rkryceski – Becca's Site

Last few practice and proctored ATI

The final ATI assignments for this course were completing the Pharmacology Proctored Exam as well as the comprehensive proctored exam and the 2 practice exams that went along with that. The Pharmacology exam I believe went as well as it could have for that moment. For the 60 questions, there was some distraction in the room for me and I was a little anxious. I know my time per question for this exam was not the best, but I am still content with the results. For this exam, after reading the question if I had not ever heard of the medication and didn’t have any guesses then I made an educated guess and didn’t waste time to dwell on the question and just moved on to the next. There were plenty of medications that I recognized and believe that I could pick out the right answer for. I think that with more focus and remediation I will increase my confidence on this section, but it has greatly improved since the first Practice Pharmacology assessment. For the 2 practice comprehensive exams, I believe overall the practice exams went good, my timing for each question as always is still lower than the average but I don’t think that as a test-taker I will greatly improve on that. If I end up looking at a question longer than I should I end up second guessing myself or talking myself out of the correct response. The day of taking the proctored comprehensive exam was a tough day, I was at Maine Med for preceptor until 3am, got 4 hours of sleep before coming in at 9am for class and then this exam in the afternoon. By question 100 my eyes were shutting every few seconds and I was forcing myself to stay awake. Based on these factors against me, I believe I did okay and with an 88% chance of passing the NCLEX with those things not in my favor I will take that as a positive. I really liked the chance of taking a comprehensive exam, some pharm questions some maternity some fundamentals. I look forward to practicing more of this style of exams in the coming weeks prepping for NCLEX. Overall, I thought these ATI assignments were going to end up being tedious this semester, but looking back now we have completed an incredible amount of practice questions, remediating each and every incorrect answer and practicing under stress of proctoring. I think this will greatly help and I look forward to the ATI review session this weekend.

Throughout the semester, I used my remediation from practice assessment to look over before we had a proctored exam. For my remediation, I would use the ATI rationale as well as sometimes even go in the textbook for the course of the subject matter. Having double the check and different wording helped to solidify why it was wrong. I liked to take my assessment at home and then was comfortable to remediate my wrong questions in any setting. Having as minimal distraction as possible was key since some practice proctored ATI when I did them on campus didn’t go so well and I felt distracted. Some self-care strategies I allowed myself to do throughout the semester was successfully scheduling my time, finding and making time for self-care and trying to go to the gym every morning. I feel like I had the best balance I could have during this tough summer semester and having a schedule to complete these ATI assessments really was the key – take the exam on the Sunday of the week and evenly split up remediation for every day to be done on Saturday and then start back up the next day. I think keeping these same good habits will allow me to have a successful plan in place for NCLEX prep and I’m looking forward to using ATI website to prepare and some other resources as well to get as much practice problems in before the big test day.

Community Health Reflection

For my senior preceptorship I was able to complete my 135 hours in the perioperative environment at Maine Medical Center. My nurse preceptor works in the PACU, ASU, Surg2 pre and PACU and the holding room. I feel really blessed to have made a connection with my nurse preceptor since we connect on a lot of the same values and way to approaching patient care. She has made me feel so comfortable jumping into new environments and situations and trusting me with handling things on my own. On our second day in the PACU, we received a patient from the OR that would keep us thinking about him until this day. He was a male and in his 60s, self-employed with no health insurance and had a surgery that would need to have him have follow-up visits with the surgeon starting the next day for the next few weeks. He lives in more rural Maine and runs his own business which requires him to be hands on, work long hours and be physically exhausting. His job was the reason that he was in the hospital and with his injury, it resulted in him having a cast on his right hand, most likely unable to do his job. I wonder about if he has other workers that would allow him to rest and have a proper recovery period or is he listening to his provider and the post-op instructions that I gave him? These un-answered questions have kept me thinking until now, at least three weeks after the fact. During his time in the PACU, he was telling my nurse and I how he was concerned about the price of his hospital stay as his wife gave us a new tshirt for him to wear home with a $2 pricetag still on it. I can’t hope but wonder if that’s all they can afford or did they buy it out of convenience.

As the PACU nurses that night caring for this patient who oversaw his Phase 1 and 2 post-operative care at 8-11pm at night, I was concerned for my patient who was going home with medications from the hospital pharmacy and would be expecting this hospital bill. I see patients and pharmacists interact everyday and hear that they have a $0.94 or $1.26 co-pay, I know for sure that his payment was not that low without insurance. I think as nurses in the perioperative environment, we are more concerned with if the patient remains stable and without complication, not necessarily worrying about the care that we were giving him solely based on his insurance status. We look at the patient as a whole definitely, since in their chart on the pages it never mentions insurance status unless the patient discloses. I think this matters since we will treat everyone with the same level of respect and care, not worrying about the payment or the bill that we never get to see. I think the health care system could make it easier for the patients to realize that they will receive the same care and should continue to go to follow-up appointments since it will be for their own health benefit. I wonder if there could’ve been a way for case management to get involved in this patient’s case for his benefit to see if he could follow-up with any providers that require a lower bill or even a less expensive clinic. As far as getting him signed up for health insurance, I don’t know how that could have been feasible for us to complete during his short stay in our care, however possibly having his follow-up appointments with MaineHealth providers work with him to get that done. I don’t think that I could’ve done anything different personally, I made sure to treat him with all the care and respect as any other patient. I appreciate him for allowing me to think about this side of nursing and his social determinants of health that all play a role together in his case to consider. I hope that he is well, is able to get back to work soon and getting back to do what he loves.

Obtaining Nursing License

Where (what state/territory) do you intend to become licensed by examination, and is this a Nurse Licensure Compact state?
1. I intend to become licensed by examination in New Jersey, and New Jersey is pending implemention to become a compact state. According to the NCSBN website, until 2021 pending implementation, NJ residents cannot hold a multistate license, someone with a compact license can practice in NJ, but NJ nurses cannot go the opposite way right now. The other state I am considering practicing in is New York, and they are not a compact state and if I get a job there I would need to apply for licensure by endorsement for that state.
How is the application completed and submitted (web-based, manual/paper-based, or either), and does the application you are filing require official transcripts, verification sign off by the director of the program, or both?
1. Paper applications are not accepted, online application is on the board’s website and I upload all supporting documents required. I need an online application, 2’’ x 2’’ passport style photo, birth certificate or passport, letter of nursing program completion, background check and successful completion of NCLEX. I am unsure at this moment if I need to file official transcript as it sounds like I can just have a letter of nursing program completion.

Does the state where you intend to become licensed require criminal background checks and/or fingerprinting? If so, what is the process?
1. Yes, obtaining fingerprinting I need to go through Identogo and to receive a service code I need to click don’t know my service code to receive a new one. Criminal background checks will be done and information on this will be mailed out to each applicant.

Reflecting on presentations from the Attorney General’s Office and the Medical Professionals Health Program, consider the following:
1. Describe any provisions for impaired nurses in the state where you intend to become licensed as described on or linked from the State Board of Nursing website, including any mandatory reporting requirements for suspected impairment, disciplinary measures, and resources for recovery.
  1. All applicants have to report all arrests and/or convictions, even if they have been dismissed. If you have ever had that done then all supporting documents must be uploaded right away or then licensure will be delayed.

Some of the most commonly occurring legal issues that impact nursing and nursing practice relate to informed consent and refusing treatment, licensure, the safeguarding of clients’ personal possessions and valuables, malpractice, negligence, mandatory reporting, abuse, and unsafe practices. How will you protect yourself and your license from these legal issues?
1. I will protect myself by knowing the rights of delegation, knowing the scope of the profession that I am delegating to. Knowing that when I delegate I am still responsible for that care and I would need to check on the job to protect myself and the public. Another thing would be to obtain professional insurance to protect myself as well as knowing what my facility will protect me on. Knowing policies, rights and procedures of my facility regarding all things and how I can advocate for myself will protect from legal issues. If I ever had a question if something arises before it is done, I will feel comfortable asking charge nurse or nurse manager to clarify and then go up the ladder to find out if necessary. Documenting all of my care to cover myself and place proof on what I have done and not falsely charting.

Pharmacology Practice B Reflection

Completing Pharm Practice B assessment is definitely increasing my confidence with pharmacology questions. There was only a handful of questions that I hadn’t heard of the medication in question. Scoring a 90% on this makes me feel good, there were still a few questions that I guess I took a lucky guess on but for the most part I knew the right answer right away. This was the last assignment that was pharmacology focused, so I know that I want to still develop and increase my confidence for this subject area so I will set a goal to work on this during my NCLEX prep. I was really excited to notice that I got the select all that apply questions right, as that was a sore spot on my last adaptive quiz for Med Surg. I notice a lot that I’ll initially pick the right answer and then I’ll let my head think through the other options and possibly change the answer from correct to incorrect, so I need to not do that. Looking forward to more practice questions over the next month.

Medical Surgical Adaptive Quiz Reflection

This week we had the last adaptive quiz assigned to us for this class and the subject was Med Surg. I went in pretty optimistic, however that optimism really dwindled quickly. I kept passing the amount of questions my previous adaptive quizzes had went and I also wasn’t feeling my best after a night of bad sleep. I ended up having to complete all 265 questions and had an average time of 30 seconds per question. I know this isn’t close to the NCLEX average, at a certain point I just needed this adaptive quiz to be done so I was just going at a faster than normal rate. Despite the amount of questions, I ended up with a 69% which I’m happy with. A weak point that I noticed within my remediations were the high amount of select-all-that-apply questions that I got wrong and think this should be a priority for me for NCLEX prep. Some of the content that I got wrong I now realize is wrong because we just learned it this week in Adult Health 3, so I feel better that I will know even more after this class is over. My mindset really needs to improve if I get a high number of questions in any other adaptive quiz or my boards. I did take several breaks when I felt myself losing concentration and don’t think that I would’ve been able to complete this with the number of questions without a few breaks.

Career Development/Florence Nightingale Movie Reflection

How did the movie affect you (feelings, inspiration, concerns)?

This movie echoed to me the reasons as to why this profession is so special and how I am excited to be entering this profession full of incredible people who want to help others. It was really inspiring to see the pediatric nurses in the beginning do little things to help make the hospital experience for children as less scary as they can. Wearing outfits with fidgets on ID badge, fun clothes looking like a superhero and even an animal covering over the stethoscope are such little things that all add up that aren’t necessary for the job, but they go out of their way to do anything they can to help improve the care of their patients. This also showed me how many different areas of nursing there are and how nursing can quite literally get into any corner of the globe, from the public health nurses having nursing knowledge they also will be asked on for help in everyday tasks like changing a tire. Each nurse that was allowed to tell their story about their passion spoke so highly of their area and their experiences, with this of course comes hard experiences but nursing school so far has showed me that there will be so many more better days than not. Being a nurse is a privilege because we enter the lives of those that are at their lowest moments, our interventions and collaboration with the client and the care team to help them balance all areas of their life to help them get back to living a healthy and happy life.

What did you learn from the video (skills you need to develop, connection to your learning)?

Some things that I learned from this video is that there are going to be experiences that it is going to be hard to experience. I am already seeing this at my clinical this semester on R5. For the past two weeks I’ve been assigned to provide care to individuals with history of extensive substance misuse and this is hard for me to see and feel like I am able to provide effective care because I don’t know how to help them. These patients were in extensive pain while on extremely high continuous doses of multiple pain medications, they were advocating for themselves to us (me and the staff nurse) and working with the charge nurse, the pain team and physicians on their case on ways that they could be able to have their pain be decreased to a more manageable level. I felt like I was unable to make a difference through my actions in those moments with the patients, but I was there listening to them advocate, I let them know that we were listening to them and that we would continue the conversation with the rest of their medical team and validating that we can see that they are in pain and we will try and do what we can for them. I need to work on my confidence with interacting with patients that aren’t the most compliant with their behavior and I know that with practice and time that skill will come. Another thing that I learned from this video was how special of a profession nursing is, sometimes the most you can do for your patient is to listen to them, have them trust you and confide in you by meeting people where they are in that moment and see how you can make a difference. As a nurse, you have the opportunity to make a difference in someone’s life through the valuable moments you spend with them.

Career Development

How will you prepare for the interview to set you apart from other applicants (research the organization’s mission, priorities, practice model, specific job responsibilities; questions for the interviewer; career goals; interview skills to make a good impression)?

A way that I plan on preparing for interviews is to: make a word document and type out my answers for potential problems that the recruiters and nurse managers will potentially ask me, review the job listing and know what the requirements are in terms of shifts, message nurses from that organization on linkedin and inquire about the interview process and their experience with it, practice my answers out loud and prep a list of questions to ask the interviewer. I have found nurses at hospitals I am interested in that went to this ABSN program so I use that as a way to make a connection and then inquire more about their job and how their transition was. A way that I want to improve since my last phone interview would be to have the prepared list of answers and know the talking points I want to address, prep a list of questions about how I would fit in the organization, what the turnover is like in the unit, what the nurse residency program entails, what a typical day is like on the unit, and ratios of nurse: patient.

How will you describe your strengths, supported by evidence (knowledge and experience gained from the UNE Nursing Program and extracurricular activities, teamwork, communication)?

I plan on describing my strengths by trying to show the interviewer who I am in a short period of time. I want to portray my work ethic on how dedicated, detail-oriented and committed I am to what I do, each thing that I decide to do and pursue has intention and is not merely a fleeting thought. I would like to share the unique experiences I have had throughout my entire UNE education especially the dedication that my cohort has had to stick through this program during COVID and having limited clinical experiences but still making the most of our 16 months. I am very happy that I participated in the Interprofessional Honors program and completed a project with students from 6 other healthcare professions and take that experience into my clinicals now and will apply it in my jobs. My leadership opportunities and positions I believe sets me apart because through these I was able to make a wide variety of connections personally and professionally and worked on my skills to do that, I am a much more confident and outgoing person than from when I stepped on foot on campus 5 years ago. Through many opportunities I have worked with people who have a different work ethic and personality and through each time there was a slight learning curve but we worked together on how to support each other and learned how to approach challenges together as they arose. Being specific but to the point and emitting my passion through my answers will be how I would like to show my strengths.

How will you describe your challenges and plans/steps taken to address them?

As for challenges, I believe coming up with an example of how I acted when I was with a ‘difficult’ patient or didn’t work well with a coworker initially would be the best way to describe it. Having concrete answers and utilizing Whitney’s STAR framework I believe will work well especially with highlighting how the situation occurred and what I did and how I learned from it now and am more aware of that mistake to not do it again in the future. Framing my challenges in a way that it was a learning experience and how I recognize those mistakes now while I am a student and in a learning environment will allow me to show that I am not perfect and that I want to improve and am grateful for the chances that I did mess up.

Pharmacology Practice A Quiz Reflection

This week’s transition to practice assignment gave a nice break from completing adaptive ATI quizzes and instead moved into the first of two Pharmacology practice exams. Having completed an adaptive pharmacology quiz last week, that gave me more confidence into this week’s quiz and believe I did well. I got 10 incorrect including one math problem and my average time on this quiz was faster than adaptive completing 60 questions in 22 min. I felt like these questions were more straightforward than the adaptive questions. Going into the second Pharmacology practice quiz next week, I will try and slow down and take my time more on the questions and my goal is to not have an incorrect math question on this next quiz. During the quiz as I am reading the questions most of the time I have remembered hearing the medication that they are inquiring about but can’t correctly identify the right answer. This shows that I need to focus more on this area of the NCLEX and dedicate more time to reviewing medications and their uses, contraindications and complications.

Pharmacology Adaptive Quiz Reflection

This week’s assignment for Transitions to Practice was to complete the Adaptive Quiz for Pharmacology as the start of review for pharmacology content that is to come over the next couple weeks. Admittedly I was not as confident going into this quiz since it has been some time since our pharmacology course in the fall, but very important to start to review. My timing taking this exam wasn’t the best idea, I took it after getting home at a day at clinical and I was quite tired so I will not make that mistake next time when deciding to start to do an adaptive quiz at 7pm. My average time for each question was 30 seconds, which has gotten faster again since my last adaptive, and I think I can attribute this to when if I wasn’t familiar with a medication, I just took a guess when I really didn’t know the answer. I’m hoping that with more review and practice for pharmacology section I will be able to improve my average time per question for this subject. I believe my thinking has improved regarding the number of questions that the adaptive quiz will take, I just am expecting it now to go past 75 and then this time when it stopped at 82 I was happy. On this adaptive quiz, there started to be more hard rated questions and I would like to improve on my percentile of correct questions. One area of medications that I know I need to re-visit is insulins and the time of onset and patient education surrounding each type. Looking forward to getting more review on pharm questions these next couple weeks.

Pediatrics Adaptive Quiz Reflection

Completing this next ATI Adaptive quiz was for Nursing Care of Children this week. My quiz was 100 questions in total and scored 58% with a total average time of 47 seconds and ranked in the 72^nd percentile. I felt good throughout this quiz while completing it and took a very short break around 50 questions for around 3 minutes and then jumped right back in. Once I reached around question 80, I didn’t feel fatigued as compared to previous adaptive quizzes and I think it’s because of the very short break and I am trying to change my mental framework not to get disappointed if it goes past 75 questions since it almost always does. Most of the content on this adaptive quiz could be related to identifying important nursing interventions for surgical procedures that are commonly done to children and developmental stages and fine and gross motor skills to expect at each age. I have noticed by the remediation that this is an area that I need to review more on to feel more confident and improve on those questions. For my next adaptive quiz to complete, I would like to improve on my timing even more again, I keep going up by 10 seconds for my average. Additionally, I would like to have a good mindset going into the next couple adaptive quizzes since I don’t feel as confident with the subject matter as I have with maternity and pediatrics.

Prepare for Transition!

I can’t believe the time has come that I am entering my last semester of nursing school. I am most excited about starting the job search process, having more time in the clinical setting and completing preceptorship later this summer (and finding out where I was placed for that!). All of those things that were just mentioned that I’m the most excited about, I am equally as anxious for those same things too. I love the anticipation of going to clinical each opportunity we get, however a main goal for this semester for me is to work on my confidence in the clinical setting. The past two times that I have gone to clinical in some moments I found myself holding back when given the opportunity to be hands on and practice a skill first, and I want to be able to let myself take the chance and learn. Not having as much clinical time up until this point in our program has been limiting and I believe that with the significantly increased number of hours we are about to have will be a great learning chance to get caught up with everything. I am also anxious about our Nursing 456 class just based on what peers have said about the class, so I need to let what has been said go and breathe and put my all in and focus and learn. After completing an exam or a big assignment, I will celebrate by giving myself some time and check something off my Maine To-Do list that I want to accomplish before I move back to NJ.

Planning my weekly schedule will be a big challenge at first since it will be different having 3 asynchronous classes along with 1 clinical course in person. I believe that starting the semester off strong with making a plan with when I will dedicate time for each course will be my best bet to follow for a successful completion. An example of a SMART goal would be to: Complete my weekly transitions assignments on the Saturday of the week that they are due by midnight, as they are due by midnight on Sunday. Allowing myself a day will give me space in case of a very busy or hectic week and still have enough time hopefully to complete what I need to submit. In addition to planning out when I will be doing course work, I would want to make a plan for myself in the beginning of each week what assignments are due and when, where I need to be and when, when I have time to fit in going to the gym and possibly planning out meals so that I don’t have to waste spare time on that.

The Nurse Logic 2.0 Modules had four sections of lessons to review prior to completing the advanced quizzes. The Knowledge and Clinical Judgment section was helpful in going over the styles of learning and the explanation of each of them helped me identify that I am a tactile learner. Being hands on and in simulation is very helpful for me to remember concepts and I take detailed notes in lecture but need to keep re-writing them. Along with learning styles, this section also laid out strategies for success that are realistic and important to hear again as I approach this new summer semester. The next module was focused on Nursing Concepts and in this I focused on the sections as an advanced student nurse as it reviewed the 5 rights to delegation, time management strategies and styles of leadership that can be seen on the unit. The next module was Priority Setting Frameworks which goes over the 7 frameworks that can be used in nursing practice and NCLEX questions. The last module went over testing and remediation strategies which included tips of things to do and not to do on days of exams, how to come up with a code for answering questions and not to change that code and question types that can be seen on the NCLEX. Even though we had been exposed to this material before, it was good to brush up on it again and hear all the modules over as we approach our final semester. I will definitely use the testing and remediation strategies module most with my upcoming ATI assessments.