shortnorthstudent

I guess I'm not quite sure I understand. Have you actually been offered a position as an RN by your place of employment? It is one thing to update your licenses on your credential list at the facility/hospital. However, if they haven't hired you as an RN, you will need to maintain licensure for the position which you have been hired to perform. I know know the ins and outs of whether you can function as an LPN once you are an RN, but even if you can, you still need to maintain that license if that is what your job is. Not every company automatically offers a new position to employees who become RNs. I would clarify whether you will be employed by them as an RN and go from there.

Our grades are listed by the number of points we got. Most of our exams were either 40 or 50 questions, so our grade would be listed as X/40 or X/50. We typically had three exams per quarter plus a final, so our total would be X/160 or X/200. Our syllabus would specify the exact number of points for each letter grade and for passing. For example, an A was 93%-100%, 86-92% was a B and anything less than 76% was failing. It varied by lead instructor on whether a class with 160 points had a cut off of 121 or 122 points for passing, meaning that some instructors rounded and some did not. We had only exam points as our grade. We had additional work, papers, careplans, etc. which were graded on a pass/fail scoring and you had to pass those in order to pass the class, but there were no "extra" points to be had by doing well on written work.

great post. i keep reading these posts about "practicing under someone's license." i am aware of no state in which a student nurse practices on someone else's license. clinical instructors, faculty and preceptors are required to have assessed a student's abilities and supervise them appropriately. however, student mistakes (as long as they are appropriately supervised) aren't "on" a clinical instructor's license. can you imaine? no one would ever be a clinical instructor if they were at risk to lose their license over students who are just learning. my understanding is that states have exeptions to the requirement for a license for students in clinical settings. you are required to stay within your scope of practice which means not performing skills for which you haven't been educated/trained. op, i think you need to work on your confidence. it is important for your patients that you don't display a lack of confidence, even if you feel one.

I am surprised at the number of posters who are blaming the patient for not turning to the right to take his medication. Sure, it would be great if our patients were all in a position to care for themselves. But, if they could, they wouldn't be in the hospital. If you have a patient who has difficulty swollowing, it is vitally important that you assess what is going on rather than continuing to push through. As for the IV skills, I wonder if the manager was talking about IV starts since you said you didn't have any while you were there. IV skills encompasses so much more than simply starting IVs. Appropriately hanging meds, pushing, documenting, assessing sites, ensuring that there are not compatibility issues, etc. Given your description of your difficulties with oral meds and narcotics, I wonder whether she was perhaps referring to your skills at IV medication administration/documentation rather than starting IVs. As a newly licensed nurse, I would have expected your school to have instilled in you the importance of protecting your license. You cannot protect your license if you simply pass medications without first assessing a patient. You were not at a clinical site. You were the nurse. There is no excuse for not knowing what is going on with your patients.

I assume that if you are looking at an NP in cardio, you plan to work with adults. Therefore, I would probably take the oncology position. Just because it isn't full time right now does not mean that you won't be able to pick up shifts or get hired in full time. You are more likely to gain experience with cardio patients in oncology than you will in pediatrics. Either position will get you a great deal of varied experience.

I print out my SBAR. I fold it in half and use one side for my info. On it I write - assess, vitals, orders, labs and then the times that I have to give meds. I then make note of pertinent information about my patient under those categories. I only not relevant labs - abnorms and sometimes even norms depending on what's going on with my patient.

I cannot speak to the hybrid program. I made the decision not to apply to the hybrid program originally because I knew that I wanted the contact of the traditional program. There are certainly pros and cons to both. I think communication has to be expected to be a potential con of a hybrid program. I took a lot of online and hybrid courses and I found that to be a huge minus in those courses. Ultimately, I didn't have confidence that nursing would be better than any other hybrid and I went with the program that I thought would be better for my learning style. The program has problems. Absolutely. But, I don't think they are any worse than any other program in the Columbus area. Every clinical site is different. There is no guarantee of skills. Have you really made it to 5th quarter with only giving one shot and no IV skills at all? I would say that your experience is unusual. But, you cannot guarantee what any unit census is going to be or what nursing care those patients will need. I personally made it to the end of 6th quarter with only a couple of IV starts and no foleys. But, loads of other IV skills and skills in general. I am in my preceptorship. I am having a fantasic time. No other students to compete with. I have 3 and 4 patients each shift. Other than needing my nurse to get meds out of the pyxis and observe certain skills, I take care of my patients from beginning of shift to end of shift or discharge. I get lots of fun skills - IV starts, IV meds, Chest tube dressing changes, foleys, etc. But, I am also finally realizing that anyone can be taught to perform skills. It takes a nurse to put it all together and take care of the patient. I like the skills. I am happy to get the experiences while I am still a student. But, much more than that, I am thrilled to know that my assessment of the patient's condition is what prompted the doctor to order the chest xray that showed a medical problem that needed treatment, etc. That critical thinking cannot be replaced. That is the important part of nursing and the part that I am really glad to get more experience and gain confidence. Hopefully your willingness to help the nurse manager will stick with her at hiring time. I would keep in touch and pick up shifts if you can. You don't have to precept on a floor in order to get a job there. I would just continue to make the best contacts you can.

If you are doing things your own way rather than the way your school instructed you, that may be the problem. As a nurse working on a floor, you can get into your own rhythm and do things your way (within limits). However, as a student, you have to fall within your school's guidelines. It isn't just about getting it done in a way you perceive to be safe, it is at least in part about doing it there way while you are a student. As far as giving you tough patients, I always try to look on it as my instructor trusting me enough to give me the difficult patients. You learn more from the challenge. Try to look at it as a compliment, not a punishment. I disagree with the other posters who believe that they are paying therefore the instructor has to be nice or should be reported to the dean. Just because you are paying does not mean that you deserve to have your hand held. You are paying for the opportunity to learn, not the opportunity to be handed an education. Entitlement attitudes will not get you far in your nursing career.

A lot of the disorganization has to do with the switch to semesters along with a push within the college as a whole to decrease costs which has meant that some faculty have taken early retirement. I am graduating in 42 days. The program has had its ups and downs, but overall I have had great faculty and wonderful clinical experiences. I cannot speak to the hybrid program. I do think that there will continue to be some disorganization as they handle some changes in faculty and make their way through the change to semesters. Board scores are back up (the class that graduated in December had almost a 93% pass rate). The faculty is trying to fix a year of disappointing Board scores - there was a lot of concern about cheating, which seems to have been dealt with. Some of the disorganization is intentional, in my opinion. It is a teaching method to make the students make their way through. CSCC is not the only school that utilizes this pressured teaching method. The further we get into the program the more we learn to work our way through relying on ourselves and our ability to handle stress. We are heading into a profession where our hands will not be held. It is a good program and has a good reputation in the community.

No need to ask for forgiveness. I was just trying to help you flush out your thinking without giving you the answers. Very interesting scenario. Not a patient I would want to have on my tele floor this term in my preceptorship.

I was going towards heart disease. Many of our COPDer wind up with CHF which is why I was asking about fluids. You certainly want to incease fluids with pneumonia, but you also have to be very aware of output as well as heart sounds, etc. because you don't want to push him in to CHF with all that fluid. My instructors are always very interested in what we really mean for the patient individually when we say: encourage fluids CDB ambulate monitor blood sugar i/o Those are catch phrases that we learn early on, but we need to make sure we think about it for the patient as an individual.

Fluids are not a no brainer. No not everything can be fixed with and IV and in fact, the point I was trying to get at is that you need to consider what problems can come as a result of COPD. What is a frequent comorbidity with COPD? Are you sure you want to throw fluids at this person? With his medical problems, he likely is dehydrated, but you have to be very careful with fluids and COPD. How much fluid, how fast, IV and oral? Encouraging fluids through refilling water jugs, making sure the water is an appropriate temp for the patient, reminding them to drink, etc. can be a good thing. But, even with something as innocuous as water, we have to be careful. Too much in the wrong places can cause serious problems for the patient.

Encourage fluids. My instructors allowed us to say that in our first term or two. But, I'm graduating in less than 2 months, so from my end encourage fluids is no longer a really good answer - and given your patient's status what do you think? What does encourage fluids mean to this patient? Are you going to refill his water jug continually? Would you expect orders for IV fluids? Why or why not? With regard to fluid status, what are you watching for? What assessments can help you watch for potential problems? Anyway, that may be much more than you'd have time for in a typical sim session. But, it would be an interesting patient to think about.

First of all, your patient's immune function is a mess anyway - between the CAP and diabetes in particular. He's going to be receiving IV antibiotics for the CAP. While it is certainly possible to contract a HAP that is not treatable with the antibiotic for the CAP, your job is to prevent him from contracting an additional pneumonia. How do you do that? Are the steroids for the pneumonia or for the COPD? I know you already posted the textbook version. But what does it mean for your patient? Think about an exacerbation of COPD without pneumonia. What would you do? Probably some oral or inhaled steroids right? Well, think about how much more difficulty this patient is having when you throw a CAP on top of the chronic problem. Will treatment modalities need to be ratcheted up? I bet your patient has orders for lots more than just the steroids and antibiotics. You need to be thinking about what the steroids are going to do to his underlying diabetes. What do you have to watch for and what are you going to be checking, how often and what do you hope is on the MAR for as a result? What else do you expect to find ordered? Meds, tests, monitoring, etc.? It's a fairly complicated patient with a whole lot of stuff that could get really bad really quickly, so you want to be watching for any little changes in the patient's condition.

Time management skills. I am in my final term and am in a preceptorship. I hope to increase my ability to manage my time while providing care to multiple patients.

So, what about the relationship between your patient's chronic COPD problems and the CAP? What concerns do you have with a COPD patient with CAP (and diabetes) that you might not worry about with an otherwise healthy CAP patient? If the patient is diagnosed with CAP, then are we worried about masking the signs of infection? What about the immune response? What are we going to be doing for the CAP? How will that treatment relate to the Methylprednisolone? Will they interfere with each other? What will you be watching for?

Sounds like a homework/lab prep work. Have you looked up the drug? What does it do? What about your sim patient would suggest that a medication in that class would be appropriate? What should you be watching for particularly with this patient in regard to this class of meds?

Think of your clinicals as your essay questions and your fill in the blanks. You have to arrive at the correct dosages for your meds. There is no multiple choice there. But, if you fail to pass them safely, you are out the program just as surely as if you cannot answer the multiple choice questions. Your essay questions are your care of your patient - ADOPIE in process, you SBAR, care plans, concept maps and the like. All of those things are testing your knowledge and understanding of the information covered in your program. Those things prepare you for floor nursing while your theory exams are preparing you for NCLEX. Clinical does not prepare you for NCLEX because NCLEX world and the real world do not match up all the time and it is important to remember to answer by the book, not by the practice when you are answering NCLEX or standard nursing exams. Theory tests do not prepare you to be a nurse, they prepare you to take NCLEX. NCLEX is there to insure that you have a minimum understanding. Clinical prepares you to be a nurse and your first job will hopefully move you further in that direction as well.

It would be a scary test to grade in a nursing course. Take the question from earlier in this thread. The question was designed to test the student's understanding of what a sexual health history is. In order to choose the correct answer, the student doesn't really need to know the gender of the patient, just what a sexual health history is comprised of and what, as a nurse, you would ask a patient. If you instead turned around and asked a fill in the blank question, there would be potentially dozens of answers that people could put down as appropriate questions to ask in a sexual health history. If you did it essay style, would you take off if they failed to mention 1 of the potential questions? How many would you expect them to know? And how long would you give them to answer that question. By asking it as a multiple choice question, the student needs to understand the purpose of the history as well as a basic understanding of what information is pertinent to that history. It would be easy to pick TSE because testicular cancer is probably a much worse condition than pregnancy. But, it wouldn't be the right answer. Ultimately, that multiple choice question is a decent assessment of basic knowledge a new nurse should possess, where the essay question might be appropriate for a CNM and the fill in the blank question leaves students simply memorizing one oar two pieces of information on each topic. Fill in the blank questions are great for courses like anatomy where there is only one potential right answer. A radial artery is a radial artery. It is a fact. Either you know it or not on the cadaver or on a picture. Essay questions are excellent for explaining processes such as the crebs cycle.

Yup, adding in female does make the question ridiculously easy. However, only one of the answers is an appropriate question to ask while obtaining a sexual health history. a - obviously telling the client they need an HIV test does not further the goal of obtaining a sexual health history b - asking if they perform testicular exams is a great question. It could lead to teaching that could ultimately save a life. However, testicular self exams are a screening for testicular cancer. While it is a cancer on a reproductive organ, it is not a sexually transmitted disease or otherwise related to your sexual history. d - ages of sexual partners isn't a generally necessary question. c - this is the only possible answer, regardless of whether or not the gender of the patient is indicated in the question -- date of LMP does in fact relate to sexual health history. LMP can screen for pregnancy. We all come across questions on our exams that we think are worded poorly or are unfair. While some instructors will throw out those questions from time to time, they are usually answerable if you have the knowledge to understand what the question is asking. In order to do so, you need to study the material well enough to know your role and what the question wants to know.

sorry about that. I didn't go back to the OP to make sure.

Ultimately, that is the point. The likelihood of ever seeing a question from an NCLEX study guide on the actual NCLEX is slim to none. So, the purpose of doing those questions is to learn, not the specific question and answer, but to learn the rationale behind the question. Those rationales can be used in other questions in the future. Given that it sounds like this is the first time something like this has happened, your instructors must have pulled from lots of other resources than just that one NCLEX book.

53 days!!!

At this stage in your education, you should not need the lure of a good grade to motivate you to study. You need your own knowledge and critical thinking to understand that learning the materials to use in practice is far more important than learning it for a test. If you are only motivated by good tests, then you are going to find yourself in the wrong field once you are out of school. I have not found people who are less motivated to study for nursing than they are for other courses. Perhaps I saw that in the early terms, but now as I approach graduation in less than 2 months, my classmates are all working towards greater ability to critically think AND how to best prepare for NCLEX. Our grades are important, but so is our ability to function as an almost nurse in the clinical setting. Whether you study for the test is irrelevant if you cannot care for your patient in the clinical setting. The actual ability to perform patient care should be sufficient to motivate you to learn those facts you need to know. The critical thinking comes with time and experience. Ultimately, you are going to learn to be an excellent nurse on the floor of your first job. Nursing school is giving you a broad overview of the basics to superimpose on your A&P and Patho courses and preparing you to take the exam that will determine whether or not you get to take a job on a floor of a hospital or other location and learn to be a nurse.

Writing a good test question is very difficult, especially when the questions are at the application or higher level. In my limited experience, there are many more problems with questions written by the instructors than there are with the questions from the books' test banks or from NCLEX review books. Those questions have all been reviewed and analyzed, tested out and used over and over again. Sure, there are some absolute duds, but those are usually easy to show your instructors that there is something wrong with the question itself. Regardless of where the question came from, if you were well prepared, you should be able to answer the question. Now, the problem comes in if a test question uses a different lab value or something like that from what you were taught. But, the nice thing is that those are easy fact issues and can be pointed out and then the instructor can adjust if necessary. It's not lazy and it's not unfair. Study your materials and do practice questions and you should be just fine.