splendid

Is there any way to meet this requirement with free continuing education credits? I am looking and looking and unable to find anything free of charge. I'm fine with the actual requirement but am really wanting to find something free of charge. The links posted above by dianah all come with a fee (some of them clearly exorbitant). I'm not currently affiliated with any institutions/organizations in Michigan (right now I live/work elsewhere but want to maintain my MI license).

I work in a Critical Access Hospital with a very low patient census. I'm a new RN and this is my first nursing job. During my clinical placements in my nursing program, I was never placed on a unit that had RNs and LPNs; all I ever saw were RNs working with CNAs. Although I studied LaCharity for NCLEX, actually working with LPNs is completely new to me. Typically our inpatient floor is staffed with one RN and one LPN. My preference at the beginning of shift is to do shift assessments on all of our patients while the LPN does some of the other beginning of shift tasks. Most of the LPNs I work with are fine with this, but there is one who finds it offensive and stated that it makes her feel like I (and the one other RN at our hospital who does this, who has been there longer than anyone else) don't believe she's capable of doing adequate assessments. My sense is that the RN should be the one who assesses each patient (there are never so many that I can't assess them all), because if push comes to shove the responsibility for having missed something will be on the RN, not the LPN. However, I understand that LPNs are nurses too, and she does have much, much more experience in nursing than I do. I do not at all doubt this person's ability to do thorough shift assessments. I did not mean to question her competence, and now I feel stuck because I don't want to offend her or get on her bad side (given how tiny our staff is it would be terrible if I got on anyone's bad side to that extent), but I also feel rather strongly that the RN needs to do that assessment first thing in the shift. As far as I can tell there is no policy on this at my hospital. Apparently the former nursing supervisor didn't think much of LPNs and this really rubbed our LPN staff the wrong way. The new nursing supervisor doesn't seem to care much as long as everything that needs to get done gets done. I would much rather work this out between me and this particular LPN than take it to our supervisor. Preserving my ability to work as a member of a team with every other nurse at this hospital is extremely important to me given the fact that I really do need to be on good terms with all of them given just how few of us there are. Plus, I'm the least experienced nurse there and everyone is well aware of that. I need to stay in people's good graces given that I have to ask them for help/guidance multiple times per shift. Any ideas about how to handle this in a professional but friendly manner? I am not dead set on telling her not to do morning assessments, but I also feel like not doing them myself would be a bad idea on my part. Am I wrong in my thinking that the RN should be doing these? Is it okay if I agree to divide them up between her and I? Or should I hold my ground and insist that I do them, even if it means she suddenly becomes far more difficult to work with (which I think is what would happen given how new I am, and how much she has expressed a dislike for RNs thinking they're automatically better nurses than LPNs)?

I graduated with my BSN in May 2013 and started working at a Critical Access Hospital (CAH) at the beginning of December. Because the hospital is so small, my orientation has consisted of working as an extra RN (usually there are 2 RNs and 1 LPN working) and learning as much as I can from the RNs and LPNs. I worked nights during my first month, then on days for the last 2 months. Just switching between the two shifts was a bit of a transition because they're quite different. As soon as I started understanding the basics of what the night shift staff does, I was put on day shift so I could "learn more." I almost felt like I was starting over when that happened. During my orientation period (which is still ongoing but may only last a few more weeks...it's up in the air right now), I have been moving back and forth between the inpatient floor and the ED (they're adjacent to each other). Lately what typically happens is that I begin the day with doing inpatient assessments and focusing on what needs to be done there, but then as the ED picks up later in the day I take patients on that side (while trying to keep track of what's going on with the inpatients, because sometimes I'm asked to give report on them even when I haven't done much there during the second half of the shift). Now I'm also being scheduled to help out in the OR recovery room (there are a handful of surgery days at the hospital each month). That is yet another new setting in which to learn as much as I can just by being pushed into doing with some explanation from the other RNs here and there. I'm thinking of asking to hold off on the recovery room days for a few months because I still have so much to learn in the inpatient/ED areas and adding one more area is another source of stress. The nursing supervisor seems to be understanding and patient with me. Besides me, she is the only RN at the hospital who graduated from a BSN program and as a result she seems to be the only one who understands just how little clinical skills are focused on in a BSN program...the rest of the nursing staff doesn't really get it. They think it's a shame that someone could come out of a nursing program not knowing how to jump into working as a competent nurse. I see their point, but it's not exactly something I can change. The nurses I work with have been helpful for the most part, but at the 3 month mark I feel like they're starting to get really impatient with me and expecting that I should know what I'm doing for the most part now. I've talked about this with some of them and they say that even after a year or 5 or 30 nurses still have moments of not being sure how to do things, and they tell me to keep asking questions rather than pretending I know how to do something, but I have a definite sense that people are starting to wonder why I'm not working more autonomously at this point. The thing is, I can see that I've made tremendous progress in the 3 months I've been there. When I started, I didn't know how to hang IV fluids, note and carry out orders from the physicians, or what was used to clean/change over a room in the ED. It seems that I learn how to do new things every shift, and I've been feeling good that each time I go to work there's a little more that I can do on my own. Coming from a background of zero healthcare experience, I thought that I was doing fine for my experience level (basically none) and making slow but steady progress. (I also completed ACLS last week, and am planning on taking PALS soon.) Yesterday, I was getting ready to leave when one of the two RNs I'd worked with caught me off guard in the break room and started telling me that I need to be confident, that I have no confidence and am timid, that I need to stop saying things in front of patients about not knowing how to do certain tasks, etc. After it was over I thanked her for the "pep talk" but it felt more like she was haranguing me. It seems like my fellow nurses are continuing to say that they want me to ask questions, that they understand that I'm new and still learning, etc., but at times it now feels like they're impatient and that I'm an annoyance. This is what happened yesterday with that particular RN: she would be chatting with the other RN, and I'd keep having to interrupt them in order to ask a question about how to do something. At one point someone came into the ED with a cut to his hand, and the physician came in to fix it but then said "you haven't cleaned it yet?" I told him I'm new (he'd only worked there once previously and doesn't know me) and that I was going to do it right then and he was fine with that. Any nurse with experience would automatically know that you clean a lac before the provider comes in to repair it, but this hospital is tiny (we don't see nearly as much variety as bigger hospitals do) and I hadn't seen one like that before so didn't know what to do. I asked this RN for help because I didn't know what to do and she helped but it seemed like she was also annoyed that I didn't know how to do something so incredibly simple. At that point I said something about how I know I look stupid right now but I just don't know what the procedure is for something like that and that I needed someone to show me one time so I can handle it in the future. I know I shouldn't have said it in front of the patient, but I let loose a bit because (a) I knew the pt was also licensed as an RN so I was being a bit more open than I should have, (b) my frustration level was at a high at the end of what had been a shift where some things went wrong, and © I had the sense throughout the day that this RN thinks I should know more at this point than I do and I was feeling emotionally exhausted by that. Fast forward to the end of the shift when she's telling me I have no confidence, to NEVER say something like that again in front of a patient, that I'm timid, and that I'm smart and know what I'm doing so I should just be confident. She also stated that by this point I should know how to do a lot of things, and that I need to stop taking things so personally. I left feeling terrible. I know myself and I know that my confidence--as an RN, and as a person--has been growing steadily as I've gained some experience. I know that it's going to take a year or two to feel like I have even a basic level of competence as an RN, and I'm okay with that. Yet when I'm at work there are times where I start apologizing left and right for not knowing things, because it feels like the only way to deflect people's judgements about me. It's not that I'm actually sorry for not knowing things or for asking questions; I'm fine with that. I end up apologizing and being self-deprecating as a way to let other nurses know that I recognize that I have a long way to go, in the hopes that it will keep them from thinking even less of me than they already do. I know that's messed up and that I need to stop, but it's something I've been doing almost automatically lately. I keep telling myself that competence is only going to come through experience, and that experience takes time. It's tough getting a variety of experience in the CAH setting because I might see something on one shift and then not see anything similar for months (a similar lac, say) or years (a birth, a chest tube, etc.). We just had a week go by in which there were NO inpatients--I didn't get much experience with inpatient care that week. The bottom line is that I'm doing the best I can, and I can see myself growing in knowledge, skills, and confidence from shift to shift. My problem is that I've now started to apologize for asking questions and not knowing how to do things because I feel like the RNs and LPNs I work with are getting fed up with my inexperienced self. I truly don't believe that the answer here is to "be more confident": I think the issue is more one of competence and that that can only come with time. In the meantime, how do I cope with the constant stress of feeling like my co-workers are saying that they know I have a lot to learn, yet are acting impatient with my questions, requests for help/guidance/instruction? How do I stop myself from apologizing for my inexperience as a way of letting everyone else know I'm painfully aware of it?

Thanks for posting this. I'm 11 weeks into my first job as an RN and still feeling the same way: anywhere from sort of incompetent to completely incompetent. I haven't had a formal orientation because the Critical Access Hospital I work at is tiny, so my orientation has consisted of working as an additional RN and learning as much as I can during each shift. A couple of things I'm noticing: (1) The degree to which I feel like I'm progressing has quite a bit to do with who I worked with that shift. Most of the staff are pretty good about helping me learn and pushing me when I need it, but there are a few (RNs and otherwise) who rub me the wrong way and make me feel stupid and hopeless. For whatever reason, their style and mine don't mesh. I suspect that they either don't want to or don't care to remember what it's like to be a novice who knows next to nothing and is just struggling to keep one's head above water. When I work with them I put in extra effort to remind myself that I'm doing the best that I can, that this is a difficult transition, and that I'm improving with each and every shift I work (even if it doesn't always feel that way). (2) As xoxJanexoxDoexox suggested, getting your own methods of organization established will go far in helping you feel like you're gaining some control over your work. I've found that it's frustrating to have different people each showing me how to do things and then criticizing me when I do it the way someone else showed me (or that the same person showed me in a different way the week before!). At some point I'll know enough to know that I'm working within acceptable parameters and be able to say "you do it your way and I'll do it mine" but right now I'm still learning what's expected in the first place. I did come up with my own "brain" which I use in conjunction with one of the pre-printed forms the other nurses use; it has prompts for the parts of my inpatient assessments that I can mark off as I do them, spaces for labs that are most common/important, and room for random notes (things to talk to the physician about, etc.). On the reverse side I have an hourly schedule where I write down meds, when someone needs VS, etc. When I use that sheet I feel much more organized and on top of my game. As for the ED part of my job, I'm still figuring out a system for how to keep track of things there. I've also started working surgical recovery and will need to figure out a system for that as well. This all takes time and experience. We need to keep reminding ourselves that NOBODY had things figured out immediately when they began working as nurses, and it's okay to be patient with ourselves even when others aren't. I don't know if any of that will help but I 100% understand where you're at because I'm right there with you. I guess we should be grateful for the co-workers who make an effort to help us, and try not to let the less understanding ones get to us too much. Easier said than done, but their actions and attitudes say more about them than they do about us. I've begun promising myself that if I ever have the opportunity to work with a brand-new RN that I'll do everything I can to be supportive and build them up rather than tear them down. Negativity is NOT the way to help anyone learn or be encouraged in a new endeavor. Good luck. I hope we can both hang in there and that at some point things will improve. Everything I've read here says that at some point (probably between 6 months and 1 year), it will. Until then, we need to have faith that we're heading toward competence, one difficult shift at a time.

I take the NCLEX-RN in 18 days. I have completed the Hurst Online Review (including the strategy questions) because I knew I needed additional content review and I feel it has helped a lot. I haven't taken any of the Hurst Q-Review tests yet. (I'm also working through LaCharity.) I was planning to purchase Kaplan On Demand as well so I could access the Question Trainers and get a better idea of what kind of shape I'm in going into the exam, but now I feel like time is running short. Would it make more sense at this point to (a) review my Hurst content, do the 6 Q-Reviews, and use some of the other sources of questions I have (Saunders CD, Kaplan CD, questions from a few other sources), or (b) would it be better to focus on taking the Kaplan QTrainers so I can get some scores predicting how I'll do (obviously this would also be a way to get used to doing lots of questions at once)? I'd planned to do the QTrainers a bit earlier but didn't finish Hurst until now. I feel like time is running short and want to make the best use of the time I have left to study. I believe Hurst when they say focusing on content will help you get more questions right, but I think I might feel nervous going into the exam without the peace of mind that predictor scores might provide. (Don't factor money into your response as I just want to know what would be the best plan moving forward if money wasn't a consideration...I'm prepared to pay for Kaplan On Demand if it will help me pass.) Thanks for any insights you can provide.

GrnTea, yes, I'm sure that I read it properly. I read and re-read and re-read some more to make sure I wasn't just misreading or misinterpreting the question. RLtinker, thanks for the information. I looked this up too and found multiple sources that say not to aspirate with subq heparin administration so I'm going to assume that that's the correct practice according to NCLEX. cll72089 and RLtinker, I agree with you that it may be a mistake. The bad news is I spent a lot of time thinking about this, but the good news is that I learned a lot in the process! Thanks everyone for your help and suggestions! Just wanted to make sure I wasn't overlooking something.

I am reviewing rationales for questions from Practice Exam 1 in Exam Cram NCLEX-RN Practice Questions, Second Edition, and need some help understanding the correct answer for question 11 (I won't post the exact question or answers here since I understand they're copyrighted): The question asks which statement made by the graduate nurse indicates a LACK of understanding of heparin. I answered: the nurse states that s/he will aspirate when giving heparin. Correct answer: the nurse states that s/he will check the PTT before administering heparin. I was under the impression that we should NOT aspirate when giving heparin (so saying that you'd do so indicates a lack of understanding). Also, I know that PTT is the test used to determine the correct dose of heparin but I thought this is checked 4 hours prior to administration so I can see why that answer would be wrong (PTT doesn't need to be checked directly prior to administering the medication so stating that you'd do so indicates a lack of understanding). Should I assume that NCLEX-RN wants nurses to aspirate when giving heparin?

Has anyone taking pre-reqs at Lansing Community College taken the Health Biology Proficiency Exam? I have to pass this before I can even register for anatomy. Just a little nervous about studying for it - I have no idea how difficult it will be and it seems like a lot of studying that I'm having to do for a pre-req to a pre-req. I have to say, all of the pre-reqs this community college requires are getting on my nerves...I know they mean well, but I've never had to do this stuff at any of the universities I've attended so it's new to me. Hopefully somebody out there knows about this exam and can at least help me feel a little less alone.