Back to School for Some

It's hard to believe that the buses are running again and that it's back to school season. Makes me very happy that I am not heading back into the classroom this semester.  One of the gals that I went to school with, who works in another department at my same hospital, has gone back to school this fall. I cannot imagine!  I am taking the advice that I got when I was applying for my job and I am going to hold off on going back to get my BSN until I've got my second year of nursing under my belt. My brain is on overload as it is after three twelve-hour shifts and it takes my four days off a week to recover and recharge for the next week. I cannot imagine trying to attend classes or studying on my days off! I need to build my confidence and knowledge for my day-to-day nursing practice before trying to squeeze more into my brain.  

But best wishes to my friends who are starting back to school- in whatever field they are in... but definitely to my friends who are starting their last year of nursing school! You are almost there!

RN Orientation: Week Five

Well, I failed to update as promised, but that's because as soon as my work week was over, I headed out of town! So I'm going to skip my Week Five update, because there's really nothing new to mention. Just continued to care for patients with my preceptor.

Thursday I drove up to Northern Virginia to joined my sister, my niece and some of her friends for a Kelly Clarkson concert that night. On Friday, I caught up with an old friend from C'ville and her VERY cute six month old baby boy! After that, I headed over to the highschool where my sister teaches and helped her get her classroom and other misc. things ready for the start of school (today). From there I went and had dinner with a blind date which we both discovered right away was not a good match. I ended up staying another night with my sister and helped her out again in her classroom on Saturday morning and then joined my sister to go watch my niece play in a travel soccer tourney (first of the season) in Germantown, MD. After dinner I made the trek back to C'ville. Whew! Full but great few days with my sister.

Next weekend my mom's family is having a reunion of sorts to commemorate what would have been my Grammy's 100th birthday. I'm looking forward to seeing everyone, especially my sisters and my cousins who I don't get to see that often.

For the past four years I've been fortunate enough to be house-sitting and not paying rent or a mortgage --just utilities. This was so perfect for when I was fresh home from Liberia with no idea as to what to do next (work-wise). And then for the past two years I've been able to go to nursing school without having to worry much about my finances. If it wasn't for this house-sitting gig, I never would have considered going back to school. The original thought was that the homeowners would be gone five years, then possibly a sixth year, but last week they called and said that he is switching positions and they'll be returning to to C'ville next month. So now I am busy making lists and exploring housing options. Thankfully they are not pushing me out and I can take my time to find my next place-- even if it takes a couple months to find.

I'd love to find a place close to work, but it also needs to be inexpensive and somewhere quiet where I can easily sleep during the day (when I move to night shift). I totally expected that I'd be making transition to night shift while living where I am currently where I don't have to deal with roommates or loud neighbors. I really need to stay away from student housing/apartments as they come and go all day long. I also need to avoid basement apartments--unless the person(s) upstairs work day shift AWAY from home. The Lord has provided abundantly for me with my current housing and I can only believe and trust He has a good plan for me. The timing is amazing (done with school and I have a job!).  I'm excited and hopeful that my next home will be beyond what I could ask for or imagine!  I have my wish list that I'm praying about.

RN Orientation: Week Four

Well, I'm already half over with week five and I realized I have not posted on week four!

I'm doing a bit better with packing sufficient food and taking breaks to eat. I've tried a few protein shakes (soy, whey, other) with mixed results. I've started packing two hard-cooked eggs which are quick and easy to eat (if I peel the night before). And I'll eat one mid-morning and another mid-afternoon. I also made a batch of peanut butter balls (PB, honey, powdered milk) and they've been tasty treat that I look forward to. I think part of my issue of feeling tired and hypoglycemic is partly being dehydrated, so I'm trying to make more of an effort to drink more water throughout the day with a goal of drinking 16 oz in the morning before work and 16 oz at lunch and 16 oz on my way home. It hasn't worked out completely that way, but I when I have consumed more water, I have felt better. Of course more water means more trips to the bathroom - which often feel like a luxury to a day-shift nurse!

There are certainly moments where I feel completely overwhelmed and clueless as to what to do or what's expected. I was an excellent student but it doesn't mean that I retained it all (disease processes, meds, heart rhythms, etc...) And here I am learning so much at one time, that I feel like I'm not retaining it very well. But with practice comes familiarity.

In school I never got to insert an IV in a live person (only fake arms) and within the last week I've had two opportunities to insert them but b/c of various circumstances I didn't get to... But chances are I would not have been successful anyways as BOTH patients were elderly and ended up being VERY difficult sticks...even for the experienced nurses (requiring several attempts). My time will come!

In a few weeks I will be caring for three patients "independently" with my preceptor as backup. I'm a bit nervous about this as every day I'm experiencing all sorts of new scenarios with each patient I'm assigned. And while I feel comfortable with certain aspects of patient care and assessments, the other aspects such as calling docs, IV therapy, patient teaching, answering patient questions, knowing protocols for post-procedures and other scenarios (stroke, chest pain etc...), well, they are a bit more intimidating. Everyone says I'm doing well, but yet I have a lurking fear that I just have everyone fooled. But I KNOW that I will rise to every opportunity. Every new RN has strengths and weaknesses and deals with feelings of insecurity and feeling stupid. But we all have to start somewhere. Everyone has been so nice and supportive and encouraging -- it's my own insecurity that makes my sleep a bit restless and not restful.

I'll write again in a few days with update on this week (week five) and some things I'm looking forward to that are not work-related.

RN Orientation: Week Three

I have survived five shifts and have completed my third week of orientation (first 1.5 weeks were classroom orientation). My unit is absolutely hopping! In one day my preceptor and I discharged all five of our patients and then admitted another four (in those same rooms!) before our shift was up. My head was spinning!

One thing I'm really struggling with is feeling hypoglycemic (hungry, tired, weak, irritable, unable to concentrate) during late morning and mid-afternoon and late afternoon. My preceptor and I will be in an alcove charting and discussing stuff and my eyes will glazed over and I know I'm not really absorbing all that she's saying. It's really frustrating. I am really trying to get to bed early so that I'm getting at least 7 hours of sleep. My unit really does encourage nurses to take their lunch break (30 min), but my body needs food much more frequently than every 5-6 hours, but it's tough when I'm not in control of what happens next (my preceptor does) and I'm afraid I'll miss something if I take a quick break. 

 I'm researching and thinking through what I can take to work food-wise that will help keep my blood sugar up that won't require any food prep (like heating up) and that I can possibly have in my pocket for those moments when I start to feel that edgy feeling. I've never learned to like coffee, so any caffeine would be a diet soda...which I really don't want to consume on a regular basis or in large quantities. I know caffeine is not the answer and neither is sugary food (although it does help short-term). I can feel crappy with a blood glucose of 80, which is not considered hypoglycemia. However, someone suggested that it can be the rate at which the blood glucose falls that can make a person feel crappy. My blood glucose tests have always been fine and my doctor has never been concerned, and the advice is always to eat several smaller meals throughout the day to keep glucose levels relatively consistent. That's easy when you can stop what you are doing to grab something to eat, but now I'm working 12 hour shifts and don't always have the convenience of stopping what I'm doing to go grab a snack!

So I probably need to go see my doctor and find out if there are further tests or recommendations. But first I think I'm going to start doing a better job of writing down when I eat, what I eat and when I start to feel crappy...and what helps or doesn't help... and maybe I'll even get a glucometer to keep track of my levels throughout the day.

I'd like to drop some pounds and I'm hoping that with the increase of activity (36 hours a week on my feet), that I will be able to. Unfortuately, there's no time to hit the gym on the days that I work - there's only time for sleeping, eating (barely) and working. But that means that I will HAVE to get to the gym on my days off and pay attention to what I'm eating...and not eating crap (sugar) when I feel like crap. Easier said than done.

Hopefully in time I will adjust to twelve hour shifts and figuring out what works for me. Right now it's just tough because I'm paired up with another nurse who has grown accustomed to shifts and knows what SHE needs to do to keep her energy up. We were a bit disorganized this past week for a variety of reasons and I'm hoping we can be a bit more organized this week. Here's hoping.

Aside from the above, I'm getting to see and DO a lot and learn a lot of new stuff! There is no way for nursing schools to teach us everything. Every hospital and every unit, has their own way of doing things (admissions, discharges, charting, etc...). I am fortunate that my hospital moved in to a nice new facility and really thought through the design and made really smart decisions about patient rooms, and access to meds/supplies, which can significantly cut down the amount of trips (and wasted time) to/from the supply room!

Aside from my patient care, I also have a number of classes that I have to take during my orientation period that are related to my unit. Since I'm working on a Telemetry unit, I am scheduled to take classes on topics such as EKGs and dysrhythmias and a handful of other classes that are cardiac and neuro (stroke) related. This coming week I'll be taking a class to prepare for a change in how physician orders are entered and retrieved (we currently work with electronic and paper charts and will soon go to just electronic).  It'll be a very good change and hopefully will save time for everyone...not to mention saving money and trees and counter space at the nurse's station!!

I've been adding some more links to articles on the side bar. I decided to break down the topics into: New Nurse General Tips, 12 Hr Shift Tips, and Night Shift Tips. When I find articles that I want to come back and read, I will link them there...but reality is that I haven't necessarily read them in their entirety (or even followed the tips). As I get time to read them, I may end up removing some if they end up repeating each other or end up useless.

RN Orientation: Week Two

My First Twelve

It's going to take a while getting used to twelves! By the end of my first twelve hour shift all I could think about was my feet. Now that I'm home and my feet are up, I'm now thinking about my knees. Maybe when I go to bed it will be my ankles. Ha!  I've not done anything about shoes. I wore my Danskos today, but since there always two of us together (my preceptor and me), she's often the one sitting and I'm left standing... so maybe I'll wear tennis shoes on Friday and see what the difference is.

This morning I was set to wake up at 0430/0445  (to leave the house at 0600), however at around 0300 I woke up and sneezed. It wasn't until I got up at 0430 that I realized my nose was running and I was probably dealing with a head cold!  It's been two years since I've gotten sick...and my first day on the unit and I start coming down with a cold! Sigh. So I'm going to treat tomorrow as if it was a sick day (even though I'm not scheduled). I'm going to get up at 0430, get a shower and then I think I'll go back to bed as if I'd called in sick. So much for getting to the gym tomorrow.

My main preceptor typically works Monday through Wednesday, so in order for me to get my hours this week, they put me with another nurse for my first day (and again this Friday). I was basically thrown into the mix of everything. Doing vitals, meds, discharges, admits, charting, calling dietary, etc... The best part was being told I can sign or co-sign something because I'm RN!! Such a strange, but fun, new experience.

The most awesome part of it all... I leave my work at work. No homework, no studying, etc... Sure I will have things I will want to review and look up at home, but I'm thinking that for now the majority of my learning is going to take place on the job. Which is how I best learn anyhow.

Overall a great first day on the unit.

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!