Practical NCLEX Tips

Preparing to take the NCLEX-RN exam is a very scary and stressful place to be. It is a time to transition from being a nursing student to a nurse. How is that accomplished? How do you make that leap?

Here are some very practical and simple tips to use while you prepare to take the NCLEX:

1. Start soon! When is it too early to start studying for the NCLEX? Never. Most nursing school books have NCLEX questions at the end of each chapter – even beginning semesters. Do them! It is a great tool to help measure if you know the material in the first place and it helps to prepare you for the style of NCLEX questions.

2. Start believing that you are a Registered Nurse. The first day of my NCLEX preparation class, my teacher made us all write our names with “RN” following them. “Cassie Applegate, RN” - It has such a nice ring to it! If you do it enough times you may actually start to believe it.

3. Find your weaknesses. There are many great tools to take NCLEX pretests. Some even analyze them for you and determine which areas you are strong in and which areas you are weak in. It is also a good idea to study the categories that you are not interested in. Generally, we tend to study the areas we like – therefore we know those areas the best. If you know you hate pharmacology, for instance, maybe that’s a good place to start.

4. Take the tutorial. The National Council of State Boards of Nursing has some great information on their website about the NCLEX. They have basic information as well as a tutorial on how to take the exam here: https://www.ncsbn.org/1213.htm This tutorial walks you through the computer-based NCLEX format, and even gives you time to practice using the calculator and manipulating the screen. The more comfortable you become with this the easier it will be when you sit down to take the test. It is also a great idea to take the tutorial again while you are taking your NCLEX exam because you will waste those first few minutes of anxiety on the tutorial instead of on the actual NCLEX questions.

5. Practice in a similar environment. This means do not study in a room where the TV or music is on, or while you’re lying in bed or sitting on a couch. Go somewhere quiet and sit on a hard chair. Try to schedule your study time into your week so that you know you will have no interruptions or distractions. It is also very useful to study for at least a couple of hours. If you’re not used to it by the time you go in to take your NCLEX, you might get too fidgety and stop concentrating completely on the questions. Try to use the calculator on your computer and use a whiteboard to write out your calculations. These tools will eventually become familiar to you and you will feel more comfortable while taking the exam.

These are just a few simple tools that you can begin to integrate into your study times. Remember that by the time you take the test you will have learned all of the material needed to make you a minimally safe and competent nurse – which is what the NCLEX is testing you for. You can do this and these tips will help you feel more comfortable and confident during the process.

TB Infection from a Patient? The Community?

Every semester in nursing school we are required to get a PPD skin test to determine whether we have tuberculosis or not. Every semester my PPD skin test has come back negative - until this summer.

This summer in order to work at the hospital I had to go through all of their procedures before acquiring the job. I had to be cleared by the occupational therapist, show my current CPR certification, and take a TB Gold test. This test is different than the PPD skin test because it works by taking whole blood to determine whether there is Mycobacterium tuberculosis present. There was. This meant that I then had to go back to the hospital to have chest x-rays done to see if I have an active case of tuberculosis. Fortunately for me I did not show an active TB infection, which means that I have a latent case of tuberculosis. This means that I cannot give TB to anyone through the usual route (air droplets) but rather that the bacteria lives dormant in my lungs until it may or may not become active at a later date.

The question that has been plaguing me since this information arose has been - how did I get it? Who did I come into contact with that had an active case of TB? I do not believe that I got it in the hospital, because I did not take care of any patients that had a TB infection. The only thing that I can think of is if I got it from the community. This last semester we spent a lot of time with underprivileged persons and outreach programs in my area. This could have very easily been transferred through the air by someone who sneezed or cough in an area around me. This was a huge wake-up call for me. As much as I have learned about disease and the risk of transmission to healthcare workers, I don’t think I fully understood how real and dangerous this profession can be at times. If there is ever an outbreak of a disease, it will be nurses who are at the frontline taking care of those patients. This is something that nursing school tries to teach us, but that I could only really understand when it happened to me.

This truly is a dangerous profession. We must be ever vigilant to ensure that we are educating the population about disease prevention and following our own advice to ensure the safety of our patients, our lives, and our family’s lives.

Has something like this ever happened to you? Have you ever experienced an infection from a patient, or a close-call? I would love to hear your stories.

NCLEX Study Material Piling Up – Where to Start?

As my summer ends and my last semester of nursing school looms near, I have become more and more overwhelmed by the pile of NCLEX study material that has accumulated in my house. I have put this pile near my bed in an effort to remind me to study when I wake up, but instead I see it right before I sleep.

This has led to numerous stress-related nightmares where I can never remember the right answer even though I know it.

I know that the best way to get over this stress is to just dive right in and study the material. But how do you even start? And where do you start?

Being a nursing student we cover such a wide variety of health information that crosses the whole lifespan of a person – it seems daunting to think that we can remember all of it. But, the truth is, we can’t. When I was doing my clinical in the ICU the primary nurse I was following made a wise comment. He said, “I never want to work with a nurse who thinks they know it all. They’re dangerous.” This man was probably the most intelligent nurse that I have come across, but he was wise enough to realize that it’s better to go find the right answer, then to just assume you know it. This is a very valuable tool to use with patients, also. I find that patients are much more comfortable and confident in my skills when I tell them honestly that “I don’t know the answer to that… but I will find it for you.” We have endless resources as nurses, and it is our duty to ourselves, the nurses around us, and most importantly our patients, that we use them.

In the context of taking the NCLEX I had a teacher tell me not to worry about the information at all. She said, “If you have sat through four years of lectures on this material – you know it. It’s just a matter of learning how to take the test.” This is one of the most valuable pieces of advice that I have heard on the NCLEX. Now when I finally stop procrastinating and start reading my NCLEX review books, I will look more to the style of the questions and learn how to objectively assess what the question is asking. This, after all, is one of the most important parts of nursing. Not just simply knowing everything, but knowing how to weigh a situation and assess for the best solution.

In the meantime, I think I will start off by learning how to read NCLEX questions. Tips and tricks are welcome!

Confidence in Nursing School

My biggest fear while I have been in nursing school has been starting my first IV on a real live patient. I have had plenty of time and practice on mannequins with plastic arms and red water, but even I knew that a plastic vein was a lot different than a human one.

While I have been doing my externship in the labor/delivery department of my local hospital I have had numerous opportunities to start IVs on admitting women. My first several attempts were complete disasters and I was absolutely horrified and embarrassed. One attempt was on a woman who had a gigantic pulsating vein on her hand that would seem to be impossible to miss - hit a valve. My second attempt on a patient I must have completely blown through the vein because her hand swelled up to the size of a softball. I felt sick. After many uncomfortable and embarrassing moments following these events, I think that I have finally gotten the hang of starting an IV. What a confidence boost!

I never thought that being only one month into my externship that I would have learned so much and gained so many basic nursing skills. I now think that I could insert a foley catheter into a women while blindfolded, prime and hang IV tubing and program a pump in complete darkness (and have had to on several occasions) and even gain a fairly good handle on doing a cervical check. I am so much farther than I would have expected at this time.

I guess this means that the goals that I had for this externship have been met. I wanted to do it this summer because I didn't want to spend my entire orientation as a new nurse trying to learn basic nursing skills while I should be focusing more on overall patient care and policies/procedures, etc. If anyone is having doubts or questions over whether they want to do an internship/externship—I would highly encourage you to do it. It is never a waste of time to have more practice! The confidence alone is invaluable.

Nursing Journals, Do You Keep One?

Recently I've been seeing fliers around town inviting nurses to join a weekly meeting where their journal entries are shared and discussed. I found this idea of sitting around with other nurses discussing work-related journal entries very exciting. As a nursing student I think it would be a wonderful idea to get other nursing students together and do the same thing.

Along with all of the joys of being a nursing student there also comes a lot of fear, anxiety and stress. While we have all discussed the many negative coping mechanisms that nursing students often turn to, we rarely discuss positive ways to release some of this tension. Writing a journal about being a nursing student can be a great way to cope with the abundance of emotions and also help to solidify the many things we are learning on a daily basis.

Although I unfortunately do not journal regularly, I have written several entries during some of the more monumental days of nursing school. Looking back I can see how I grew from being a nervous wreck the night before my first clinical to finally being comfortable with patient care. I also think that by sharing journal entries with other members of the profession it might be encouraging to see some of the same fears or worries and perhaps get tips on how to deal with problems or situations in a positive manner. It could also be educational to have seasoned members of the profession and student nurses in the same group to remind older nurses where they came from and to let younger nurses see what to look forward to.

If any of you are members of a group like this, please share your experience with us! I am very interested to see how a group like this supports one another in a profession that needs a lot of peer support.

Are You Marketable?

In nursing school we are taught ways to become a well-rounded nurse and we learn a wide facet of skills to cover every dynamic field within nursing. But how are we outside of the classroom? As I sneak closer to my graduation date every day, I have come to ask myself the question, "Am I marketable?" Sure, I get good grades in class but is that all that it takes anymore?

In the current state of our country, where more and more hospitals are placing hiring freezes and more nurses are staying put, I have found that the job market is not near as friendly as we were hoping it would be by the time we graduate. This means that is so important to not just be a student nurse with great grades and an okay resume, it is now the time to be an incredible student nurse that can't be turned away.

So how do we do this? By speaking with several recent graduates from my school and several recruiters from my area, I have come up with several great ways to add to your repertoire and make you stand out.

The first thing that I would recommend is to be active in your school. This means becoming a class representative, joining the Student Nurses Association or maybe starting a new club that might serve your school well. This will show initiative and enable you to show concrete ways that you are a facilitator.

The second thing that I would recommend is to become active in your community. This could mean either joining the American Red Cross, working with a local food bank, organizing blood drives, etc. There is no end to the multiple ways that you can help your local community. Not only will this give you great memories and make you feel great, but it will also add to your skills of becoming a compassionate nurse and giving member of society.

The third thing on my list is doing an internship or externship at a hospital. Usually these take place over the summer before you graduate and can be a great way to add to your skills as a nurse and help prepare you for the NCLEX. If you plan on working at the hospital you accept an internship with this can also help get your name and face out there and you may even become friendly with the people that may someday interview you for a job. Some hospitals are now offering internships after you graduate. This may also provide many of the same benefits and give you a foot in the door at a specific hospital or field you may have your eyes set on.

The last thing is to be excellent at your job. If you are one of the many unfortunate ones that have to work during nursing school make sure that you are doing it as well as you would if you were finally a nurse. This shows great work ethic and time management. I was fortunate enough to become the employee of the quarter. Not only did this make me feel great, but it told me that even though it is very hard to juggle school and work, it is not impossible to succeed and do well at both. I believe that my future employer will also take this into consideration.

If you do not work, make whatever you do a success. If this means being an excellent parent, getting straight As, writing a blog, or enjoying your hobbies - do it with the intention of being great.

I know there are many other things that I could add to this list that would make you a more marketable graduate, but these are just a few ideas to get you started. Of course not everyone can do all of these and be successful, but pick and choose among them to become a well-rounded student and someone an employer would be honored to hire.

Concerns About the Nursing Job Market for New Grad Nurses

When I first started nursing school two years ago, the local hospital had pages and pages full of positions for registered nurses. Now that list of jobs has shrunk to less than a page with only part-time or PRN positions available. The hospital has also done away with loan repayment for new hires and has also temporarily frozen personal paid leave. This had scared most of us who are graduating in December and were anticipating working locally.

Many of us are willing to move away once we graduate, but is the situation that much different around the country? It seems as though hospitals are now being hit by the economic crisis and are being forced to impose hiring freezes, decrease salaries and to reduce the overall benefits offered to newly graduated nurses.

Does this mean that the need has subsided? I don’t believe so. I think that there is still a nursing shortage throughout the country, but my concern is that the ratio of patients to nurses may change in some areas, as well as the overall expectations put on current registered nurses.

Throughout nursing school we were told that the older nurses will soon be retiring and that will leave a big hole in the nursing workforce across the country. But, with the current economic situation, are more nurses postponing their retirement? Are more nurses coming out of the woodwork to start working again? Are stay-at-home moms returning to the field to make some extra income for the family?

As a new nurse who will be entering the job market shortly, my concern is that I will not be able to enter the field that I am most interested in. I am also concerned that I will have to accept a part-time position first before a full-time spot opens up and that the pay and benefits will be half of what was being offered in the past.

These are just a few of the worries that current nursing students are facing. What was once a field of opportunity has now given way to a fear of what the status of the profession will be during this recession.

Perhaps this is not a time to be picky about positions available, but rather to be safe and take what is available. This is a time for nurses to stick together and help one another through this period in our country.

Do any of you have any thoughts on this? Any positive takes on the situation?