Prepare Nurses to Pass NCLEX, or Prepare Nurses for Real World?

[Hoosier_RN]

On 7/28/2020 at 5:42 PM, KatieMI said:

I do not know how schools nowadays let out nurses who literally do not know ABCDs of pathology and pharma and how these nurses successfully pass NCLEX in droves and get employed without having the slightest idea of what they are playing with.

Oh, bother....

Schools teach to the NCLEX because of the all important pass rates needed to stay in business. Students don't get the same education that I got 30ish years ago, that taught me to learn in depth and develop the critical thinking skills needed to adequately care for patients once I left school and got my license. Nowadays, they depend on facilities to fill in the blanks, which is proving to be detrimental to nurses, as well as patients. Not all residencies are good, and not all new nurses get the training and support that they need. I don’t blame nursing instructors, per se, they are hired to teach a class by the model the school wishes. I blame the schools that take these students money and leave many of them grossly under prepared.

[guest1008832]

On 8/12/2020 at 5:09 PM, londonflo said:

Here is the location of the regulations in PA (https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Pages/Board-Laws-and-Regulations.aspx#.VTAurP50xRA) which state:

Did your school not even have you review what a Nurse Practice Act details? I just now read you did NOT go to school in PA.

I am glad that you are still able to work as a paramedic as you would be responsible for the failure and know that and are just projecting again. In most states you must work for an employer for a certain period of time to be eligible for Unemployment Compensation. I am sure this information is available on the PA Department of Unemployment Compensation (https://www.uc.pa.gov/Pages/default.aspx) I am just wondering if you yourself felt there was a significant chance of failure. If so, I am glad you paid attention to your instincts.

Thank you for the resource. I see you amended your statement about my attending school in PA. I was going to correct you.

Unfortunately, neither my school or anyone I spoke with at the PA BON referenced 49 Pa. Code § 21.7. Temporary practice permits. - PA Bulletin. I never saw it. Epic failure!  If the school or state didn't bring it to your attention, the student can not be held liable for such ignorance.

We live by the expression, "Ignorance of the law is no Excuse". It is impossible for anyone to know every law for every circumstance. I simply feel the PA BON had an obligation to make certain a student apply for such a permit was "aware" of the PA Bulletin and they did not. If it would have been brought to my attention, I would not have paid the extra fee.

My apprehension to take the job rested not on my confidence to pass the test but rather listening to my peers who have taken the test previously. In most instances...people would respond with "Good luck with that one" or "I have no idea how I passed that thing". Some claim, "Better you than me because if I had to take it today, I would fail it miserably".

If so much credence is placed on a test to clear you to practice but after you start practicing you default to another form of nursing practice, what is the point? As you know, I spent 23-yrs in the Army. We had a philosophy, "Train as you fight" so why don't we "Test as we practice"? It makes common sense! If someone put a blindfold on me and escorted me to a shooting range and said, "Soldier, I need to shot all the targets to prepare for your role as a Soldier and to defend your Country". If I were to deploy into combat with that form of teaching/testing strategy...GOD HELP ME! I'd be dead before getting a single round off.

Bruse

[londonflo]

On 8/12/2020 at 5:41 PM, emtpbruse said:

Unfortunately, neither my school or anyone I spoke with at the PA BON referenced 49 Pa. Code § 21.7. Temporary practice permits. - PA Bulletin. I never saw it. Epic failure!  If the school or state didn't bring it to your attention, the student can not be held liable for such ignorance.

We live by the expression, "Ignorance of the law is no Excuse". It is impossible for anyone to know every law for every circumstance. I simply feel the PA BON had an obligation to make certain a student apply for such a permit was "aware" of the PA Bulletin and they did not.

How much more could they do other than putting it on the top of the application for licensure and telling you to read and keep a copy of it!

https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Documents/Applications and Forms/Online Instr Grad Exam GTPP.pdf

First two lines of the application for a permit:

Quote

Online Instructions for GRADUATES Applying for Exam and/or Graduate Temporary Practice Permit (TPP)

Read this Entire Document Prior to Any Application Submission and Print/Retain for Reference.

Quote

NEW GRADUATE TEMPORARY PRACTICE PERMIT (TPP) INFORMATION: • Applications for a Graduate TPP can be submitted during the 1-year period from completion of an approved nursing education program. • The practice of nursing may begin after a TPP is issued by the Board. A TPP can be verified at www.PALS.pa.gov/verify. • Once the licensure exam is taken, the following will occur: on passing the exam and meeting all licensure requirements, a license will be issued and any TPP that was issued will be marked Null and Void. on failing the exam, in PA, any TPP that was issued will automatically expire and all nursing practice under that license type must cease immediately. on failing the exam, in any state or territory, an applicant is NOT eligible for a TPP

This was on the instructions that were provided to complete the application.

Look, I have responded to all of your excuses, attacks, angry rebuttals, etc to help you see that you alone are responsible for the situation you find yourself in. No one else neglected to read instructions, follow the NCSBN test plan, or study the content of the profession you wished to join. You underestimated the knowledge, skills and attitudes needed for professional nursing and attempted to sully the good name of Associate Degree Nursing and Nursing Education.

Per your request I have attempted to find the ADN Generic and Bridge Program Graduate Exam scores because I'm a nice guy. The most recent I can find on line is 2018. My last word of advice is call the FSBON for the information you seek. Best wishes on whatever you choose to do - FWIW having 3 lawsuits published on the internet already ( and now the new one you are contemplating) probably may reflect on how you attempt to resolve problems.

[Hoosier_RN, MSN]

48 minutes ago, emtpbruse said:

We had a philosophy, "Train as you fight" so why don't we "Test as we practice"? It makes common sense! If someone put a blindfold on me and escorted me to a shooting range and said, "Soldier, I need to shot all the targets to prepare for your role as a Soldier and to defend your Country". If I were to deploy into combat with that form of teaching/testing strategy...GOD HELP ME! I'd be dead before getting a single round off.

Bruse

We cannot "test as we practice" as there is too much variance in the way policy is set up between practice areas.

[guest1008832]

35 minutes ago, londonflo said:

https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Documents/Applications and Forms/Online Instr Grad Exam GTPP.pdf

First two lines of the application for a permit:

This was on the instructions that were provided to complete the application.

Look, I have responded to all of your excuses, attacks, angry rebuttals, etc to help you see that you alone are responsible for the situation you find yourself in. No one else neglected to read instructions, follow the NCSBN test plan, study the content of the profession you wished to join, etc. and a whole lot more.

Per your request I have attempted to find the ADN Generic and Bridge Program Graduate Exam scores because I'm a nice guy. The most recent I can find on line is 2018. My last word of advice is call the FSBON for the information you seek. Best wishes on whatever you choose to do - FWIW having 3 lawsuits published on the internet already ( and now the new one you are contemplating) probably may reflect on how you attempt to resolve problems.

Dear Londonflo,

Unfortunately, when a GN files their request for initial testing to the PA BON, their first request must be completed "on-line". During this process, they offer only a box to check asking the GN if he/she also wants to have a "Temporary Permit" issued while they await testing. It is nothing more than a box to check. Once you check the box, additional fees are added to include the cost of a permit when you pay.

Just so we are clear, I was never provided with the information you provided for the PDF link regarding temp. permit restrictions if a student fails the NCLEX. Any subsequent applications to the PA BON must be done by paper format and since the permit was already restricted after my January failure, I found no need to request a permit application. I never completed an actual "Permit" application in the first place procedurally.

I resent your comment about lawsuits and resolving disputes. 126+ nursing students would disagree with you regarding my level of advocacy to change a system. Sometimes, it takes legal action to shine a light on a broken system. I'm not the party who created the system, I'm just trying to become a better person and I didn't realize this experience was going to cost me my sole.

Bruse.

[londonflo]

12 minutes ago, emtpbruse said:

request for initial testing to the PA BON, their first request box you had to check. must be completed "on-line"

These are the directions you had to start with to go to the next site to check whatever box you had to check.

Quote

APPLYING FOR A LICENSE by EXAMINATION: PA Program Graduate - $95.00 / Out of State Program Graduate - $115.00 Step 1: Click on the link “Login” at https://www.PALS.pa.gov. Step 2: Login with your "User ID" and "Password." If you do not have one or have forgotten your information, follow the options on the menu to the right side of the page. Step 3: Once you are logged into your PALS dashboard, click on “Apply for New License” located at the bottom of the page. The screens that follow will be a series of questions to assist with obtaining the correct application. • Board/Commission - Select State Board of Nursing • License Type - Select Registered Nurse or Practical Nurse • Survey - Please answer all questions on the survey to obtain the correct application and instructions. PLEASE NOTE: You can apply for a Graduate Temporary Practice Permit by answering a question within the application. A fee of $70.00 will be added to your account prior to payment. DO NOT SUBMIT A SEPARATE APPLICATION. Step 4: Pearson VUE Registration (test administrator): To take the exam, register and pay the required fee

If it only cost you your sole - no I can't go there. Once again best wishes.

[guest1008832]

On 8/12/2020 at 6:32 PM, Hoosier_RN said:

We cannot "test as we practice" as there is too much variance in the way policy is set up between practice areas.

Ahhhh, see...now your tracking. You just proved my point. I needed someone to make that statement. Thank you kindly. This form of reasoning says...just know it for the test and then learn as you go. Every facility/institute or agency has their own set of rules on how to do nursing.

I loved when my professor would tell us, "Don't answer that question like how you do it in the real world" and I would say, "But I'm not going to be working on mannequins, I will be working on REAL people" in the real world. There was often awkward silence afterward followed by an under the breathe claim of "I know but just follow the book for now". SMH!

Bruse

[Hoosier_RN, MSN]

On 8/12/2020 at 7:10 PM, emtpbruse said:

Ahhhh, see...now your tracking. You just proved my point. I needed someone to make that statement. Thank you kindly. This form of reasoning says...just know it for the test and then learn as you go. Every facility/institute or agency has their own set of rules on how to do nursing.

I loved when my professor would tell us, "Don't answer that question like how you do it in the real world" and I would say, "But I'm not going to be working on mannequins, I will be working on REAL people" in the real world. There was often awkward silence afterward followed by an under the breathe claim of "I know but just follow the book for now". SMH!

Bruse

But there is a standardized method to learning basic information in nursing. Facilities also have standardized policies based on state NPAs, ANA guidelines, etc. NCLEX tests your understanding of that at a basic level, using specifics-medications, procedures, assessments, etc. Reading your rants, I realize that you don't get it.

On 8/12/2020 at 7:06 PM, londonflo said:

These are the directions you had to start with to go to the next site to check whatever box you had to check.

If it only cost you your sole - no I can't go there. Once again best wishes.

baby needs a new pair of shoes? ?

[Susie2310]

On 8/12/2020 at 5:10 PM, emtpbruse said:

And to piggy-back on your conclusion, I was told by a host of nurses not to apply at several different hospitals here in the Allentown, PA area if I didn't have a BSN degree or if I wanted to work in the ER. The hospital I referenced before in an earlier blog post, who offered me a GN position in the ER, was a Stewart Hospital based in Easton, PA and was recently bought out by a larger hospital system. Nurses here in the PA area have been told...get your BSN or "find a new job!".

The ASN program I attended in FL was closed voluntarily so it could submit the proper documentation to the FL BON to receive BSN level recognition. It was a fully accredited program. My local community college also closed their Associate Degree program . That was a mistake!

My point is that while there are specific geographic areas of the country that require a BSN for employment, this is not universally required, e.g. not all geographic areas of the country require a BSN. In my area, the community college ADN program has expanded, is going strong, and has a reputation for producing well trained nurses who are sought out by employers. One has to find out what the educational requirements are for employment at the facilities in the geographic area in which one wishes to practice.

[HiddencatBSN, BSN]

6 hours ago, londonflo said:

How much more could they do other than putting it on the top of the application for licensure and telling you to read and keep a copy of it!

https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Nursing/Documents/Applications and Forms/Online Instr Grad Exam GTPP.pdf

I was going to say, when I applied for initial licensure in PA it was abundantly clear that your GN is revoked if you fail the NCLEX on the first try.

There are still several ADN programs in the area you applied- while it is true many of the hospitals there now have either a hiring preference or a requirement for a BSN, there continue to be hospitals that do not. It was a big factor in my decision to choose an expensive accelerated BSN program over a very affordable ADN program: I wanted to give myself the best shot of getting a job. This is going to be the case in certain areas where there’s that hiring preference but it has nothing to do with how well the programs prepare for the NCLEX.

Testing is never going to match real world practice perfectly. With very sick patients there are multiple people doing multiple tasks at one time: but the BON needs to assess that you know what the first priority is. In the real world we do a lot of things with limited resources and time and simply can't do textbook perfect practice: but in order to know how to deviate from textbook standards without being unsafe you need that basis of care. You probably got silence about your real world comment because you are far from the first student to make that comment and based on what we are seeing here are pretty rigid in your judgment of the problem being the test standards and not you. In my experience folks who get excessively hung up on real world versus textbook rules are simply not mastering the material well.

Best wishes.

[HiddencatBSN, BSN]

8 hours ago, emtpbruse said:

However, through all my didactic training and clinical periods, I was never required to be a "charge nurse" or make big decisions pertaining to department budgets, staffing, equipment, Q&A or other pt. care aspects...but I was tested on it! Was that fair? Should a Paralegal be required to take the same Bar Exam a recent law student is required to take after completing law school?

YES. Because being a charge RN, making staffing assignments, delegating safely and QI (which is what I assume you mean by Q&A) all RN functions. Some facilities might prefer or require a higher degree for management positions but that’s not universal. Smaller facilities and particularly LTC often put RNs in roles where they are managing the unit.

And the Bar Exam does require lawyers to show competence in all areas of the law despite it being a highly specialized field (a lawyer might be planning to do family law, or contract law, but still needs to show competence in criminal law). It’s also a different profession with different requirements MUCH LIKE paramedicine.

Second chance pass rates reflect that if a grad has failed once they have a higher likelihood of failing again. With the pass rate for first time takers high followed by low subsequent attempt rates across the board, why doesn’t that suggest to you that grads who are not initially successful have themselves not integrated the education well or have teat taking difficulties?

First time pass rates for schools are available online (the PA BON publishes rates based on schools within the state, I would be shocked if Florida didn’t) and I was often able to find that information for the school directly on the school’s website and that was part of my evaluation process for determining the programs I applied for. That just seems like basic due diligence in selecting a program.

[HiddencatBSN, BSN]

7 hours ago, emtpbruse said:

Dear Londonflo,

Unfortunately, when a GN files their request for initial testing to the PA BON, their first request must be completed "on-line". During this process, they offer only a box to check asking the GN if he/she also wants to have a "Temporary Permit" issued while they await testing. It is nothing more than a box to check. Once you check the box, additional fees are added to include the cost of a permit when you pay.

Just so we are clear, I was never provided with the information you provided for the PDF link regarding temp. permit restrictions if a student fails the NCLEX. Any subsequent applications to the PA BON must be done by paper format and since the permit was already restricted after my January failure, I found no need to request a permit application. I never completed an actual "Permit" application in the first place procedurally.

I resent your comment about lawsuits and resolving disputes. 126+ nursing students would disagree with you regarding my level of advocacy to change a system. Sometimes, it takes legal action to shine a light on a broken system. I'm not the party who created the system, I'm just trying to become a better person and I didn't realize this experience was going to cost me my sole.

Bruse.

You didn’t read the instructions before filling out the application. That’s on you. The information is available and it’s your responsibility to make sure you understand the requirements and conditions of applying before you apply.

[RoundAbout33, BSN, RN]

Hi Bruse,

As I have read through your responses, I feel as though you are avoiding the main point coming from most of those providing thoughts or comments: Regardless of how you feel about the NCLEX-RN, it is your responsibility to pass this exam, period. Right now, this is the requirement to become a nurse. Your mentioning of bringing suit for the content of the NCLEX is a little misguided as many others, including those with previous careers or professions, have successfully passed this required exam. Additionally, if you're still wanting to become an RN anytime soon, you need to put your focus into how you can pass, not spending so much time and effort on how you're going to be ultimately compensated for what you believe has been a disservice to yourself.

There is a reason why there are so many different platforms, resources, and content dedicated to helping you pass the NCLEX - there is a strategy to the test. NCLEX-world you have everything you could need and everything available right then. I had a practice question once involving a pt who had a previous resuscitation earlier in the day and was now in v-fib again. Two of the answers were start compressions and shock. I chose compressions (as what we are always taught in the real world - jump on the chest) as in the real world, we would do compressions until the AED was charged and ready; however, in NCLEX-world (perfect world), it was already charged and v-fib is a shockable rhythm. Perfect world, without assumptions puts everyone on a level playing field for this test.

Also, to your comments about charge nurse questions, I would say that a main reason to know these would be to advocate for yourself as a nurse. These types of questions would help you know appropriate staffing and delegation so you ultimately would be more likely to know if you were receiving an appropriate assignment.

Moving forward, I would suggest two study resources for you as they helped me immensely: Kaplan and Nursing.com. My school used Kaplan, but I didn't really appreciate it until I started using it to prepare for NCLEX. They not only have practice tests, but also numerous recorded and live lectures on content and test-taking. They teach strategy so well. Nursing.com was a resource I used just before I started nursing school. They are all about helping students pass the NCLEX and have very good and relatable lectures.

I'm a second career nurse as well, graduated with my BSN in May, and passed NCLEX in July. Sure, I thought some questions were strange or too vague, but my study preparation prepared me for those types of questions and the strategies to answer them.

You have to remember that once you pass this exam, you never have to take it again. You really need to let go of this frustration and "attack" mindset and just put all of this energy into finding a new study method to pass this required test. YOU have to decide that you are ready to do that.

Side note: NCSBN is looking to change the NCLEX to what they call "Next Generation" which will look a bit different from what it is now (just like the current version is very different from past versions).

I really hope you will consider my and others' suggestions. Nurses want to help nurses (which you will be if you want it), but you have to help yourself first. Best of luck in making the right decision.