Reality Shock PP Transition into RN
What if you're in a noncompact state but want to move and work in the compact state?
- Apply for licensure by endorsement in the new state of residency - Your single state license is not affected and will remain active if you maintain the license and if so provided by the laws of that nonparty state.
What if youre in a compact state but want to move and work in a NONcompact state?
- apply for a licensure by endorsement in the new state of residency - compact license changes to single state license valid ONLY in that state - Notify BON that you have moved out
What are the requirements for a eNLC?
- meets requirements for licensure in home state. - Graduated from a board approved nursing program or an international edu. program - Passed English proficiency examination (if eng. is not first language) -Passed NCLEX -Holds an unencumbered license *without active discipline* -Fingerprint-based crimincal background check -no felony or misdemeanor convictions (misdemeanor r/t nursing practice) -NOT currently in an alternative program*you are required to disclose if you are.* -Valid SSN
Requires a report to a specific health care providor's board if (3 cases):
-Employment terminated -Resignation in lieu of termination -Suspension of privileges to practice
Examples of positive transitions
-NR programs help new nurses make the transition from sheltered environment of NURS school to the practice setting. -Preceptorships, student works with a preceptor is assigned to one RN for supervision for the most of the semester. Experiences the role of the RN by working the same hours and on the same unit as the nurse. -Internships/externships, allow students between junior and senior year to work as nurses' aides while permitting them to practice with a few restrictions.
Client health needs consist of:
-Safe and effective care environment -Physiological integrity -Psychosocial integrity -Health promotion and maintenance needs
What if you're moving from one compact state to another?
-You can practice on the former residency license for up to 30-90 days -Apply for licensure by endorsement 1-2 mo in advacne of a move. -Pay any fees, complete declaration of new residency in the new home state. -You are issued a new multistate license and the old one is inactivated. NOTIFY BON in old state that you have moved out - Proof of new residency may be required.
Prevent Discouragement
-ditch the guilt, move on -compare and despair, stop that -we want to be able to do it all, does not work in a 24/7 operation -if you are drowning let someone know- NO secrets -save warm and fuzzies: tender moments with patients that remind you of why you're here -Maintain a schedule -Get and stay organized -Get to know common dx, meds, etc. really well.
Strategies to ease transition
-stress and time management, take time to decompress and make room for fulfillment -Identify underlying problems, view problems as challenges and opportunities -work on delegation skills (should be done in beginning of shift) -Avoid procrastination, start the task even if it is only a small step. -Prioritizing a task list, do one at a time. -ask for help and do not see it as a weakness -set personal goals (long term, short term) -take a few minutes to slow down several times a day -practice a healthy lifestyle (eat, sleep, exercise) -Focus on whats happening now rather than what could happen -use appropriate self-assertion -laugh and take time for self -keep 6 months in mind, it takes 6 mo to feel comfortable (if not, address it).
Describe the process of preparing for Nclex
1) Background Check- fingerprinting (done 3 mo prior to testing ) 2) Online Application Process 3)Pearson Testing sites 4)ATT from MSBON
There are 3 primary components to the Nclex Exam
1) Client Health Needs 2) Levels of Cognitive Ability 3) Integrated Concepts and processes
Client Needs: Percentage of Items from Each Category/Subcategory
1) Safe and Effective Care Environment: Management of care 17-23% Safety and infection control 9-15% 2) Health Promotion and Maintenance 6-12% 3) Psychosocial Integrity 6-12% 4)Physiologic Integrity: •Basic care and comfort 6-12% •Pharmacological & parenteral therapies 12-18% •Reduction of risk potential 9-15% •Physiological adaptation 11-17%
NCLEX Measures Nursing Knowledge:
1. Integrated, coordinated, safe, and ethical care 2. Expected stages of growth and development 3. Recognizing and assisting clients to cope with health alterations and promote health practices 4. Promote and support physical, psychological, spiritual, and social well-being 5. Managing care related to the administration of medications and parenteral therapies 6. Managing care for clients with acute, chronic, or life-threatening health conditions
Client health Needs make up
25-38% of total questions on NCLEX: -Overt safety issues -Use of restraints -Medication administration, lab results -Injury and Infection prevention -Isolation precautions -Safety measures with Pediatric clients -Safety needs of clients with mental problems
What percentage of new nurses leave the profession in the first three years?
30-50%
What percentage of new nurses in North America change their place of employment or plan to leave nursing all together in their first year of professional practice?
33-61%
How much time do you have to take the Nclex?
4 hrs (includes eerrthang)
The Nclex is a computerized exam that consists of how many Qs?
75-145 items (15 are pretest items that aren't scored)
What if during an IC a solution is not reached?
A formal adjudicatory hearing, following hearing decision, the nurse may appeal to court.
burnout syndrome
A general malaise with increased feelings of being emotionally exhausted, of detachment from both colleagues and patients, and of professional failure.
What is the purpose of Maine State Board of Nursing (MSBON)
A state regulatory agency charged with protection of the public health and welfare in the area of nursing service.
What states are NLC states?
Alabama Arizona Arkansas Colorado Delaware Florida Georgia Idaho Indiana Iowa Kansas Kentucky Louisiana (Registered Nurse and Practical Nurse) Maine Maryland Mississippi Missouri Montana Nebraska New Hampshire New Jersey (*New Jersey is allowing nurses who hold active, unencumbered, multi-state licenses issued by Nurse Licensure Compact member states to practice in New Jersey under their multi-state licenses.) New Mexico North Carolina North Dakota Oklahoma South Carolina South Dakota Tennessee Texas Utah Virginia West Virginia (Registered Nurse and Practical Nurse) Wisconsin Wyoming
What states are NONcompact states?
Alaska American Samoa California Connecticut District of Columbia Hawaii Illinois Mariana Islands Minnesota Nevada New York Ohio Oregon US Virgin Islands Washington
What is the first step to taking the Nclex?
Apply for licensure with ONE BON
What is the responsibility of the Board to protect the public?
Approve nursing programs, licensure by examination and endorsement, Administration of disciplinary programs.
What is the 7th step to taking the Nclex
Arrive for exam- present photo ID and ATT
The difference between BON and professional associations?
BON is a law of state in charge of public protection. Professional association is a membership that is supposed to advance and promote profession.
Alternatives to Discipline Provision
Board contracts with the Medical Professionals Health Program
Be careful to not look like you are _____________
Cheating!
Before starting the process to apply for the Nclex exam, you need to do what?
Criminal background check- fingerprinting $52 fee
Board decisions on complaint can be either (2 things)
Dismissed or schedule for an IC
Who is Kim Esquibel, DNP, RN?
Executive director of MSBON
Symptoms of burnout include
Extreme fatigue, exhaustion, frequent illness, overeating, headaches, sleeping problems, physical complaints, alcohol abuse, mood swings, emotional displays, anxiety, poor quality work, anger, guilt, depression
True or false? An agency may decline to issue a license on the basis of race, religion, sex, national origin, or ethnic background
FALSE< NO Agency is allowed to do that.
True or false: You can delegate teaching assignments
False
true or false: If you pass the Nclex it means your supernurse
False
True or False: When you arrive, you just need to state your name to enter the test.
False, A digital fingerprint scan/palmer vein scan, digital picture, and digital signature is taken when you enter.
True or false: If you are more than 15 minutes late you forfeit your test time and will need to pay again
False, If you are more than 30 minutes late you forfeit your test tie and will need to pay again.
True or false: you can access your cellphone during your exam if youre on break
False, No cellphones, materials to help with answers, or personal items allowed - it stays in a VUE sealed bag.
True or false: wear tight fitting clothes on day of exam
False, comfty clothes like gym clothes
True or false: On day of the exam you should walk in with the attitude of "if i don't know it now, i never will"
False, cut that ish out.
true or false: you should decrease foods in glucose and protein on day of the exam
False, increase it to maintain blood sugar
True or false: Computer selects questions from a pool of 500 questions
False, pool of about 4000 questions
True or false: There is only one session available to take the Nclex
False, there are two 6-hour sessions (morning and afternoon)
True or False: In ME, a post office box counts as a residence?
False.
How can you study for the retake?
For each area, you are given a descriptor of performance (Above, Below, or Near the passing standard).
Study Tips for Nclex
Formal NCLEX reviews Do 4000-7000 questions Complete a 265 item tests in one sitting in 6 Hours Practice/Study Set Study Goals and Schedule Study Time
BON may take action in cases of
Fraud- Deceit, Incompetence, Unprofessional conduct Criminal convictions, Substance abuse, Diversion Violation of its rules.
Where does the MSBON fit in the state gov?
MSBON is part of the execuitive branch of the government. Their rol e is to execute laws that regulate practice of nursing.
In nursing practice, you care for clients using nursing priorities (ex. ABCs) what are some other nursign priorities?
Maslow's Hierarchy (physiological needs come first) Nursing Process (1st step is assessment) Safety Issues (basic needs of survival: oxygen, nutrition, elimination, reduce environmental hazards like falls, accidents, med errors)
What if you fail the Nclex?
Must wait 45 days to retake. Some states have limits on number of times it can be retaken.
How many members are part of the MSBON?
Nine members appointed by the governor. 5 RN, 1 APRN, 1 LPN, 2 public members.
Are you allowed to go back and change your answer once you click "next" on the Nclex exam screen?
No
Is your PSOR a compact state? Ex. New York
No
An RN has called out and the Med Surg unit is now short on staff. The New Grad offers herself to take the absent RN's assignments. Is she allowed to do this?
No, a new graduate should not be part of the facility's staffing pattern. They do not carry a patient assignment
As a graduate who lives in MAINE (compact state), should you apply for a license in a different compact state?
No, the applicant cannot apply for a compact license in a compact state that isn't her legal residence.
Consequences of substance abuse
Nurse may be impaired, criminally convicted, excluded from Medicare/Medicaid participation
If a complaint was made to the Board, what happens?
Nurse will receive the receipt within 60 days and is expected to respond within 30 days for the Board to review
Integrated Processes are asked throughout the exam, what do they consist of?
Nursing Process, Caring, Communication and Documentation, Teaching and Learning
What is Enhanced Nurse Licensure Compact (eNLC)?
One license- active in 31 states and counting. Allows nurses to have one multi state license with he ability to practice in both their home state and other compact states
What is the 3rd step to taking the Nclex?
Receive receipt of registration from the Pearson VUE
What is the last step to taking the Nclex?
Receive results from BON and receive your license!
What is the 5th step to taking the Nclex?
Recieve an ATT (authorization to test) via letter or email from Pearson VUE
What is the 4th step to taking the Nclex?
Recieve eligibility from BON
What is the 2nd step to taking the Nclex?
Register with Pearson VUE
The government may decline to issue a license when it sees fit to do so as long as the denial does not violate state or federal law, right?
Right.
What is the 6th step to taking the nclex?
Schedule an exam with Pearson VUE via website or telephone
When you enter the Exam room what should you expect?
Sit at computer with your picture Given an eraseable noteboard and onscreen calculator Two chances to complete tutorial Tight security: all sessions are taped, proctor remain in the room
What is the first step in preveneting compassion fatgue?
Taking care of yourself.
What happens if a New Grad who was on an orientation failed her NCLEX and her 3 month deadline is up?
The new graduate may function only as an UAP
What does the Legislative branch include?
They pass state laws. The Nurse Practice Act is an example.
True or False: Orientation of new graduates require that the new grad submit an application for the nclex, get declared eligible by the Board, and then provide a copy of the ATT to the employer before working as an RN as proof of applying to the Board of Licensure.
True
True or false new graduates are required to pass the NCLEX within 3 months of starting orientation.
True
True or false: Delegate tasks that have specific guidelines
True
True or false: If you pass the nclex it means you probably won't harm someone the first time you take care of a client.
True
True or false: It is unlawful for an individual not licensed to practice, offer to practice, use a sign, card, or device to indicate that the individual is an RN or LPN in the public.
True
True or false: Nclex is a licensure exam that establishes a minimal level of competency to protect the public from unsafe nurses
True
True or false: You can pass/fail the exam in 145 questions
True
True or false: You can pass/fail the exam in 75 questions
True
True or false: You must leave all your belongings at the door in a locker when taking the Nclex
True
True or false: You should arrive atleast 30 minutes before the exam
True
true or false: For quality control purposes, every NCLEX is scored twice; once by the computer at the test center and then the result is verified after the examination record has been transmitted to Pearson VUE.
True
True or False: The NCLEX can be taken in any jurisdiction.
True! The Nclex can be taken anywhere.
True or False: On day of exam you should avoid intake of diuretics because
True, a lot of coffee and sugar will make you more nervous and increase bathroom breaks
True or false: Think positively
True, if you truly believe u will do well it'll happen.
True or False: IF you are under disciplinary action your multi state privileges may be removed and you will be restricted to practice only in home state?
True.
True or false: A nurse must hold a separate license in each NONcompact state where practice privileges are desired.
True.
Performed role
What the RN actually does.
What is cognitive dissonance?
When a new grad knows how they should do it but circumstances do not allow them to carry it out results in increased apprehension.
Is your primary state of residence or PSOR a compact state? Ex. Maine
Yes
What if your PSOR is a compact state?
You apply for a multi state license in your primary state of residence.
What if your PSOR is not a compact state?
You apply for a single state license in any one state of choice.
What if you're not eligible for an eNLC?
You may still be eligible for a single state license.
When should you recieve your Nclex results?
You will be aware of your results in 24-48 hours. It can take up to 6 weeks.
burnout syndrome is a result of
accumulative stress of an individual's life, work, personal, and family responsibilities
What is an informal conference (IC)?
an executive session to come to resolution.
percieved role
an individual's own definition of the role. Often, more realistic than the ideal role.
Earliest indicator of burnout is
attitude that work is something to be TOLERATED rather than eagerly anticipated. Irritable, impatient, cynical, pessimistic, whiny, or callous towards coworkers and clients. (usually don't cope well).
NCLEX STRATEGIES: CLIENT'S AGE
consider that the client is an adult unless otherwise stated
First step in dealing with burnout is recognizing burnout, what are KEY signs that a nurse may be experiencing burnout:
continuous physical and excessive illness strong feelings of being taken advantage of and unappreciated Feeling of impending doom when preparing to go to work Pulling back at work (little time as possible spent on tasks/communication) Lack of empathy
What is a New Grad NOT ALLOWED TO DO?
delegate NURS fx, independently pass meds or administer IV therapy.
NCLEX STRATEGIES: CALL MD
do not pass the responsibility for care of the client to someone else - there is usually a nursing action to be taken before contacting someone for assistance
Strategies to prevent compassion fatigue
eat right, exercise, plenty of rest, close contact with family and friends, spiritual needs, fun hobbies, rely on coworkers
True or false: Begin study the day before the exam
false
Reality shock often produces
feelings of anxiety, insecurity, inadequacy, and instability.
NCLEX STRATEGIES: POSITIONS
for comfort, tx, or prevent complications
NCLEX TEST STRATEGIES: NCLEX HOSPITAL
great place to work; everything is available for client care; questions are based on textbook practices, not necessarily real world; clients respond just as book said they would; "Nursing care provided on the exam is performed in NCLEX Hospital; the nurse has adequate staff, supplies, and whatever is required to provide the safest care for the client"
Sally is taking the nclex, she notices she getting many questions that seem to be very hard, what does this mean?
it is a good sign, means you're in the upper-difficulty level
NCLEX STRATEGIES: MATH
know dosage calc.
NCLEX STRATEGIES: LAB VALUES
know norms; know what to anticipate when client's condition is improving or getting worse; progress or lack of progress; how will results impact nursing care? ie. blood sugar levels, Hgblevels
The Nclex is designed to test
knowledge, skills, abilities essential to the safe and effective practice of nursing at the entry level
Who is more likely to burnout?
more intelligent than average, hardworking, idealistic, and a perfectionist. One with a job in demand for high quality performance, unrealistic expectations, inadequate $ awards, requires constant contact with people.
Pass/Fail Rule: 95% confidence interval rule
most common. Computer will stop giving items when it is 95% certain that your ability is clearly above or below passing standard.
When you schedule the Nclex Exam do not wait until the ATT date almost expires
must test within the validity dates (90-365 days)
What is the RN preceptor responsible for?
provide continuous supervision, may designate an LPN to participate.
Keep an eye on the " " box, if taking more than " " put down an answer and move on.
remaining time... if taking more than 2 minutes on any question, put down an answer and move on.
Anything you know REALLY well will NOT be on the Nclex, there are no "happy questions" on Nclex which means that there is
something always wrong, you ned to worry about it.
Angel of mercy is the ideal role of the nurse that might require someone with
superhuman strength, possess superior intelligence and decision making ability, prevent errors and carries out DO orders. This shit don't exist.
Nclex asks entry-level type questions, so the questions tend to be very
textbook-ish, do not look for exceptions. Look for the expected.
How could one safeguard the life and health of the people in this state?
the individual must submit evidence that he/she is qualified so to practice and that person must be licensed.
Reality shock is:
the transition from nursing student to RN
Practicing below the level of licensure may find that
they will be held to the standard expected of the higher licensure level should legal problems occur in that health. This places the nurse in potential legal jeopardy and is of serious concern to the Board.
True or false: You do not delegate assessment, evaluation, or nursing judgement
true
True or false: the nclex is designed so no one gets 100%
true
True or false: when delegating, you want to find the most stable client
true
Pass/Fail Rule: Maximum-Length Exam rule
when the computer is having difficulty establishing a clear zone of knowledge above or below the pass standard after you 've maxed out on items. If your final ability estimate is above the passing standard, you pass.
Pass/Fail Rule: ROOT Rule
when you run out of time before reaching maximum amt of items. You must've answered atleast 75 items. In your last 60 items, if above the passing standard you pass.*Doesn't mean you must answer the last 60 items correctly*
1st time test takers are offered a date
within 30 days, repeaters within 45 days or later if you wish.
What you need to know/memorize
}Names of common drugs }Lethal and therapeutic dosages }Lab norms and values }Growth and development norms }Foods high or low in iron, protein, Na, K, or carbohydrates }Conversion formulas }Anatomical names }List of cranial nerves and their innervations }Definitions of defense mechanisms
NCLEX STRATEGIES: FOCUS ON CLIENT
•generally the answer that does this is right
Bloom's Taxonomy
◦Level 1. Recall/memory (knowledge; comprehension) ◦Level 2. Analysis (application) ◦Level 3. Synthesis; evaluation (judgment)
Many questions in one topic area may mean:
◦Trial-testing those questions ◦You are having trouble in one area
