hgh usage

Critical Thinking in Nursing

Written by kimmel52 on January 8, 2012 – 9:57 pm

nurse pic

critical thinking in nursing
nancy kimmel
September 30, 2014

Critical Thinking in Nursing

As a new nurse, I remember how frightened I was that someone would die do my lack of experience or a poor judgment call. I will never forget my one instructor who said, “You will make a medication error at some point in your nursing career.” That statement shook me to the core. How could that happen? During my orientation on the medical/surgical step down unit, I witnessed nurses nonchalantly switching out I.V. bags of different solutions without first checking the drugs compatibility. What if one of those medications causes a precipitate to form in the line? Then what? Someone could die of an embolism!
Soon I was on my own shift with my own patient load. The fears that plagued me during nursing school did not magically disappear, but instead became magnified. I was a nervous wreck. How did these other nurses manage their patient load with such grace under pressure? When would this ominous fear of doing something wrong let up? For me, it never did. The delicate balance between life and death based on a decision or action is what kept me sharp. Eventually I was able to display a calm exterior while internally; I was ready to react at the slightest change in my patient’s condition. There were no cutting corners. I know that sounds crazy. Obviously, when there were no washcloths we had to use towels, or sometimes we had to make do with what supplies were on the floor. Did I ever deliberately cut a corner just to save time? The answer is no. Everything that I do is for my patient. Even the smallest action of making a toe pleat in the bed or mitering a corner was a action of respect for the patient in that bed.
Nursing school prepared me with critical thinking skills. As my experience as nurse progressed, I became better at assessing a patient’s condition. I would not say that I became an expert according to Benner’s Stages of Critical Competence.(Benner, 2011, para. 5)
Making a competent clinical decision is not based on just one lab result or a patient’s symptoms. The personality traits of going above and beyond, taking risks and deliberate practice seem to be the traits that make an expert nurse.(Kaminski, 2010, p. 967)
Benner’s Stages(Benner, 2011, table 1) verified that I have much to learn. I am looking forward to learning more about evidenced based practice and the critical thinking skills necessary in advanced practice nursing.
Advanced Practice Nurses have the responsibility of providing and documenting research on evidenced based practice for the nursing profession as a whole. Nursing continues to develop and progress into a clinical science. This development is due to the efforts of those nurses who understand the dynamics of change in the role of the nurse in today’s society.

Benner, P. (2011, December 20). “Staged” Models of Skills Acquisition. Society of Gastroenterology Nurses and Associates. Retrieved from http://www.umdnj.edu/idsweb/idst5340/models_skills_acquisition.htm
Kaminski, J. (2010). Theory applied to Informatics- Novice to Expert. Retrieved from http://cjni.net/journal/?p=967

Tags: , , , , , , , , , , ,
Posted in Pass The Nursing Entrance Test | No Comments »

Did You Pass The Nursing Boards?

Written by kimmel52 on November 12, 2008 – 12:16 am

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

Congratulations! So you finally passed your boards, and now you are a real Registered Nurse. How does it feel, to have passed the final test of all tests? Great? Absolutely! Now what? Well, to begin, you need to celebrate. There are many loved ones that are also looking forward to taking part in the celebration. Read more »

Tags: , ,
Posted in New News in Nursing, So You Finally Passed The Nursing Boards | No Comments »

What You Need to Know Before you Take the NCLEX!

Written by kimmel52 on November 11, 2008 – 11:45 pm

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.

Tags: , ,
Posted in New News in Nursing, What You Need to Know Before you Take the NCLEX! | No Comments »

What Every Graduate Nurse Needs to Know About State Boards!

Written by kimmel52 on September 20, 2008 – 5:13 am

Nursing Education – Passing The Nursing State Boards

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

The following information is from the Oklahoma Board of Nursing Task Force, that investigated the pass and fail rate of nursing students that have taken the NCLEX. The scores for the state of Oklahoma were lower than most of the states in the Union, prompting the formation of a task force and investigation of possible reasons for the low scores. What all perspective nursing students can gain from this report is how crucial it is to sit for the boards as soon as possible after graduation and to take advantage of all the help available in preparing for the NCLEX. The nurses efforts in putting this wealth of knowledge together has been a monumental task and all nursing schools across the country are grateful for the information that they have been able to provide after many long hours of research.

Summary of Information from Pass Rate Reports

In reports submitted by nursing education programs with NCLEX pass rates ten percentage points or more below the national average, the following commonalities were noted:

1. Some programs do not regularly use accessible sources of data to evaluate the correlation between admission scores, grade point average, NCLEX predictor examination scores, and NCLEX pass rate. This impacts the ability of the program to make informed decisions about changes likely to result in an improvement of their NCLEX pass rate.

2. Many programs have only recently begun the use of NCLEX predictor examinations as a requirement of the program. Data on the efficacy of these examinations and on appropriate follow-up plans is limited.

3. Grade inflation is a factor leading to a low NCLEX pass rate in some nursing education programs, particularly in programs that allow significant point credit in theory courses for attendance, participation, and completion of assignments.

4. Some programs do not identify minimum academic requirements for admission to the program. Instead, a point system may be used to select those who are deemed to be better qualified. While the use of point systems in admission decisions may be appropriate, point systems fail when applicant numbers drop. In cases in which there is a small applicant pool, identifying minimum academic requirements (such as minimum scores on standardized pre-entrance examinations) may be necessary to ensure that students admitted have a reasonable chance of success in the program and on the NCLEX examination.

5. Student characteristics identified by programs as leading to NCLEX failure include a high number of work hours, family commitments, English as a second language, and low admission points.

6. In some cases, problems within the program, such as resignation of the program director, faculty turnover, inexperienced faculty, lack of knowledge regarding the NCLEX examination and/or test development, and increased use of adjunct faculty were noted as having an impact on the NCLEX pass rate.

Nursing education programs tend to take similar actions to address NCLEX pass rate concerns. Actions commonly taken by programs include:

1. Initiating the use of an NCLEX predictor examination as a requirement in the program

2. Requiring students to complete NCLEX review, tutoring, or other actions if the predictor examination score is low

3. Increasing the minimum passing grade

4. Providing faculty education in the areas of the NCLEX examination and test development skills

5. Changing or increasing admission requirements

Results of Survey of Nursing Education Programs

In December 2002, a survey was sent to all state nursing education programs to identify the directors’ perceptions of factors impacting the NCLEX pass rate and the actions taken by programs to address pass rate. Based on the data obtained from 50 respondents (an 86.2% return rate), the task force noted the following:

1. The majority of programs have minimum academic requirements for admission; generally based on minimum scores on standardized assessment tests and/or a minimum required grade point average on high school or college courses.

2. The minimum grade average to earn a “C” in nursing courses tends to be higher than the parent institution’s requirement. The majority of respondents require at least a 75% average to pass nursing courses.

3. Most respondents allow students who fail a course to repeat the course one time, and almost half only allow students to repeat one course in the program. Respondents with a pass rate at or above the national average were slightly more likely to allow students to repeat a course only once and to repeat only one course in the program. A higher number of respondents with a pass rate below the national average had no limit on the number of courses that could be repeated.

4. Most respondents have established a written policy to identify students at risk for failure in the program or on the NCLEX. The indicators most commonly used are scores earned on nationally-normed examinations designed to predict NCLEX success, grades earned in nursing courses, and repeats of nursing courses. Once the student has been identified as at-risk, the majority of respondents will notify the student and require the student to meet with a faculty advisor at least once.

5. Nearly all respondents report using a standardized NCLEX predictor examination, but only 34.8% require students to earn a certain score on the exam as a requirement for course completion or graduation.

6. Student and graduate issues most often identified as negatively impacting pass rate are the number of hours of employment, a limited number of hours spent studying, more family responsibilities, being less academically qualified, and an inadequate amount of time spent preparing for the NCLEX. Respondents with a pass rate below the national average were more likely to note that students spend less time studying.

7. No single faculty/program issue was identified by the majority of programs as having a negative impact on the pass rate. Increased faculty turnover was selected most often as a negative factor. Respondents with an NCLEX pass rate below the national average were more likely to identify that administration has pressured the program to maintain capacity enrollment and that faculty spend inadequate time evaluating NCLEX result data and planning program changes based on the data.

8. The majority of respondents believe that their administrations have been supportive of maintaining high academic standards.

9. Most respondents report that faculty have received training on test development and instructional techniques.


Recommendations for the Oklahoma Board of Nursing

1. Clearly articulate and enforce regulations requiring programs to use a systematic program evaluation process to analyze student outcomes on the NCLEX examination and develop appropriate actions based on the analysis.

2. Continue to evaluate full-time faculty to student ratios in the classroom and clinical area to determine the relationship between such ratios and student outcomes.

3. Ensure that pass rate reports include a thorough analysis of student and program factors impacting success on the NCLEX exam.

4. Hold nursing education programs accountable for their NCLEX pass rates. Utilize focus survey visits, warnings and conditional approval status when there is evidence of continued low pass rate and failure to meet educational standards.

5. Develop a mechanism to communicate and encourage the use of best practices that promote NCLEX success.

6. Utilize the annual report for ongoing evaluation of factors influencing each program’s NCLEX results.

7. Provide opportunities for faculty development related to the NCLEX examination and curricular resource sharing.

8. Require that every program whose pass rate is below the standard provide a pass rate report to the Board, regardless of its size.

9. Institute regulations requiring the NCLEX candidate (excluding foreign-educated and other endorsement candidates required to take the exam) to pass the examination within one year of graduation from the program. If the candidate does not take the exam or pass within this time period, the candidate would be required to complete additional education prior to re-testing.

Recommendations for Nursing Education Programs

1. Identify requirements for English language proficiency and develop a plan for continued support of students for whom English is a second language.

2. Consider providing part-time program options to allow students to complete their nursing education at a slower pace.

3. Use the systematic program evaluation plan to track the correlation of such factors as admission/ACT scores, high school or college GPA, nursing course GPA, other selected student characteristics, repeats of coursework, scores on NCLEX predictor examinations, with results on NCLEX examination.

4. Perform a cross-analysis of the curriculum with the detailed NCLEX test plan, in order to ensure essential elements are covered adequately.

5. Utilize consultants, including Board staff consultants, as needed in program evaluation and curriculum development.

6. Provide continuing education for faculty members on test development and analysis skills.

7. Assess students for at-risk status upon admission or early in the program. Implement a plan to assist at-risk students with success in the program and on the NCLEX.

8. Develop and publicize scholarship programs in order to facilitate minimal employment during the time the student is in the nursing education program

Recommendations for Students and NCLEX Candidates

1. Accept responsibility for own success in the program and on the NCLEX examination and become an active participant in the learning process.

2. Participate in study and test-taking skill workshops early in the program to facilitate the development of such skills.

3. Seek out all available resources to ensure minimum work hours while attending the nursing education program.

4. Join a study group early in the program and ensure that the study group time is used effectively.

5. Use NCLEX review material and study questions throughout the program to increase own familiarity with the NCLEX examination.

6. After graduation, develop a study plan for NCLEX preparation. Use computerized NCLEX practice exams on a regular basis. Practice taking these exams in a campus computer lab to simulate NCLEX testing conditions.

7. Take the NCLEX examination as soon as possible after graduation, as studies show that early completion of the NCLEX increases chances of success.

Recommendations for Employers

1. Establish programs that foster success for employees attending nursing education programs.
Consider options such as providing full-time benefits for part-time status during the school year, full-time salary for reduced hours, and tuition reimbursement.

2. Encourage new graduates employed as nurse technicians/nursing assistants to adequately prepare for the NCLEX exam, through options such as allowing specified work hours for planned study sessions, reimbursement for review courses, and reimbursement for the examination.

3. Provide special recognition for employees who pass the NCLEX examination, such as restaurant and movie coupons, employee newsletter notice, or other options.

Tags: ,
Posted in State Boards, The real scoop | No Comments »