I did the Excelsior CPNE workshop in Irving the last 3 days. I had a great time and learned a lot. So, the question was posed......why is the test so difficult? Why is the pass rate only in the 60's%?
These are the components of the test.
First is the planning phase.
Implementation phase. You are given the things they want you to do
Evaluation phase. Evaluate your plan and the patient's response to what you did.
There is also the documentation.
Reasons people fail:
Medication errors. I could not believe how many in the workshop could not do the math. Even after a demo on IM injections, the nurse that volunteered to do it first, gave the injection right in the middle of the butt cheek, right over the siatic nerve and calculated the dose wrong.
Poor care plans
. I thought I was about a 3 on a scale of 1-5 before I went. I was a 1. After the workshop, I think I'm a 3 or 4. You need to be a 5.
The skills are the basics we learned in nursing school. Ascultate the lungs, ascultate the abdomen, vital signs, I & O's, ROM and PROM on a leg or arm, checking pupils and orientation of a patient, checking placement of an NG tube, giving an IM injection or SQ injection, checking an IV site, having a patient rate their pain, checking a patients hydration status. Assisting with ambulation. We did most of this our first day on the floor with a patient in LVN school..............so why the nerves?????? Because if you don't DOCUMENT it, you didn't do it and therefore you fail, and the documentation has to include a list of stuff they want. If you are assigned to assess respiratory status, they want you to assess and document breath sounds----clear or diminished, equal bilaterally? not equal? and breathing pattern-----labored or unlabored. But if you forget to document....beep.....fail. If you say normal----what do you mean by normal??? what is normal???? Beep.....fail. They want you to keep it simple, short and very understandable.
Evaluation. The form specifically asks what was the Patient's response to what you did for them. 90% of the class wrote what they did for the patient in just a different way. Beep. Fail. There is place to explain why you picked the ONE nursing diagnosis that you did as the priority. They are looking for nursing judgement related to Maslow's hierarchy of needs, not the nursing diagnosis restated in a different way.
DON'T DO WHAT YOU ARE NOT ASSIGNED. This gets lots of people in trouble. You have 2.5 hours to complete each patient assignment. They have figured out that if you are not nervous and you have any time management skills at all, you can finish in half that time. But lots of people come and they do more than assigned, they have no plan, they document stuff they weren't supposed to do or double document. They do stupid stuff like open a sterile field on the floor because the patient has a dressing change to a stump and the patient is in a chair and it is easier to reach.......hello!!!!.......can you think and put the patient back in the bed to do the dressing change????? They weigh the patient and they weren't assigned to weigh the patient. They empty and count the urine in the foley. They weren't assigned to do that. They forget to sign the MAR when they give a medication........you don't document, you didn't do it. They forget to write down the rate of an IV going. Their documentation doesn't cover the required items they want documented.
So, for all the people scared, don't be. This test is doable. You do have to study. Excelsior supports JAHCO, CDC and American Nursing Asso guidelines on "BEST PRACTICE". They expect you to properly use asepsis. They expect you to be able to put on sterile gloves properly and do a sterile dressing change maintaining a sterile field. They expect that you can calculated a medication dosage correctly. They expect that you can hang an IV correctly. They expect that you can assess an abdomen and place the stethoscope correctly... AND be able to document it so that the next nurse or doctor or lawyer can understand what you have written. They expect that you can do a simple care plan and evaluate whether your patient has responded to that care.
That is the CPNE.