I have attached my clincal exemplar above. In this exemplar I recount an experience from my senior preceptorship that reflects on a memorable experience that taught me about my future as a nurse. The client I talk about is a young client with pancreatitis as well as other complications. This experience was an emotional and educational situation that pushed me to learn some of the harder lessons as a nurse. It also instilled the idea that every little thing matters and the smallest gesture can have the greatest impact. This story will stay with me through out my career and continued path as a nurse and I hope that those who read it can take away something for themselves.
We have taken countless ATI exam throughout this semester. I have had an up and down relationship with the ATI and remediation process. At first I was enjoying the learning process of these tools and felt like it was benefiting me. Towards the end I lost this sense not because it was no longer helping it was just because I was overwhelmed with the lack of time and the fact that I couldn’t dedicate the time and effort I wanted to when taking these exams and performing my remediations. That being said I learned a lot about my self and test taking skills. I used to rush and try and get the questions done as fast as I could to be done. After the first two exams I started taking my time and reading the questions carefully and taking more breaks to allow myself to reset. this process greatly improved my test taking and allowed me to recall information and also understand what the questions were asking. Another thing I learned is to not pay attention to the question numbers. When taking the adaptive tests I would get frustrated if I went over 75 and just wait for the test to end and with the set number ones I would start to lose focus and interest once within 15 questions of finishing. I started ignoring the question numbers and just focusing on each question one at a time. Once I did this the tests started going by so much faster and I was again improving. ATI also highlighted the sections I need to focus on to improve. I know my biggest weaknesses are pharm and prioritization. I know now as I review for NCLEX that these are two sections to focus a little extra on to improve my skills. I think that remediations are supper helpful in reviewing what you struggled with and that the ATI resource do an amazing job explain the whole concept and not just the path or nursing interventions but is able to paint a picture of the whole process. Self care is something I have always struggled with and worked hard at. This semester more than ever has highlighted the importance of taking care of yourself and not letting the stress overwhelm me. I started working out more regularly and setting a schedule of work for my self. I made it a goal that no matter what I was going to stop doing homework by 10 pm. This allowed me to be more motivated earlier in the day and I was able to be more productive and still be able to relax at night. I also tried to have my work done before the weekends so I could have that time to myself and be able to hang out with my roommates and relax. These little steps made it so I was able to cope with the stress and anxiety of this year. The test taking and academic skills as well as person self care skills will hopefully carry into my professional life. I think ATI was helpful in showing that I know a lot more than I think I do and that with some time refreshing and the review sessions I will be able to successfully pass my NCLEX. I plan on testing soon after graduation once all my documents and forms are in and cleared. I think for me if I take a long time to study after finishing school I will lose focus and second guess myself where now I have the confidence that I can pass if I where to take it right now. UNE and ATI have made me feel confident in my knowledge and know that even if I do not know the specific medication of condition in detail, I am able to eliminate the answers that are not correct and give myself a better shot at an educated guess. These passed four years have allowed me to grow as a person and increased my excitement to become a nurse and make a difference in peoples life. I am thankful for the experiences that I have had and the professors and clinical instructor as well as my family who have supported me. I can’t wait for this next chapter to begin!
Going into this exam I wanted to make sure I was better able to focus than I was in Comprehensive A. This time I made sure to set aside time to be able to sit down and fully focus on what I was doing and take the time to read each question carefully. I also tried not to pay attention to what number question I was on and how many more I had to go. I took it one question at a time and by doing this it actually allowed the test to go by faster and help me to stay more focused. From the pediatric practice I also learned the importance of taking breaks. Taking several multiple choice questions in a row and be draining and a short break helps a lot to reset the brain. Overall I thought that this exam went well and I am happy with the score I got. If I am able to get this score again on the proctored exam as well as on the actual NCLEX than I think I will be on the right path to pass the exam. It is interesting when taking these exams the information that can be recalled that I honestly forgot we had learned about. It is reassuring to know that behind some of the cob webs there is still the knowledge of what we learned way back in adult health 1 and with a little brush up on the content that knowledge will comeback.
This was the hardest ATI I have done so far. Not because of the content but rather it was just hard to stay motivated. In the past few weeks, we have had a lot more work as everything is starting to come to a close. I feel like we have spent a lot of time doing remediations and this time it really got to me. With every question that I was unsure of I kept thinking of the remediations I was going to have and how long those would take. I also was struggling to stay focused and got frustrated as the test continued to go on and not shut off. Despite all the negatives, I was very pleased with how I did on this test. It is a lot easier to take these tests on the content we are actively learning. When I took the maternity one I also did well because everything was so fresh in my mind. A lot of the questions on this exam were similar to the content that is coming up on our next exam. After taking the exam and reviewing I read the explanations on the ones that will be on the exam to help get a better understand even if I got the question correct. This was a helpful aspect that I was not expecting when taking this exam and it made the frustration a little less because then I started to feel like I was also studying for the pediatrics exam.
The pharm proctored ATI that we took in class did not go as well as I had hoped. After taking the two adaptive quizzes and improving on my score I was expecting to do a little better. Pharm has never been a super strong subject for me but I was expecting to get at least a level 2. Unfortunately, I got a level 1, but on the high side of level one close to level 2. After seeing my score and seeing how close I was to level 2 I have decided that I am going to retake the exam and give it another try. I feel like the first time I took this exam I was not in a good mindset and was completely unfocused. I did not take my time reading the questions and was rushing to be done. while doing the remediations I was surprised by some of the categories because they were medications and conditions that I was familiar with and thought I understood. I feel like after taking the time to remediate the ones I got wrong, I have a better understanding of the topics which will benefit me moving forward. I am hopeful that the second time around I am able to take my time and get a score that I am more proud of. Pharm is hard and even if I do not do better on the second test, at least I can hopefully feel better about the effort I put into the test.
Of all the ATI, I thought that this one was the most similar to what we would see on the NCLEX. This was kind of expected because it is a predictor exam but going into it I was unsure of how it would actually be formatted. My favorite part of this test was the fact that their was several different topics being covered which made it so I didn’t feel as fatigued because it was requiring me to recall several different topics rather than only one topic. When taking a focus exam that is only on one topic it gets frustrating and redundant which makes it impossible to stay focused. Like I said, the fact this exam was the closet to NCLEX made me feel a little more confident than I had with the other ATI’s. I have been worried about my ability to stay in the zone and not lose interest but despite my interruptions, I was able to do just that. This is an exam that I will probably retake in the near future when I am in a better setting an able to put more time and focus into the test itself. I took this exam when I had free time but stuff in my surrounding environment became distracting and my help was needed with things in the house so I had to take breaks. These interruptions made it hard to stay focused and not took away from the test-taking environment I tried to set up for myself. Despite all this I did a lot better on this exam than I was expecting too. I felt like since I was not completely focused I was just skimming the questions and making an educated guess. If I was to take anything from this experience I think it would be that even when not completely focused and zoned in, the fact that I was relaxed and not putting stress on myself regarding the exam, I was able to reprising well in my opinion. Over I think I learned a lot about myself and test-taking strategies that are continuing to grow and change. I think when I take B I am going to try and remain calm and unstressed while also benign the zone. I will also make sure that I am not going to need to do other things and can just focus strictly on the exam.
After graduation, I plan on sitting for my licensure by examination in Massachusetts. Originally, I had planned on staying in Maine but after talking to my family as well as thinking through some logistics I have chosen to sit in Mass. By living and working in Massachusetts I can stay at my parents’ home for a few years and save some money to pay off my loans and then potentially be able to buy the property of my own. I have never been a huge fan of the idea of renting, so by living at home I am able to save money to be able to gain the opportunity to buy a house of my own. Luckily my parents are super supportive and are the ones that advocated for this idea. Unfortunately, Massachusetts is not a Nurse Licensure Compact state which is another reason I had wanted to sit in Maine. I like the idea of the compact states and the versatility and opportunities it provides. I am excited to work in Mass and have started looking at different positions. Where I live provides me with the ability to commute into Boston relatively easily as well as work in a lot of smaller community hospitals. I truly think that going back to Massachusetts is the right step for me and will provide me with the experiences I need to grow as a nurse. I can defiantly see myself coming back to Southern Maine at some point in the future and continue my career up here.
The application is Mass is a web-based application process. The application requires the applicant to submit an official transcript as well as the verification sign-off by the director of the program. An applicant has to have a good moral character by state law and has graduated from an accredited nursing program. If an applicant has a criminal background, then they would need to submit documentation for evaluation by the nursing board. A criminal background check and fingerprints are required to be on file and then renewed every three years. The nursing school director will also need to complete the certificate of graduation form and need to send that to Nashville, TN at the professional credential Services. The application has a $230 fee and requires the submission of a passport-style photo. There is then an additional $200 fee to register for the NCLEX and once the Massachusetts Board of Nursing provides clearance the applicant is able to test. Once authorized, the test taker has 90 days form the authorization date to schedule their exam.
Massachusetts has the standard of conduct that states that a nurse has a duty to report any abuse that is happening to a patient, diversion of a controlled substance, as well as nurses using substances while working. If a nurse suspects any of these situations are happening, they need to submit a report to the Executive Director of the Mass Board of Nursing that explains what they have seen and a declaration that they are being honest. It is also good to know that as a nurse there is a Substance Abuse Rehabilitation Program that is available to nurses that have substance issues. I think this program is really important for nurses to know about because if they are struggling and want help, they are able to go through this program while also knowing that with compliance they are able to return to practice. On the other hand, if a nurse knowingly does not report abuse, diversion of a substance, or a nurse working under the influence, they may have to pay a $1,000 fine as well as face disciplinary actions by the board of nursing for failing to report these behaviors.
As a Registered Nurse, protecting my license is something that will be important. I have to be aware that my actions can directly impact my ability to work as a nurse and that sometimes you might have to do things, like reporting co-worker wrongdoing, in order to protect the patients as well as yourself. One of the easiest ways to protect your licenses is to document everything that you do in as much detail as possible to ensure that even if questioned, you have the rational and proper reason why something was done. Documenting might seem tedious at times but ultimately it is one of the most important ways to protect yourself. You can have proof of documentation for informed consent, refusal of treatment or medication (as well as wasting if needed), and where a client’s possessions are. It is also important to make sure that you are always working within your scope of practice and knowing the guidelines and protocols at your hospital for reporting abuse and other issues that may arise. If you practice following the guidelines and protocols as well as with the patient’s best interest at the forefront, then there should be no need to have to protect your license because it will never really be under fire.
This was by far the most successful I have been when taking an ATI quiz. I based on my scores from the previous pharm exams, this was reassuring to see such an improvement. I really think that these ATI tests and the remediations are helpful and have taught me a lot. I was a little skeptical that this process actually worked and more viewed it as being kind of a time-waster. Once I started seeing improvement and learning different test-taking strategies, I starting taking these exams a little more seriously. For this exam in particular I did it about a week before it was due because I had the time and knew that I could take the time and do it right. I believe that being in the right mindset when taking an exam is so helpful in your ability to perform well on that exam. For example, when taking an exam for a class, you have about a week that you are preparing for this exam and the content. With ATI, the thing I have been struggling with is not treating it like an exam or study tool but more so as an assignment. Now that I have been going into it as more of a study tool I have been seeing an improvement in my test-taking both in ATI as well as class. Being able to read questions and eliminate answers and use reasoning and nursing knowledge to get to the correct answer without totally understanding the content. Overall I have found these ATI practice tests to be helpful and can see that they will be a helpful study tool for NCLEX.
I was a little nervous going into this exam after having taken the adaptive pharm exam and struggling. That being said this exam went a lot better for me than I was originally expecting. I like the format of these practice test more than the adaptive ones because it feels more similar to what we are used to. There isn’t the unknown of when is this test going to end. We know it has 60 questions and that once we reach that number we are done. This might be something that makes it easier to get through but in reality, it isn’t as similar to the formatting of the NCLEX where we really do not know when the test will shut off and how many questions we will have. All the formatting stuff aside, I was pleasantly surprised with how this exam went. I had really struggled with the content on the adaptive quiz but with this one, I felt more confident with the content and my test-taking strategy. Throughout the time taking this exam, I saw an improvement in my ability to understand the wording of the question and eliminate answers even if I am not sure of the answer. I also have learned to take the exams when I have free time and am not overwhelmed instead of around the time it is due. By allowing myself to be in a better mindset and focus fully on the exams I was able to do a lot better and dedicate my full attention to what I am doing. Although these practice exams are not the same format as the adaptive ones, I like the way it allows for less frustration and focuses on the logistics of the test, and rather be able to focus on the content being presented.
We all have people in our lives who we look up to not only personally but also in a professional capacity. The nurse who I interviewed on February 24th, 2021 is an amazing woman who has dedicated 30 years of her life to be a nurse as well as 15 years teaching and inspiring certified nursing assistants and future health professionals. This one person has dedicated their life to helping others and given it all she has on every day. It was apparent just from listening to her talk that she is passionate about what she does and views obstacles as learning curves to overcome.
Although I have known this nurse for 6 years, I was able to learn so much more about her journey through her career during this interview. After high school, she attended a diplomacy nursing school and became a registered nurse after 2 years. From there she went on to work at South Shore Hospital in Weymouth Mass on various different floors. She mostly worked in the cardiac ICU where she worked as a charge nurse. Based on the way the health care field started to change, most diploma nurses or LPN’s were required to go to school to get their BSN or continue to work but in a lesser capacity. After dedicating so much time to nursing and going from a leadership role back down to a lower position was a hard transition to make. While going back to school she began teaching at the high school as the assistant teacher for the Allied Health technical program. This program was a culmination of practical and educational content that leads to the certification of the student as CNAs by the end of their junior year. These role changes taught her a lot about what it meant to be both a formal and informal leader.
As the charge nurse, she was in a formal leadership role where everyone looked up to her and she was in charge of the day-to-day the floor. Once her role changed and she was now practicing in a different capacity she took on an informal leadership role of leading by example. She explained what the transition period was like for LPN’s as they were forced to restructure the care they were allowed to perform and how many of the LPN’s were resentful of the younger BSRN’s who has so much less experience and in some cases no experience yet they were considered to be their superiors. After going through this change at work she also had to take on a new form of leadership in the classroom as a teacher that she had never taken on before. I asked her, “based on all the leadership positions you have had thrown out your career, what has been the hardest aspect of being a leader?” She responded, “ I never saw myself as being a leader until I became a teacher. When working as a nurse no matter your title everyone works on the same level and works together with mutual respect. But as a teacher, you have all these young people looking up to you and expecting so much out of what you are to teach them.” She went on to talk about the fact that being an educator for potential young health professionals is a stressful job and a lot of responsibility. “As you know, you students have so much trust in Ms. G and me, and you guys trust and expect us to provide you with the skills needed to be CNAs. This is a lot of responsibility for us and luckily our students have created a great reputation for this program within our community and the facilities they work in.” I was surprised by the wording she used when answering this question and the fact that she said the students created a great reputation. Even though she provides the student with the education and skills needed to succeed in their careers, she personally does not take the credit for that.
I learned during this interview that a nurse leader does not only pertain to positions in a hospital but also encompasses leading through education and example. This leader I interviewed does not view themselves as a leader. Once I told them that’s how I saw them and looked up to them both professionally and personally they responded by saying, “I was just doing my job, but thank you that means a lot.” This she views her job as a nurse educator as well as a nurse as a position to provide help to those in need whether it be a patient or up-and-coming health professional. A leader is not just someone who barks orders at others and has a particular title. A leader is someone who inspires others to do better and makes strides to achieve a common goal. I also learned that a good leader doesn’t take credit for other successes but rather acknowledges their influence in the matter but is able to see that it was not all their doing. A leader knows their own strengths and weaknesses as well as the strength and weaknesses of the team and is able to overcome these obstacles and work as a team to achieve the goals set. This interview experience was very informative to me in getting to know someone on a different level. I have only ever viewed them as a leader and someone I was able to look up to. Years later now that I am no longer their student and about to become a nurse myself, our conversation was more at a level of peers talking to each other and I was able to develop a new level of respect for them as a person and leader. I will apply what I learned from her in all aspects of both my student career as well as a professional one. A good leader leads by example and is able to ask for help and admit when they are wrong.
