RN Orientation: Week One

First day of work, er, orientation. I'm so thrilled to be at this hospital. Having been through orientation in other jobs...this has been well-organized, well-staffed, and everything has tied together well and feels pertinent to my role. Class act!

I think the most thrilling part of the day was the end when they took my picture and handed me my ID. To see the RN tag attached was a really cool moment. I've been envying everyone else's RN tag for years. Now I have my very own!

Tomorrow will be another day of basic hospital orientation. Then Wednesday through Friday and Monday and Tuesday of next week I will be in the simulation lab getting trained and tested on a variety of nursing skills and related information. Then next Wednesday and Thursday I will hit the unit for 12 hour shifts! Wow, it's been a LONG time since I've worked a 36+ hour week!

I stopped by the unit this afternoon and learned that my preceptor primarily works Monday through Wednesday. So it seems that I will be working few, if any, weekends during orientation. I'll take it! Working 12 hour shifts is definitely going to take some getting use to! I'll wake around 5am, leave house at 6am, work 7am-7pm, then have two hours to drive home, eat dinner, & chill out  before heading for bed at 9pm so that I can get eight hours of sleep. Whew. I'm not sure it's even realistic to think that I could squeeze in a quick trip to the gym after work...I'm thinking that it might wire me up if I work out and then shower right before going to bed. Oh well...something to try a few times to see.

Last week I ordered up a bunch of scrubs on-line and they are scheduled to be delivered tomorrow! Can't wait! I bought a variety of top/bottom styles and I'm hoping that I'll like the majority. I decided to go with solids and skip printed tops all together and the local shops did not offer options that I liked. I'm not all that inspired by the scrub top prints that are out there these days,and it's also recommended that I wear monochromatic tops/bottoms to make me appear taller and leaner [prints/color blocks make your look short and wide(r)]. We'll see.

Well, I am exhausted and about to fall asleep. Guess I need to take a short nap to revive for another couple hours.

Reflections on My NCLEX Experience

As promised, here are my thoughts, tips and suggestions related to NCLEX.

Testing Location | The Lynchburg, VA PearsonVue testing center was AWESOME! Relatively easy to get to and the two women staffing it were very kind and friendly. I am so glad that I switched from the Richmond location to the Lynchburg location. Rumor has it the Richmond location has room for over 50 people to test at their center (maybe even 75?), whereas the PearsonVue testing center in Lynchburg has room for only NINE people. While smaller does mean there are fewer available spots/times available on the schedule, the reason that smaller is better is that there are far less people making noises and creating distractions during the exam. PearsonVue administers over 100 different types of tests/exams and so there's no telling who you will be seated next to. Some of these other tests/exams require essays, so there could be extensive typing noises -- imagine that in a room with over 50 people. While waiting to be registered/admitted to the exam room, I learned that the nine of us were all scheduled to take the NCLEX-RN exam...so minimal noises coming from each mouse. PearsonVue sites offer earplugs...so take advantage of them if you are stuck testing at a location with lots and lots of people.

Scheduling/ Time of Day | When I signed up for the Richmond testing site, the only available time was 8am around the dates that I was looking for. Since it was going to take me about 1.5 hours to get there...plus I needed to be there at least 30 minutes early... I was looking at trying to leave my house at 6am (at minimum)...and so that meant waking up at 4:30am. Uh, no thanks! I could've gotten a hotel room... but who wants that extra expense and the possibility of a poor night's sleep in an unfamiliar, possibly noisy environment? So I was really happy that the Lynchburg site had an afternoon slot available when I checked their availability.

Scheduling/ Day of Week |  I did enough research in advance, that I learned that it's best to schedule early in the week and not right before a holiday. The reasoning is that you don't want to have to wait any longer than necessary to get your results. After taking the NCLEX, all you can think about for the rest of day is whether you passed or not. Do you really want to wait all weekend? Probably not. In Virginia, you are supposed to be able to call a phone number and get results the next business morning if you used your social security number at the time you applied with the Virginia Board of Nursing. Being the ever-conscientious me, I didn't want to use my SSN and therefore used my driver's license ID number to apply for licensure. I discovered several weeks before my exam that I'd have to wait until the second business day after my exam to find out my results over the phone.  WHAT I DID:  I scheduled on a Friday. Yes, exactly what I don't recommend. But my options were limited and my priority was to get an afternoon slot - even if I was going to have to wait all weekend (and possibly longer) to get my results. WHAT HAPPENED:  Well, I got my results on Monday via the Virginia Board of Nursing's website (so much for having to wait a second business day!) I also was not freaked out all weekend primarily because I was distracted with the big storm that blew through our area. The derecho hit Friday night and out went my lights, water, air conditioning, internet, etc... So I ended up packing up and heading over to my parent's house (45 minutes away) on Saturday to avoid the unrelenting 100+ degree heat. So I was at my parents house all weekend and the disruption to my normal routine was all the distraction I needed. And it was fun to be able to get my NCLEX results and be able to tell my parents right away and in person. So it worked out for me, but I'd definitely recommend scheduling for early in the week (also avoiding holidays like Memorial Day or July Fourth).

Mock Run |  I totally recommend doing a dry-run to the testing site. Ideally done at the same time of day and same day of the week that you are scheduled to test. I planned to go the Friday before my Friday exam, but something came up and I couldn't. So while I still made the drive (using Googlemaps and my GPS for directions) and got a rough idea of the time it would take and knew I could find the location, I still didn't absolutely know the timing on a Friday afternoon. However because my test was at 2 pm and I knew it would take roughtly 1.5 hours, I decided I would eat lunch in Lynchburg in advance of my test, and allowed myself an hour to do that-- which provided plenty of buffer time in case traffic was bad (accident) or if there was unexpected/new road construction. Another girl from my same school did not do a test run and she arrived several hours ahead of time to make sure she could find it... and then proceeded to camp out at the testing site. Boring, stressful, etc... I arrived 30 minutes before my assigned testing time - as instructed - and I was glad that I was not any earlier. A lot of the girls taking the test with me were really anxious and stressed out. You generally want to avoid that - it's not going to help you stay calm. If you arrive early...just wait in your car (unless a 100 degree day like it was for me!).

Here are some other thoughts:

• Take the Kaplan course, or at least buy access to Kaplan's Q-Bank. Doing 50+ questions in one sitting builds endurance. And you will need endurance for the NCLEX!  I feel that Kaplan's Decision Tree was very helpful--especially when I wasn't sure of the answer. And I'm not sure I would've really understood or used the Decision Tree if I had had to learn it myself. I'm SO GLAD I took the Classroom Anywhere (online) class!  I did not complete every QBank question, only about 750-800 qeustions. I simply ran out of time, but I did do all the QTrainers. While taking the Kaplan course, I posted about my experiences each day: Day One, Day Two, Day Three, Day Four, and then posted my scores here.   Also, Kaplan's QBank and Qtrainer formatting and questions look EXACTLY like the NCLEX. So while taking NCLEX...you can calm down and pretend you are just doing Kaplan questions. :)
• Take NCLEX before starting your RN job. Starting may not even be a possibility for you as some hospitals require that you get your license before you start orientation (too expensive to begin orientation of a new grad only for the new grad to fail NCLEX). My hospital is not that way, they are willing to allow new grads to start without their license (which is permitted by the state of Virginia, of course!) Yet I knew myself enough to know that I would feel better having it out of the way. Orienting to a new job is stressful enough, not to mention 12 hour shifts! I'm relieved to have it behind me and to be able to start orientation without having NCLEX hanging over my head. However, I understand that some folks need to start work right away because of finances and in that case... just make a plan for studying for NCLEX. Pick a test date and work towards it...don't put it off. Get it over with as soon as possible.
• Before exam day, READ all materials on the PearsonVue and NCSBN sites related to NCLEX and testing center...especially the rules. No sense in being caught off guard that you can't chew gum during exam or that you cannot take lip balm in with you! No surprises...take responsibility and know the do's and don'ts and what to expect! 
• Don't study/cram the day of your exam or even the day before your exam. I found this particularly helpful in de-stressing. Reality is that you only know what you know. No amount of cramming is going to help! Also, looking back, there is NOTHING that I would have chosen to study that would have helped me on any of the questions! The material is to vast to even have a clue what you should cram for!
• Take deep breaths from time to time. There were times when my eyes glazed over while taking the exam and I ended up re-reading several questions multiple times - simple because I was having a hard time focusing mentally! I was aware of every little thing: the clock, the video monitors, the audio recording (yes, they do audio recording of you taking your test!) and the sounds of other test takers... and of course the voices of your head saying "what happens if I don't pass?" (despite trying to avoid that type of self-talk). So when I would catch myself being distracted, I consciously took a few deep breaths and tried refocus.
• Select your answer, then REREAD the question. No sense in getting a question wrong because you failed to read the question correctly. One of the things that doing endless Kaplan questions does -- is that it reinforces the need to really understand what the question is asking. It is looking for a positive or a negative answer? Is it looking for a psychosocial answer rather than a physical answer? While doing Kaplan I regularly went back and reviewed the questions that I got wrong and there were always a few questions that I failed to read the question correctly.
• The PearsonVue Trick (PVT) DOES work. Essentially by trying to sign up to take the NCLEX again, you can find out if you passed or not. I did the PVT trick within an hour of taking my exam. Here was my "good pop-up."  You can read more about the PVT here. 
• Other thoughts about NCLEX that I posted are here and here.

I hope there's something here that you might find helpful. I can only talk about it from my point of view and to   point out what I've read online (mostly at allnurses.com) that influenced me and my experience.

Whatever you do... keep a positive attitude. It will take you far and reduce your anxiety about NCLEX! Best wishes for those who still have NCLEX on the horizon. You can do it!

Bad Dream

Last night I had my first dream related to starting my new job. You know...those dreams where everything is crazy and goes unbelievably wrong and when you wake up you are sooo relieved that it was just a dream. For me, throughout my dream I was in a state of frustration, stress, embarrassment and completely overwhelmed. When I woke up, I was so relieved that it was not real and started processing through all the problems encountered in my dream and how I should've handled them or how I could've prevented the problem in the first place. For example....in my dream, I had multiple patients (five?) in one room and I had an elderly patient who was peeing endlessly and consuming all my time as I repeatedly tried to clean her up! Hello??? Why the heck did no one think to put a brief on her? And because of this I had not gotten any vitals on any of my patients and not a single assessment either! In my dream I was glued to this patient and stressed out about not getting to my other patients. Ack!

This afternoon I was telling a friend from nursing school about the dream, and she laughed when I told her that I reviewed everything that went wrong in my dream. She said... "It's like you were evaluating your nursing interventions!"  Yeah, what interventions?!?! hahah!  But it's true- I was using the nursing process in my dreams (albeit mostly unsuccessful), but especially after I woke up when I starting thinking through all the things I could've/should've done instead. I guess I learned something in school!

So there you have it... I guess I'm experiencing some anxiety about starting my first RN job. I guess I should be prepared for some more crazy dreams in the coming days, weeks and months. So not fun.

Scrubs for Your Body Type

Stumbled upon an online tool by Scrubs Magazine to help you figure out the best scrubs for your body type. Find it here.   Guess I'll be sticking to plaid shoes or hair ties and not plaid scrub tops.

Scrubs Magazine also has interesting articles too. You can follow this link to their current edition. And be sure to scroll through archived articles for other interesting reads.

Off to go scrub shopping (again). 

Shift Work

Since it looks like I will be working the night shift once I get off orientation, I have been doing a little research trying to collect info, strategies and tips for working nights. I've been adding some links regarding working night shift to the "NEW NURSE LINKS" on the side bar - mostly for me to go back and read.

My hospital organizes a couple mini-retreats for new grads throughout our first year of nursing. My understanding is that one the topics at the retreats is sleep and/or night shift issues! Obviously the nursing admin is interested in patient safety issues and want to address issues that affect job satisfaction, but they also want to keep us medically and mentally healthy too. I'm nervous about the health aspects, but also about effect it will have on my social life. Is this going to be one more obstacle to dating? 

An "Ah-ha" Moment

 During my recent interview process and through reading of various hospital documents, I have become more aware of the importance of developing a professional nursing portfolio. A nursing portfolio is basically a snap shot of one's career. It is now expected and/or required when applying for jobs or when challenging the clinical ladder within institutions. I've been told and have read in multiple places that it's never too early to start working on your portfolio.

The past couple days I've been doing some internet research and information gathering (so grateful my school doesn't cancel my access to online journal articles through the library) on nursing portfolios. I am a very visual person and so I want to SEE an example, what's included, and to understand how it's presented or submitted.

While searching for articles and examples on-line, it occurred to me that I had already started a nursing portfolio, except mine was created and then subsequently forgotten after NUR 100 (my very first nursing course two years ago). At the time, my instructor, who was requiring it, did not call it a portfolio. I have no recollection of what she called it or how she framed the assignment, but I do not remember the word portfolio being used. But at the time, we were all pretty clueless about why we were being asked to develop a website. It made absolutely no sense to us at the time and even a year or more later we were still joking about the assignment - still clueless! If you are curious, here is mine.

Obviously it was created without regards to professionalism. I'm not kidding, on the "About Me" page under Factoids, I actually include "I can touch my tongue to my nose. My tongue regularly palpates my tonsils."  Oh boy! At the time I was just looking for filler and looking to amuse my instructor. I remember that I proudly went above and beyond the requirements for our assignment.  Definitely a little too far.  Anyways, my website is desperately out of date and not even close to the professional portfolio that I would actually create and submit. But it's good for a laugh now.

One year from now I will be gearing up for my first performance evaluation and at that point I will  automatically be bumped up from RN-Clin I status to Clin II status. But to advance further on the Clinical Ladder, I will need to submit a portfolio for consideration. It could be a couple years before I would pursue Clin III status and that's time enough to misplace important documents or to forget stories that might be appropriate as an exemplar of my clinical and/or leadership skills. My thinking is that by simply collecting and writing supporting documents over the next couple years, I will have much less work to do when the time comes to prepare and finalize it for submission. It seems overwhelming now because I'm at ground zero, but over the next year or two I can certainly spend time working on it (once I know what MY hospital is looking for). And then the point it is to never really let it get out of date.

Looking back, I really wish I had understood the reasoning and rationale behind that website assignment. It makes sense now. Perhaps it wasn't sufficiently explained or maybe it was explained but it just went over my head? Either way, I'm sure there will be a lot of "ah-ha" moments in the coming months and years as I connect the dots between my education (and what we thought were bordering on ridiculous, time-wasting assignments) and my actual practice. Life is funny that way.

One of the most significant things I learned in nursing school is that the majority of people/patients need a rationale in order to fully embrace the need for change (or to do homework). It's one thing to inform a man with high cholesterol that he needs to change his diet and lifestyle and something else all together to explain WHY he must work to lower his cholesterol levels. Preaching rarely gets you the same results as teaching.  Well, at least that's true for me. I need to understand the rationale and the bigger picture before I'm able to embrace new information or change.

Footwear

So... I have been looking for some nursing shoes. Something that will be both functional and also reflect my personality. The other day I was inspired to look for plaid clogs. Why? Because plaid is my favorite color!!!  (Yes, you could argue that plaid is not a color, but for me it is. I don't have a favorite color...and who says they have a favorite print?)  My favorite plaids are tartans, specifically:'

Royal Stewart Tartan Plaid

Dress Stewart Tartan Plaid

Black Watch Tartan Plaid

So I start looking around for plaid clogs. This is what I found:

Perfect, except that I really want my heel covered.

Too cute, but since they are fabric they would absorb bodily fluids. Also I think my feet would kill me before my 12 hour shift is up. Oh so cute. Maybe I should get them for every day use?



At some point I bumped into the idea of handpainted clogs. And these "argyle" ones are the closest I've come to plaid. But at $219 they are way out of my price range.

I even posted on Facebook my disappointment in lack of plaid footwear for nurses and the mom of a childhood friend mentioned that her son (my childhood friend) airbrushes all sorts of things and is quite talented. But plaid is plaid and I'm not sure you can airbrush plaid effectively. Sigh. And I'm not sure I'd have the courage to buy expensive red patent leather Dansko clogs and paint my own. I know I'd end up hating them.

So I think my dream of plaid nursing footwear is kaput unless I find someone in Scotland who could locate a pair -- but the whole "buy without trying on" freaks me out--especially if I'm also looking for comfort. I don't need a $150 pair of uncomfortable shoes.

Today I strolled into the local high-end shoe store that sells Danskos. And I fell in love with their 20th anniversary clog.

Dankso 20th Anniversary clog

20th Anniversary shoe artwork

I LOVE the script, the words (very appropriate for nursing), the color -- EVERYTHING. But alas, a limited edition means just that. I'm late discovering these awesome shoes. The only size I can find online (including e-bay) and local stores is a size 37. I need a 39. Ack!

So back to the drawing board!

May be I should write to Dansko and suggest they add a tartan plaid to their shoe designs. It would be a BIG seller!   If anyone has any ideas for where to find plaid clogs, please drop me a comment!

Another thought crossed my mind... what if I ONLY owned and wore plaid scrub tops? I'd FOR SURE become known as the plaid nurse!!  There's no flying under the radar for this girl! haha!

Why I Want to Be a Nurse

Once upon a time I promised to post my "Why I Want to Be a Nurse" paragraph. This was required when I applied to my nursing program. It's kinda fun to go back and read my thoughts from over two years ago.

Why I Want to Be a Nurse!

I recently spent a year living in West Africa where I worked with a health-oriented NGO. My days were a mishmash of emotions as I poured myself into my work as a nutrition volunteer. I experienced great heartache as I uncovered the willful neglect of a malnourished four-year-old child. And then experienced profound joy and pride five months later when that same child was growing and laughing and learning how to walk again. Those experiences, and many more, revealed to me that I have the heart of a nurse, but I am frustrated with my lack of knowledge to really be effectual in that role. I carry in me a desire to educate and to bring hope and encouragement to my patients. To advocate and fight for those who have no voice and to empower those who have lost their voice. To help families find solutions for themselves and to laugh and cry with them as they walk uncertain paths. To promote dignity and life in the midst of the most challenging of circumstances. I want to be a nurse so that I can make a positive difference in people’s lives—whether they are taking their first breath or last breath. I also want to be a nurse because the nursing field is diverse and affords limitless opportunities for learning and professional development. The demand for nurses has also made it a field where there is excellent income potential and opportunities for advanced education. And finally, I want to be a nurse so that when earthquakes and tsunamis, wars and famines happen across the world, I will have critical skills that can be put to use immediately!

Copyright © 2010 Joy Hancock.
This is my intellectual property. Please do not steal and/or use any portion of it for your own use. It would be unwise and unethical to take my words to use as your own. Think.

Thinking Ahead

Found this article "Tips for Your First Year as a Nurse" and it definitely has some helpful tips...even includes her 12 hour day shift routine.  Think I'll post this on my side bar links.

I'm looking for other articles. I'll keep posting as I find them.

Registered!

It's official. I am a Registered Nurse!

I logged on to the Virginia Board of Nursing website to check my status. I went from "pending license" to having a license number issued! Woohoo!  Feels great!

In other great news, I got the job! My nurse manager just called with the official offer (I was told on Friday to expect it early this week). I'll be working on a 30 bed telemetry unit that is primarily cardiac and neuro patients. I'll be starting orientation on July 23!  Now, I have about two dozen thank you notes to write to faculty and friends who provided references and/or put in a good word for me with those looking at my application. Plus, then there are all those great nursing instructors who helped me from start to finish!

How cool to get license confirmation and job offer all in the same day! God is good! I must tell you that I am SO GLAD that I went ahead and took NCLEX before starting work. Starting a new job is always a bit stressful for me. There's always so much to learn and remember, that my brain is usually shot at the end of the day. I knew it would be too hard for me to manage starting a new job and studying all at the same time, so I really forced myself to study and get the NCLEX over with.

Virginia permits new grads to work without a license within 90 days of obtaining their ATT (authorization to test for NCLEX), but it's up to the hospital to decide how they want to handle it. The larger teaching hospital in town does not permit new grads to start working as RN's until they have their actual license. They hire tons of new grads and it costs mega bucks to train and orient a new grad, that they don't want to take the risk of having a partially trained new hire fail NCLEX and not be able to work. The hospital where I'll work does permit new grads without a license to begin orientation with the expectation that they will pass NCLEX within orientation. But thankfully I don't have to worry about it anymore. I'm registered. :)

So two great pieces of news today is quite a feat! Even better would be to get news that power has been restored at home. Been without power since Friday night. I'm presently crashing at my parent's home where they've got the benefits of electricity... WATER, AC, and internet.