I apologize for taking so long to post this here... I've posted in 2 other boards and can't believe I forgot this one!!!
After passing at Grady...
I would like to share my thoughts on this test after taking it at Grady this weekend. I don't know that I'd feel any different had I taken it elsewhere... I doubt it. I passed with no repeats on labs or PCS's. The CA and most CE's were nice and professional at this site. I personally feel that this should be a graded test, and not a pass/fail one, but that is beside the point.
This was the most stressful thing I've done in my life (and I've had my share of stress...). Sorry if this is long.
Yes, it is doable. I did it. But it was VERY HARD. I had studied my brain out, and still, it was VERY HARD. I set up a home lab and practiced all my skills and PCS ad nauseum, and still, it was VERY HARD. I had prayed until I had calluses on my knees, and still, it was VERY HARD. We all know how difficult this test is because we hear people tell us that all the time, but we don't REALLY KNOW until we've taken it ourselves. It's very easy for me now to see why so many people fail - ANXIETY/NERVES! It doesn't matter how well you prepared, if you don't get your nerves under control you will fail. Taking that into consideration, it's SO important to be truly ready with the things that you CAN control beforehand, one of them being the academic part of your preparation.
You MUST know your critical elements like you know your name and DOB (I know everyone says that and it is true - if you don't have them engraved in your brain, you will forget something when writing your grid, and omitting one single element is enough to fail you). You MUST be proficient on all phases of your care plan (just some of it won't cut it). You MUST be organized and show that to your CE by the way you control your room and your patient. You MUST be flexible and able to change your game plan in a moment's notice. You MUST keep your cool and your composure even if inside you're in shambles and feel like you're going to throw up on your pt or CE at anytime. You MUST be assertive and ready to "professionally and tactfully" advocate for yourself and intelligently explain the reason for whatever decision or choice you may have to make over the course of this weekend (be it a NANDA label, an outcome, an intervention, a CDM...).
If you fail a lab (or a PCS), PLEASE excuse yourself and go to the bathroom to regroup, pray, wash your face. Don't allow the CA or CE's to rush you into the next station (or PCS). I saw people this weekend failing a station for a silly mistake made due to nerves, and then moving right on to the next lab just to fail again. Regroup. Be mindful of the time you spend on your labs and PCS's. Your mind may play tricks on you because of anxiety and you may be second guessing yourself on your steps, math, technique, and end up running out of time. Someone this weekend failed a station because she ran out of time. This same station was taking her 7 minutes to finish at home. Watch for silly mistakes - again nerves... syringe in sharps container (not trash), watch your bubbles, watch your dosage with much care (difference of 0.1mL on a saline flush was brought to the table this weekend), ID your model, gloves on to push, lower your primary for IVMB, ID your patient first thing in the room, ID your patient AGAINST MAR before you give your meds. These are all things that we know to do. These are all things that failed students this weekend because of extreme anxiety. They couldn't believe they had done (or failed to do) these things.
Watch your time for each PCS. You may think that 2 ½ hours to take care of just one patient is a lot of time. I thought so too... Remember the clock is ticking for you to check your chart, get report, do your grid, implement your care, evaluate and document all your care. Time flies. Interruptions happen and things may not go as planned. Allow for that on your preparation. You may be very OCD like I am, have all your care mapped out, but when you get in the room things may not go the way you anticipated and you have to be flexible, think on your feet, and get your cues from the pt. That's why your grid is so important! Refer to it shamelessly. Ask questions from your CE - the worst that can happen is hearing "I'm sorry I can't answer that". Check your chart for your baseline data related to VS and all your AOCs. Take the report you receive from nurse or CE with a grain of salt.
Don't be afraid to ask your CE to help with doing something for your pt that is not assigned for you to do but is being requested by the pt. For instance, pt is unable to feed himself and ask for you to feed him. Your clock is ticking and you don't have time to play tech. Ask the CE if she minds feeding him while you continue with your assignment.
The worst that can happen is for you to hear a "no"... at least, you tried. It's better than running out of time later when you're trying to document everything in 15 minutes.
For the first PCS in the morning, keep in mind the darn breakfast that will come while you're trying to provide care. That can throw you a curve ball and I can attest to that...
Be mindful of your time with peds as well, considering interruptions, parents, and the willingness (or not) of the patient to cooperate with care.
Consider also the possibility of your mind going blank as you are on your planning phase. You may be doing care plans now in 5 minutes with your eyes closed for various patient scenarios, however you are not stressed out at home while you do them. Same thing goes for your mock PCS at home. I always had a perfect "patient" at home that followed what I said, when I said it, and didn't have a mind of his own... not so much on the floor :)
Be careful with medication dosages. I know we've been nurses for a million years but we don't practice under the kind of stress you will experience during this test. When your CE hands you a pill don't assume that's the dosage you're supposed to give. The medication is coming out of the Pyxis and being handed to you by your CE because YOU don't have direct access to the Pyxis. It doesn't mean she is handing you the medication dosage that should be given - it's the same as if YOU were opening the drawer to retrieve the medication yourself. It's not because it's in the drawer that it's the correct dose for your pt... the fact the CE is handing it to you doesn't automatically make it the right dose or medication... That pill may have had to be scored... (another issue this weekend).
Watch your documentation and make sure you don't miss writing anything down. One single thing forgotten will render your whole PCS a fail. Even if you did it... if it isn't written... (another issue this weekend). All these are things that happen because of stress, not because you don't know any better.
Be VERY meticulous, deliberate, and verbal in your actions during your PCS. Don't assume the CE is looking or "must have seen" you perform the elements of your AOC - another problem during this weekend... Find a balance between being gentle and humble versus assertive when dealing with your CA and CE's. Do believe you can do this, you are prepared, and trust your judgment. However, don't bring in the attitude of "I know it all" and "I could never fail this"... they will read you and that won't sit well with them.
Try not to be bogged down by what's going on with the other students. That was very hard for me as I normally empathize with people. I kept praying for me and for them, wondering if they were doing OK, and being sad and crushed when hearing that so and so failed at such and such. Try to focus on your performance and yours alone. I know it sounds cold, but you can't get distracted. That was very difficult for me. If you don't have that particular problem, it may still cross your mind that the person who just failed could easily have been you... Try to stay positive and remember how much you've accomplished. Remind yourself that every lab and PCS you pass, you're one step closer to the finish line... you're almost there!
I hope this helps some. It's not my intention to discourage or make anybody more stressed out. It just doesn't seem right to me to come here after seeing what I saw and felt what I felt, just to say "It's doable! You can do it! Just go for it!" I think that would be a disservice... Yes, it is doable! I did it! And I am so thankful it's over. You can do it too! However, you MUST be prepared academically, mentally, emotionally, and spiritually. I'm committed to continue praying every weekend for the testers. Feel free to pm me if you think I could be of any help.
Be Blessed!
Claudia
