My Cpne Saga Part 2: The Rise

[TheBecoming]

Here's part two for your viewing pleasure.

MY CPNE SAGA PART 2: THE RISE

Even though I had this failure on my back, I knew I had to reload and give it another shot. I scraped up the money to take the test and reapplied. I knew that I was shell shocked from not passing, but I also knew the shock would wear off and I would have to do this all again. There's the 4-6 months to wait for a new date and I couldn't put it off for to long.

I of course spent a lot of time going over and over in my head the things that I felt had caused me not to pass.

1- The nervousness and anxiety that I had during the test was my main hurdle. That KILLED me during this test.

2- I knew my areas of care and critical elements inside and out. It was executing them in a timely manner that hurt. You have 2.5 hours for each PCS. Everything you do needs to fit into that timeframe.

3- My documentation was not up to where it needed to be. My care plans were poorly written and my evaluations were rushed and sloppy.

I wasn't exactly sure how to control the nervousness. In the end I just rearranged my thinking. I told my wife, parents, in-laws, and 2 people from work that I was retesting. My first time around I had told everybody. I figured that the fewer people I told the fewer I would have to tell I had failed if in fact I ended up failing again (a little pessimistic, I know). Then I told myself not to think about anything after the test; concentrate on everything up to the test and the test itself, but do not think of anything afterwards. Do not think of failing, do not think of passing, just focus on the test. During the test, do not think of the next step, think of only the step that you are doing at that time. My biggest change in thought came from my wife:

"You took the test once and failed. The hard part is over. Now you know how to do everything and you know what they are looking for. This is your test. YOU are paying THEM to test you. It's your time and your show. Go in, do what you have to do, then go home. Go in, kick ass, go home."

Is that not brilliant? That's why I married her.

As far as working on my slow pace with the areas of care, I went with the "Go in, kick ass, go home" theme. During your PCS all you have to do and all you are being "graded" on are your areas care and the critical elements involved. Do that and only that. Don't do anything else. I'm not saying blow through as quickly as you can and ignore your patients needs, I'm saying focus on what you HAVE to do. That is why you are there.

I ended up contacting Lynn (CPNE workshop) and ordering her PCS workbook and her Care Plan and Documentation workbook. I didn't do her workshop, I just used the two books. I went through the PCS workbook and filled in the whole thing. I then made up my own patients and diagnosis and assigned them areas of care to practice and document on. I focused mainly on my documentation, writing only what was needed and keeping it simple and straightforward. I did the same with the Care Plan and Documentation workbook. I picked a handful of diagnosis that were common and that I would most likely use and concentrated on those. I also took all the areas of care and attached nursing diagnosis to them. To keep it simple, any diagnosis I chose would involve an area of care that I was assigned. This made writing my diagnosis easier and would save me time during the PCS.

For example:

-Patient post-op day 2 following an open appy

-Assigned area of care: Comfort Management

-Nursing Diagnosis: Impaired Comfort r/t abdominal incision AEB patient c/o discomfort

Patient will: Verbally state a tolerable level of comfort

Interventions:1) Asses level of comfort

2) Reposition to position of comfort

For comfort management the main critical elements involve assessing your patients level of comfort and providing comfort measures. When you assess and reposition, not only are you performing the critical elements, you are also following through with your nursing diagnosis.

I basically tried to strip everything down to its' simplest form to make things as easy for me as possible and make things run slick and smooth.

Also, I divided my 2.5 hour PCS time into three chunks: A half hour for planning, one hour for implementation and one hour for evaluation. I would stick to that plan to keep me on task and provide me with the time I needed to make sure everything was done.

Excelsior started opening up test dates during the week, not just the weekends, so I was hoping that I wouldn't have to wait so long for a test date. I had my application in the second week of February, so I was expecting a date sometime July-September. I did get a cancellation call in May. It was a Friday-Saturday exam and they called me the Wednesday before the weekend. It was in Plano, Texas and there was no way I could make arrangements on that short of notice. I finally got a call the first week of June for a test date of June 25-27 in Madison, Wisconsin. I took it.

I kept reviewing the things I mentioned above and a week before the test I started practicing my labs again. After screwing up the first time I wanted to jam through the labs the first day with no repeats.

I left Wednesday the 25th at 9:00. It's 3 hours to Madison from here and leaving at 9:00 gave me time to check in to the hotel and find the hospital. My wife went with me this time. The time in the hotel room by myself the first time around was brutal. Way to much time to think and fret and worry. Having my wife there would help control the voices in my head and keep me relaxed. I did not use the hotel suggested by Excelsior. My wife found a hotel that was closer to the hospital and cheaper. Of course, I had my car to get back and forth to the hospital. A lot of people fly in to take the test and the hotel suggested by Excelsior offers shuttle service to and from the hotel. If you can drive to your test site, research the hotels in the area and I'm sure you'll find a much cheaper rate.

I got to St. Mary's Hospital at 4:00, ready for the 4:15 start time. There were three other students taking the test this time. Much to my surprise, one of the students was a girl who tested in Racine with me. I thought for sure she had passed the first time around. She filled me in on the other students who were in Racine with us. The guy from Salt Lake City who was on his third try taking the test had failed. He failed both his adult patients the same way- he didn't sign the MAR after giving his meds. Not once, but twice. Such a simple, yet huge mistake. Now he has to start EVERYTHING over; three strikes and you're out. I thought I was miserable after failing the first time. I couldn't imagine failing it for a third time. Brutal. I feel bad for the guy and I hope he keeps moving. She wasn't sure who else had failed or passed, but we both felt that the two other people who were there had passed. So, out of 7 only 2 had passed in Racine.

The other two people there in Madison were both on their first tries. The CE met us in the lobby and off we went to start.

The CA took us through the orientation and then we readied ourselves for the labs. Before I started I had zero nerves. I was excited to be there and ace those labs. I went through each lab step by step, moment by moment. I focused only on the step I was doing and nothing else. I wasn't nervous, I wasn't shaking. I was a machine doing its' job. I did all the labs well under their allotted times and passed all of them.

At that point I felt like a God. A king. An emperor. I told myself I was going to sail through those labs and I did. What a massive ego boost that was.

I met my first examiner and she took me to the floor to get the info on my first patient. She was a 65 year old who had a bowel resection 2 days earlier. No complications, textbook recovery. My areas of care were medications, comfort management and respiratory management. This was going to be a piece of cake.

My wife picked me up from the hospital and we went back to the hotel. I sat down immediately and wrote my Nursing Diagnosis/Care Plan. I went with Impaired Comfort and Risk for Impaired Respiratory Function. Straight forward and simple. It took less than 10 minutes to write everything down. I then wrote up my grid for the next day and planned out the PCS (You can't write down your grid for the first patient the night before. Nothing goes on the form but your care plan. I just wrote mine separately for practice.) The process took 20 minutes. I then put everything away for the night. There was nothing left for me to study, nothing left to look over. I knew I already had everything in my head that I needed. From that point on it was putting everything into use that mattered. My wife and I got take out (I believe the place was called The Glass Nickel Pizza Company or something like that. The food was good, the prices reasonable and they deliver. I recommend it.) and spent the rest of the night relaxing.

I woke up at 5:30, showered, ate and my wife drove me to the hospital so I wouldn't have to deal with parking (is she great or what?). I was a little nervous but it was NOTHING in comparison to the first time. I was excited to get moving, but I wasn't worried about my performance. At that point I felt confidant in my skills and I was ready to get it done.

My examiner and I went up to my patients unit and I got the standard unit orientation. After that I got started. My Care Plan was okayed and I wrote up my grid. I went through the PCS lust as I had planned the night before. I did my areas of care in the order I wanted to and at a good pace. I finished all of my cares within 45 minutes, which left me plenty of time for my evaluation phase. I sat down, wrote everything down that I had to and reviewed a dozen times to make sure it was correct and I hadn't forgotten anything. When I felt ready I handed in my form with 20 minutes to spare. I then sat and waited for the result.

The wait time following the PCS is the most gut wretching, brutal part of the exam. You feel someone waiting to be pardoned by the governor. I waited 20 minutes for the pass/fail. You know what? I FAILED! I forgot to sign off on my meds! The examiner said I had done everything 100% and was hoping that I would remember to sign the MAR. I didn't remember. I was baffled. I NEVER THOUGHT TO SIGN THE MAR! I could not believe it! What a massive DUH on my part (Didn't I say it was a simple but stupid mistake a few paragraphs ago? That's what I get for being a smart ass.)

I felt pretty damn stupid, but to be honest with you it didn't phase me too much. I was stunned for a few minutes, but my confidence was still running pretty high and I was sure I was going to be alright. I went back to the meeting room and met my next examiner.

My next patient was my peds patient. The first day you're there you draw cards to determine if your first patient is an adult or peds. She was a 17 year old (Talk about lucky. One of the other students had a 2 year old on isolation precautions who cried the entire time.) with Chiari Malformation. Her posterior fossa was misshapend, which caused the cerebellar tonsils to protrude from the bottom of her skull. She had surgical correction done 3 days earlier and would probably be going home later that day. I had NO IDEA what the hell Chiari Malformation was. My examiner was very helpful and gave me a lot of information on it (Google it and take a look). My areas of care were respiratory management, comfort management, neuro assessment and medications. I wrote up my Diagnosis/Care Plan, using Impaired Comfort and Risk For Injury, and wrote down my grid. My Care Plan was good, so I got started. Again I went through my areas of care in the order I wanted to and everything went smooth. For all of my PCS's I did my vitals immediately to get them done. I finished all of my cares in 45 minutes and I made DAMN sure I signed the MAR. I sat in my little room and wrote my evaluation, reading and rereading as I went to make sure I covered everything. With 15 minutes left I handed my paperwork in. I then stood in the hall to wait another excruciating 20 minutes to hear what the verdict was.

During the eval phase, if you screw something up and fail, the examiner will contact the CA and they will review it. The CA will then come by herself or with the examiner to tell you that you failed and how. With the patients that I had failed during the course of the two CPNE's the CA came by herself once and with the examiner twice. If your examiner comes to get you it's a good sign that all is well and you passed.

After waiting 20 minutes for the outcome the CA comes walking around the corner and almost bumps into me. My stomach slammed straight up into my throat.

"Oh hi!" she says. "I have to run upstairs quick. Don't worry, you passed." She kept on walking and got in the elevator.

I almost threw up.

My examiner came around the same corner and said "Congratulations, you passed!"

My initial wave of nausea passed quickly and I was elated. I went downstairs to wait for my wife to pick me up.

At that point I knew there was no stopping me. I had this exam in the bag. No more mistakes. I felt confident and ready to keep kicking ass. The first patient was a reorientation, but after that I was set.

The girl who had been in Racine with me was waiting outside for her ride. She had passed all her labs the day before and passed both of her patients. She was feeling good. The other girl with us failed one or two labs and made them up. She had failed one patient and passed the other. The guy that was there testing had failed some labs and made them up, but he had failed both of his patients that day.

You will have only 2 patients the second day of testing. The third and final day is when you make up the patients that you failed.

You can fail one adult patient and one peds patient. Any failures after that and you're done. If you fail both the first adult patient and the first peds patient you will make them both up on the third day, giving you three patients to test out of. I had failed my first adult patient so I had two patients to do on the last day. If you pass your first two patients you have only one to do on the third day. (It probably sounds confusing, but in my head it makes perfect sense.)

My wife picked me up and we went back to the hotel. I was wasted tired and napped for an hour or so. My wife and I then left the hotel and went walking around downtown Madison. We stopped at a sidewalk café for a couple of hours and had drinks, talked and enjoyed the summer night. It was like being on vacation. I didn't think of the test the whole night. We went back to the hotel and got food from the same place as the night before and I conked out for the night.

I had a hard time sleeping that night. It wasn't nerves that kept me up though. I felt on fire and ready to go. I knew that the next day was going to be all mine and I wanted to get it started. I went outside at 1:30 and enjoyed the quiet for a while. I went back up to the room at 3:00 and did manage to get some sleep before the wake up call at 5:30.

We all met at the hospital at 7:15 to get started. My third patient was a 39 year old female a few days post op following gastric bypass. Areas of care were Respiratory Management, Abdominal Assessment, Medications, Comfort Measures and Drainage Collection. Again I used Impaired Comfort and Risk for Ineffective Breathing Patterns.

I was able to use Impaired Comfort for ALL of my patients. If the same diagnosis works, you can use it. I didn't mix it up at all and come up with different diagnosis for all my patients. I used the simplest, most effective diagnosis I could for each patient. You don't get "points" for how many different ones you can use and the college isn't concerned with that for this exam. They want to know that you can effectively write a care plan/nursing diagnosis and implement it into your cares.

Again, I put the areas of care into the order that I wanted to do them in, with vitals being first. Everything went slick as could be. All cares done in less than 45 minutes. I didn't rush or feel rushed. I did everything step by step until that area was done, then I moved on to the next area.

I had plenty of time for my evaluation/documentation phase. I wrote and proof read everything multiple times until I was sure it was ready. I handed it in knowing that it was gold and that I would pass. I still paced the hall waiting to hear from the examiner though. She came into the hall and said, "Passed".

I felt great knowing that I had passed and was only one more patient away from being done. I followed the examiner upstairs to wait for my next examiner and last patient.

I get upstairs and the girl who tested with me in Racine was sitting and waiting for her last patient. She had failed what was suppose to be her third and final patient, so she had to make it up. She didn't appear frazzled or nervous at all. I think she knew that she had it wrapped up and all she needed to do was focus and finish up.

The other guy who was testing didn't make it. I'm not sure what happened to him or how he failed. I knew that he had failed both of his patients the first day and was having a rough time. I hope he returns again for a second try.

The other girl testing with us had failed one of her patients the first day, either her adult patient or her peds patient. As the girl from Racine and myself were waiting for our final patients, she came into the room with her examiner. You could tell by looking at her that she had bad news. She came over to us and started crying. I felt absolutely horrible for her. We tried to help soothe her because we had both been in the position of failing this test and knew EXACTLY how she felt. At the same time I'm trying to not focus too much on her failing because I still had my last patient to get through. The CA came and got her and tried to help calm her down, and my examiner took me out of the room to meet my last patient.

My last patient was a 63 year old man who had a THA done a week prior and had developed an infection in the wound. My areas of care were Respiratory Assessment (I had either Respiratory Management or Assessment for all of my patients; if there is one thing I can do blindfolded now it's Respiratory anything), Peripheral Vascular Assessment, Comfort Management, Drainage Collection (another JP drain) and another area that I don't remember at this time. I went through everything step by step as I had done with my previous patients. I finished in a short amount of time and had plenty of time for documentation. Again I read and reread what I had written before I turned it in. This was my fourth and final patient and I wanted nothing to ruin my chances of passing. I HAD to nail this one. I handed my paperwork in and began the waiting process.

Waiting for that last pass/fail was hellish. At that point, the machine that I was through the past three days had burned out and was replaced with a nervous, twitching human. I paced and waited and paced and waited. I knew that I had aced my areas of care and I felt confident that my documentation was spot on, but there was still that lingering flicker of doubt that I had missed or forgotten something that was going to make my plane come crashing to the ground. I waited 25 minutes, and then the CA came into the hall.

"Under Peripheral Vascular Assessment there is something missing in your documentation. Take another minute and figure out what it is."

I of course grabbed it, immediately went to the section I needed and started reading what I had written. I read, and I read, and then I read it again and then I read it again and then I read it some more. I couldn't figure out what I had forgotten.

On the outside I looked cool as could be. On the inside my brain exploded and I could feel it starting to drain out of my ear.

"Color, warmth, movement, sensation and pulse. Color, warmth, movement, sensation andpulse.Colorwarmthmovementsensationpulsecolorwarmthmovmentsensationpulsecolorwarmthmovementsensationpulsecolorwarmthmovementsensationpulse."

I had documented everything. There was nothing else that I needed to write. Everything was RIGHT THERE. My panic had consumed me and I thought that was it. I thought I was done. Everything collapsed around me.

I gave my paper back to the CA and, almost in tears, told her that I didn't know what else to write. I read what I had out loud to her. For the life of me I had no idea what I still needed to write.

"Oh, sensation. I don't think your examiner read that right. Let me take that back to her."

She left the hallway for maybe 10 seconds. She and the examiner returned and the CA said "Congratulations, you passed."

A HUGE wave of elation swept over me. I went from almost throwing up and crying to joyous ecstatic in one second. The examiner tried explaining what had caused her the confusion with my documentation but I honestly have no idea what she said. I didn't care. My head was in the clouds and I had not a care in the world at that point. I HAD PASSED!

We walked back to our meeting room and ahead of me I could see the girl from Racine already there. She made eye contact with me and I could tell by her expression that she was looking for a sign on my face that would say passed or failed. I gave her the old Gene Simmons tongue wag and the double devil horns followed by a huge smile. She screamed "Woohoo!", ran over and gave me a hug. She had passed as well.

All the examiners and CA said their congrads. There is a notebook at all of the testing facilities that students who have passed can write in and give encouragement to incoming CPNE students. I didn't write a word. All I wanted to do was find my wife and tell her I was done. I said thanks and goodbye to all and took off.

At 12 noon that day was check out time for the hotel, so my wife had packed up and drove to the hospital to wait for me. I went down to the lobby just in time to catch her as she was heading outside. I hollered out to her and she turned around to look. I'm sure that the whole morning was rough for her. She wanted me to pass as much as I wanted to and everything had come down to this moment. The look on her face as she turned around was almost blank. She just stood there and waited for me to say SOMETHING. I threw my arms up, smiled and said, "I'm done. I passed."

She exhaled loudly and hugged me. It was and always will be a highlight of my life.

What can I say now? I was on the biggest natural high of my life on the drive home. I was able to return the victor. Even now, 2 weeks after having passed I still feel awesome. I get to start a new chapter in my life. The opportunities open to me are endless now. All of the work and sweat paid off and I get to sit back and enjoy it now. All the time spent reading, studying and practicing is done. That time can now be spent on my family and the things I have wanted to do but couldn't because my focus was elsewhere.

For those of you who have yet to take The Test, I hope I gave you some insight into what to expect. Remember that what I have written here is my account. This is what I experienced. Someone else who has taken the test I'm sure has a completely different tale to tell. Or, maybe they don't. Either way, all I can tell you is to study and practice in whatever way is right for you. There is plenty of literature, web sites and workshops that you can use to help you along the way. Research everything you can and find out what is going to work best for you to help you pass.

To those of you who have failed and trying your second or third time remember the famous words of my wife- "Go in, kick ass, go home." You know how you failed the first time. The first time was a practice run. Now you know exactly what you need to do. Strengthen your weaknesses until they are no longer weaknesses. It's your time, your test. "Go in, kick ass, go home."

Any questions or feedback are welcomed.

Good luck to all!!!!!!!!

P.S.- You know the CPNE study guide, the one that I read and poured over 643 times? The evening I returned home I dragged out my grill and I burned that guide until there was nothing left. You know those study guides that you get for every course that you take? I burned all those as well. It felt good to torch all that stuff. I recommend that to all of you when you're finished.

[Melinurse]

:lol2: Loved the study guide burning!!!!:hehe::hehe: You've given me a great idea for mine.

[Lunah, MSN, RN]

You have no idea how much I wanted to burn my study guide and throw that critical elements CD out the window on my drive home!! Only the fact that I had promised another student that I'd send her all my shtuff kept me from doing it. Let me tell you, that was one package I was happy to seal up and ship out!! :)

I am SO PROUD OF YOU!! It's all well and good to pass with no repeats, but it's another thing to fail parts and have to repeat them (been there, done that, forgot to ID the patient!!), and THEN it's another thing ALTOGETHER to fail the CPNE and go back for more. So my hat's off to you, man!! You rock. And so does your wife!! :)

[cynditoksRN]

Congratulations, ur story is such an inspiration. u must be very proud of urself.

[Manderlay, MSN, APRN]

Great read! I hope others are inspired. You certainly captured the whole CPNE experience with your account of the "monster".

Congratulations and much success for your future career.

[TashaLPN2006RN2012, ASN, RN]

Thanks so much for sharing your story!

[firegrrl]

I had a great time reading your saga....thank you for sharing your story, and congrats on choosing such an awesome life partner!

[toicole]

This was a very inspirational story, Congrats to you. You truly have a gift for writing and Nursing. :yeah: I love the words you wife gave you, she is exactly right.

[dkhrbh]

Thanks for sharing your story. The CPNE is the one thing that has me scared to death. This gives me the courage to keep going for my RN through EC.

[greenvalley]

thanks for all the info it was a good read, i'm still terrified, i guess they feel we have money to burn on retests, lvns earn soo much money!

[SuesquatchRN, BSN, RN]

Do you know what? I brought my husband with me this time and he has been my strength.

I failed IVPB tonight - I discarded an unused flush in the trash instead of the sharps container. I SWORE that I hadn't done that, but I had. She dug through the damned trash to find it.

It's okay.

Mike (husband) keeps saying, "You're just going to work in the morning. It's not like you don't know this stuff. You're a nurse!"

Just pray that I don't flunk the push again.

[formyfly]

thanks for all the info it was a good read, i'm still terrified, i guess they feel we have money to burn on retests, lvns earn soo much money!

You are an inspiration, and you have one hell of a wife! I like her moto, kick ass! Congrats!