My Nursing Education

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

In today’s economy with declining employment in many fields that require degrees, the profession of nursing is as solid as it ever was. People with prior degrees are looking to enter the nursing profession.

Nursing careers are appealing for many reasons. One positive aspect of nursing careers is the opportunity to serve others through medical treatment and rehabilitation. Nursing careers also boast a glowing job outlook that has consistently risen along with increasing demand for registered nurses. Plus, nursing careers offer a wide range of employment options within various sectors of the health care field. When you become a registered nurse, you open the door to a variety of nursing career paths, including forensic nursing careers, traveling nurse careers, and nurse coordinator careers.

The salary of a nurse varies greatly. There is really no base salary but a fluctuation across the board. The reasoning for this is a varied as the salaries in nursing.

The base pay of a nurse is determined by many different factors. The first of these factors are the years of experience that the nurse brings to the table. A GN or graduate degreed nurse will start out at the lowest salary of nurse pay. They will remain at this level until they pass their board exam or NCLEX. Upon passing their boards they will receive a small increase in pay anywhere from $2.50 per hour to $5.00 per hour. The most important factor in this scenario is to keep in mind that if the graduate nurse does not successfully pass the board exam the hospital can terminate their employment or extend to them a grace period in which they have the opportunity to pass the boards a second time. In the past years, it was not unusual for a graduate nurse to stay on as a hospital employee for years before finally passing or taking their boards. This practice is no longer widely accepted. Also the graduate nurse is not allowed to pass any medications until they have their licensure. The question remains, what is the typical base salary for a graduate nurse. It is safe to say that the salary ranges in the low to mid forty thousand dollars per year. This discrepancy of several thousand dollars has much to do with the location of the hospital. For instance, in rural communities where much of the hospital funding comes from the government, the pay rate may be higher or lower than a privately funded institution. The mitigating factor is how successful the grant writers are at tapping into government funds, and how much private endowment monies are bestowed to the hospital. Even with these two factors in place comes the process of dissemination of the funds. This is dependent on how the board of directors see fit to use the funds. These funds could be put to the construction of a new hospital wing, or to the purchase of new diagnostic equipment.

Whether or not the nurses are unionized is also another factor in entry level nurse pay. Unions can either work for or against nursing wages. Sometimes non-unionized hospitals pay more.

Shift premiums are also a factor. Read more »

It has been predicted that the baby boomer generation will be the most effected by the changes health care system with regard to nursing care. The current health care system is in a state of flux. With insurance companies constantly raising rates and premiums, and the hospital stays becoming less frequent, the end result is that health care must extend to the home.

Looking down the barrel of a world wide pandemic, comes the news that there are 135,000 unfilled nursing positions in the United States. By 2015, this number is expected to go to be 683,000 unfilled positions.

Two main reasons are given for these shortages:

1. Nursing hours are long, difficult and stressful
2. There is a huge shortage of nursing faculty.
We are running out of nurses to teach prospective nurses.

The impact of this new era of home care will have various effects on the population that is served. Although it is true that home care has been in existence for almost as many years as the profession of nursing itself, the amount of clients that home care now serves is quite a bit larger than the past as well as more medically demanding. What this situation implies for the nursing profession is a larger responsibility in ensuring that clients who are discharged within one to two days receive the necessary teaching and follow up nursing care to ensure progressive healing and a maximum return to wellness.

In order to help ensure the goal for the client after discharge, the hospital nurse must be acutely aware of what the clients teaching needs will be from the time of admission.

Immigration issues are adding to the shortage of nurses. There is a 6 year wait for nurses to be allowed to come here legally. Several acts are before congress to help speed along the immigration process for those who want to come here to practice medicine. Currently, the only thing stopping new nurses coming here is red tape. Many are standing in line, but the line doesn’t seem to be moving. If something doesn’t change, we can expect to face severely diminished nursing care in the very near future.

The big payoffs of any nursing career include a solid paycheck, reliable employment, and the immeasurable reward of helping others. Outside of these constants, though, the nursing field is spread along a wide spectrum of specialties, paradigms, and settings. These variables subdivide the industry into more measurable salary ranges. But other elements factor in as well:

• Region of practice
• Degree attainment
• Years of experience
• Public or private sector practice
• Staff RNs have dozens upon dozens of specializations from which to choose. Each specialty has a distinctly different salary range that also varies from region to region, metropolitan to suburban or rural, and from public to private healthcare practice.  Associate degree RNs earn anywhere from $ 53,000 to $63,000 on a scale of national averages that spans specialties. However, there may be wide disparities outside this margin.RNs in specialties such as Critical Care, Emergency and Trauma medicine, Intensive Care Unit nursing, and OR and Recovery Room Nursing are at the higher end of the salary spectrum, while nurses in Home Health, Long Term Care, and Geriatric Nursing, are most typically at the lower end of the salary scale.

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

In the nursing profession, more now than ever, the ability to think critically is essential. The responsibilities of a Registered Nurse have increased over the years. In correlation with this increase in responsibility comes the additional increase in educational prerequisites and core requisites required to achieve a degree in Nursing. The ANA (American Nursing Association) Standards has set forth the framework necessary for critical thinking in the application of the “nursing process”.

Critical thinking is taught at the beginning of nursing school.  Many students feel that the nursing school tests are too difficult mainly because of their lack of training in the use of critical thinking and analysis.

The nursing process is the tool by which all nurses can equally become proficient at critical thinking. The nursing process contains the following criteria:

1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

It is in the application of each of these processes that the nurse may become proficient at critical thinking. It is important to look at the components that describe critical thinking in nursing, The table below lists components that define the critical thinking process. There is much more that goes into critical thinking than what is listed in the table. The table is a rough draft of the process.

CRITICAL THINKING COMPONENTS

Entails purposeful, informed, outcome focused thinking, that requires careful identification of specific problems and other physiological and psychological factors that affect the clients position on the health and wellness continuum. The process is driven by the client, the client’s family and other health team members who are also collaborating in ensuring essential client care.

Specific educational knowledge base and level of experience in applying that knowledge in client care. (Nursing School to graduate nurse to experienced nurse) As the level of experience of the nurse increases so will the scientific knowledge base that the nurse applies.

Proficiency in the application of the institutions standards, policies and procedures.

Application of the humanistic standards of caring in conjunction with the nursing process, to holistically treat the clients response to an actual or perceived illness.

Constant evaluation and re-evaluation of the nursing process to determine the clients level of wellness.

Nurses learn critical thinking via application with experience. Experience is the best teacher. But it is equally important to know that the process is being applied correctly. Many institutions will ensure that this pathway is followed by enlisting new nurses in a eight to ten week orientation program. During this time the new nurse will learn about the polices and procedures of that institution and what type of documentation is used for charting purposes. Also, the new nurse will have an experienced mentor who they will follow and who will evaluate their performance as well.

Documentation is an essential part of the critical thinking process for the nurse. Every institution places emphasis on documentation. It is said, “that if it is not documented, then it was not done”. Since the nursing process is a scientific process. In scientific research, all things are documented. In this documentation, researches can look back to see if the results were due to interventions and whether or not the interventions were successful or have to be altered.

The documentation process helps the nurse accomplish the same goals. Many times procedures are used that have unproven efficacy. In it is this framework of critical thinking and documentation that such procedures can be either continued or eliminated, depending on the efficacy of the research. In other words, does the procedure actually improve, help or otherwise jeopardize the client’s health. An example of the critical thinking process and scientific reasoning is in the efficacy of taking a rectal temperature of new born infants. Currently, this procedure is still widely accepted. However the scientific approach is to ask the following, is the procedure safe, is it necessary, and can an axillary temp be used in place of the rectal temp? In answering these questions, the nurse can better evaluate whether the efficacy of taking a rectal temp on a infant should be continued. This is just one example of how the critical thinking process is used within the nursing profession.

The scientific approach using critical thinking helps the nurse develop evidence based practice. It is through “evidence based practice” that the Joint Commission on Accreditation of Health Care Organizations (JCAHO) rates the performance of hospitals. Further research is still continuing in delineating the intricacies of the nursing process and the integration of critical thinking. All health care professionals are encouraged to pursue this type of research in their practice to ensure the quality of client care and enhance the validity of their profession.

REFERENCES

Zerwekh, J.,Claborn, J.(2006).Nursing Today Transition and Trends. (5th ed). St. Louis: Saunders
Alfaro-LeFevre, R. (2006). Applying Nursing Process, A Tool For Critical Thinking. (6th ed). Philadelphia: Lippincott Williams & Wilkins

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Nurses are trained to learn and apply patient assessment skills. These skills are the cornerstone of being a proficient nurse. The knowledge and procedures for developing these skills are learned in the first two years of nursing school and honed in clinical as the student nurse takes on a greater patient load. The “Standards of Care” that are the basis of nursing include the following:

Standard 1. Assessment

In an assessment the nurse must use all of his or her senses. These include hearing, touching, visual, and therapeutic communication. The cephalocaudal approach is most always used. In other words, assessing a patient from head to toe. The nurse must self aware to be able to conduct a thorough assessment. Data collection forms the basis for the next step in standards of care which is diagnosis. A nurse must have all the necessary equipment, such as a scale, tape measure, thermometer, sphygmomanometer, a stethoscope and pen light. The setting is also very important in doing an assessment. If a client is nervous or anxious they may not be as willing to answer questions that the nurse asks or to be examined. Obtaining a quiet environment is not always possible, especially in an emergency situation. Therefore, the nurse must be very observant, and try to get as much pertinent data as possible to formulate an nursing diagnosis For example, when doing an assessment on a client that is complaining of severe stomach pain, asking them what foods they last ate would give the nurse more pertinent information than asking them how many brothers or sisters they have.

Standard II. Diagnosis

A nursing diagnosis is not a medical diagnosis. A medical diagnosis would be the medical condition of “Diabetes”. Whereas, a nursing diagnosis would be, “Altered Tissue Perfusion”, related to decreased oxygenation of tissues as evidenced by a pulse oximetry of 92% , secondary to the medical condition of “Emphysema”. A nursing diagnosis is a formal statement that relates to how a client reacts to a real or perceived illness. In making a diagnosis the nurse attempts to formulate steps to assist the client in alleviating and or mediating how they respond to real or perceived illness.

Standard III. Outcome Identification

In this process the nurses uses the assessment and diagnosis to set goals for the patient to achieve to attain a greater level of wellness. Such goals may simply be that the patient now comprehends the regime of testing their blood sugar, or perhaps a new mother gleans a sense of security now that she has been instructed in the correct method of breast feeding. The nurse must plan the goals that the client is to achieve around the clients ability. For instance, the goal that a client will walk normally after two days of having knee surgery is unrealistic, in the sense that the client’s knee will not be completely healed. However, the goal that the client will be able to demonstrate the correct use of crutches, would be more realistic. This goal is also measurable, since the patient will be in the hospital and the nurse can teach and observe a return demonstration. Therefore, the goals or outcomes for the client must also be measurable.

Standard IV. Planning

The planning standard is designed around the clients activities while in the hospital environment. Therefore the nurse must plan to teach and demonstrate tasks when the patient is free to learn. This would involve administering pain medication prior to learning to walk with crutches or waiting until after a patient has finished a meal before teaching on how to use a syringe. The atmosphere should be conducive for the client to learn.

Standard V. Implementation

This standard requires that the nurse put to the test the methods and steps designed to help the client achieve their goals. In implementation, the nurse performs the actions necessary for the client’s plan. If teaching is one of the goals then the nurse would document the time, place, method and information taught.

Standard VI. Evaluation

Evaluation is the final standard. In this step the nurse makes the determination whether or not the goals originally set for the client have been met. If the nurse concludes that the goal or goals have not been met, then the plan has to be revised and documented as such. Goals therefore should be timely and measurable. If the client’s goal was to use crutches successfully, and the client was able to perform a repeat demonstration for the nurse, then the goal was met.

The above standards are the cornerstone of the nursing profession. These standards take time and experience to learn and to implement. Experience is the best teacher, and a nurse should continuously strive for excellence in their care of patients, and recognizing how to help patients achieve a higher level of physical and emotional wellness.

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Nursing is a profession that places on its participants a great responsibility for maintaining the highest possible standards to ensure superior quality of care. Each state has its own Board of Nursing which is responsible for the regulation and licensing of nursing practice. As the profession of nursing continues to grow and change the practicing nurse will bear more responsibility as well as legal accountability for their actions. This truth is evident in the various professional licensures that are available for nurses, such as Nurse Practitioners, Nurse Midwifes and Nurse Anesthetists. It therefore behooves each licensing board to not only self regulate judiciously but to also refine the scope of nurse practice from time to time. The individual states must also act in accordance with the overall nursing theory in mind. Self regulation is done by continually refining such goals as 1) Defining its scope of nursing practice, 2) Developing a code of ethic, 3) Establishing standards for nursing education and practice and for structures through which nursing services will be delivered,4) Developing a system of credentialing, 5)Providing for peer review and quality assurance, 6) Providing for research and continuing development of the knowledge base for nursing. (Michigan Nurses Association, Legal & Professional Regulation,, Co. 1999, ISBN0-9634643-1-0, Okemos, Michigan)

As with most professions there is a code of ethics that are inherent to each. Nursing is no different. The code for nurses consists of eleven major topics that each nurse across the nation is required to adhere.

Code for Nurses

1. The nurse provides services with respect for human dignity and the uniqueness of the client unrestricted by consideration of social or economic status, personal attributes, or the nature of health problems.

2. The nurse safeguards the client’s right to privacy, by judiciously protecting information of a confidential nature.

3. The nurse acts to safeguard the client and the public when heath care and safety are affected by the incompetent, unethical or illegal practice of any person.

4. The nurse assumes responsibility and accountability for individual nursing judgments and actions.

5. The nurse maintains competence in nursing.

6. The nurse exercises informed judgment and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibilities, and delegating nursing activities to others.

7. The nurse participates in activities that contribute to the ongoing development of the profession’s body of knowledge.

8. The nurse participates in the profession’s efforts to implement and improve standards of nursing.

9. The nurse participates in the profession’s efforts to establish and maintain conditions of employment conducive to high quality nursing care.

10. The nurse participates in the profession’s effort to protect the public from misinformation and misrepresentation and to maintain the integrity of nursing.

11. The nurse collaborates with member so the health professions and other citizens in promoting community and national efforts to meet the health needs of the public. (Michigan Nurses Association, Legal & Professional Regulation,, Co. 1999, ISBN0-9634643-1-0, Okemos, Michigan)

One can interpret from the above Nurse Code that many of the hospitals employ a similar code to their organization for promotion of client health care needs. Some of the principals that hospitals employ include the responsibility of each of its employees to maintain the highest standards of care for each client served, to judiciously guard the privacy of clients, to maintain a safe environment and to take independent action when a situation arises where they are the only one that can act.

There are states that allow nurses that have attained advanced practice degrees to write prescriptions and bill insurance agencies independently. With the health care field burgeoning continuously with a growing aging population, the need for Nurse Practitioners will also continue to grow as well as the responsibilities of the Registered Nurse.

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Since the days of Florence Nightingale, the profession of nursing has been viewed as a career consisting of self sacrificing individuals who, with caring and compassion have devoted their lives to easing the pain and suffering of those in need. Such noble and honorable individuals would surely never strike for what ever reason, right? Wrong! So, what has happened over the centuries to the profession of nursing?

To begin to understand what has taken place in the arena of nursing, one needs to understand what the nurses of today are faced with in the hospital settings. First, many nurses are required to care for more patients than they can handle safely. This is to say that a patient care load of seven on a medical surgical unit can go up to eleven during the afternoon and midnight shift. Depending on the acuity (level of care needed) of the clients, the nurse may not be able to safely attend to all of the clients needs, and need to forego certain aspects of care just to be able to get the majority of their responsibilities completed by the next shift.

This situation of patient overload can result in very serious health consequences for the patient and ultimately, death. The direct consequence of patient neglect for the nurse involved would usually entail a law suite being filed by the family naming the nurse and the hospital as well. Patient overload is just one of the many reasons that nurses have sought to form a coalition and be represented by their own organizations.

Another reason for nurses to organize is due to the policy of pulling nurses to other floors where the patient acuity care process requires specific knowledge to be able to practice safely as a nurse. An example would be a maternity floor nurse being pulled to a medical surgical floor and being assigned a patient load consisting of newly admitted pre-operative patients and others that require suctioning and vent care. The maternity floor nurse would not only be unsafe to work on the medical surgical floor, but could also put patient’s lives in jeopardy due to her inexperience. So, what is that nurse supposed to do if they decide to decline being pulled to another floor? Many nurses feel that they may be reprimanded by the shift supervisor and perhaps written up for insubordination. But are they not in fact, declining for a valid reason? Also, shouldn’t quality patient care be the utmost priority as well as patient safety? The answer to both of these questions is of course a resounding, YES! However, many nurses are faced with these dilemmas day in and day out. They leave at the end of the day feeling as if they haven’t been able to give proper nursing care. They would be correct. It is an unsafe practice to float nurses that are unfamiliar with a particular floor to work there. The fact is, that it is done on a regular basis. Would this be a sufficient reason to strike? Many nurses think so. The list could go on and on. How safe would you feel with a nurse caring for a loved one who was on the sixteenth hour of a double shift? Not very, right? Approximately 60% of nurse in practice are providing care in hospitals (Work-Place issues, 2005)

In 1946, the American Nurses Association’s House of Delegates unanimously approved a resolution that opened the doors to nurses to engage in collective bargaining. Then about thirty years later the legal precedent that determined that state nursing associations are qualified under labor law to be labor organizations is the 1979 Sierra Vista decision. The important consequence that affected nurse was that they were free to organize themselves and not be organized by existing unions. Currently, it is the American Nurses Association that is in the forefront of establishing coalitions and bargaining for nurses nation.

The Patient Safety Act:

What the Bill Does

It protects patients safety

- The Act calls for the Massachusetts Department of Public Health (DPH) to develop and implement limits on the number of hospital patients assigned to Registered Nurses in Massachusetts. The limits would be based on scientific research and testimony from public hearings. Once established, the staffing levels would be adjusted in accordance with patient needs and requirements using a standardized, DPH-approved acuity system. An acuity system provides a means of measuring the illness level of the patients on a particular unit and their needs for care.
- These scenarios represent just an overview of why the nursing profession has sought to organize themselves into a union status.

“It is time for a new generation of leadership to cope with new problems and new opportunities. For there is a new world to be won.” – John F. Kennedy

References
Zerwekh, J.,Claborn, J.(2006).Nursing Today Transition and Trends.
(5th ed). St. Louis: Saunders
The Coalition to protect Massachusetts Patients, P.O. Box 309 Canton Massachusetts 02021 617.731.2813

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

NCSBN (National Council of the State Board of Nursing) does not have established guidelines for graduating students as to when to register. However, registering for the NCLEX examination and licensure during the month of the student’s graduation is common. Note that registering to take the examination and applying for licensure to a state board of nursing are two different processes.

Please keep in mind all NCLEX examination registrations will remain effective for a 365-day time period during which a board of nursing may determine the candidate’s eligibility. The time limit begins when the board of nursing receives the candidate’s registration from the test service. Candidates who are not made eligible by their board of nursing within the 365-day time period will forfeit their registrations, including the candidate registration fee. Candidates who wish to take an NCLEX examination will need to re-register, including repaying the examination fee, in order to receive an examination.

Students can register for the NCLEX examination and pay the $200 by credit card by calling Pearson VUE at 866.496.2539 or register via the Internet at www.pearsonvue.com/nclex.
1. Apply for licensure to the board of nursing in the state or territory where you wish to be licensed. Contact the state board for the requirements.

2. Register for the NCLEX examination with Pearson VUE by mail, telephone or via the internet.

o The name with which you register must match exactly with the printed name on the identification you present at the test center.
o If you provide an e-mail address when registering for the NCLEX examination, all subsequent correspondences from Pearson VUE will arrive ONLY BY E-MAIL. If you do not provide an e-mail address, all correspondences from will arrive only through U.S. mail.
o All NCLEX examination registrations will remain open for a 365-day time period during which a board of nursing may determine your eligibility to take the NCLEX examination.
o There is no refund of the $200 NCLEX registration fee for any reason.

3. Receive Confirmation of Registration from Pearson VUE.

4. Receive eligibility from the state board of nursing you applied for licensure with.

5. Receive Authorization to Test (ATT) from Pearson VUE.

If more than two weeks have passed after you have submitted a registration for the NCLEX examination and received a confirmation from Pearson VUE, and you have not received an ATT, please call Pearson VUE.
o You must test within the validity dates of your ATT. These validity dates cannot be extended for any reason.
o The printed name on your identification must match exactly the printed name on your ATT. If the name with which you have registered is different from the name on your identification, you must bring legal name change documentation with you to the test center on the day of your test. The only acceptable forms for legal documentation are: marriage licenses, divorce degrees and/or court action legal name change documents. All documents must be in English and must be the original documents.

6. Schedule an appointment to test by visiting www.pearsonvue.com/nclex or by calling Pearson VUE.
o To change your appointment date:
o For exams scheduled on: Tuesday, Wednesday, Thursday, and Friday, call Pearson VUE at least 24 hours in advance of the day and time of your appointment.
o For exams scheduled on: Saturday, Sunday and Monday, call Pearson VUE no later than Friday at least 1 full business day in advance of the time of your appointment.

7. Present one form of acceptable identification and your ATT on the day of the examination.
o The only acceptable forms of identification in test centers in the U.S., American Samoa, Guam, Northern Mariana Islands and Virgin Islands are:
o U.S. drivers license (not a temporary or learners permit)
o U.S. state identification
o Passport
o For all other test (international) centers, only a passport is acceptable. All identification must be written in English, have a signature in English, be valid (not expired) and include a photograph. Candidates with identification from a country on the U.S. embargoed countries list will not be admitted to test.
o You will not be admitted to the examination without acceptable identification and your ATT. If you arrive without these materials, you forfeit your test session and must re-register; this includes re-payment of the $200 registration fee.

Receive your NCLEX examination results from the board of nursing you applied for licensure with within one month from your examination date. Under the guidance of its membership, the National Council of State Boards of Nursing, Inc. (NCSBN) develops and administers two national nurse licensure examinations; the National Council Licensure Examination for Registered Nurses (NCLEX-RN.) and the National Council Licensure Examination for Practical Nurses (NCLEX-PN.). These two examinations are used by all U.S. state and territorial Boards of Nursing to test entry-level nursing competence of candidates for licensure as Registered Nurses and as Licensed Practical/Vocational Nurses. The NCLEX examinations are provided exclusively as (CAT) computerized adaptive tests.

Several steps must be completed before a nurse can safely enter the profession. These typically include: Graduation from an accredited nursing program Meeting specific requirements of the state board of nursing Passing the National Counsel of State Boards of Nursing (NCSBN) NCLEX examination for registered nurses (RNs) or licensed practical/vocational nurses (LPN/VNs)

About the Test

The NCLEX examination is designed to test knowledge,skills and abilities essential to the safe and effective practice of nursing at the entry level. NCLEX results are an important component used by boards of nursing to make decisions about licensure. Only boards of nursing can release NCLEX examination results to candidates.

The NCLEX examination is administered in the United States, American Samoa, the District of Columbia, Guam, the Northern Mariana Islands, Puerto Rico and the Virgin Islands. The NCLEX examination is also administered internationally at Pearson Professional Centers. For a complete list of international test centers go to www.pearsonvue.com/nclex or http://www.ncsb.org/. The CAT (computerized adaptive test) type test adapts to your skill level. The first questions that are presented to you are determining your ability level. Once your ability level is determined, the questions are presented in increasing level of difficulty/decreasing difficulty until you have answered enough questions for the computer to determine (with 95% statistical certainty) that you have met the passing standard. The minimum number of questions you will have is 75 (60 questions plus 15 pilot items). You will not be able to distinguish pilot items from “real” items. SO, if you get 265 items, that means the computer has not yet determined that you have met the passing standard at the 95% confidence level. There is no random number of candidates that get the exam with 265- that is a myth. The test is now 6 hours long (up from 5), and you should take your time. Rushing through the questions will most likely lead to failure, because each one you get wrong due to guessing means the next question is easier, and then on and on, until you fail because you are guessing at them all. Take your time to think each question through and choose the best answer. NCLEX is given throughout the US and its territories, so the same format is used and the same question bank is used across the US. You’ve studied hard, finished most of your clinical experience and now you’re ready for the National Council Licensure Examination (NCLEX examination), often referred to as the “State Boards.” The State Boards exam is the culmination of all the hard work you completed in nursing school. The purpose of the exam is to test and ensure the knowledge, skills and abilities for safe, competent practice in the field of nursing.

Who needs to take the NCLEX examination?

At the completion of nursing school, all graduates are required to take the NCLEX examination in order to practice as an entry-level licensed RN or LPN in the United States. The registration process begins near the end of your final year in nursing school. At that time you will receive an application to take the NCLEX examination. It must be filled out and returned to the Board of Nursing in the state in which you expect to practice as a nurse.

Preparing for the NCLEX examination

If you’ve graduated from nursing school, you possess all of the knowledge you need in order to pass the NCLEX examination. It’s easier than you think; all you have to do is review the material you haven’t seen in a while. The trick to passing is starting the review process immediately following your final exams when the information is fresh in your mind. Learn all you can about the test particulars and ways to assure a passing score.

Getting test results

You will be notified of your NCLEX examination results by mail within 2 to 4 weeks, depending on the distribution procedures for the state in which you applied. If you are successful, expect to receive a sheet of paper notifying you of your passing score. If you did not pass the exam, expect to receive a diagnostic profile that describes overall performance in each section of the exam. Keep in mind that you must wait three months before applying to retake the NCLEX examination. If you want faster results, you can use the NCLEX Quick Results service. Results are available by phone three days after taking the NCLEX examination. Call (900) 328-8378 and follow the prompts. There is a $7.95 charge.

Results are also available online. The $7.95 charge still applies and you will need your user name, password and a credit card.

The National Council of State Boards of Nursing operates the NCLEX examination Quick Results service. This service is currently available in 38 states: Arizona, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia-PN, Georgia-RN, Illinois, Idaho, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Texas (VN only), Utah, Vermont, Washington, West Virginia (PN only), Wisconsin and Wyoming.

If you did not take the test in one of these states, you cannot get your unofficial results using the Quick Results service. If you have questions about this service, call the National Council of State Boards of Nursing at (866) 293-9600.

Tips on Test Taking

(1) Watch out for the words: except, always and not in all NCLEX questions.
(2) Answer each question. You are not penalized for taking an educated guess.
(3) Get a good night’s sleep before the NCLEX.
(4) Wear layered clothing to the exam.
(5) Practice with a watch and bring a watch to the test.
(6) Study for each material section of the NCLEX individually.
(7) If you extremely weak in one area of content focus on that area.
(8) Don’t cram for the NCLEX. Read over a good practice study guide at least one week in advance.
(9) Stay away from negative talk about the NCLEX with other students.
(10) Know the route to the testing center,
(11) Double check that you have the appropriate ID prior to the NCLEX test.
(12) Work through several practice tests prior to the exam.

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

In considering going into the nursing profession, there are a few priorities that are crucial to determining future success.

When individuals look at all of the criteria it becomes clear which schools would be a better choice. The first criteria that many people face when going back to school is financial. Some of the factors that need to be considered about the school are for instance, how much will it cost per credit hour? Cost per credit hour depends on the school, whether or not it is accredited, a community college, a private college or a four year university.

The other criteria for determining which nursing school to attend, is of course whether or not one can obtain financial aid. Financial aid is available for many that are in the working class.

There are also Federal loans that can be obtained with very low interest rates. It would be considered a wise step to visit the financial aid office of a college or university near ones home to find out about the availability of government funding.

The next criterion, which may or may not be important for some, is the vicinity of the nursing school. For many whom work and plan to attend school, the closer the school’s location the easier the commute. In this society of multitasking, the closer that work, home and school are to one another the better.

Also, gas is now a real concern. Driving fifty miles may not have been a deterrent to some a few years ago, but certainly with the cost of fuel now days; it has become a real deterrent to many.

Along with the schools vicinity, one needs to look at whether or not the nursing school is accredited. If someone is considering obtaining an Associates Degree in Nursing from a non accredited nursing school, then if they decide to go on to their Bachelors of Nursing, they will find that they cannot continue. The reason for this is due to the following; an accredited Bachelor of Science in Nursing Program, requires and accredited degreed Nursing Program from the two year Associate Degreed Nurse.

What this imples is that the two years Associate Degreed Nurse who graduated from a non accredited nursing school will not be able to transfer in their nursing courses to the four year university. This may be a real stumbling block to those nurses who wish to go on for a Bachelor of Science in Nursing.

It is also important to know how the nursing school graduates perform on the NCLEX®, the National Licensure Examination for Registered Nurses. When there is only a forty or fifty percent passing rate on schools National Boards, this should raise a red flag for the prospective nursing student. There is no greater disappointment then failing the boards on the first time around. Many hospitals will hire graduate nurses prior to their sitting for the national boards, on the premise that if they fail their national boards, one of two things will take place;

1. their job as graduate nurse with the hospital will be terminated,
2. they will be demoted to a lesser position with less money,
3. they will be demoted to a lesser position with less money and be offered a second chance with a specified time frame to sit for the national boards once more.

None of the previous scenarios is an attractive option to any graduate nurse. Therefore the percentage of students that pass the boards at a particular school should also be included in the criteria for choosing a particular nursing school. However, do not judge the school too harshly on their rate of students who do or do not pass the national boards. The reason for this is due to the fact that some schools require a high grade point average, such as a four point zero just to get into the nursing program. This requirement will of course skew the results of passing scores in favor of those with higher grade point averages. These criteria will of course preclude many from even entering the nursing program, since many students are not four point zero in academics. Generally speaking, an average of seventy percent and above passing rate on the national nursing boards is a good predictor of the nursing school. But, it is up to the individual as to how much time and effort is put into the program as to how much they get out of the program. The nursing programs in general are very physically demanding, time consuming and mentally challenging. It is a very serious profession and there are those who find out that the field of nursing is not for them very early in the program. The best advice to those deciding on which nursing school to attend, is to use the above mentioned criteria only as a guide, because it will be up to the individual how well they do in the final analysis.

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

As the student nurse approaches graduation, thoughts of beginning a career in nursing come to mind. A new nurse should think very seriously about their career goals. These include long term as well as short term goals. As with any path of life that an individual takes, it is not random. Each person that seeks an education does so with a set of plans and directionality for their immediate goals and long term. The idea of graduating from a nursing program once again dictates to the graduate that plans once again must be laid for the road ahead. Nothing worthwhile doing is done haphazardly. All things require preparation. Even as one contemplated going into the nursing field, certain pre-requisites had to be completed before hand. Graduating from a nursing program is another transition phase that must be approached with the same dedication and planning as was first applied. The short synopsis below is a sample of a career goal paper. Everyone will have their own unique career goal paper. Now is a good time to start thinking about career goals.

INTRODUCTION:

The field of nursing attracted me for several reasons. The first reason being, that a nurse is the front line person in caring for others and saving lives. The nurse will in many cases such as in the hospital or homecare environment discover the patient who needs emergency attention before the physician. It will be up to the nurse to respond accordingly within the scope of their practice and hospital procedures. Why does this facet of nursing attract me? Well, it is because that this type of responsibility is not too far off from the type of responsibility that a physician has, which is what I had hoped to become many years ago. Nurses did not have that crucial level of responsibility initially. Because of this, many patients died. For instance, a nurse from the past may not have known the therapeutic values of electrolytes and blood gases thereby putting the patient’s health in jeopardy. Now, in present times, the nurse must know all of the pertinent lab values and act upon any change immediately, either by calling the physician or implementing standing orders.

The other aspect of nursing that is also attractive to me in becoming a nurse, is that the nurse uses therapeutic communication and treats the patient’s response to real or perceived illness. This is the corner stone of which nursing is based on. The holistic approach is so successful in helping patients to heal. I am a firm believer that for an individual to be able to heal from without, they must first heal from within. Therefore the nurse can help clients to adapt and grow in a positive way rather than negative. Since all of nursing is now based on evidenced practice, it is exciting to be able to put the scientific method to use. There are now logical and provable reasons that a nurse should take a particular course of action.

These are just some of the reasons which have attracted me to the profession of nursing.

SHORT-TERM CAREER GOALS:

My short-term career goals consist of successfully passing Nursing 255, then passing the national board exam. Once this is accomplished, I hope to be work on a medical-surgical floor and hone my skills as a graduate nurse. I have chosen medical-surgical nursing as a starting point because this particular field will help me to develop my clinical skills.

LONG-TERM CAREER GOALS:

I hope to be an active member in the profession of nursing, joining the American Nurses Association, attending seminars and lobbying for the advancement of nurses to prescribe medication independently. Hopefully within the next five years or so I will have a degree as an advanced practice nurse in the field of family healthcare and be working in an emergency room.

PERSONAL GOALS

My personal goals are humble. Money has never been a goal, rather doing that which enriches the soul. I am thankful to my Lord that I have been given the opportunity to have made it thus far. I take care of my mother and help my family as best I can. I am happiest when I am helping others, and owe a large debt of gratitude to my instructors, who have given of themselves their wealth of knowledge and experience to help produce competent nurses. I hope to make them proud.

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

For those student nurses who are about to graduate, their main priority is to pass the NCLEX-RN examination. The practice of nursing is regulated according to licensing authorities in each state jurisdiction.

Each jurisdiction must ensure that each nurse has the minimum competency to practice nursing in their state. In order to ensure such requirements, the National Council of State Boards of Nurses, Inc.

(NCSBN) has developed a comprehensive examination entitled, National Council Licensure Examination for Registered Nurses (NCLEX-RN). The NCLEX test plan occurs in several steps. The first step is to conduct a practice analysis. This is used to collect data on the practice of entry level nurses. By collecting this data the board can design NCLEX test questions that will be applicable to the majority of graduate nurses.

For instance, it has been found that the majority of new graduate nurses find work on medical/surgical units. The majority of the new graduates surveyed also indicated their primary responsibility was in the delivery of direct patient care. (1) Therefore, questions regarding the care of patients on medical/surgical units is pertinent and important for graduate nurses to know. Although some graduate nurses will tell you that they had more questions on psychiatric nursing or maternity nursing on the NCLEX, this is not the norm. Six thousand or more newly licensed registered nurses are asked about the frequency and priority of performing more than one hundred and fifty care activities. These activities are analyzed in relation to the impact on patient care, safety and client settings where they are performed. It is in this framework that NCLEX test questions are designed to be applicable in real world settings, thus requiring graduate nurses to be knowledgeable of such practices.

The second step in the NCLEX test plan is to develop a method to test behaviors regarding the content formed in step one. The NCLEX-RN, Test Plan, provides a focused summary of the concepts to be tested. It serves not only to delineate what content to cover and the method of presenting the test questions but also serves to assist in developing a study guide in preparing those who will take the test. The NCLEX assesses the graduate nurse’s knowledge of required skills to practice nursing safely and competently.

Beliefs about people and nursing underlie the NCLEX-RN test plan. People are finite beings with varying capacities to function in society. (2) Each person is a unique and special individual existing in a system that they exert some control over, such as their beliefs, social systems, family systems, health customs. It is in this underlying theory of each individuals beliefs that the nursing process guides in the intervention to promote psychological and physical wellness. Nursing is an art as much as it is a science, founded on a scientific body of knowledge that has been tested and proven effective in meeting the goals of each individual. The cognitive learning domain is a integral part of the NCLEX test plan. The use of Bloom’s taxonomy is the basis for writing and coding items (Bloom,e tal.,1956: Anderson & Krathwohl, 2001) Since the practice of nursing requires application or higher levels of cognitive ability, it becomes imperative to test graduate nurses complex and abstract reasoning.

The framework of Client Needs was selected for the NCLEX due to its all encompassing body of nursing knowledge that must be applied to successfully meet these needs. There are four distinct categories of Client Needs that are integrated into the exam, with two of the four categories subdivided to more adequately cover all subject matter. The categories are as follows:

A. Safe and Effective Care Environment
1. Management of Care
2. Safety and infection control

B. Promotion and Maintenance

C. Psychosocial Integrity

D. Physiological Integrity
1. Basic Care and Comfort
2. Pharmacological and Parenteral Therapies
3. Reduction of Risk Potential
4. Physiological Adaptation

Integrated concepts and processes are fundamental to the nursing practice and are applied to the various and categories of client needs.

These integrated concepts are as follows:
A. The nursing process- a scientific problem solving approach to client care that includes, assessment, analysis, planning, implementation and evaluation.

B. Caring- interaction between the nurse and client that provides for a nurturing, positive, and helpful environment whereby the client feels special and important knowing that the relationship that develops between themselves and the nurse will provide the needed assistance in their achieving a higher level of psychological and physical wellness.

C. Communication and Documentation- verbal and or nonverbal interactions between the nurse and client, significant others and multidisciplinary health teams. Validation either through written and or electronic entry which reflects that what has been done is documented and is within the scope of the nurses educational and licensure level as well as meeting the policies of the hospital or other client care environment.

D. Teaching-Learning- facilitating the acquirement of further knowledge which will lead to a more informed and skilled nurse with the application of the newly learned material.

The distribution of content and the percentage of test questions assigned to each Client Needs subcategory in the NCLEX test plan is based on the results of the Report of Finding from the 2005 RN Practice Analysis:
1. Zerwekh, JoAnn, Claborn, Jo Carol, (page95) 5th Edition, Co. 2003, Nursing Today Transition and Trends , Saunders, Philadelphia 2. Henry Ford Community College, Division of Nursing, NSG255 U-1 M-1.6, Co.2006 page 3-5, Dearborn, MI