. I give up and head for coffee. It was a very nice, not so quiet, accommodating hotel. I booked it because it had a restaurant attached, but unfortunately doesn't open until 5 so we never dined there.

Here we go, SIM LAB~

In the hotel lobby, students testing at both Meriter and St Mary's had gathered and waited for shuttles. It was a very positive group of students, but a bit quiet. Shuttle driver picks us up at 3:45 pm and we head to St Mary's. We gather in the lobby of the hospital, meet with 2 other students and our CA Forrest arrives to pick us up and we head to our Sim Lab Conference room. Things were getting pretty exciting? I was finally able to set my eyes on the hospital was imagining for 4 months! How I would have loved to peek in on the OR unit  Orientation is very much like what you see in the DVD, paperwork, name tags, introductions, etc. I am tapping, waiting...I want to get at those LABS! Quick bathroom break and then it is play time with the equipment. Wound was the same, tried on gloves, opened the boat, IV minibag-pretty standard; Hmm...okay, the IV PUSH has paper packaging but not the hard plastic packaging I was used to, okay...no biggie there either. IM/SQ-separate needles and syringes, with needle protective recapping system. No biggie, play with it...okay fine. Lets go! First station, IM/SQ, praying for IM and YES! I got it. Do my calculation, no problem, open packages and assemble the needle/syringe and here comes the shakey hands!! Heard about this happening, didn't believe it, couldn't believe it! Discard my first syringe in the proper receptacle d/t shake...and #2....and #3! This is where I had my quick consult with Jesus as a friend had recommended and I was back on board. Draw up both meds, hand to CE and she has to have CA look at it, oh dear. No matter, I actually waited patiently and refused to get upset again and she came back and told me to proceed. I quietly verbalized my landmarks as well as palpated, aspirate, inject, sign...PASS! IV PUSH next, 1 ml over 30 seconds....went awesome...PASS! IV Minibag, little time getting the perfect drip rate, but there it was...PASS. Wound station, similar to my EC wound, but the inner aspect protruded more, little more tricky I thought to work around but no problem, PASS. I was so happy I was ready to burst into tears. Okay, lets get to the floor.

PCS1

My first CE was Tina, and she was amazing; She recommended good sleep, gave me an excellent orientation to my unit and made sure I didn't have any questions. My first patient was s/p incarcerated hernia w/stomal revision repair, a post GI post op, Yay!! Impaired physical mobility and Acute pain, I had a back up also but don't remember it now. St Mary's has electronic charting, and I was given ample time to look at the computer. I left and was back at the hotel sometime after 8 pm. We ordered Pizza Hut, and I looked at my care plan a bit more but left everything the same. I woke up at 4:30 am, looked at my care plan once more, and went down to the lobby at around 0600. The breakfast wasn't available yet but we were able to sneak some coffee. Our shuttle left at 0615 and we met with Forrest at 0630 in the cafeteria where our Mosby's and drug books were looked at. Our CE's picked us up here and we were off to the floors. I was able to access the chart once more, and my patient's blood pressure was running around 120/50, and I did ask my CE if she knew of any parameters for her Lisinopril, as I was scheduled to give it at 0800 and I didn't see any mention of holding it in the chart. She said we would need to check with the primary nurse. We did try and hunt her down for many minutes, and when I mentioned the BP issue, she said she would need to check. Okay, so now I am off to my patient. My patient was on the phone, on "hold" waiting to order her breakfast. I do what I can with intro/Id/20 minute check but things are not flowing very well. Her breakfast is ordered and I try to work fast now. I had VS/Transfer from bed/chair/abdominal assessment/pain management. It was a very nice first assignment, but it was by far the hardest of my 3 PCS because I had no "routine" or "flow" with my patients yet. My patient was making arrangements to go home, so she was on the phone for much of our time together. I do get my areas of care done, and make it out of the door and finish my charting with very little time to spare. CA came in with my CE and my heart just sank. I had documented patient quotations in multiple locations on my evaluation form, which was still a PASS! Here come happy tears x1. Things come up during your PCS, and the CA can be called, come to see you, just keep your head in the game and keep going! I had a few times during this PCS that I wasn't happy how things went, but I dismissed them immediately and moved on.

PCS2

Forrest brings me down to the conference room in the cafeteria, where I meet up with another successful student and we chat a bit. I have enough time for yogurt and juice and my CE is ready for my next PCS. After my first PCS, I had already made decisions on how I wanted my 2nd one to go, and started to formulate strategies. I was determined to work around whatever issues pop up and do what I can in a smooth manner, and I was PUMPED! I have Deb for my next PCS and away we went. My patient was a 2 day s/p total left hip, possible thrombosis in left popliteal. I was assigned up to chair or back to bed/abductor pillow/compression socks; Pain management w/ice pack; Resp Manage w/DB&Cough, IS; Neuro Assess and PVA!! Very exciting assignment! We had some trouble locating a new ice pack as the old was leaking, when I went to introduce to patient, PT was still working with patient so the CE and I went to sit down and wait for a few more minutes (and I was given 5 minutes back) We get into the room and I go to work! Patient is sitting upright in her chair, 20 minute check performed, Patient has half empty can of pop on overbed table, I and I ask if I can get rid of that one and get her a fresh one? Sure! Her water mug is full and on we go. New problem, patient now has in IV minibag to hanging which there was some concern as to if it should be assigned to me as it was added after I had done my care plan, CA was contacted and no, I don't need to count it, we keep going; The minibag is now beeping, and the CE is looking at the minibag and fixing that issue, and I continue to move to something I can verbalize to her so I can keep going, I ask if I may do the neuro assessment questions while she is working on the pump, and she said, "sure!". I assess the patient's LOC, and then we move on to hand grasps. I get to plantar flexion and my patient is having left leg pain radiating all the way done the leg and foot. I invoke CDM as I feel plantar flexion would increase this patient's pain, CE agrees, and we move on the PVA, then Resp Management; Patient produces moderate amounts of sputum with hygien! Yay, more success! Time to transfer, reposition patient back to bed, abductor pillow, compression socks, lifted up in bed, reapplied ice pack, reassess pain, and review intake and output, and we are done! My patient and her daughter were simply lovely, and I enjoyed every minute I was able to participate in her care. I have 45 minutes to chart, YES!! I used cheaper mechanical pencils I bought at Target, and the pencil lead was flying in every direction. I turn it in with 7 minutes remaining, and it comes back a PASS!!! Happy tears x2! I float down to the lobby, call for the shuttle and reconnect with my son at the hotel. We head out for steak dinner followed by a leisurely dip in the hot tub. No more studying. I slept like a rock!

PCS3

I wake up at 0430 and I simply can not believe that my last day is here! I head down to the lobby and all six students (at St Mary's) are all still in the game! Way to go guys! My 3rd patient was my pediatric substitute; I had an elderly gentlemen with admitting dx of afib/chf/sob/vertigo, S/P MI 1/2011; Activity intolerance and impaired physical mobility, with one back up; Patient's bp has been dropping with activity to 70/40, possible dehyrdration. I was assigned to transfer patient to chair, neuro assess (fall at home) medication, patient teaching with medication. My CE now is Jen, and again very nice. 20 minute check, vital, reposition patient-was slumped in bed and he is a tall man! Neuro assess, patient teaching re new antihypertensive, instructions given on how to assess radial pulse with return demonstration, meds given, smooth as silk! I love this! Time to get patient up to chair...and patient states, "I don't want to move again, my blood pressure will get all goofed up again. Nope." AHHH!! Time to deploy a revised care plan!! I needed to change my activity intolerance goal of "Will transfer saftely..." to "will reposition safely without an increase in shortness of breath" as well as change my interventions! Whoo hoo!! Resubmit, approved, went back to reassess patient, Intake and output, thanking patient for allowing me to participate his care and I am out the door with 35 minutes to chart! Chart my heart out, pencil lead flying and submit my paperwork and it is over! On the cardiac floor at St Mary's, we sit in an amazing sun room that looks out over a gorgeous wooded area, and the fall colors were glorious. Jen came back and said she needed to verify one thing with the CA (oh, heart sinking...but hang on!!) We walked down to the cafeteria, and a few CE's and CA are sitting at a table. Jen told me charting was just beautiful (yay!) but that one little thing needed to be checked. I think the problem was I carried down both of my dx in my revision, and I only needed to do one, but again, it was overkill. Jen came over and told me, "it is a pass, I hear you are done!" OHHH!! Tears X3 and in triplicate. Forrest gave me a big hug, and congratulated me. I am just bawling now, and Forrest said, "She is our crier this weekend, we have one in every bunch." And now I am laughing like crazy, so true!! St Mary's has a journal from previous students that have passed, and I was given the book to write some encouraging words. I had applied to our local nursing school in 1994 and was placed on a waiting list, and was accepted into the program 5 days after the start date, and I declined it at that time, but it has been my dream to go back ever since the day I turned that down. Because of my current position and the amount of call I take, I would not have been able to accomplish my education with a traditional program. I will forever be grateful for this opportunity as well as the amazing support I have received from fellow students. I have met some of fantastic friends on this journey!!

I prepared for about 4 months for this exam. I became one with the study guide, and set up a practice lab in my home. I practiced on my kids quite often. Lung sounds are far more interesting to listen to on an 80 year old post op with diminished lung sounds than a 20 year old healthy male--try to listen to a variety if you can. I did the EC Workshop prior to my clinical, as well as 2 months of Tina Logan's care plans (priceless!!). I would have done them both again, felt that both gave me great confidence. If I have any advice, I would say go into this prepared and try to enjoy your time with your patient if you can! It helped to keep me focused!! Good luck to all future testers!

Loops, GN :)

[BeachCathyRN]

:ancong!: so happy for you and thank you for the journal they help so much for those of us getting ready to go through it!!!

[Lisa1980]

Congratulations!!! I tested at St. Mary's almost 2 years ago. Forrest is an absolutely wonderful CA. I loved every minute at St. Marys. I stayed in the same hotel too. Again congrats Loops!!!

[Raggedy Ann]

congrats and thanks for the awesome journal. i agree tina logan is amazing. enjoy your new found freedom. blessings! traci:yeah:

[PomPomRN]

Congrats Loops!! Good for you!! Thanks a bunch for the journal. it is so encouraging to read journals from others who have already been there!! God Bless and good luck on the NCLEX!

[t-lo]

:hpygrp:

wtg loops!

on a side note...do you miss the red ink yet?:hhmth:

[t-lo]

:nmbrn:I love the Smilies on this site!

[LoopsRN2]

:hpygrp:

wtg loops!

on a side note...do you miss the red ink yet?:hhmth:

looking back on it, i am sure glad i visited the red ink lady!! thank you!!! :hug:

[Hotnurse06]

Thank you for posting your journal. It gives the rest of us encouragement. Congratulations!

[NurseCubanitaRN2b, BSN, RN]

Reading your post made me feel like I was with you. Since you have nursing experience already I'm sure that played a big part, and to add that you studied your butt off. Congratulations!!!