My Cpne Saga Part 1: The Fall

[TheBecoming]

I had originaly posted this in the Disatance Learning forum, but I wanted as many Excelsior students as possible to see this.

It's a 2 part posting due to length. Feel free to post/email any comments or questions. Now that I'm finished with The Big Test I'd like to be able to help others along their journey.

MY CPNE SAGA PART 1: THE FALL

This is my saga related to the wonderful little test known as the CPNE a.k.a. The Completely Life Changing, Nausea Inducing, Brain Melting, Esteem Crushing, Almost-Get-Me-Divorced Test. (I'm sure many of you feel this is the more appropriate title).

Not only did I subject myself to this fun fest once, I liked it so much that I thought I would fail it my first time around just so I could take it again and experience its' lovely goodness twice.

I'll start with the first time I took it in February '08 and bring you up to my second stab at it this past week, June 25-27. I'm not going to go into detail about how you should do your simulated labs or how to do an abdominal assessment. All of that information is available elsewhere for you to find. I'll tell you what I did and how I felt through this experience. I'll try and remember as many details as I can, but some stuff is a little foggy.

Anyway................

I graduated as an LPN in 2003. I was lucky enough to get a gig at a hospital close by and I absolutely love the place I work at. It's a small rural hospital and I work Med/Surg and ER. The other nurses I work with are wonderful, the docs are good and I have been able to see and do a ton of different things since I've been there. I started to get the itch to move on to my RN in '04 and in October of that year I started with Excelsior. With work and family I needed the flexibility that Excelsior offered so it was a perfect fit. I took Psychology, Sociology, A&P, Microbiology and Nursing Concepts 1-7. I did fairly well with all my courses. I failed Nursing Concepts 2 and 4, retook them and got a B on both of them. After finishing the Nursing Concepts courses I applied for the CPNE. While waiting for my test date I took A&P and Microbiology. I got The Phone Call the first week of December '07 saying that my test date would be February 1-3 in Racine, WI. At this point I had just finished A&P and still wanted to have Micro done before the CPNE so that when I was done with The Big Test I would be finished completely. I started Microbiology December 5, hauled ass through it, finished December 25 (Merry Christmas!) and passed the test with a B on December 27. That left me with the whole month of January to study for the CPNE.

I used the CPNE study guide as my main resource for information. I read through that thing 643 times (that number is a guess, but I'm sure it's close). I didn't use pneumonics at all. I memorized each and every Critical Element for each and every Area of Care. After memorizing them, I wrote all of them down 3-5 times a day. For my Simulated Labs I obtained (stole) all the things I needed from work and set up a lab room in my house. I practiced my labs every night. I also used Allnurses.com (shameless plug), where I was able to read about all the good and bad experiences that people had, and I also discovered The Grid (One of the most important things ever invented by man. It's right up there with beer and the toaster. That's how important it was). I studied like a mad man for the whole month. I mean tunnel vision, nothing else is important in this world but this test kind of studying. I slept, worked and studied. I pounded and ingrained this stuff into my head, all the time looking forward to being finished and being able to enjoy the aftermath. I had taken so much time away from my wife and family that I had to pass, just so that I could justify all of the late nights, missed school events, missed holidays and your basic absent husband/father syndrome that can occur when you over-focus on something. I wanted to show my girls that if you work hard and intense the reward you get would be ten-fold. I just wanted to make them proud.

My test ran Friday through Sunday. It's a six-hour drive from my house to Racine. I live in Wisconsin and requested that my test site be in Racine or Madison. I didn't want the added expense of flying halfway across the country. I'm just lucky that I had two test sites in the state where I lived. I left Thursday morning by myself. I didn't want anyone else with me so that I could just concentrate on the test and nothing but the test. I brought a suitcase full of nursing textbooks to use in my hotel room. I brought food and drink to keep in the room so I wouldn't have to venture out. I brought my CD player and tunes and a few books completely unrelated to the test to help give my head a break if I needed it. I pulled into Racine at 3:00PM, just as the snow started. Man did it snow! It was still snowing at noon the next day. They got nailed with 13 inches of snow in one night. It wouldn't have been bad, but I wanted to head out and make sure I could find the hospital that night so I didn't have to worry about it on test day. It took 30 minutes to drive 5 miles. Not fun. I found the hospital and in my mind I was set to go.

I spent Thursday evening and the better part of Friday going over everything. I left the hotel at 3:15 to give myself plenty of time to make it to the hospital for the 4:15 start time. At this point I was a little anxious. More excited than nervous. That would change.

There were 7 of us who waited in the hospital lobby for the CA. If I remember correctly, all of us were testing for the first time except for one guy from Salt Lake City who was testing for his third time. I spoke with him throughout the weekend and the poor guy was visibly a nervous wreck. He said that testing situations made him extremely anxious and that's what killed him the previous times he had taken the test. I felt bad for him but at the same time I tried not to think about it and just worry about myself. All of the students there were friendly and talkative. They had come from all over the U.S. to take this test. We waited until the CA showed up and she took us to the room where the simulation labs were set up. It also served as our central meeting point for the weekend. She gave us our orientation, walked us through the labs and then we started. By this point my excited turned more into nervous which was fast approaching terror. My nerves which I was convinced were made of steel were actually made of rubber bands and licorice. I don't know where or how I lost it, I just know that I did. The importance of this test and the whole everything-is-riding-on-this-thing kicked in and turned me into a jittery idiot.

My first lab was the wound change. My hands were shaking so bad that I couldn't control them. I did all the steps correctly only to have my sterile wet to dry 4x4 hit the outside of the wound, contaminating it immediately. I of course didn't see myself do it. I failed my first lab. I tried to mellow myself out before my next lab, IV push meds. I bungled the syringe, dropped it, picked it up and threw it in the trash. I started over and finished the lab. I did everything right accept.......................... the syringe I chucked in the garbage should have gone in the sharps container. That's right kids, another failed lab.

The CA tried soothing my nerves to get me to calm down, which didn't help all that much. I knew what I had to do to get these labs done. It's not that I didn't know what I was doing, it's that my nerves were completely shot. I pulled myself together and managed to sail through the next two labs. Since I failed the two labs that meant I HAD to pass them the next day. Not a good feeling.

After the labs we went to the unit where our patient was and got the information for our first PCS. I remember the patient was a female, post op day 2 following an open appy. I don't remember what areas of care I had, but I do remember thinking it was an easy first patient. I went back to the hotel and poured over the PCS I had. I wrote and rewrote my nursing diagnosis. I went over and over my areas of care. I tried to prep myself as much as possible. After trying to choke down some food and smoking 100 cigarettes I tried to go to sleep. Of course that was impossible. I kept going over everything in my head and couldn't stop. I started fretting over the PCS and fretting over the labs. Everything was doing circles in my head. I could not sleep. The last time I looked at the clock it was 3:45 and I had a wake up call at 5:15. Not good.

I wake up, shower and throw on my white snowman scrubs. I get to the hospital at 7:00 and the other students start showing up for our start time at 7:15. There were 7 of us at first, but only 6 now. One student had failed all the labs and decided that she couldn't do it and left for home. We were all pretty stunned to find that out. We head to our meeting room and the nerves are really going again. We pair up with our examiner and move to our patients. My nursing diagnosis was given the ok so I was then ready to start. I wash my hands, knock on the door, say hello, tell my patient who I am and what I'm doing, and move onto checking her IV site and skin turgor. The examiner, who has so far been silent, speaks up and says, "Please stop what you are doing and step out of the room."

I immediately start backpedaling, trying to think what I could have messed up within the first 2 MINUTES OF MY PCS. I had no idea what I had done wrong. We get out in the hall and the examiner calmly tells me that I didn't use 2 identifiers for my patient. I said "Hi, Miss Patient!". That's it. I didn't check the patient name and birth date on her wristband. I do that everyday at work AND I FORGOT TO DO IT! That was it. I failed my first patient because of something as simple as that. I am a moron. I am such a moron that I teach other morons how to be morons.

The examiner and I head back to the meeting room after which I am convinced is the shortest PCS in history. The CA speaks to me again about my nerves. I nod like a bobblehead and try to mellow out before getting my next patient. My next examiner scoops me up and we head out to do my second PCS, which is a pediatric substitute. There were no pediatric patients in the hospital that weekend, so no one had a peds patient.

I remember very little of this patient as well. I don't even remember if they were male or female or what their diagnosis was. I know that my nursing diagnosis/care plan was good. I know that I made it through all of my areas of care without a mishap. I remember being very tense and clunky with my cares and taking WAY to long to do things that I should have sailed through. I took so long that I left myself with only 15 minutes to do my documentation at the end. I scribbled furiously so I could finish on time and I still didn't finish on time. The examiner gave me an extra 4 minutes to finish, bless her. I wrote like mad and finished. You couldn't read anything I had written, but I finished. I handed in my PCS form and waited for the verdict. The examiner had to call the CA to help read my writing and they ended up having to ask me what I had written in a few spots, but in the end, I passed.

I was high as can be after passing, which was good because I still had to get through the two labs that I had failed the day before. My nerves were still working overtime, but I somehow managed to settle enough to get through the labs and pass.

I was surprised to learn that of the 7 of us, only 3 had made it through the labs the first run through. I had assumed the labs were the "easier" part of the test for everyone and I was the only butter fingers in the bunch (except for the lady who bailed out after failing all 4 the first try.) We lost another student that afternoon. She failed one of the labs her second attempt and that was it, she was done. She had also failed one patient and passed one like I did. I was extremely thankful to live another day.

It was 12:30 when I finished the second day, which left me with a whole lot of day to use up. I stopped and restocked on food and hit the hotel for another round of studying. I tried to relax as much as possible, but nothing worked. My mind kept going a thousand miles a minute no matter what I tried. I called my wife 4 or 5 times that day. She tried her best to settle me down, but all I could do was lie and say I felt better. I studied and smoked and studied and smoked and studied and smoked and studied and smoked. Every once in a while I'd meet the guy from Salt Lake City outside smoking and we would try to calm each other down, but he didn't help me and I sure didn't help him. This test had gotten me so wound up and anxious that the only thing that would have helped would have been 4mg of Ativan. I tried going to bed at midnight. I remember checking my pulse because I could feel my heart thumping in my chest. My pulse was 135. Is it possible to sleep with a pulse of 135? My body finally gave in to exhaustion only to be torn awake at 5:15. I showered and packed up all my crap into my car because check out time was noon and I knew I would still be in the middle of the test at that time.

At the hospital, those of us left were visibly jittering. At that point there was only 1 student who had made it that far with no needed repeats. I knew I had at least 2 patients to get through that day, my second adult patient and then my make-up patient from the one I had failed. I was of course a bundle of nerves, but I felt ready. My advisor grabbed me and took me to meet my next patient.

I remember very little about this patient. My nursing diagnosis/care plan was good. I did well with my areas of care. I took too long again and cut myself short on time needed to document. I turned in my paperwork with no time left and I didn't get the token extra few minutes that I had gotten before. I sat and waited, of course still nervous as could be, and 20 minutes later my examiner and the CA came in the room. I knew I had failed. They showed me the areas on my evaluation form that I had filled in incorrectly and they showed me the area that I didn't write what I needed to write. I was right.................... I had failed.

It was 10:30 and I was done. I honestly felt like crying. I'm 6'2, 190 lbs. and I could have bawled like a little girl. I found a pay phone (I'm the one guy in America who has no cell phone. I still don't have one.) and called my wife to tell her I was done. Then I started the 6 hour drive home.

I can't begin to accurately describe how completely worthless and wasted I felt at that point. I had failed at something that I felt I should have excelled at. I thought about all the time and effort I had put into preparing myself. I had to go home and tell my wife that I had failed. I had to tell my daughters, my friends, my co-workers and my boss that I had failed. I had spent $2500 and I flushed it away. All the plans I had made for when I was finished were obliterated. I failed myself and I failed everyone around me.

It sucked.

At this point let me back track and say that the examiners and the CA at Racine were wonderful. They didn't fail me, I failed me. The CA was excellent and tried her best to make us calm and focus. She was very professional, yet easygoing. The examiners were also very good and I have nothing bad to say about them. They did their job. They are there to make sure you know your craft. If you make a mistake they are suppose to catch it. You have very, very little room for error. If you fail it's not because they don't like you, it's not that they are out to get you and it's not that they want to see you fail. They are there to make sure you perform at a high level of expectation. If you fail it's because you didn't perform at the level that is expected.

I failed in Racine, but that in no way reflects on the site. If you can take your CPNE in Racine, go for it. I wasn't sure at the time I failed how many students made it through the test and passed. I assumed that everyone still there on Sunday had made it the whole way.

I spent the next few days bouncing between depression and anger. I had worked so hard to get to that test that it killed me not to pass. I felt small and worthless because everyone was waiting for me to pass that test so life could return to normal and I would be there for them instead of school, which had taken up massive amounts of my waking hours. I had to go to work and tell the people that I worked with that I failed the test that everyone was sure I was going to sail through. I was angry and disappointed with my performance and myself. I was angry for not being able to control my anxiety and letting myself make stupid mistakes. All that was between me and a return to normalcy was that test and I had blown it.

Those of you who have taken this test and failed know exactly what I am talking about. If you haven't taken this test you might be thinking that I'm blowing this WAY out of proportion and being a little over dramatic.

Imagine training for months to run race. You train, you diet, you stretch, you train, you diet, you put everything you got into it. During the race you blow by everyone and keep the lead through the whole race. Five yards before the finish line you trip and fall. The guy who was right behind you passes you and crosses the line. You lost. Everything that was riding on that race is gone. When it came down to the final minute you blew it.

This test was that important to me. This test symbolized a pinnacle in my career and my life. I may sound over dramatic, but that's how I felt.

END PART 1