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The BoN in most states will approve an RN with appropriate experience as a Clinical Teaching Assistant - one who instructs students in the clinical area only. There is often a shortage of these sorts of instructors in schools. You might consider working in this scenario while you continue with schooling as it will expose you to the realities of busy, underfunded schools of nursing where you will be required to supervise and instruct up to 12 student nurses in the clinical setting. You will also get insights into classroom teaching and other duties associated with an MSN prepared instructor position. Incidentally, check out the pay scales for these positions before committing yourself. You might be surprised at how much more clinically active RNs earn (without any further ed.) Preceptor style teaching can be more rewarding than school based teaching. The above is just for balance and perspective.

In my school we revamped all our examinations to be in the form of NCLEX style questions. It took a few years to get to that point, but it did help our students by their own reports. Writing NCLEX style questions is a skill in itself - I had been an 'item writer' in another state and was also used to teaching part time for Kaplan, so I gave a workshop on how to write appropriate questions - this needed DON support and some staff were against it at first. I was also surprised at the low level of educational knowledge of the instructors - things like Bloom's taxonomy were new to so many. Eventually, with DON support, we gave workshops/CEUs for staff in these areas too. Schools with 'low' pass rates do not continue to receive BoN approval for the program; this is one thing the BoN monitors well because they are a consumer advocate agency and the students, to some extent, are consumers of what the school purports to offer. So I question the issues over 'low' pass rates. How does your school compare to the average in your state, or nationwide? When pushed by students to recommend an NCLEX style question book I would suggest the National Student Nurses' Association book - it seemed closest to what I knew about NCLEX questions. I do think it is very important to dispel the myths about NCLEX-RN (CAT) for students. Hold a fact session about the test with exact details on how a student is determined to pass or fail (this is complex - best illustrated by a graph with a hurdle on it, I believe), about the time issues involved and the mandatory break and optional break. Remind them to take water and possibly a snack and to take a test run to be sure they know how to get there and where to park etc. Do reinforce, 'while the computer is running, you still have a chance to show you can pass the test. Keep on.' I've had students take five hours and get thru nearly all the questions and still pass. Or had students failed with a shut off at 75. Remind students that the first questions are for practice, but they run into the real test with no clear break. Tell them that if a question just reads in a weird manner, to make a choice and move on (it is just possible that question is not part of the test, but is itself being 'tested'. Warn students that the test center may not have ideal conditions e.g. some students of mine took NCLEX with road works and drills outside the window or noise in the test center. Otherwise I just taught good nursing care, did not get into expert care scenarios with students as NCLEX tests a new graduate, not a critical care RN, critical thinking skills (e.g. we all know that to prevent osteoporosis, regular weight bearing exercise on the long bones is a good idea - make sure they can translate these sort of stylized responses into real life and realize this includes dancing, safe weight lifting.) I was surprised at the number of students who could trot out the text book statements, but did not know what these statements really meant in practice. Hope this helps.

Ask for Kytril or Zofran before/with/after chemo; your health insurance plan may require you to undergo a trial of one of the simpler antinauseants, but you truly can insist on the latest generation meds. I do believe there is a later version than these two too. I worked thru a year of old fashioned chemo given q3 weeks (dependent on blood counts) for a year. And only getting Compazine - this was the 80s. I was teaching nursing at the time, so perhaps had a bit more flexibility than you might have. I was mentally strong about it all, but only in my 30s. Had the chemo on Thursday PMs so I had Friday and the weekend to deal with the nasea. I kept the weekend totally clear. I think high dose chemo over 3 months might be preferable and it is probably what you will be offered. I'm a long term survivor; you can be too. I wish you well.

I take issue (and thus hope to help clarify for you) the statement that 'the IRS does not view nurses as independent contractors. Over about a ten year history in CA I have been an independent RN IC and had no problems with the IRS using Turbo Tax for my returns. Sometimes I am even an employee (of a different organization) at the same time. At the same time one of my colleagues was undergoing a huge tax dispute related to their home based business growing a certain plant, so I was aware of some similar issues. Usually the IRS looks for certain criteria in determining IC status. Ask any general contractor - he is responsible for verifying the fact that his sub contractors are IC or he will be required to withhold taxes. The details can vary, but some of the pointers are a business license, working for more than one organization, i.e. having more than one contract, independently printed stationery. A separate business entity e.g. S corp, LLC etc is very helpful, but not essential, at least in a tax sense. Beware of organizations offering 'huge' tax savings. Very detailed paperwork can sometimes get you small benefits. If you are thinking of a large capital expenditure e.g. new computer for your business, then check into the tax savings possible before you buy. Otherwise I have not found the paperwork and slight worry worth the effort. Beware of home offices - there are many rules as to how much space and use of the equipment can be claimed against tax. If you use your home office space/computer etc for private use there will be issues you need to clarify before you start. I keep IC very simple, do my own paperwork with occasional resource to a CPA or atty. prn on specific matters. Use the govt. resources in your state - they can be very helpful. Use people's opinions and ideas, including this one, as pointers, but do your own homework using govt. based web sites, offices and resources. The IRS web site is much more user friendly these days and everything is there if you devote a day or two to finding the info. "Most hospitals will not deal with ICs" - that's a very sweeping statement; as we speak, more and more hospitals are having to go with IC nurses because we are a growing force that will not go away. (Think of how many PTs are IC!) I belong to Nat. Assoc. of Ind. Nurses (NAIN) at independentrn.com - nothing to do with the web address you posted I believe. We are a sane group of practising ICs but you need membership to get to the bulletin board. Also NAIN is setting up a Professional Practice Group for ICs to join forces, without this being an agency or compromising IC status in the eyes of the IRS. The above is not legal information; just some pointers I have followed successfully. Incidentally, Medi-Cal allows RNs (not nurse practitioners) to be Independent Nurse Providers and classes them as Independent Contractors. How can the IRS not believe this is a a genuine IC RN?

As 3rdshiftguy stated, the number of questions before shut off is irrelevant. But we should keep the facts in mind for future NCLEX (RN) CAT takers. The computer keeps offering questions until 1. you answer 'enough' questions right (and thus 'prove' you are safe to practice nursing) 2. you answer 'enough' questions wrongly (and thus 'prove' you are not safe to practice nursing 3. you run out of time (approx five hours give or take mandatory and optional breaks) 4. you run out of questions (over 300) Proving you are safe is more a matter of getting over a threshold level of accuracy rather than getting every question right, whether you get cut off at 75 or 300+. The test is a measure of consumer protection; whether it actually measures a minimum level of safe practice is irrelevant. You need to have the skills to pass it before you may get a license. I was one of the instructors who had students who volunteered to take the pilot tests for the computer generated NCLEX some years ago. We all feel it beats the old 'two-days in a strange basement doing MCQs'. The important thing to remember is that while the computer is still running, you still have a chance to prove you you can pass the test. Keep calm, take all the breaks offered to you, take a snack and water for the breaks and keep going. I've known students pass (and fail) at minimum questions, maximum questions, 40 mins, five hours and everything in between. If you've got thru nursing school, you can pass this test. Good luck to those waiting (and those reading for the future).

To be approved as a full instructor in most states by the Board of Reg. Nursing you will need an MSN. Most MSN will offer final year options, including education. Not much, but a start. It is laudable you wish to be appropriately prepared to teach; so many instructors are appalling teachers (learning facilitators). It is possible to pick up courses in education theory (and practice) at local colleges. Even grade school teaching prep. helps with educational background. Like Tim, I really value my teaching degree. But you do need that MSN. Have you looked at the MSN online from CSUDH?

Waves: The replies you have already received are sane and sensible. I am an experienced, approved nurse instructor and I believe you have more than enough tools to achieve your goals. You can do this even if you don't get any more than the problems you list from your school. But you do need to keep within the school; only the school can put you forward to the Board of Vocational Nursing as having completed the nursing curriculum. It is the school that recommends you to the board to be able to take your state board examinations which will license you to practice. Stay savvy, stay within the school system. You've had a disgusting experience and one which seasoned instructors know happens all the time. We fight against it and do what we can for students, but new DONs seem always to reinvent the wheel with untested results for the students. The BoN will not be able to help you 'police' the school - they have had staff cuts. My advice (and I presume that is what you wanted when you posted) is to go through the motions, meeting the school requirements, learning what you can from your texts and from practising staff. Just make sure you get the class, clinical and lab time in and documented. You wrote an impressive posting; I believe you have what it takes to almost teach yourself the theory; the clinical seems to be doable if you can just simply get to clinicals and learn what you can. If you don't feel prepared for your boards, take a prep course or ask for help from a previous instructor. I've often tutored students for free that I felt had a poor deal.There is no magic check list of skills for the board and you will really learn your skills when you graduate, get licensed and get a job. Attitude is everything here. Make a solid, non-complaining, positive support group within your saner buddies and start helping each other. Don't waste your time with 'issues' with the school - I know for certain you will not change anything and the less time the DON spends on your short-term issues, the less time she will have to complete your paperwork to the board appropriately which is really what you want from her. I do wish you success. Keep us posted. I know this is tough advice; I also know it works.

Why is anyone even interviewing without knowing what the basic pay scale is the for position? It is such a waste of time and in this RN and LVN job market employers need to state up front, at least to a suitably qualified applicant, what the scale is. But tntrn is so right. Sometimes the new grad is earning more than a senior person because the facility had to offer more to recruit new grads. I believe we should be firm about knowing the basics before we prep ourselves for an interview etc. And this will slowly leak out and make a fairer playing field for those who have been at the facility for a long time and who have missed out on the 'shortage of nurses' increase in rates.

Seems to me to be a common (nosocomial?) infection in the immunocompromised. A little like PCP, but in the gut. Yes?

I'm with Tim in being very careful, as an instructor, what I say about students and their habits. At the beginning of clinicals I set out the rules per school of nursing and the additional ones per the facility. Breaks should be taken per the rules; what students do with them is their business, but I encourage eating and taking fluids. I impose sanctions on any student who takes more or longer breaks than allowed. I strongly reinforce the facility smoking policy (where and wearing what) and that no odor (perfume, smoke, incense etc) is usually preferred by patients who may be nauseated. Clinical placements in some areas of the country are hard for a school to maintain. In 'difficult' facilities, the students are required to sign a form which lists the special issues of this particular facility e.g. enter and exit by rear door, park in designated employee parking, smoking only in smoking designated break area, knock before entering rooms, etc. etc. (I won't post too much detail as it might identify a facility!) but you get the picture. I think it's up to the clinical instructor to set the tone for behavior that is acceptable or unacceptable and really spell it out. But even then you can be caught out; I once had a student who thought it was OK to leave the facility for his half hour break and drink two cans of beer. I had not specifically said otherwise, was his counter statement.

Serena: Seems to me that you will do better than most educators for the nursing students - at least you are thinking about appropriate preparation for the role and trying creative avenues to get information. I wish you (and your students) success. Dwell in possibility. And I really do advise checking out the CSUDH Master's - I'm sure you can do this online.

I think the word that escaped you was 'factoring,' Agnus.

Yes, there are MSNs which offer a 'specialization' in education. And yes, there are expert nurses and expert educators and the secret, I think, is to stay current in both areas so that you truly know what you are talking about. This is called being a professional. Any college which takes senior faculty out of the clinical area is doing students a disservice, I believe. From the comments of those trying to teach with MSN with educator option preparation, and from my own observations, I have not been impressed by the 'educational' components of MSN degrees. For example, as an Assistant Prof. it was I who had to 'teach' the new (MSN type) profs about working within the BoN curriculum rules, how to work out theory, lab and clinical hours per course; that examination time is taken out of these hours, not additional to them, and how to write a lesson plan (!) And that playing the whole of a commercial video (however well a nursing point is demonstrated) to students BREAKS COPYRIGHT law and threatens the school. Not to mention if 2 hours of this sort of 'teaching' is really appropriate use of precious course time. It was I, although technically not 'qualified' by the BoN (MA, not MSN), who headed up the new curriculum committee, teaching other faculty as we went along about curriculum, syllabus, Blooms' taxonomy of educational objectives, increasing the level of these objectives as the students progressed thru the program, writing measurable learning objectives which correlate with Bloom, and about student centered learning. When, oh when, are MSNs going to stop 'lecturing' - I fielded numerous complaints from students who stated their doctorally or masters prepared 'educator' was reading the text book chapters to them, or just droning on about the subject. Or telling 'war' stories all the time. Like NewCastle Ken in another, similar thread, I have found ways around the education/nursing divide and now both practice expert nursing and 'teach' using sound educational principles and student centered learning with two establishments that know the value of a properly prepared educator. And I am very picky about the quality of my own continuing education. But I am still a little angry and very sad at how poorly many of our students are taught.

I'm seconding Ken's post; I've been in education many years with a B.Ed and MA. It would have been simpler to have had an MSN. I very much value the B.Ed (thorough prep. in psychology of learning, philosophy of learning/teaching, social policy, plus teaching strategies, curriculum and syllabus issues, classroom control, assessment (term usually used in education for 'evaluation'), audio visual aids, examination design and grading etc etc.) The theory was followed by a year of teaching practice in a variety of educational settings, with each session assessed by at least two people. This was in the UK. This B.Ed. degree provided a very valuable tool for me and I always felt rather sorry for those trying to teach with just the 'education' part of an MSN; it's approved for doing the job by the BoNs, but I just know I had an easier time over exam issues, class control, lesson planning, writing learning objectives etc. However, if I were in your shoes now, I would get the MSN, probably by distance learning (try CSUDH at Dominguez Hills - they've been in MSN distance learning territory a while and know what they are doing, also reasonably priced - also a main stream Uni) and when that is all over, realize what little you have been taught about education and read some ed. philosophy (even regular grade school ed. philosophy is good background), ed. psych. etc or audit a few classes - even at junior college level to give you some real practical assistance. I do hope this helps you decide how you are going to achieve your goals.

I once walked into a Med/Surg II level class - I was the 'visiting expert' lecturer on liver disease - and asked each student to put a hand on his/her liver. Half the class placed a hand on the left side. Next I asked each student, without a book, to draw a rough sketch of the relations of the liver, stomach, pancreas, spleen, gallbladder. After several minutes only about 5 students out of 40 or so had an even half way accurate diagram. I told the students I would be ready to teach them when they were appropriately prepared, but this might mean a very late evening for them! I asked them to send a class rep to my office when they were ready. I then walked to the DON and told her what had happened. She was reasonably supportive, but an educator can't refuse to teach and you can't disrupt the day's schedule of classes for this sort of thing. (I knew all this in advance, but had just had enough - these students were supposed to have the prerequisites). I post the story because it may be the norm you have to learn to deal with. There was a lot of pressure in my school to keep students in the program whatever the issues. Over a few years I started to post my pre class expectations very clearly, but I did keep them very simple and even posted ways of doing something appropriate even if a student truly had no time. (I was cognizant that one student had a very sick diabetic two year old, etc etc.) Eventually most came with the basics, but it was very hard and took being consistent and insistent. Other faculty accused me to 'teaching to the test' - I'm not sure this matters too much - the students still have to have the knowledge and I toughed this out. But I have been thru all your frustrations and understand. Look at the other standards in your school and see what successful (defined as you please) educators are doing. I wish you some success.