Showing posts with label community nursing. Show all posts
Showing posts with label community nursing. Show all posts

Saturday, August 22, 2009

NCLEX Hex

Many weeks have passed since I sat for the dreaded nursing boards, (bka: NCLEX which is the National Council Licensure Examination for Registered Nurses). What a nightmare. Let me say that standardized tests are not my bag. I could say a lot about these tools, as a social scientist. But I won't. Not because I did well on the SAT -- as matriculating community college student I never had to endure them -- but because I have been privileged enough to do well enough on the GRE to get into gradate school, twice. Because, let's face it, it's not about what you know, but how you've learned to test -- and that is about factors that have absolutely nothing to do with intelligence. Let me also point out that I passed with flying colors the qualifying examinations in my doctoral program... 72 hours of exams that did not even come close to the hell that is the NCLEX.

First of all, for anyone who has yet to experience this rite of passage, you will walk away thinking you've failed. Or at least normal people will think this... plenty of my colleagues walked away celebrating the 75 question blue screen moment, a kind of confidence that I will never know in this lifetime. I would have presumed failure. But not that this matters, as I sat through 265 questions and 5.5 hours, having left convinced that I did not answer a single question correctly. This means that never, not once, was I certain of an answer I was giving. That experience erodes confidence very quickly.

Because of laws governing the boards and the insanely detailed waiver I had to sign after being fingerprinted and photographed and finger printed again, I cannot give any hints about test content. But that is not really the useful or interesting part of the story. The interesting part is that this is a psychometric test, which creates a "passing standard" for all of those who sit for the boards. In simple terms this means that every person who takes the exam should get an equal percentage of questions correct and incorrect. As a person performs well, the questions become more difficult until a question is answered incorrectly. In that case, the next question will be slightly less difficult until the person is again answering correctly. Once a threshold is reached, wherein the test-taker has demonstrated that s/he is answering more difficult questions correctly than incorrectly, the the exam will end. This can be at 75 questions, or any arbitrary number in between, up to my 265. Likewise, if one is doing poorly, answering lower-level questions incorrectly more than 50% of the time, the exam will end. The clincher is that once the blue screen appears, you have to raise your hand, are escorted from the room, and then you have to wait up to two weeks for your results.

Many of my colleagues were able to log on to the BRN website and check to see if their names appeared in the permanent license verification system within the next two days, a kind of work-around for those waiting for results by mail. Personally, I took the test on a Friday, expected to see (or rather not see, given my commitment to failure) my name on the site on Tuesday. When my name didn't appear, I prepared for the studying process, again... but, on the advice of a friend, I called the BRN to be certain the documentation in my file was complete. Lo and behold, no transcripts had ever arrived from my institution. I dragged myself to the registrar, paid for transcripts (again) and waited.

One night before bed, about three weeks later, The Kid said, "Mom, I know you passed that test. You're a nurse now." With this bit of kismet, I woke the next morning and checked the BRN. There was my name. The card arrived the next day.

The moral of this long, long story is: never fear. It is a very difficult test for which to study, the questions are very hard to comprehend on first reading (and I am a native English speaker... bless all those who take it with English as a second language), it is difficult to gauge and it is not by any means an accurate judge of what kind of nurse you will be. I am not sure how well it even measures competence. It is, like many other standardized exams, a test of something determined to be a means to find a 'measurable' proficiency among candidates. This does not address ability nor knowledge. I suspect some of the best nurses are those that have to take it more than once. And anyone who has to sit through it more than once deserves a medal of honor.

Tuesday, January 27, 2009

First Do No Harm

The Kid is reading, among other things, The Fortean Times Book of Strange Deaths. He said to me last night after my first med-surg exam, over which I was having mild to massive anxiety, "Mom, you'd better read this; I don't want you to make the same mistake."

"A newborn baby in a Chicago hospital came to an abrupt end when someone accidentally connected the child's heart monitor cables attached to electrodes on the chest and abdomen directly to the mains. Twelve day old Stratton Vasilakos died instantly. Apparently this was caused by a design fault which had resulted in several previous accidents but was supposed to have been corrected."

Somehow that wasn't really the anxiety relief, nor the vote of confidence, I was looking for.

By the way, did you know that "Primum no nocere" is not even in the Hippocratic Oath? I'm no doctor so it doesn't really matter. Interesting, nonetheless. It's actually attributed to the Roman physician, Galen.

Saturday, October 18, 2008

Tat-B-Gone

Today's assignment: tattoo removal clinic. The process is not as magical as it sounds: it's not painless and it doesn't exactly "remove" the tattoo. In fact, immediately after treatment, the outline of the tattoo actually becomes edematous and is thus more prominent and reddened. The surrounding skin becomes inflamed, apparently with the sensation of having been burned. Eventually, after several treatments, the tattoo fades - sometimes completely. Other times, there is a shadow, scar, hypo or hyper pigmentation. One guy who was having treatment on six (6!) tats revealed where another of his tattoos had been, and there was no sign. So, it works, depending on a person's skin integrity, the quality of the tattoo (do-it-yourself = yikes!) and the immune system. The way it works is that a laser sends short impulses of light into the epidermis; the light is absorbed and breaks the pigment from the ink in the tattoo into smaller particles that can be removed by the immune system. Varying wavelengths are used in order to deliver the best possible ink removal.

Basically, it's a great service. It serves a lot of former gang members and a lot of guys who took penknives and fountain pens to themselves in juvie. The docs take off a lot of neck and face tattoos. (Ouch!) I should mention that I was even allowed to be zapped for three seconds, just to have the true anthropological participant-observer moment. I went "cold" (no lidocaine) and the laser was, of course, set much lower than for the tattoo removal. Also, not having the ink in my skin prevented the pain that ensues from the ink's dissipation into the skin and the macrophagic action. When I was zapped by the laser myself, it was like being burned by spattered, hot cooking oil. The difference for me than for those having their tattoos removed? I had no relationship to the freckle being removed from my arm, while these kids have a whole lifetime of experience related to the tattoos that they wear. Tattoos, traditionally a symbol of belonging and the renunciation of the self to the group, are symbolic to the wearers in more ways than I could possibly understand. The choice to have the tattoos removed demonstrates a degree of humility that is above and beyond my comprehension. Having a tattoo removed is more about loss than about renewal. It took some serious strength for those kids to be there.

Tuesday, September 16, 2008

Community Health

So, one of the great things about MEPN is the community rotation. Today I learned that as a part of my placement I will not only be doing immunizations for the flu season, but also in-home prenatal Hep B screening, communicable disease education and screening, and we will all participate in a countywide bio-terrorism drill where we will perform "drive-by" immunizations of thousands of police officers and fire fighters. (And we have to be deputized to do this. Yes!) We also have the opportunity to volunteer for free tattoo removal and/or perinatal education for low-income families. As a part of our concurrent L&D rotation, we have 12 hours on the floor, and the option to volunteer in the NICU or at the Women's Option Center. That, and a pretty laid back academic quarter, makes us all happy.