TheBecoming

There has never been a class or course in the history of mankind that would allow you to pass with a D.

I haven't been here to allnurses for a while. I was scrolling through and found that someone had commented on this CPNE post that I had done last summer (My CPNE Saga). It's nice to know people are reading it and hopefully getting something from it. Life has been a blur since I finished Excelsior. I'm working the ER and charge nurse on a Med/Surg floor. It has been nothing but awesome. All the studying and fretting that I did for the CPNE seems like eons ago. This website helped me immensely while I was in school and I hope people get as much from it as I did. Good luck to everyone out there who is currently up to their nostrils in PCS's, study guides and grids. The pain and torment are all worth it in the end.

You have every right to feel angry and upset with yourself. You blame no one but yourself and thats good. Take the time to be upset and get it out of your system. When you're done, send the money in and wait to take it again. I failed in February and passed in June. You know EXACTLY what you need to do next time. Regroup, go back and kick ass. I know you feel like crap right now. It gets better. Once you take it again and pass it won't even matter that you didn't make it the first time. Godd Luck!

Your first time through was just practice. Now you know EXACTLY what you have to do and how to do it. This is your time to show them how it's done. You know everything that you need to know. Go in there, do everything one step at a time and get it done. Let all the first timers be nervous. You're the vet that gets to show them how it's done. I was in the same boat as you. It was a thousand times better my second go. Don't freak. Go in, kick ass, go home. Then, you get to party like it's 1999.

Nice to re-meet you exnavygirl/Christy! TheBecoming/Jeremy

MY CPNE SAGA PART 2: THE RISE Even though I had this failure on my back, I knew I had to reload and give it another shot. I scraped up the money to take the test and reapplied. I knew that I was shell shocked from not passing, but I also knew the shock would wear off and I would have to do this all again. There's the 4-6 months to wait for a new date and I couldn't put it off for to long. I of course spent a lot of time going over and over in my head the things that I felt had caused me not to pass. 1- The nervousness and anxiety that I had during the test was my main hurdle. That KILLED me during this test. 2- I knew my areas of care and critical elements inside and out. It was executing them in a timely manner that hurt. You have 2.5 hours for each PCS. Everything you do needs to fit into that timeframe. 3- My documentation was not up to where it needed to be. My care plans were poorly written and my evaluations were rushed and sloppy. I wasn't exactly sure how to control the nervousness. In the end I just rearranged my thinking. I told my wife, parents, in-laws, and 2 people from work that I was retesting. My first time around I had told everybody. I figured that the fewer people I told the fewer I would have to tell I had failed if in fact I ended up failing again (a little pessimistic, I know). Then I told myself not to think about anything after the test; concentrate on everything up to the test and the test itself, but do not think of anything afterwards. Do not think of failing, do not think of passing, just focus on the test. During the test, do not think of the next step, think of only the step that you are doing at that time. My biggest change in thought came from my wife: "You took the test once and failed. The hard part is over. Now you know how to do everything and you know what they are looking for. This is your test. YOU are paying THEM to test you. It's your time and your show. Go in, do what you have to do, then go home. Go in, kick ass, go home." Is that not brilliant? That's why I married her. As far as working on my slow pace with the areas of care, I went with the "Go in, kick ass, go home" theme. During your PCS all you have to do and all you are being "graded" on are your areas care and the critical elements involved. Do that and only that. Don't do anything else. I'm not saying blow through as quickly as you can and ignore your patients needs, I'm saying focus on what you HAVE to do. That is why you are there. I ended up contacting Lynn (CPNE workshop) and ordering her PCS workbook and her Care Plan and Documentation workbook. I didn't do her workshop, I just used the two books. I went through the PCS workbook and filled in the whole thing. I then made up my own patients and diagnosis and assigned them areas of care to practice and document on. I focused mainly on my documentation, writing only what was needed and keeping it simple and straightforward. I did the same with the Care Plan and Documentation workbook. I picked a handful of diagnosis that were common and that I would most likely use and concentrated on those. I also took all the areas of care and attached nursing diagnosis to them. To keep it simple, any diagnosis I chose would involve an area of care that I was assigned. This made writing my diagnosis easier and would save me time during the PCS. For example: -Patient post-op day 2 following an open appy -Assigned area of care: Comfort Management -Nursing Diagnosis: Impaired Comfort r/t abdominal incision AEB patient c/o discomfort Patient will: Verbally state a tolerable level of comfort Interventions:1) Asses level of comfort 2) Reposition to position of comfort For comfort management the main critical elements involve assessing your patients level of comfort and providing comfort measures. When you assess and reposition, not only are you performing the critical elements, you are also following through with your nursing diagnosis. I basically tried to strip everything down to its' simplest form to make things as easy for me as possible and make things run slick and smooth. Also, I divided my 2.5 hour PCS time into three chunks: A half hour for planning, one hour for implementation and one hour for evaluation. I would stick to that plan to keep me on task and provide me with the time I needed to make sure everything was done. Excelsior started opening up test dates during the week, not just the weekends, so I was hoping that I wouldn't have to wait so long for a test date. I had my application in the second week of February, so I was expecting a date sometime July-September. I did get a cancellation call in May. It was a Friday-Saturday exam and they called me the Wednesday before the weekend. It was in Plano, Texas and there was no way I could make arrangements on that short of notice. I finally got a call the first week of June for a test date of June 25-27 in Madison, Wisconsin. I took it. I kept reviewing the things I mentioned above and a week before the test I started practicing my labs again. After screwing up the first time I wanted to jam through the labs the first day with no repeats. I left Wednesday the 25th at 9:00. It's 3 hours to Madison from here and leaving at 9:00 gave me time to check in to the hotel and find the hospital. My wife went with me this time. The time in the hotel room by myself the first time around was brutal. Way to much time to think and fret and worry. Having my wife there would help control the voices in my head and keep me relaxed. I did not use the hotel suggested by Excelsior. My wife found a hotel that was closer to the hospital and cheaper. Of course, I had my car to get back and forth to the hospital. A lot of people fly in to take the test and the hotel suggested by Excelsior offers shuttle service to and from the hotel. If you can drive to your test site, research the hotels in the area and I'm sure you'll find a much cheaper rate. I got to St. Mary's Hospital at 4:00, ready for the 4:15 start time. There were three other students taking the test this time. Much to my surprise, one of the students was a girl who tested in Racine with me. I thought for sure she had passed the first time around. She filled me in on the other students who were in Racine with us. The guy from Salt Lake City who was on his third try taking the test had failed. He failed both his adult patients the same way- he didn't sign the MAR after giving his meds. Not once, but twice. Such a simple, yet huge mistake. Now he has to start EVERYTHING over; three strikes and you're out. I thought I was miserable after failing the first time. I couldn't imagine failing it for a third time. Brutal. I feel bad for the guy and I hope he keeps moving. She wasn't sure who else had failed or passed, but we both felt that the two other people who were there had passed. So, out of 7 only 2 had passed in Racine. The other two people there in Madison were both on their first tries. The CE met us in the lobby and off we went to start. The CA took us through the orientation and then we readied ourselves for the labs. Before I started I had zero nerves. I was excited to be there and ace those labs. I went through each lab step by step, moment by moment. I focused only on the step I was doing and nothing else. I wasn't nervous, I wasn't shaking. I was a machine doing its' job. I did all the labs well under their allotted times and passed all of them. At that point I felt like a God. A king. An emperor. I told myself I was going to sail through those labs and I did. What a massive ego boost that was. I met my first examiner and she took me to the floor to get the info on my first patient. She was a 65 year old who had a bowel resection 2 days earlier. No complications, textbook recovery. My areas of care were medications, comfort management and respiratory management. This was going to be a piece of cake. My wife picked me up from the hospital and we went back to the hotel. I sat down immediately and wrote my Nursing Diagnosis/Care Plan. I went with Impaired Comfort and Risk for Impaired Respiratory Function. Straight forward and simple. It took less than 10 minutes to write everything down. I then wrote up my grid for the next day and planned out the PCS (You can't write down your grid for the first patient the night before. Nothing goes on the form but your care plan. I just wrote mine separately for practice.) The process took 20 minutes. I then put everything away for the night. There was nothing left for me to study, nothing left to look over. I knew I already had everything in my head that I needed. From that point on it was putting everything into use that mattered. My wife and I got take out (I believe the place was called The Glass Nickel Pizza Company or something like that. The food was good, the prices reasonable and they deliver. I recommend it.) and spent the rest of the night relaxing. I woke up at 5:30, showered, ate and my wife drove me to the hospital so I wouldn't have to deal with parking (is she great or what?). I was a little nervous but it was NOTHING in comparison to the first time. I was excited to get moving, but I wasn't worried about my performance. At that point I felt confidant in my skills and I was ready to get it done. My examiner and I went up to my patients unit and I got the standard unit orientation. After that I got started. My Care Plan was okayed and I wrote up my grid. I went through the PCS lust as I had planned the night before. I did my areas of care in the order I wanted to and at a good pace. I finished all of my cares within 45 minutes, which left me plenty of time for my evaluation phase. I sat down, wrote everything down that I had to and reviewed a dozen times to make sure it was correct and I hadn't forgotten anything. When I felt ready I handed in my form with 20 minutes to spare. I then sat and waited for the result. The wait time following the PCS is the most gut wretching, brutal part of the exam. You feel someone waiting to be pardoned by the governor. I waited 20 minutes for the pass/fail. You know what? I FAILED! I forgot to sign off on my meds! The examiner said I had done everything 100% and was hoping that I would remember to sign the MAR. I didn't remember. I was baffled. I NEVER THOUGHT TO SIGN THE MAR! I could not believe it! What a massive DUH on my part (Didn't I say it was a simple but stupid mistake a few paragraphs ago? That's what I get for being a smart ass.) I felt pretty damn stupid, but to be honest with you it didn't phase me too much. I was stunned for a few minutes, but my confidence was still running pretty high and I was sure I was going to be alright. I went back to the meeting room and met my next examiner. My next patient was my peds patient. The first day you're there you draw cards to determine if your first patient is an adult or peds. She was a 17 year old (Talk about lucky. One of the other students had a 2 year old on isolation precautions who cried the entire time.) with Chiari Malformation. Her posterior fossa was misshapend, which caused the cerebellar tonsils to protrude from the bottom of her skull. She had surgical correction done 3 days earlier and would probably be going home later that day. I had NO IDEA what the hell Chiari Malformation was. My examiner was very helpful and gave me a lot of information on it (Google it and take a look). My areas of care were respiratory management, comfort management, neuro assessment and medications. I wrote up my Diagnosis/Care Plan, using Impaired Comfort and Risk For Injury, and wrote down my grid. My Care Plan was good, so I got started. Again I went through my areas of care in the order I wanted to and everything went smooth. For all of my PCS's I did my vitals immediately to get them done. I finished all of my cares in 45 minutes and I made DAMN sure I signed the MAR. I sat in my little room and wrote my evaluation, reading and rereading as I went to make sure I covered everything. With 15 minutes left I handed my paperwork in. I then stood in the hall to wait another excruciating 20 minutes to hear what the verdict was. During the eval phase, if you screw something up and fail, the examiner will contact the CA and they will review it. The CA will then come by herself or with the examiner to tell you that you failed and how. With the patients that I had failed during the course of the two CPNE's the CA came by herself once and with the examiner twice. If your examiner comes to get you it's a good sign that all is well and you passed. After waiting 20 minutes for the outcome the CA comes walking around the corner and almost bumps into me. My stomach slammed straight up into my throat. "Oh hi!" she says. "I have to run upstairs quick. Don't worry, you passed." She kept on walking and got in the elevator. I almost threw up. My examiner came around the same corner and said "Congratulations, you passed!" My initial wave of nausea passed quickly and I was elated. I went downstairs to wait for my wife to pick me up. At that point I knew there was no stopping me. I had this exam in the bag. No more mistakes. I felt confident and ready to keep kicking ass. The first patient was a reorientation, but after that I was set. The girl who had been in Racine with me was waiting outside for her ride. She had passed all her labs the day before and passed both of her patients. She was feeling good. The other girl with us failed one or two labs and made them up. She had failed one patient and passed the other. The guy that was there testing had failed some labs and made them up, but he had failed both of his patients that day. You will have only 2 patients the second day of testing. The third and final day is when you make up the patients that you failed. You can fail one adult patient and one peds patient. Any failures after that and you're done. If you fail both the first adult patient and the first peds patient you will make them both up on the third day, giving you three patients to test out of. I had failed my first adult patient so I had two patients to do on the last day. If you pass your first two patients you have only one to do on the third day. (It probably sounds confusing, but in my head it makes perfect sense.) My wife picked me up and we went back to the hotel. I was wasted tired and napped for an hour or so. My wife and I then left the hotel and went walking around downtown Madison. We stopped at a sidewalk café for a couple of hours and had drinks, talked and enjoyed the summer night. It was like being on vacation. I didn't think of the test the whole night. We went back to the hotel and got food from the same place as the night before and I conked out for the night. I had a hard time sleeping that night. It wasn't nerves that kept me up though. I felt on fire and ready to go. I knew that the next day was going to be all mine and I wanted to get it started. I went outside at 1:30 and enjoyed the quiet for a while. I went back up to the room at 3:00 and did manage to get some sleep before the wake up call at 5:30. We all met at the hospital at 7:15 to get started. My third patient was a 39 year old female a few days post op following gastric bypass. Areas of care were Respiratory Management, Abdominal Assessment, Medications, Comfort Measures and Drainage Collection. Again I used Impaired Comfort and Risk for Ineffective Breathing Patterns. I was able to use Impaired Comfort for ALL of my patients. If the same diagnosis works, you can use it. I didn't mix it up at all and come up with different diagnosis for all my patients. I used the simplest, most effective diagnosis I could for each patient. You don't get "points" for how many different ones you can use and the college isn't concerned with that for this exam. They want to know that you can effectively write a care plan/nursing diagnosis and implement it into your cares. Again, I put the areas of care into the order that I wanted to do them in, with vitals being first. Everything went slick as could be. All cares done in less than 45 minutes. I didn't rush or feel rushed. I did everything step by step until that area was done, then I moved on to the next area. I had plenty of time for my evaluation/documentation phase. I wrote and proof read everything multiple times until I was sure it was ready. I handed it in knowing that it was gold and that I would pass. I still paced the hall waiting to hear from the examiner though. She came into the hall and said, "Passed". I felt great knowing that I had passed and was only one more patient away from being done. I followed the examiner upstairs to wait for my next examiner and last patient. I get upstairs and the girl who tested with me in Racine was sitting and waiting for her last patient. She had failed what was suppose to be her third and final patient, so she had to make it up. She didn't appear frazzled or nervous at all. I think she knew that she had it wrapped up and all she needed to do was focus and finish up. The other guy who was testing didn't make it. I'm not sure what happened to him or how he failed. I knew that he had failed both of his patients the first day and was having a rough time. I hope he returns again for a second try. The other girl testing with us had failed one of her patients the first day, either her adult patient or her peds patient. As the girl from Racine and myself were waiting for our final patients, she came into the room with her examiner. You could tell by looking at her that she had bad news. She came over to us and started crying. I felt absolutely horrible for her. We tried to help soothe her because we had both been in the position of failing this test and knew EXACTLY how she felt. At the same time I'm trying to not focus too much on her failing because I still had my last patient to get through. The CA came and got her and tried to help calm her down, and my examiner took me out of the room to meet my last patient. My last patient was a 63 year old man who had a THA done a week prior and had developed an infection in the wound. My areas of care were Respiratory Assessment (I had either Respiratory Management or Assessment for all of my patients; if there is one thing I can do blindfolded now it's Respiratory anything), Peripheral Vascular Assessment, Comfort Management, Drainage Collection (another JP drain) and another area that I don't remember at this time. I went through everything step by step as I had done with my previous patients. I finished in a short amount of time and had plenty of time for documentation. Again I read and reread what I had written before I turned it in. This was my fourth and final patient and I wanted nothing to ruin my chances of passing. I HAD to nail this one. I handed my paperwork in and began the waiting process. Waiting for that last pass/fail was hellish. At that point, the machine that I was through the past three days had burned out and was replaced with a nervous, twitching human. I paced and waited and paced and waited. I knew that I had aced my areas of care and I felt confident that my documentation was spot on, but there was still that lingering flicker of doubt that I had missed or forgotten something that was going to make my plane come crashing to the ground. I waited 25 minutes, and then the CA came into the hall. "Under Peripheral Vascular Assessment there is something missing in your documentation. Take another minute and figure out what it is." I of course grabbed it, immediately went to the section I needed and started reading what I had written. I read, and I read, and then I read it again and then I read it again and then I read it some more. I couldn't figure out what I had forgotten. On the outside I looked cool as could be. On the inside my brain exploded and I could feel it starting to drain out of my ear. "Color, warmth, movement, sensation and pulse. Color, warmth, movement, sensation andpulse.Colorwarmthmovementsensationpulsecolorwarmthmovmentsensationpulsecolorwarmthmovementsensationpulsecolorwarmthmovementsensationpulse." I had documented everything. There was nothing else that I needed to write. Everything was RIGHT THERE. My panic had consumed me and I thought that was it. I thought I was done. Everything collapsed around me. I gave my paper back to the CA and, almost in tears, told her that I didn't know what else to write. I read what I had out loud to her. For the life of me I had no idea what I still needed to write. "Oh, sensation. I don't think your examiner read that right. Let me take that back to her." She left the hallway for maybe 10 seconds. She and the examiner returned and the CA said "Congratulations, you passed." A HUGE wave of elation swept over me. I went from almost throwing up and crying to joyous ecstatic in one second. The examiner tried explaining what had caused her the confusion with my documentation but I honestly have no idea what she said. I didn't care. My head was in the clouds and I had not a care in the world at that point. I HAD PASSED! We walked back to our meeting room and ahead of me I could see the girl from Racine already there. She made eye contact with me and I could tell by her expression that she was looking for a sign on my face that would say passed or failed. I gave her the old Gene Simmons tongue wag and the double devil horns followed by a huge smile. She screamed "Woohoo!", ran over and gave me a hug. She had passed as well. All the examiners and CA said their congrads. There is a notebook at all of the testing facilities that students who have passed can write in and give encouragement to incoming CPNE students. I didn't write a word. All I wanted to do was find my wife and tell her I was done. I said thanks and goodbye to all and took off. At 12 noon that day was check out time for the hotel, so my wife had packed up and drove to the hospital to wait for me. I went down to the lobby just in time to catch her as she was heading outside. I hollered out to her and she turned around to look. I'm sure that the whole morning was rough for her. She wanted me to pass as much as I wanted to and everything had come down to this moment. The look on her face as she turned around was almost blank. She just stood there and waited for me to say SOMETHING. I threw my arms up, smiled and said, "I'm done. I passed." She exhaled loudly and hugged me. It was and always will be a highlight of my life. What can I say now? I was on the biggest natural high of my life on the drive home. I was able to return the victor. Even now, 2 weeks after having passed I still feel awesome. I get to start a new chapter in my life. The opportunities open to me are endless now. All of the work and sweat paid off and I get to sit back and enjoy it now. All the time spent reading, studying and practicing is done. That time can now be spent on my family and the things I have wanted to do but couldn't because my focus was elsewhere. For those of you who have yet to take The Test, I hope I gave you some insight into what to expect. Remember that what I have written here is my account. This is what I experienced. Someone else who has taken the test I'm sure has a completely different tale to tell. Or, maybe they don't. Either way, all I can tell you is to study and practice in whatever way is right for you. There is plenty of literature, web sites and workshops that you can use to help you along the way. Research everything you can and find out what is going to work best for you to help you pass. To those of you who have failed and trying your second or third time remember the famous words of my wife- "Go in, kick ass, go home." You know how you failed the first time. The first time was a practice run. Now you know exactly what you need to do. Strengthen your weaknesses until they are no longer weaknesses. It's your time, your test. "Go in, kick ass, go home." Any questions or feedback are welcomed. Good luck to all!!!!!!!! P.S.- You know the CPNE study guide, the one that I read and poured over 643 times? The evening I returned home I dragged out my grill and I burned that guide until there was nothing left. You know those study guides that you get for every course that you take? I burned all those as well. It felt good to torch all that stuff. I recommend that to all of you when you're finished.

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

The first time I tested I had my mind set that I would go alone. That was before I knew that my nerves and anxiety would kill me and make it the worst three days of my life. I spent most of the time outside smoking (ALOT!), watching TV (I hate TV), studying (I spent every waking hour for a month studying. If I didn't know it at that point I wasn't going to learn it the night before) and trying to dream up a debilitating illness that would get me out of the test but wouldn't make me have to pay another $1800 (I couldn't think of anything). So, in hindsight, me going alone---bad idea. I took my wife the second time and the difference was night and day. Would I have passed my first time with my wife there? I'll never know. If you think you'd be better off alone then go for it. If you need a buddy, bring them along for the ride (they can pitch in for gas). In the end, whatever makes you the happiest and whatever helps you to pass is all that matters.

I know it sounds cheesy and cliche, but I have to say it. If I can do it so can, anyone can!

Here's part two for your viewing pleasure. MY CPNE SAGA PART 2: THE RISE Even though I had this failure on my back, I knew I had to reload and give it another shot. I scraped up the money to take the test and reapplied. I knew that I was shell shocked from not passing, but I also knew the shock would wear off and I would have to do this all again. There's the 4-6 months to wait for a new date and I couldn't put it off for to long. I of course spent a lot of time going over and over in my head the things that I felt had caused me not to pass. 1- The nervousness and anxiety that I had during the test was my main hurdle. That KILLED me during this test. 2- I knew my areas of care and critical elements inside and out. It was executing them in a timely manner that hurt. You have 2.5 hours for each PCS. Everything you do needs to fit into that timeframe. 3- My documentation was not up to where it needed to be. My care plans were poorly written and my evaluations were rushed and sloppy. I wasn't exactly sure how to control the nervousness. In the end I just rearranged my thinking. I told my wife, parents, in-laws, and 2 people from work that I was retesting. My first time around I had told everybody. I figured that the fewer people I told the fewer I would have to tell I had failed if in fact I ended up failing again (a little pessimistic, I know). Then I told myself not to think about anything after the test; concentrate on everything up to the test and the test itself, but do not think of anything afterwards. Do not think of failing, do not think of passing, just focus on the test. During the test, do not think of the next step, think of only the step that you are doing at that time. My biggest change in thought came from my wife: "You took the test once and failed. The hard part is over. Now you know how to do everything and you know what they are looking for. This is your test. YOU are paying THEM to test you. It's your time and your show. Go in, do what you have to do, then go home. Go in, kick ass, go home." Is that not brilliant? That's why I married her. As far as working on my slow pace with the areas of care, I went with the "Go in, kick ass, go home" theme. During your PCS all you have to do and all you are being "graded" on are your areas care and the critical elements involved. Do that and only that. Don't do anything else. I'm not saying blow through as quickly as you can and ignore your patients needs, I'm saying focus on what you HAVE to do. That is why you are there. I ended up contacting Lynn (CPNE workshop) and ordering her PCS workbook and her Care Plan and Documentation workbook. I didn't do her workshop, I just used the two books. I went through the PCS workbook and filled in the whole thing. I then made up my own patients and diagnosis and assigned them areas of care to practice and document on. I focused mainly on my documentation, writing only what was needed and keeping it simple and straightforward. I did the same with the Care Plan and Documentation workbook. I picked a handful of diagnosis that were common and that I would most likely use and concentrated on those. I also took all the areas of care and attached nursing diagnosis to them. To keep it simple, any diagnosis I chose would involve an area of care that I was assigned. This made writing my diagnosis easier and would save me time during the PCS. For example: -Patient post-op day 2 following an open appy -Assigned area of care: Comfort Management -Nursing Diagnosis: Impaired Comfort r/t abdominal incision AEB patient c/o discomfort Patient will: Verbally state a tolerable level of comfort Interventions:1) Asses level of comfort 2) Reposition to position of comfort For comfort management the main critical elements involve assessing your patients level of comfort and providing comfort measures. When you assess and reposition, not only are you performing the critical elements, you are also following through with your nursing diagnosis. I basically tried to strip everything down to its' simplest form to make things as easy for me as possible and make things run slick and smooth. Also, I divided my 2.5 hour PCS time into three chunks: A half hour for planning, one hour for implementation and one hour for evaluation. I would stick to that plan to keep me on task and provide me with the time I needed to make sure everything was done. Excelsior started opening up test dates during the week, not just the weekends, so I was hoping that I wouldn't have to wait so long for a test date. I had my application in the second week of February, so I was expecting a date sometime July-September. I did get a cancellation call in May. It was a Friday-Saturday exam and they called me the Wednesday before the weekend. It was in Plano, Texas and there was no way I could make arrangements on that short of notice. I finally got a call the first week of June for a test date of June 25-27 in Madison, Wisconsin. I took it. I kept reviewing the things I mentioned above and a week before the test I started practicing my labs again. After screwing up the first time I wanted to jam through the labs the first day with no repeats. I left Wednesday the 25th at 9:00. It's 3 hours to Madison from here and leaving at 9:00 gave me time to check in to the hotel and find the hospital. My wife went with me this time. The time in the hotel room by myself the first time around was brutal. Way to much time to think and fret and worry. Having my wife there would help control the voices in my head and keep me relaxed. I did not use the hotel suggested by Excelsior. My wife found a hotel that was closer to the hospital and cheaper. Of course, I had my car to get back and forth to the hospital. A lot of people fly in to take the test and the hotel suggested by Excelsior offers shuttle service to and from the hotel. If you can drive to your test site, research the hotels in the area and I'm sure you'll find a much cheaper rate. I got to St. Mary's Hospital at 4:00, ready for the 4:15 start time. There were three other students taking the test this time. Much to my surprise, one of the students was a girl who tested in Racine with me. I thought for sure she had passed the first time around. She filled me in on the other students who were in Racine with us. The guy from Salt Lake City who was on his third try taking the test had failed. He failed both his adult patients the same way- he didn't sign the MAR after giving his meds. Not once, but twice. Such a simple, yet huge mistake. Now he has to start EVERYTHING over; three strikes and you're out. I thought I was miserable after failing the first time. I couldn't imagine failing it for a third time. Brutal. I feel bad for the guy and I hope he keeps moving. She wasn't sure who else had failed or passed, but we both felt that the two other people who were there had passed. So, out of 7 only 2 had passed in Racine. The other two people there in Madison were both on their first tries. The CE met us in the lobby and off we went to start. The CA took us through the orientation and then we readied ourselves for the labs. Before I started I had zero nerves. I was excited to be there and ace those labs. I went through each lab step by step, moment by moment. I focused only on the step I was doing and nothing else. I wasn't nervous, I wasn't shaking. I was a machine doing its' job. I did all the labs well under their allotted times and passed all of them. At that point I felt like a God. A king. An emperor. I told myself I was going to sail through those labs and I did. What a massive ego boost that was. I met my first examiner and she took me to the floor to get the info on my first patient. She was a 65 year old who had a bowel resection 2 days earlier. No complications, textbook recovery. My areas of care were medications, comfort management and respiratory management. This was going to be a piece of cake. My wife picked me up from the hospital and we went back to the hotel. I sat down immediately and wrote my Nursing Diagnosis/Care Plan. I went with Impaired Comfort and Risk for Impaired Respiratory Function. Straight forward and simple. It took less than 10 minutes to write everything down. I then wrote up my grid for the next day and planned out the PCS (You can't write down your grid for the first patient the night before. Nothing goes on the form but your care plan. I just wrote mine separately for practice.) The process took 20 minutes. I then put everything away for the night. There was nothing left for me to study, nothing left to look over. I knew I already had everything in my head that I needed. From that point on it was putting everything into use that mattered. My wife and I got take out (I believe the place was called The Glass Nickel Pizza Company or something like that. The food was good, the prices reasonable and they deliver. I recommend it.) and spent the rest of the night relaxing. I woke up at 5:30, showered, ate and my wife drove me to the hospital so I wouldn't have to deal with parking (is she great or what?). I was a little nervous but it was NOTHING in comparison to the first time. I was excited to get moving, but I wasn't worried about my performance. At that point I felt confidant in my skills and I was ready to get it done. My examiner and I went up to my patients unit and I got the standard unit orientation. After that I got started. My Care Plan was okayed and I wrote up my grid. I went through the PCS lust as I had planned the night before. I did my areas of care in the order I wanted to and at a good pace. I finished all of my cares within 45 minutes, which left me plenty of time for my evaluation phase. I sat down, wrote everything down that I had to and reviewed a dozen times to make sure it was correct and I hadn't forgotten anything. When I felt ready I handed in my form with 20 minutes to spare. I then sat and waited for the result. The wait time following the PCS is the most gut wretching, brutal part of the exam. You feel someone waiting to be pardoned by the governor. I waited 20 minutes for the pass/fail. You know what? I FAILED! I forgot to sign off on my meds! The examiner said I had done everything 100% and was hoping that I would remember to sign the MAR. I didn't remember. I was baffled. I NEVER THOUGHT TO SIGN THE MAR! I could not believe it! What a massive DUH on my part (Didn't I say it was a simple but stupid mistake a few paragraphs ago? That's what I get for being a smart ass.) I felt pretty damn stupid, but to be honest with you it didn't phase me too much. I was stunned for a few minutes, but my confidence was still running pretty high and I was sure I was going to be alright. I went back to the meeting room and met my next examiner. My next patient was my peds patient. The first day you're there you draw cards to determine if your first patient is an adult or peds. She was a 17 year old (Talk about lucky. One of the other students had a 2 year old on isolation precautions who cried the entire time.) with Chiari Malformation. Her posterior fossa was misshapend, which caused the cerebellar tonsils to protrude from the bottom of her skull. She had surgical correction done 3 days earlier and would probably be going home later that day. I had NO IDEA what the hell Chiari Malformation was. My examiner was very helpful and gave me a lot of information on it (Google it and take a look). My areas of care were respiratory management, comfort management, neuro assessment and medications. I wrote up my Diagnosis/Care Plan, using Impaired Comfort and Risk For Injury, and wrote down my grid. My Care Plan was good, so I got started. Again I went through my areas of care in the order I wanted to and everything went smooth. For all of my PCS's I did my vitals immediately to get them done. I finished all of my cares in 45 minutes and I made DAMN sure I signed the MAR. I sat in my little room and wrote my evaluation, reading and rereading as I went to make sure I covered everything. With 15 minutes left I handed my paperwork in. I then stood in the hall to wait another excruciating 20 minutes to hear what the verdict was. During the eval phase, if you screw something up and fail, the examiner will contact the CA and they will review it. The CA will then come by herself or with the examiner to tell you that you failed and how. With the patients that I had failed during the course of the two CPNE's the CA came by herself once and with the examiner twice. If your examiner comes to get you it's a good sign that all is well and you passed. After waiting 20 minutes for the outcome the CA comes walking around the corner and almost bumps into me. My stomach slammed straight up into my throat. "Oh hi!" she says. "I have to run upstairs quick. Don't worry, you passed." She kept on walking and got in the elevator. I almost threw up. My examiner came around the same corner and said "Congratulations, you passed!" My initial wave of nausea passed quickly and I was elated. I went downstairs to wait for my wife to pick me up. At that point I knew there was no stopping me. I had this exam in the bag. No more mistakes. I felt confident and ready to keep kicking ass. The first patient was a reorientation, but after that I was set. The girl who had been in Racine with me was waiting outside for her ride. She had passed all her labs the day before and passed both of her patients. She was feeling good. The other girl with us failed one or two labs and made them up. She had failed one patient and passed the other. The guy that was there testing had failed some labs and made them up, but he had failed both of his patients that day. You will have only 2 patients the second day of testing. The third and final day is when you make up the patients that you failed. You can fail one adult patient and one peds patient. Any failures after that and you're done. If you fail both the first adult patient and the first peds patient you will make them both up on the third day, giving you three patients to test out of. I had failed my first adult patient so I had two patients to do on the last day. If you pass your first two patients you have only one to do on the third day. (It probably sounds confusing, but in my head it makes perfect sense.) My wife picked me up and we went back to the hotel. I was wasted tired and napped for an hour or so. My wife and I then left the hotel and went walking around downtown Madison. We stopped at a sidewalk café for a couple of hours and had drinks, talked and enjoyed the summer night. It was like being on vacation. I didn't think of the test the whole night. We went back to the hotel and got food from the same place as the night before and I conked out for the night. I had a hard time sleeping that night. It wasn't nerves that kept me up though. I felt on fire and ready to go. I knew that the next day was going to be all mine and I wanted to get it started. I went outside at 1:30 and enjoyed the quiet for a while. I went back up to the room at 3:00 and did manage to get some sleep before the wake up call at 5:30. We all met at the hospital at 7:15 to get started. My third patient was a 39 year old female a few days post op following gastric bypass. Areas of care were Respiratory Management, Abdominal Assessment, Medications, Comfort Measures and Drainage Collection. Again I used Impaired Comfort and Risk for Ineffective Breathing Patterns. I was able to use Impaired Comfort for ALL of my patients. If the same diagnosis works, you can use it. I didn't mix it up at all and come up with different diagnosis for all my patients. I used the simplest, most effective diagnosis I could for each patient. You don't get "points" for how many different ones you can use and the college isn't concerned with that for this exam. They want to know that you can effectively write a care plan/nursing diagnosis and implement it into your cares. Again, I put the areas of care into the order that I wanted to do them in, with vitals being first. Everything went slick as could be. All cares done in less than 45 minutes. I didn't rush or feel rushed. I did everything step by step until that area was done, then I moved on to the next area. I had plenty of time for my evaluation/documentation phase. I wrote and proof read everything multiple times until I was sure it was ready. I handed it in knowing that it was gold and that I would pass. I still paced the hall waiting to hear from the examiner though. She came into the hall and said, "Passed". I felt great knowing that I had passed and was only one more patient away from being done. I followed the examiner upstairs to wait for my next examiner and last patient. I get upstairs and the girl who tested with me in Racine was sitting and waiting for her last patient. She had failed what was suppose to be her third and final patient, so she had to make it up. She didn't appear frazzled or nervous at all. I think she knew that she had it wrapped up and all she needed to do was focus and finish up. The other guy who was testing didn't make it. I'm not sure what happened to him or how he failed. I knew that he had failed both of his patients the first day and was having a rough time. I hope he returns again for a second try. The other girl testing with us had failed one of her patients the first day, either her adult patient or her peds patient. As the girl from Racine and myself were waiting for our final patients, she came into the room with her examiner. You could tell by looking at her that she had bad news. She came over to us and started crying. I felt absolutely horrible for her. We tried to help soothe her because we had both been in the position of failing this test and knew EXACTLY how she felt. At the same time I'm trying to not focus too much on her failing because I still had my last patient to get through. The CA came and got her and tried to help calm her down, and my examiner took me out of the room to meet my last patient. My last patient was a 63 year old man who had a THA done a week prior and had developed an infection in the wound. My areas of care were Respiratory Assessment (I had either Respiratory Management or Assessment for all of my patients; if there is one thing I can do blindfolded now it's Respiratory anything), Peripheral Vascular Assessment, Comfort Management, Drainage Collection (another JP drain) and another area that I don't remember at this time. I went through everything step by step as I had done with my previous patients. I finished in a short amount of time and had plenty of time for documentation. Again I read and reread what I had written before I turned it in. This was my fourth and final patient and I wanted nothing to ruin my chances of passing. I HAD to nail this one. I handed my paperwork in and began the waiting process. Waiting for that last pass/fail was hellish. At that point, the machine that I was through the past three days had burned out and was replaced with a nervous, twitching human. I paced and waited and paced and waited. I knew that I had aced my areas of care and I felt confident that my documentation was spot on, but there was still that lingering flicker of doubt that I had missed or forgotten something that was going to make my plane come crashing to the ground. I waited 25 minutes, and then the CA came into the hall. "Under Peripheral Vascular Assessment there is something missing in your documentation. Take another minute and figure out what it is." I of course grabbed it, immediately went to the section I needed and started reading what I had written. I read, and I read, and then I read it again and then I read it again and then I read it some more. I couldn't figure out what I had forgotten. On the outside I looked cool as could be. On the inside my brain exploded and I could feel it starting to drain out of my ear. "Color, warmth, movement, sensation and pulse. Color, warmth, movement, sensation andpulse.Colorwarmthmovementsensationpulsecolorwarmthmovmentsensationpulsecolorwarmthmovementsensationpulsecolorwarmthmovementsensationpulse." I had documented everything. There was nothing else that I needed to write. Everything was RIGHT THERE. My panic had consumed me and I thought that was it. I thought I was done. Everything collapsed around me. I gave my paper back to the CA and, almost in tears, told her that I didn't know what else to write. I read what I had out loud to her. For the life of me I had no idea what I still needed to write. "Oh, sensation. I don't think your examiner read that right. Let me take that back to her." She left the hallway for maybe 10 seconds. She and the examiner returned and the CA said "Congratulations, you passed." A HUGE wave of elation swept over me. I went from almost throwing up and crying to joyous ecstatic in one second. The examiner tried explaining what had caused her the confusion with my documentation but I honestly have no idea what she said. I didn't care. My head was in the clouds and I had not a care in the world at that point. I HAD PASSED! We walked back to our meeting room and ahead of me I could see the girl from Racine already there. She made eye contact with me and I could tell by her expression that she was looking for a sign on my face that would say passed or failed. I gave her the old Gene Simmons tongue wag and the double devil horns followed by a huge smile. She screamed "Woohoo!", ran over and gave me a hug. She had passed as well. All the examiners and CA said their congrads. There is a notebook at all of the testing facilities that students who have passed can write in and give encouragement to incoming CPNE students. I didn't write a word. All I wanted to do was find my wife and tell her I was done. I said thanks and goodbye to all and took off. At 12 noon that day was check out time for the hotel, so my wife had packed up and drove to the hospital to wait for me. I went down to the lobby just in time to catch her as she was heading outside. I hollered out to her and she turned around to look. I'm sure that the whole morning was rough for her. She wanted me to pass as much as I wanted to and everything had come down to this moment. The look on her face as she turned around was almost blank. She just stood there and waited for me to say SOMETHING. I threw my arms up, smiled and said, "I'm done. I passed." She exhaled loudly and hugged me. It was and always will be a highlight of my life. What can I say now? I was on the biggest natural high of my life on the drive home. I was able to return the victor. Even now, 2 weeks after having passed I still feel awesome. I get to start a new chapter in my life. The opportunities open to me are endless now. All of the work and sweat paid off and I get to sit back and enjoy it now. All the time spent reading, studying and practicing is done. That time can now be spent on my family and the things I have wanted to do but couldn't because my focus was elsewhere. For those of you who have yet to take The Test, I hope I gave you some insight into what to expect. Remember that what I have written here is my account. This is what I experienced. Someone else who has taken the test I'm sure has a completely different tale to tell. Or, maybe they don't. Either way, all I can tell you is to study and practice in whatever way is right for you. There is plenty of literature, web sites and workshops that you can use to help you along the way. Research everything you can and find out what is going to work best for you to help you pass. To those of you who have failed and trying your second or third time remember the famous words of my wife- "Go in, kick ass, go home." You know how you failed the first time. The first time was a practice run. Now you know exactly what you need to do. Strengthen your weaknesses until they are no longer weaknesses. It's your time, your test. "Go in, kick ass, go home." Any questions or feedback are welcomed. Good luck to all!!!!!!!! P.S.- You know the CPNE study guide, the one that I read and poured over 643 times? The evening I returned home I dragged out my grill and I burned that guide until there was nothing left. You know those study guides that you get for every course that you take? I burned all those as well. It felt good to torch all that stuff. I recommend that to all of you when you're finished.

Hello everybody! I had posted a couple of weeks ago about passing the CPNE June 25-27 in Madison. Here is the tale behind it. Please read and feel free to send comments or questions. I'm more than happy to help out anyone who is preparing for this test. There are two parts to this post because the whole thing was too long for one entry. 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

I just finished reading your journal and you did a wonderful job retelling your adventure. I just passed the CPNE this past week June 25-27 and I wish I would have caught your journal before hand. After reading it I want all the more to write my experience to share with everyone here. Congrads on passing that beast and great job on the journal!

I first posted this on the LPN to RN forum and someone said I should post here as well so that you folks on the Distance Learning forum can read it. I took the CPNE at St. Mary's in Madison this past week June 25-27 and passed. I read every posting on the CPNE that was available through allnurses and I felt that it helped me a great deal. Reading about all of the other experiences that people have had, good or bad, was very informative and helped to get me ready. I will soon write my entire experience so that someone else will maybe read it and get some insight. If any of you out there have any questions at all please feel free to ask me. I will be more than willing to help.

There are 2 sites that you can test at in Madison. There is Meritter Hospital and there is St. Mary's. I had mine at St. Mary's and it could not have been a better facility. I'll soon post my experience and let you know more about the facility.

Hello Everyone! I have never posted here before, but I have spent a fair amount of time reading other peoples thoughts, questions and answers regarding the CPNE. I have probably read every thread regarding the CPNE on this forum. Some were very usefull while others weren't. Either way, the information I got from many of you helped me to pass the CPNE in Madison June 25-27. Thank you to everyone who posted their experiences, regardless if it was good or bad. I will soon post my experience for all of those who want as much information as possible when it comes to this test. If any of you have any questions you would like to ask or if you would like to ask me for any advice I would be more than happy to share my thoughts with you. Again, thank you everyone!