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NCLEX did not fail the students, the Canadian Nursing Association and the regulating provincial bodies did.

I’ve been a nurse for under 5 years and I still remember all too well studying for the CRNE (Canadian Registered Nursing Exam) and the stress and anxiety I felt from it.  I  also knew that CRNE for the most part attempted to  reflect on what I learned in nursing school as well as how our Canadian Health Care system operated.

Then all of a sudden arrived the NCLEX.

A number of years ago, the CNA (Canadian Nursing Association) and the rest of the provincial nursing regulating bodies in Canada were being proposed of a new exam called the NCLEX (National Council Licensure Examination) that would serve as a uniform way of testing all nurses both in Canada and the US (the  US has had this testing since 1994.)  This year was the first year that graduating Canadian Nurses wrote the exam.

Nursing_Textbooks_1

And unfortunately many of them failed.

Questions and possible answers immediately started to arise as to why this was the case.  Blames to the type of school and programs immediately surfaced as many tried to find an answer.  Many schools however have proved that statistically prior to the NCLEX they were had successful rates with the CRNE.  So the real reason is not because these students were not smart enough.

The real reason is that simply these unfortunate students were used as guinea pigs in a failed experiment that did not prepare them.

It seems the one thing that was often overlooked and what some organizations such as the RNAO (Registered Nursing Association of Ontario) had chanted for years is that simply nursing in Canada is different from the nursing in the United States.   Nursing up here tends to be more psycho-social where in the United States it is more bio-medical and pathophysiological.  There is no argument as to which one is better or worse but it is also unfair to subject a test to nursing students who essentially spent four years if not more studying and learning nursing in a Canadian health care system to only be subjected to a licensing exam that does not reflect this at all.

Furthermore, a lot of nursing schools did not have enough time or prep for these graduating students to take the NCLEX exam.  Most of the prep exams for students are based on the CRNE format.  A brand new curriculum would have to be implemented to prepare these students and usually preparing such curriculum can take months if not years.

What I always found quite odd (and also a waste of money) is that though the NCLEX is an American standardize test, as Canadians if we want to practice in the United States, we have to take yet another NCLEX just to practice in the few states that we are allowed to if we chose to practice south of the border.

In my department where I currently worked, we hired 8 new graduate nurses who all took the new NCLEX.  Out of the 8, only one passed.  This is a staggering number considering in the past, most if not all of our new grad nurses d passed the CRNE.  As a new graduate nurse, I can only imagine  how detrimental this must feel, especially if this was your first nursing job to only have taken away from you because of this botched exam.

I wish I could give advice to these new students but because I have not written the “Canadian NCLEX” it would be like the blind leading the blind.  But more importantly I wish the CNA and the other regulating bodies across the country can see that this was not implemented or planned properly and perhaps was a big mistake.

And most importantly…….If ain’t broke…..don’t fix.

Medsoulbrother

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Posted by on August 26, 2015 in Uncategorized

 

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Life of a Murse Episode 3: The Lady in White.

IV

The last two years of nursing school were not so bad but the workload was still heavy. Perhaps the most anxious thing was writing the CRNE (Canadian Registered Nurse Exam.) I literally had nightmares of failing the exam (likewise with other fellow students.) While in my last year and juggling two jobs I got a sweet summer job at a hospital close to me working as an extern. For better lack of terms, it was being nursing assistant, and I got to be one in the Emergency Department. At that point this is when I knew I would love nursing. As a nursing assistant I was doing so much and helping the staff. In fact, I was doing stuff that I never got to do in my other clinical settings in school but was only taught in lab. I was putting in Foley catheters, doing ECGs, doing vitals signs, and even helping with doing bloodwork (which was so nerve wrecking at first.) As I was in my final year and continued working as a nursing assistant.(I was working three jobs just so I would not have no school debt) I was encouraged by the educator and the charge nurse to apply for a new grad position in the emergency department. Without hesitation I applied, and I was hired.

One of my first ER shifts was when I was with another nurse in the acute area on a nightshift.
Oh boy.
One of my fondest memories was learning how to start IVs. Doing straight blood draws was not an issue as I learned them quite well when I was an extern. The tricky part came when i had to put in an actual IV. The IVs were quite tricky as you had to make sure you applied pressure so the blood would not spewing all over the place like a bloody crime scene. I said to myself.. nope I am gonna do an IV I don’t care.
Again…..Oh boy.
One night I was working along with my preceptor. It was a Friday night so of course we were getting all the drunks coming in. We had one lady who was dressed in complete white who was here for a problem that to be honest with you I could not remember. All I remember was that she was wearing all white. White blouse, white jacket, white pants and white shoes to match.
Maybe there was a white sale at Sears? Maybe I should have told my mom at the time?
Who the heck knows. Anyhow, the distinct thing I remember about this patient was that she had some form of social issues at home that required to be seen by our crisis worker. The doctor had ordered some blood for work and I told my preceptor that I was going to the blood work.
“And you are putting an IV in her.” she chimed as a reminder.
I closed my eyes for a quick second and kept repeating myself. “Don’t fuck up, don’t fuck up, don’t fuck up. You can do this.. you got this man. You’ve done straight pokes before, you can put an IV, it will be ok.”
Clearly my conscious lied to me.
The patient rolled up her sleeve as I tightened the tourniquet on her arm trying to feel for a vein. I felt a nice fat juicy one right in the centre of her arm. I had all my equipment and blood vials set.
I took a deep breath.
You can do this. You can do this it’s okay you can do this.
Grabbing my 20 gauge IV, I aligned it with her vein and slowly entered. Learning from all the nurses, I would count one to three so the patient would know (for those who had quite apprehensive to needles.)
Immediately I saw blood return to the tip meaning that I had entered the vein.
Great!!! Okay so part 1 was done.. .now I had to remember the rest of the parts. I indistinctly remember to make sure I had placed good pressure over the IV so the blood would not spew out before I attached it to an IV lock.
Ok you are doing good. You got this bro.
The patient then gazed at me with this weird look. “You’re quite good looking you know that?”
I lifted my head surprised by her comment. “Huh??” My fingers immediately released from the IV as I was trying to make sure who she was referring to. I guess you can call me modest but I never considered myself the model GQ type or that attractive so when usually when a woman makes a comment like that either she is intoxicated, high on some kinda of drugs or had a dementia. I forced a smile trying not to be rude but then my eye caught something red on her sleeve.
SHIT!!! I let go of the IV!
I did not even have time to respond as blood started pouring out of her IV like a leaky faucet. The blood started soaking on her white blouse, jacket and her pants.
Fuck my life!
My voice all of a sudden sounded like Grover from Sesame Street. “Uhm, help me here please.” As I turned to my preceptor.
She saw smiled a bit and quickly grabbed a couple of two by twos gauzes. She immediately helped me IV lock the patient but at this point this woman looked like a bloody mess. She look like she was part of a crime scene from criminal minds.
Immediately I began apologizing while we were cleaning up. “I am so sorry about that. ”
Surprisingly the woman did not react or act mad. “It’s ok.”
My preceptor immediately grabbed a patient’s gown and gave it to her to change while we grabbed her white clothes and placed them in a container with hydrogen peroxide.
She turned to me. “And this is why we always tell patients to dress in a gown before they are seen by a doctor.”
I nodded still feeling like shit. “Yeah I got it. ”
“Don’t worry you were okay, you will be a pro at it.”
“But I screwed up. ”
“Trust me, this is so minor compare to other things.”
“Really?”
“Trust me as you work in the ER you will know and you will look back to this and laugh.”
I was not laughing. I just kept thinking how I screwed up.

Later on that week was my actual graduation ceremony. The day I was graduating was such a rewarding time for me. But it was also a time of mixed emotions.
“So, dad are you and mom going to be at my graduation?” I had asked a month ago.
My dad shook his head. “I can’t I am busy.”
“Busy with what?”
“I am going to the racetrack that day for a big race. Sorry.”
“So a bunch of horses galloping around a track is more important than seeing your son cross the graduation stage?”
“I’ve been to your graduation before for your first degree.”
“You really don’t like what I am doing do you?|
My father ignored me and shrugged his shoulders. “All I want to know is what you are going to do after. Do you plan to stay as a nurse are you actually gonna do something better?”
I glared at my father. “I can’t believe this. My father does not want to go my graduation for a degree program that I worked my ass for because it makes him look like a fool in front of his friends.'”
“I am not gonna this discuss with you. ”
“WELL I AM!”
“Don’t you dare raise your voice at me! Have respect for your father!!!”
“Well have respect for me dad!! This is my graduation. Not every parent gets to see their child graduate. Not everyone graduates period. This should be a happy time for me and yet you are making it miserable.”
My dad grabbed his jacket as he headed out the door. “I have other plans. You’re mother is going. She will be there to support you.”
I stared at the half opened door as he started the car and drove off.

 
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Posted by on February 27, 2015 in Uncategorized

 

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Being a New Graduate Nurse: The Feelings, Experiences and the Questions.

      You are a new graduate Registered Nurse starting out on your unit but let’s rewind six months ago when you went through some drastic changes that easily could have been a feature reality show on TLC or the Discovery channel: You’ve made it through your final year.  You pass your pre-grad, you graduate from your program, you walk across that podium and smile like you are constipated shaking the hands of the Dean Chancellor and everyone else on the faculty as you get that degree in your hand.  After celebrating that you are finally graduated, you go back studying like the world is going to end for that CRNE which seems to determine your fate no matter how you look at it.  You write the CRNE not remembering how you got to the examination centre, writing it or even remembering some of the questions but you keep on thinking what would happen if you did not pass the CRNE.  After six agonizing weeks of hell you get the best news of your life that you pass the CRNE so you are now an official Registered Nurse while at the same time landing a new graduate position in a hospital working as a nurse.

     So far so good right?

     But then reality hits.  You are now responsible for everything you do and I mean EVERYTHING.  You are now to trying to juggle what you learned in your four years of nursing plus squeezing in what your clinical teachers and what your pre-grad preceptor has taught you.  You try to remember the right ways that your lab and clinical teacher taught you but you find out that the department you work in does things a bit differently which sometimes causes your mind and thinking to do a summersault.  These are just a few things that as a new graduate nurse you are faced with and perhaps what many new grad nurses are faced with. When I got hired as a new graduate  in the emergency department I was like a child opening his first toy on Christmas morning.  I was happy, excited, contented, flabbergasted, the whole nine yards.  I mean come on, this is the ER we’re talking about right?     As with any job however, there are some challenges that you come across that over time you learn to overcome and adapt to.

      One of my obstacles I faced was prior to me being a new graduate, I worked in the ER as a clinical extern therefore creating job role conflict.  As a clinical extern, I was there to assist nurses and other staff members in the department with anything which included anywhere from helping changing a heavy patient to assisting in a code where I needed to help do chest compressions.  Being an extern was great because I was able to be everywhere and was always be able to jump in and help when the time needed.  Once I became a RN, the roles changed.  I had my own specific area, my own patient assignments therefore, I was only able to help out in my area.  I couldn’t just run off and help someone who needed help or I couldn’t simply stop what I was doing to go run off and do something; I had to prioritize. This was a challenge for some other staff in the department who forgot that I was now a RN and not a clinical extern and would sometimes grab me in the middle of the task and ask me to help them with something.  This leads to my second challenge, the responsibility.

      You now have complete responsibility on what you do which means that you have to triple check if not sometimes quadruple check your stuff to ensure that everything is done right.  I would not call this a challenge but it becomes a challenge when the amount of time used to triple check everything might work against you.  As a new graduate nurse, you will (and I still do) certain things slow because you are still learning.  The last thing you want to do is rush something fast to only find out later on that you made a mistake.  Though taking your time to do something is great, time as mentioned can work against you which leads me to another challenge that I personally face and continue to do so; time management.

     This is perhaps my biggest struggle that I have as a new graduate and likely a skill many other new graduates face.  It’s one thing when you have two or three patients or even four patients with your pre-grad instructor but when you are by yourself and have the responsibility of managing four patients in an environment where the turn over can potentially be fast (especially in the ER) it can be quite challenging.  I personally still find this a challenge for me because throughout my clinical experiences the time management skills I had and were taught throughout school were based on if I was on a floor or a unit.  When you are in a fast pace environment such as ER, you learn to adjust your time management skills to adapt to the fast pace environment.  For someone who is used to working at a constant speed and having time on their hand, this can be quite challenging (which I found out quite easily.)  Despite these challenges which I believe every new nurse will face, I will say that working in the ER has been a blessing. The staff here (and I mean entire staff from the physicians to the nurses to the unit clerks to the patient transport representatives to even the housekeeping staff)  all make the department a great place to work.

     So what advice do I have for upcoming new graduate nurses, pre-graduate students or current new graduates?  First, believe in yourself (I know I sound like a 3am Anthony Robbins self help infomercial) but seriously trusting yourself and having self confidence is key.  Everyone makes mistakes and if you don’t know the answer to something, ask.  As a number of fellow experienced nurses in my department have told me “a nurse who asks few questions are the ones that you want to be careful of instead of the ones who ask a lot of questions.”  Second, everyone has different learning patterns and ways on how you learn and do things.  It does not mean you are stupid, or dumb or slow, it just means you learn things differently.   This leads to my third advice, don’t feel discourage or better yet don’t let anyone make you feel discouraged.  I will admit I have these feelings while working as a new graduate and sometimes like a stubborn cold sore they tend to flare up again.  As a new graduate nurse it is very easy for you be discouraged.  You are working with other staff members who have more experience than you, you might have some nurses who give you that “you should know this by now” look, you sometimes feel nervous when talking to a doctor about a situation and don’t want to appear as a “newbie”, and sometimes even a patient might even question your ability because they can sense that you are fresh young and new.  As nurses, we are constantly learning everyday and our learning curve increases exponentially with our years of experience.  Try not to let someone’s words of discouragement get to you and if it does, focus on something positive.   A couple of weeks ago I was being attacked my own feelings of discouragement and began doubting myself as a good nurse.  Half way through my shift I heard two comments that made my day. “You did an awesome job today.” and “You were a really great nurse today, thanks for taking care of me.” Though for some that might mean a little pat on the back, for me it transformed and transcended my feelings of self doubt to encouragement.  You see, sometimes you worry over the biggest things when it’s the little things as a smile, and acknowledging someone that can make someone else’s day, and in turn yours.

      New graduate nurses should remember that we are now the upcoming new nurses for our health care.  We carry vast amount of knowledge as well as our new learnt experiences.  We are definitely not perfect ( no one is) but as we continue our new path and career we will be absorbing vast knowledge.   With time comes experience; don’t feel discouraged, mislead, and confused thinking that you are not a good nurse when you know deep down you are.  Remember a good nurse isn’t just a nurse who can just read off an ECG flawlessly, insert a Foley catheter with ease, predict an illness before the doctor can, insert an IV after the first try or able to have all their tasks and meds done ahead of schedule and have time to relax. A good nurse is also one that is able to make their patient smile, laugh and have that patient remember who you were and what you did for them, even it was something little like giving them a warm blanket or  asking them if their okay.

     Let’s now fast forward six months ahead.   You are no longer a “new graduate nurse.”  You are now a nurse working on your unit.  You are still learning new skills, tasks procedures but you now have learned to be confident.  More importantly, you push away your discouraging feelings and continue to believe that you are a good competent nurse that will provide the best care you can for your patient that day.  This is what passing that CRNE was for.  This is what graduating from your nursing program was for.  More importantly, this is what makes you stand out as a good nurse from others.  Don’t give up……give in.

Dwight Barrett RN. BSc. BscN. aka medsoulbrother

 
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Posted by on September 15, 2012 in Uncategorized

 

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