Passed CPNE in Mansfield!

Baloney Amputation, BSN, LPN, RN · Nov 16, 2008

Congrats, Sara!!! :bow:

SuesquatchRN, BSN, RN · Nov 16, 2008

:nmbrn:

Congratulations, Sara, GN!

Lauren'sMommy · Nov 16, 2008

SARA, Job well done!!:ancong!::ancong!::ancong!::ancong!:

cynditoksRN · Nov 16, 2008

Congratulations,God is good.

it's hot in phoenix · Nov 16, 2008

YEAH :yeah: :yeah: :yeah: Sara GN,doesnt that look good, great job:bowingpur:bowingpur:bowingpur, donna

Melinurse · Nov 16, 2008

:w00t: :hpygrp: :dncgcpd::dancgrp::dancgrp:

Raggedy Ann · Nov 16, 2008

:yeah:i work nights, so as soon as i got up...i got on this site especially to see if you had posted anything. yay!!!! you passed! i know you are just elated. you so deserve this. how long did it take you from first test until today. you like so many others are a true inspiration to the rest of us that are working hard toward realizing our dream to become an rn. thanks for sharing! so proud of you. enjoy your day and your trip home tomorrow. stay safe. hope you complete a journal. i have printed everybody's off, so i will have that info when i am going thru my cpne prep. anyway...again, congrats! now you can start studying for the nclex...after you chill a bit. traci

Editorial Team / Moderator · Nov 16, 2008

:anpom: :anpom: :anpom: :anpom: :anpom:

caliotter3 · Nov 16, 2008

:hpygrp: :ancong!: :hpygrp:

pielęgniarka, RN · Nov 16, 2008

Ok I had nothing but time as I wait to go home tomorrow-- since I was out of the hospital by like 10:15 this morning! So as requested here is my very detailed journal. I'll post it on the EPN too, but I don't have my log in password memorized so it will have to wait until I get home.

So grab a glass of wine or a bag of chips or something and make yourself comfortable, this will be lengthy!

Day one all 7 of us met in the hospital lobby at 4pm or so. I could tell we had an amazing and intellegent group of students! The CA came and met us, she was very lively and upbeat and encouraging which was very refreshing as I was expecting a robot of some sort. She took us down into the bowels of the hospital in Mansfield to the nursing education area. We all introduced ourselves by name only per the CA's request. After that we had about 30 maybe 45 minutes where she read us through a guide, signed some stuff and got the routine squared away for the w/e and then we could check out the labs and the instructors answered any questions at the end. We also find out who our CE is for the morning and if we have pedes or adult for the first PCS. I had pedes, and was relieved! Get the higher risk one out of the way. But either way it works out. So we get to go around and mess with the wound, check out the dummies for injection sites, she said to open up whatever we wanted to. For me, I couldn't see any of the previous injection sites on the mannequin so don't count on that backing you up.

So we all go to wait in the hallway and the CA calls us in one by one and tells you what lab to go to. My first lab IVP. I completed all the critical elements but went over in time-- I could have kicked myself. Right when I was ready to attach the medication, the CE said I'm sorry your time is up. I didn't think I had been there more than 5 minutes! So I went and finished up anyway and prepared mentally to manage my time better tomorrow for the repeat. Not the best way to start out.... The calculation was easy 2 ml over 1 minute. I just fought with air bubbles. The CA told me, instead of bothering to flick them out, next time just toss the syringe in the sharps instead and start new. Advice I'd heard many times over but I was dead set on just using the draws I got the first time. I just didn't realize it was taking me so long. I knew I had the routine down for the lab, instead of using mnemonics I just wrote down on my calculation page: ID pt, Palpate, Aspirate, MAR, Sharps.

Second lab was wound. Did that with plenty o' time to spare. I had to go through 2 sets of gloves, they are really bunched up, not the neat ones you get in the skills bag from EC. The CE started laughing when I was packing the wound... she was funny though... she looked mortified after she saw all the color drain from my face when she laughed, and she said... no no it's not you! I was like are you sure? And she said I'm sorry go ahead. I still don't know what was so funny! Oh, I opened up my gauze the long way like a loose ribbon and fed it from my palm into the wound so the pattern was like flower pedals, holding the pedals down with one sterile finger. I tried the parachute method a bit at home but couldn't get it to work as well for me.

Next one was IM/SQ lab. I got IM meds to mix.The syringes are very straighforward. 22 or 25G, 3 or 5cc or insulin syringes. I already had decided on the ventrogluteal. You can totally feel the trochanter and the iliac crest so I was very confident on the placement for this one. I asked the CE to hold the dummy and they are very accomodating: she said just let me know exactly what you'd like me to do. I think my total ml's was 2. For this lab I just wrote ID, Aspirate, MAR, Sharps, on the calculation sheet.

IVMB I got 25 gtts/min for my calculation- the one I'd been practicing the most. I seriously got my 6gtts in 15 seconds the first roll I did the with the clamp! I rechecked it for 2 more minutes after the line settled and she asked if I was done with all the critical elements and I was! It was no time at all. A nice way to end the labs anyway. I wrote on my calculation sheet here ID, Palpate, Lower (primary), Air/Kinks, MAR.

After we were all done with the Sim labs that evening our personal CE for the next morning takes us up to the floor we'll be working on and lets us gather info on our pt. I had a preemie, she was almost a year old but weighed as much as my kids did when they were born. She had URI and wheezing. I got my info and went back to the hotel to work up my plan of attack. I picked Ineffective Airway Clearance (later added r/t retained secretions AEB abnormal lung fields). PT will have patent airway during PCS. and Interventions: Reposition x1 ( I had to hold her x1 on kardex) and assess o2 saturation (which was also assigned on my kardex) This one ended up being my priority. My other dx was old reliable: Risk for Injury (r/t maturational age added later)

Got there the next morning a little before 7am, meeting in the hospital front lobby again. Every now and then a staff member of the hospital would stop by and wish us luck, how nice that was to know that they were rooting for us as well! I guess not all nurses eat their young! AND what a wonderful bunch of EC students we were! We talked a little about things to lighten the mood a bit: things like Hannibal Lector, and Nurse Ratched, and serial killers LOL! We went up to our floors, I turned in my care plan for approval and then wrote up my grid. We enter the room my pedes was snoozing. The CE's do guide you a little, just barely though. She said hey, now that the baby is sleeping it would be a great time to start with some of those VS..... hint taken. I had abd. assessment, respiratory assessment, VS: AP, O2 sat, FLACC pain, Neuro assessment, I&O's and weigh diaper, and something other things. Oh, she had a saline lock to her scalp. Baby was also on an apnea monitor. I had that PCS done in about an hour and a half. Finished up on charting checked everything over about 12 times, turned it in & I was so nervous I was forgetting something but 20 minutes later the CE came back and said CONGRATULATIONS! Lets get you to your next CE so you can get ready for the next pt.

I got a break for one hour and was taken to a different unit to get report on my next pt. Pt had COPD and telemetry attached and 50% o2 at like 12 L Veturi Mask. I had IV meds, Respiratory teaching, Neuro, Resp. Managment and god it seemed like tons of other stuff. Pt had a saline lock that I had to flush prior to starting the IV abx. The saline flush was 3ml-- the syringes are prefilled with 10ml. So in the med room where they store the IV's the CE set up my supplies, I had to pick the med out of the fridge. I got the flush ready there too, drained the extra 7 mls out over the sink. IVMB was 250ml to infuse over 30 minutes (but pumps are programmed to admin hourly so calculations need to be doubled) Anyway, I nervously figured out the ml/hrs beforehand, but it turns out the ml/hr is listed on the IV bag anyway. :-) so I fretted over nothing. It's probably a good idea to figure it out I guess. I used up all 2 hrs and 30 minutes (plus some time) on this one. I was so worried that I would fail because of time and I had to really write furiously to finish up on my charting! CE checked in with me once and said it would be a while before she had a chance to confer with CA and it ended up being AN HOUR AND 25 TOTAL MINUTES LATER! Said sorry for the hold up but the CA was busy with other students. She said congratulations! I had passed! WOO-HOOO I won't have to do make-up PCS's tomorrow and by Gods grace I will pass the one PCS at that time I would have remaining. For my care plan I used Ineffective Gas Exchange (r/t dyspnea AEB fluctuting 02 sat) I think and Risk for Injury (r/t fatigue), LOL. Also, when I was sitting there charting, the CE said to me IF there's anything else you need to go back into the room to do, let me know so I can go with you. I went ohhh shi*t. What did I forget? Looked over my grid, it was all checked off. Looked at my Fluid management sheet, it was all filled in. Figured I was reading too much into her statement and decided not to go back in. Everything ended up being fine. They probably just start saying that to all students to help them double check that everything was done.

Do or Die: I had already decided I would drive off a cliff if I failed this one. Went to do my redo on IVP. calculation ended up being 1.5 ml over one minute. Got it done in the nick of time! They all-- CA and CE's-- gave me hugs and said good job. Got back to the hotel, called my husband just bawling for stress relief. He thought I had failed or something. I'm like no, no it just all went so good! It was so hard but it went so well! Went back to the hotel feeling like 100,000 bucks. Tomorrow I would feel like 1,000,000 bucks! I ordered a bacon cheeseburger with garlic fries and a large glass of wine for room service that night, took some benedryl for sleep reasons, set my cell phone alarm clock, the room alarm clock and set up a front desk wake up call so I would be sure to get to the hospital on time. I was mentally and physically exhausted.

Last day. I sat in my car and rocked out to some 60's music before heading in, they were doing a best of the 60's on sirius. I'm only 31 but feel like I was born a few decades too late :-) Went in to the hospital lobby feeling pretty confident. Was led to a different unit again with a new CE. Got report on my pt. He had aspiration pneumonia. I was assigned IVPB med, Respiratory Management, Respiratory teaching, 2 PO meds for after breakfast, PVA, I&O, umm what else, O2 management? I don't remember. For dx I picked Ineffective Breathing Pattern (later added r/t retained secretions AEB abnormal breath sounds in 4 lobes assessed) and Ta-daaaa Risk for Injury (r/t needing one assist with transfers) The IV med was 250 mls to infuse over 90 minutes. So that had to be calculated into hourly increments. Again, the ml/hr is on the IV bag but I figured it out beforehand anyway just in case the CE decided to ask before I saw the bag. Again the CE does things to help you get though it. She would say, this paper towel would make a great barrier to use when preparing the IV, etc! Man, when I went to hook up the IV med, it was the last thing I had to do. ID'd the pt with the MAR, palpated the IV site, took those gloves off, went to hang the med and all of a sudden my hands started shaking because I realized everything was perfect up to now and I was almost done and almost sure to pass. She knew it, I knew it. My eyes went unfocused and I thought I would contaminate the spike! CE chuckled and said hard to do when your shaking, huh? I got it spiked and hung the bag. Oh, I had to backflush the IVPB line on all my IV meds, so that made it easier. I didn't have to hang a new line or anything. I thanked the pt profusely and went back to do my final charting. Used up the whole 2 hrs and 30 minutes on this one. I had time added on when the nurse and doctor were making rounds so that helped. The CE was beaming when she walked away, but before she left, she had me sit down and got a glass of water for me. Came back in 15 minutes after conferring with the CA and said great, you're on your way! I said, I passed? She said of course! Led me back to the meeting room where all the CE's and the CA were waiting. The CA had tears in her eyes. I think they love to see people be successful! I got hugs and congratulations and questions about how long I've been working at this, etc, etc! There was one other student that finished the same time as I so we hugged and walked out to our cars together. We both chuckled on what it was like feeling as light as a feather! Man, what an amazing feeling! Truly!

Tips: Make up a mad scientist lab in your basement. Get the skills kit and practice the sim labs until you can do them without looking at a list. Then have someone observe you while you do it and them hold a checklist to critique you. My husband works in construction and he was my "silent observer". It's much harder with an audience. Make a dummy out of old clothes. And hook it up to an IV. It may scare visitors to your house but-- practice PCS dialog and go through all the AOC motions with this dummy until it's second nature.

Get a calculations book and practice figuring out IV pushes, and IV gtt/min rates, and IV ml/hr rates, and mixing med formulas. Get comfortable with math!

I don't work with IV's currently. And I was really nervous about doing this during the CPNE. An occasional picc line I've worked with but that's it since LPN school 6 years ago and that was a one way valve, so I didn't even have to aspirate or anything. All my studying and rehearsals walked me right on through the PCS's with IVPB's or saline locks. I knew exactly what steps I had to perform and the CE programmed the pump based on what I told her to do.

I bought a little hand held voice recorder and recorded myself doing PCS dialog. I submitted care plans and narrative notes to the EC advisors and recorded their responses and advice and encouragment. I recorded my mnemonics. I recorded normal ranges for VS and the sizes of needles to pick out for IM and subQ. I recorded myself walking though dosage calculations. I would put an ear piece in while doing dishes and listen to me. I would play it in my car. During my lunch break at work. I am SO SICK of listening to myself! But it all became second nature and the CPNE ended up being doable. I watched cpnex.blogspot. I went to allnurses.com. I had help from Lisa Arends. This EPN was invaluable. Also get all the information you can from your EC advisors as that is the final word. Use your phone calls to them.

Also, all my nursing dx interventions were taken off the Kardex. Every single one. For whatever dx they fit into: SR up x2. Ambulate to BR x1. Transfer to chair x1. Respiratory assessment assigned I would put Assess lung sounds or even Reposition x1. So on and so forth. Ensure call light within reach, etc. Instruct on deep breathing. That sort of stuff.

I didn't get to get report from the pts primary nurse, not once! All the info I got from my CE. I didn't get to report off either, the primaries are so busy. The CE takes control of report so you don't have to in that case.

Also, I want to mention that I am moderately hearing impaired. I have bilateral hearing aids and use an amplified stethoscope. Most people that meet me say they would never even know. :-) Everyone at my work wants to use my scope because it ROCKS! I had approval granted from the disability office at EC to use my own stethoscope during the CPNE after submitting a doctor's note stating I've had this since birth and an audiogram from my audiologist. Don't be afraid to ask for the help you need. The CE's and CA were very accommodating, they would either listen right next to me or wait until I was done and listen themselves. They said it was not a new experience and they are used to it. EC made it known, however, that if my result ended up being different than the CE, that it was not able to be contested and that the CE result would stand and not mine. I practiced manual BP's at work and Apical pulses like crazy to get back in the game, it paid off.

ALSO, I totally don't believe any posts about the students that fail the whole thing because they dropped a pen on the floor or put their papers on the pts bedside table or something like that. I think instances of that sort are just the straw that broke the camels (or CE's) back. There was a time when one of the 15 pens or pencils fell out of my pocket, the CE swooped in and picked it up with a paper towel, set it by the sink so I could "gel" it off later. There was one time I forgot to close the door and was about to start an assessment and the CE dove over and stated "I'll just close this door here." You can bet my privacy measures were over the top and obviously stated after that! There was one time when I set my papers on the foot of the pts bed and I went ohhh crap and looked at the CE, she said thats fine just put them back in your pocket. The CE's are incredibly professional and smart. Treat them with respect and they will do the same for you.

Thanks to everyone for all the support. I hope this helped a little bit! What a relief to be done!!!!!

Sara

bjbabs24 · Nov 17, 2008

Congratulations and thank you for your summary of your CPNE experience!!!!!!!!!!

I am waiting until this week to update my cpr so I can submit my application. I thank you for all the information and it is encouraging to know that with hard work and practice that it is doable. I made myself a six month plan of attack so now I just have to stick with it but I think having people like you that are willing to share what you went through will help those of us that are starting the waiting and anxiety game.

Sincerely,

BJ