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.
Category: Self-care
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.
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.
Each time I feel like I try a new strategy. This is my way of finding out what works best for me I guess. This time my strategy was to not have a strategy. I made sure to still have a testing environment set up with no distractions, but other than that I just did what felt right. At some points I would answer 20 questions without a break others I was taking a break every 2 or 3. It all depended on how I was feeling. I also tried to make sure that I was not changing my answers but also not that I was taking my time and reading thew all my options. I think of all the tests this is the one that I new the most content on. This is most likely due to the fact that I am currently in maternity and we are learning this content so it is fresh in my mind. Another reason is of all the topics, I am most interested in maternity so it comes a littles more easily to me. I did find that I was getting more frustrated while taking this exam because it seemed to be never ending and although I was able to reason through the questions as well as understanding why options where not correct, I struggled to find the ones that where correct. I kept getting caught up in the wording of the questions and trying to pick out individual words and ended up making it more complicated for myself. From this exam I learned that when it come time to take the NCLEX, I believe that I will be able to study and review a lot of the material that we have learned and be able to refresh my memories. This exam as well as the med-surge one where the freshest topics in my mind and thus the ones that I was able to recall more information on. I have found that these exams as extremely helpful in preparing me for the NCLEX as well as providing me with the topics that I need to refresh myself on.
It almost does not feel real that we are in our last semester of senior year. In six months, it is likely that myself and many, of my classmates will have sat for our boards and will be starting work as registered nurses. Everyone has always told me that college flies by but until now, sitting here reflecting on what I’m excited about, I never really saw how fast everything has gone by. I think the thing I am most excited about is seeing all the hard work and sacrifices pay off. For as long as I can remember, I have wanted to be a nurse and have never seen myself in a different profession and to be so close to achieving that goal is so exciting. At the same time though it makes me anxious. All I have known for the past 18 years is school and while the prospect of finally being done is so exciting, it is also terrifying because of the unknown. It is such a weird feeling to be at the point in life where the goals I have always been working toward are about to be achieved. It leaves me with this feeling of what now, where do I go from here? It is almost like as soon as I get excited thinking about being done, the anxiety creeps in and takes that excitement away. It is one of the weirdest feelings to try and explain. Ultimately though I think the excitement wins and with achieving my goals comes the opportunity to set new ones and continue to grow not only as a person but also as a professional. Another thing I’m excited about is making my parents proud. They have been such a strong support system for me threw out my life and always pushed me to do my best so I cannot wait to see the pride on their faced when I graduate. The only way I really want to celebrate is just hanging out with my family and having a nice dinner and just relax and be together. I had originally planned on taking a trip after passing my NCLEX but in this day and age I don’t really think traveling will be an option. That being said I still can’t think of a better way of celebrating than being with the people who helped me get to this point in my life.
I have never been a super organized person in the way that I tend to only looks at things on a week to week basis. By that I mean I never write out all my due dates and plan out what needs to be done in advance. I also usually sit down on the weekends and say I am going to do work all day and end up not getting anything done and get distracted because I am overwhelmed and unsure of where to start. This semester though, there is an overwhelming amount of assignments and dates that are important. After having all the classes and seeing all that needs to be done, I decided that I was going to change things up and be more organized. I made the goal that I was going to write all my assignments out and know what is due and set up a schedule for when I would get this stuff done. As I have started tackling work, I have been checking off the things that are finished and moving on to the next task. Although this semester is crazy busy, I also wanted to allow myself some time to relax and recharge, so my work was still at its best. This led me to the idea that on weekends I will wake up at around 0900 and do work until no later than 1500 and then give myself the rest of the day to relax and recharge without feeling guilty for not doing work. I think these goals will help me to succeed this semester and also make it, so I am accountable to myself. It is so easy to get overwhelmed in nursing school, but I am hoping my new organization and almost set schedule to work will allow me to fell not only successful but also give me the needed time for myself and to recharge.
As I have been writing this response, I have been taking the Nurse Logic 2.0 Modules. Going through the lessons, I was remembering the first time I went through them and noticing how much more I was gaining from them now with more overall nursing knowledge than I had first time around. For example in the first module about nursing and clinical judgement I remember thinking at the time that I learned best through reading, while this is still true, I now know that that I also retain the information so much better when I get to physically put it in practice or at least have a contextually understanding of information. Although that is only an example from one of the modules, I found that throughout them all I was understanding the importance of the information in a different way. What was being said about critical thinking and analyzing information, as well patient education and overall test taking strategy was more applicable and useful when it came time to take the tests. While the lessons themselves where helpful, I also enjoyed the taking the tests. These where the first nursing style questions I have looked at since the end of last semester. I found that with the first module I was struggling to answer because I was not using the skills and analyzing the questions in the way I usually do. After the first couple questions I got back into the mind set and really started to take my time and look at what the question was asking. I also found that some of the time I would over think a question and change my answer. This was mostly because I was looking deeper into the question than what it was asking. I always think that the questions are trying to trick me and that they are way more complicated than I originally think so I will change my answer. Making my way through the modules, I found that for the most part, questions were straightforward and that if I just read the words in the question carefully and didn’t assume additional information than I was better off. Overall, I learned from these modules different ways of looking at information and knowing what works best for myself as well as ways to answer a question even if I am not 100% on the information. Going forward with ATI assignments as well as NCLEX I know that I need to take my time and not rush through things and make sure I completely understand what the question is looking for and that answer is not only factually correct but also with what is best for the patient and what their needs may be.
