19th Edition study guide
So, I need to start right off the bat that I really, truly, did not feel at any point (before doing this CPNE) that I could do this and pass successfully, the first time. I am not that type of person at all to be considered a ''Debby Downer'' either. Something about this test gets the best of you. Whether it is the nerves, all the money that has been on the line, travel expenses, all of your dreams you just want to make a reality, the time, energy and effort that you've spent, or the fact that you just want to be done. This is by far the hardest thing I can say I have EVER DONE IN MY LIFE. The pressure and stress for me was just completely overwhelming, but I did it! And I did not have to repeat any labs or PCS's. I wanted to write this because it helped me to read other successful peoples' journals and gave me a glimmer of hope that this can be done! Hopefully I can help others too!
The preparation time I spent was roughly 4 months. I did do the EC workshop which I found helpful. I did buy the skills bag from EC and practiced daily and timed myself. I also practiced all of my assessments on my 3 year old son, husband, inlaws, and my little sister. I felt this way I had a variety. Some young, some older. I work as an LPN at a nursing home currently and have to listen to lung sounds and bowel sounds all ready so, I did have some practice at work prior to this. (I've been an LPN for 3 years) I also wrote out the areas of care on flash cards and would mix them up and write out the critical elements. Once I memorized the critical elements I started writing out a grid for each area. I sent in my care plan submissions via email to the college, as well as utilized the care plan phone calls. I did not take the care plan conference or the documentation conference thing that EC offers. I felt that I received accurate information from the teachers reviewing my care plans and new how to correct my mistakes. As far as documentation goes, I felt that the study guide provided enough information so I knew what to document on after each assessment. But that was just me.. Do what works for you!
Day 1 started at 4:30 p.m. in the lobby of the hospital. The CA came down and took us to the lab room which basically consists of tables and chairs and all the lab stations set up. You introduce yourself, sign some papers. You are to select from a note card what rotation of the PCS's you will have for the next day. I happened to draw Peds, adult adult. Which I wanted anyway so I could review a few things back at the hotel. The CA checks your calculator to make sure its non programmable. CA explains each station as far as what is expected. Then you get 30 minutes to look through all of the lab stations and supplies yourself. All supplies you need are on the table in front of the station itself. Try on sterile gloves because they are marked S M L only. No 7 or 7 ½ like the ones in the skills bag. Also check out needle lengths. The required length for IM is 1 inch. They might try to trick you so be sure to switch out the needle to the correct size. Then the examiners come in the room introduce each other and then you start your first lab. If you pass the lab and have to wait for someone to finish the next one the CA directs you to a middle area between the 2 lab rooms until the next lab opens. The calculations were very straight forward. Everything was just as I practiced. Make sure to put sharps in sharps container with safety up first! My IV calculation was 16 gtt/min. I had practiced all different ones but never 16. I had to adjust my roller one time, after my first initial count because I had 21 and I didn't want to take any chances so I slowed it down a hair and nailed it. Don't forget to sign your mar! ID your patient prior to giving any meds. The wound station wasn't bad. I chose parachute method and passed in 5 minutes. It couldn't imagine doing any of the labs successfully without practicing my butt off let me just say that. 2/7 passed all labs with no repeats.
After labs I get my patient assignment with the CE who is examining me the next day. We discuss the peds unit, she takes me up to the floor. She gives me a tour. I look at the chart, get a run down of what kind of patient it is. She goes over the kardex and assigned areas, hands it to you and says basically ''Ill see you at 7am.''
My patient was a 2 month old with sepsis and constipation and irritability. No fluids running, no need to check picc line. I had a skin assessment (pick 2 areas) I picked peri and gluteal folds. I had to change his diaper to weigh it(1gm=1ml) scale was in the room. Abd assessment. Vitals, and comfort management.
So for planning I chose Impaired comfort and Constipation. I was exhausted because I couldn't sleep at all that night. 5:30 A.M came way too early but I had to think positive. I just kept saying. I can do this I can do this.
Go up to the peds floor passed my care plan for planning phase. Went into implementation. Wash hands check ID. CE was very helpful as far as keeping him quiet for me to listen to lung and bowel sounds. Got my assessment stuff done and headed to do my charting. Oops for got to check the anterior fontanel! Tell CE and we go back in and I get it done. Washing hands prior to entering and leaving of course. My interventions were reposition to my arms and change wet diaper. So I did that. My goal for comfort was patient will show signs of less discomfort after 3 interventions are performed. So I repositioned, changed wet diaper, and offered to change bed linen, but they had previously been changed. Baby stopped crying after diaper changed so that worked! And baby stopped crying after reposition to my arms so that worked too! Turned in all my charting and care plan eval phase.. And after 20 minutes (which feels like eternity) I PASSED!
Took a 20 min break CE grabs me from cafeteria for PCS 2. A 34 adult female with PVD and pain at 7/10. I had to do a PV assess of lower with Doppler. Resp mgt. with IS x 10 and cough and deep breathe. Fluid mgt. no IV running but had picc line. No need to assess site. Up to walk hall way x 1. Pain mgt. Pt teaching co-assinged with pain mgt. Full vitals.
Planning phase I used acute pain and impaired mobility. Pt will rate pain less than 3 after interventions. Pt will verbalize increased feeling of strength after ambulating hall. Wrote out my grid. Passed planning. Ready to go into implementation. Yes!
Lady was sleepy had previously been medicated with valium, dilaudid, and idk what the heck else but, I told the CE I have to get these assesments done. So I tapped pt on shoulder sorry to wake you but I need to check your ID and check your feet but first I'm going to wash my hands spheel. Get all my assessments done. Rated pain 7/10 before intervetions. 3 pain mgt interventions were Reposition, which I did. Gave her back rub, which she loved! And Turned TV on to distract. How do you feel now after interventions? 5/10. Perfect! Assisted her to bathroom after she was more awake and alert. Non skid footwear bed locked. Assisted back to bed Collected output. Did resp hygiene. Lung sounds prior were clear, Cough DB and IS. No sputum produced but I did have gloves on and tissue ready to go. Checked mucus membranes for my hydration check. Double checked my grid to make sure I didn't forget anything. Collected her intake which was a full water at bedside (she didn't drink any) If it wasn't full I would have asked to get her a fresh water so I would be able to measure it. She did not drink any thing when I was in the room so Intake was 0. Washed my hands before leaving.
Charted my @$$ off because I had so much to document on it was redic. Did my care plan eval of acute pain. Interventions worked so everything was met, however you do have to write even though pt did not report pain on 3, repositioning patient and giving a back rub will push patient toward meeting goal of less than 3 on pain scale. And for evaluation it's the classic: to be free from pain is a basic physiological need. If pain needs aren't met, pt may not participate in the plan of care resulting in a longer hospital stay and complications such as pneumonia. I used that same quote for every eval for my care plans. Have you completed all phases the CE asks.. YEP. Turned it in. 30 mins later, PASS!
I head back to the hotel feeling like $1000000000. I rocked the labs so no repeats. I rocked the first 2 pcs! Just need to pass one more adult and I'm out of here. I'm all ready crying at this point. I knew many had to repeat labs and had failed PCS. It was hard to stay focused but just focus on you and getting the heck out of there by 10 a.m on Sunday.
It was around 1:30 pm by the time I got back to the hotel after day 2. I was so wound up but physically needed to sleep. Ate some lunch and just laid down for a while. I cant believe that I'm so flipping close to this. I can do it.. I can do it.
Next morning I was up at 4:30 just wide awake. Nervous energy apparently. Couldn't eat anything. Took a bite of a granola bar. I felt like I could literally puke. I knew how much was riding on this. I cried that morning! Listened to some motivating music by the black eyed peas before I walked over lol! I get to the hospital at 7A.M and there were 3 left. It was very disturbing. Weather they failed the repeat labs or failed 2 adult PCS in a row I'm not sure. Tried not to think about it. CE comes to get me up to the med surg floor.
Last flipping PCS. 62 male with faciotomies. I had lower PV assessment, Pain Mgt, fluid mgt. Mobility transfer to chair x 1 with walker. Full vitals. I and 0. Meds. Planning acute pain and impaired mobility. Passed planning. I did all my assessments in bed. Asked about pain 7/10 lower leg burning for 20 mins. Repositioned to chair. Turned TV on and offered back rub, he refused. How do you feel now? The same. So I used impaired mobility. Pt will verbalized increased feeling of strength after Transfer. No he said he felt the same. Instructed to walk slowly also an intervention and he did. So my eval was even though he feels the same instructing him to walk slowly when transferring and using walker for transfer, these things will still push him toward the goal of verbalizing increased feeling of strength. So no need to revise anything.
Turned in all my paperwork. Prayed that this would be my last PCS. Cried because I have wanted this for so long. Paced the waiting area. CE comes back and says.. I have to ask the CA about something. My heart dropped.. What did I forget? What did I chart wrong? Ive heard the CA horror stories of people who then fail. Please please please.. don't make me do a repeat. I want to go home.. I am physically, and emotionally drained. So we walk down to cafeteria, CE tells me to wait. 20 mins later... CA and CE come back and say congratulations you passed!!!
I cant believe it I'm crying at this point. It felt such a relief to hear those words and to see that flipping paper! I wasn't really listening to what the CA was saying about working on a BSN and taking the boards. He directed me out of the hospital. I was in such a hurry to get out of there before they changed their minds! I walked the entire wrong way out of the building but that's ok! Ran across the street to the hotel to tell my husband the news (who was also on pins and needles all weekend) We were both crying because he has been in this with me the entire way. And I cant thank him enough for the support and for driving all the way here from Michigan and everything else really! I wanted a picture of me in front of the hospital with my letter like everyone else does. So we took one! Everyone was probably looking at me like I was crazy but I didn't care. I have worked so hard for this!
All of the time and energy and effort and up downs of emotions is horrendous. But the confidence I got from passing the labs first time definitely helped, and once you pass one PCS, it gets a little more routine. The CEs were all friendly and nice. The hospital itself is really nice too! I know for sure that out of the 3 of us at the start of day 3, one other did not pass. So it looks like 2/7.. Possibly just me. Which is not what EC says is the pass rate! I overheard people failing for not washing their hands properly, care plans not being done the EC way, forgetting critical elements, and not checking ID.
Just know your critical elements, practice assessments like crazy, and practice the labs over and over. I never felt 100% ready at all.. But I was so sick of looking at this IV crap and the wound, and mixing insulins, and writing out grids that I needed to just go and try and see what happens. What worked for me may not work for you. Do what helps you. Ill gladly answer any questions anyone has. If I can do this.. You can.
