# Accepted to RN bridge!



## FiremanMike (Mar 18, 2020)

Our local community college opened up their LPN to RN program to paramedics and I found out today I was accepted!

I have so much of the coursework done, it'll be 5 semesters, 3 of which will have 2 classes (pharm 1, pharm 2, and human lifespan) and the rest are nursing core classes..

Wow, if you type w o o t! it makes it a hyperlink to a spam site.. interesting..


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## MMiz (Mar 18, 2020)

That's awesome, congratulations!


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## Jn1232th (Mar 19, 2020)

Where is this at?


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## DrParasite (Mar 19, 2020)

congratulation Mike!


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## Capital (Mar 19, 2020)

Congratulations! And welcome to the nursing profession 🤪


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## Monday (Mar 19, 2020)

I'm new so sorry if infraction of local protocol to post up...

But amazing news and congratulations to the acceptance 
Best of luck with your next studies.


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## E tank (Mar 19, 2020)

Monday said:


> I'm new so sorry if infraction of local protocol to post up...
> 
> But amazing news and congratulations to the acceptance
> Best of luck with your next studies.


3....2.....1.....


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## Akulahawk (Mar 23, 2020)

FiremanMike said:


> Our local community college opened up their LPN to RN program to paramedics and I found out today I was accepted!
> 
> I have so much of the coursework done, it'll be 5 semesters, 3 of which will have 2 classes (pharm 1, pharm 2, and human lifespan) and the rest are nursing core classes..
> 
> Wow, if you type w o o t! it makes it a hyperlink to a spam site.. interesting..


That's great!! It's only 5 semesters... My program required us to have all but perhaps a couple prereq's done for entry and those, if not done, were to be done during a summer semester. Of course I went through a "traditional" program and that took 4 semesters from start to done, all 4 semesters of which were full-time core nursing courses. Our LPN-RN upgrade program required that ALL prereq's be done as well along with a short primer course, and then those students could complete the upgrade with just 2 full-time semesters. The primer course was basically a "catch-up" course that covered material that LPN students don't usually get in their programs that 1st year RN students get. 

Congrats!! It's going to be a lot of work, a lot of fun, and a different way of thinking about your patients.


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## FiremanMike (Mar 23, 2020)

Akulahawk said:


> That's great!! It's only 5 semesters... My program required us to have all but perhaps a couple prereq's done for entry and those, if not done, were to be done during a summer semester. Of course I went through a "traditional" program and that took 4 semesters from start to done, all 4 semesters of which were full-time core nursing courses. Our LPN-RN upgrade program required that ALL prereq's be done as well along with a short primer course, and then those students could complete the upgrade with just 2 full-time semesters. The primer course was basically a "catch-up" course that covered material that LPN students don't usually get in their programs that 1st year RN students get.
> 
> Congrats!! It's going to be a lot of work, a lot of fun, and a different way of thinking about your patients.



So this is the middle step of a long journey for me..  I started back to college in 2009 because I wanted to fulfill my dream of going to medical school.  Unfortunately life got in the way and I never found a time when I was going to be able to quit the FD in order to get the prereqs done, so I settled for a public safety degree instead..

So 2 years ago I started working on the prereqs for nursing with the plan of going right into a part time NP program, so the current plan is this RN in 5 semesters, followed by FNP over 27 months, then a post masters ACNP certificate over 12 months, all of which should line up with my pension date, so I’ll hopefully retire into a second career as an NP..

Why not medical school now?  I just don’t want to do it all at 50.. Realistically, I feel I’d be successful down that pathway, but doctors never turn off their drive, nor would I, and I want to slow down a bit and enjoy life..


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## Missourimedic38 (Apr 18, 2020)

FiremanMike said:


> Our local community college opened up their LPN to RN program to paramedics and I found out today I was accepted!
> 
> I have so much of the coursework done, it'll be 5 semesters, 3 of which will have 2 classes (pharm 1, pharm 2, and human lifespan) and the rest are nursing core classes..
> 
> Wow, if you type w o o t! it makes it a hyperlink to a spam site.. interesting..


Im interested in program and am a fireman. Can you PM I have questions


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## Sled Driver (Apr 18, 2020)

Congratulations and Good Luck.


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## Carlos Danger (Apr 18, 2020)

Akulahawk said:


> Congrats!! It's going to be a lot of work, a lot of fun, and a different way of thinking about your patients.





Akulahawk said:


> Congrats!! It's going to be a lot of work, a lot of fun, a different way of thinking about your patients, and in the end you'll be really glad it's over and really glad you did it.



Fixed it for you. You are welcome.


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## Summit (Apr 18, 2020)

Congratulations! Welcome to the dark side! 

Interesting it is still 5 semesters as a "bridge." My traditional BSN program was 4 semesters over 21mo (3mo off over the summer for externships or electives like critcare/ER). Sounds like the course load might be lighter so you can keep working more easily during school?

typing woot to see


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## Missourimedic38 (Apr 18, 2020)

I live in saint louis, missouri and Im interested in paramedic to RN programs. I work full time and have a family. Anyone tried Excelsior or College Network?


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## VFlutter (Apr 18, 2020)

Missourimedic38 said:


> I live in saint louis, missouri and Im interested in paramedic to RN programs. I work full time and have a family. Anyone tried Excelsior or College Network?


 
Some on here can speak to the Excelsior program however it is not a perfect solution. 

IMO get your prerequisites done, save up, and go for Goldfarb's upper division. I did not have a family but worked part time during the program and got tuition assistance through the hospital I was working for.


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## Missourimedic38 (Apr 18, 2020)

VFlutter said:


> Some on here can speak to the Excelsior program however it is not a perfect solution.
> 
> IMO get your prerequisites done, save up, and go for Goldfarb's upper division. I did not have a family but worked part time during the program and got tuition assistance through the hospital I was working for.


Awesome, did you work at Christian EMS?


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## VFlutter (Apr 18, 2020)

Missourimedic38 said:


> Awesome, did you work at Christian EMS?



Nope, worked at MoBap as a tech while in school. Now I work at ARCH


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## Missourimedic38 (Apr 18, 2020)

VFlutter said:


> Nope, worked at MoBap as a tech while in school. Now I work at ARCH


Awesome. Did you have to work part time in order to do GoldfArb?


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## MackTheKnife (Apr 18, 2020)

Missourimedic38 said:


> I live in saint louis, missouri and Im interested in paramedic to RN programs. I work full time and have a family. Anyone tried Excelsior or College Network?


No personal experience, but California does not accept Excelsior.


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## MackTheKnife (Apr 18, 2020)

FiremanMike said:


> Our local community college opened up their LPN to RN program to paramedics and I found out today I was accepted!
> 
> I have so much of the coursework done, it'll be 5 semesters, 3 of which will have 2 classes (pharm 1, pharm 2, and human lifespan) and the rest are nursing core classes..
> 
> Wow, if you type w o o t! it makes it a hyperlink to a spam site.. interesting..


Pardon the late reply, but stand your ground.  I had my didactic and clinical instructors telling me ad nauseum that I was a nursing student and couldn't do what a medic does.  I reminded them I know how to stay in my lane and knew I was a student.  One clinical instructor wouldn't let it go and I pulled her aside and told her nicely to f**k off. And guess who got asked by the floor nurses to start IVs on their hard sticks?????


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## Akulahawk (Apr 19, 2020)

MackTheKnife said:


> No personal experience, but California does not accept Excelsior.


This is correct. California requires concurrent didactic and clinical experiences. As an example, if you're doing Peds in class, that same semester/quarter you must have Peds clinicals. This requirement doesn't just affect Excelsior students, it also affects some other US and overseas students as well. Philippine students have been impacted greatly by this, not all, but many. 

If a nursing program basically follows the basic California pattern for didactic/clinical experiences, it'll likely be OK enough for its students to be licensed by California. Excelsior doesn't (and won't) follow this pattern, so their students are SOL for obtaining a California nursing license. I'm not saying that Excelsior is or isn't a good program, just that their graduates WILL be limited in where they can work (not California).


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## Akulahawk (Apr 19, 2020)

MackTheKnife said:


> Pardon the late reply, but stand your ground.  I had my didactic and clinical instructors telling me ad nauseum that I was a nursing student and couldn't do what a medic does.  I reminded them I know how to stay in my lane and knew I was a student.  One clinical instructor wouldn't let it go and I pulled her aside and told her nicely to f**k off. And guess who got asked by the floor nurses to start IVs on their hard sticks?????


I agree with this. My personal experience wasn't as bad, but the instructors definitely did, at least initially, keep a closer eye on me than the others. Unfortunately for nursing, the profession doesn't play well with other professions if it's not "nursing." The same could be said for EMS too... I couldn't use some of my nursing class stuff for my CE because it was "nursing" and not "EMS" (and vice versa) even though the courses involved patient care and assessment.


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## FiremanMike (Apr 19, 2020)

Missourimedic38 said:


> Im interested in program and am a fireman. Can you PM I have questions



Definitely!


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## FiremanMike (Apr 19, 2020)

Summit said:


> Congratulations! Welcome to the dark side!
> 
> Interesting it is still 5 semesters as a "bridge." My traditional BSN program was 4 semesters over 21mo (3mo off over the summer for externships or electives like critcare/ER). Sounds like the course load might be lighter so you can keep working more easily during school?
> 
> typing woot to see



1 semester is a "transition to RN" class which is next semester.. It's supposed to be nursing theory and nursing skills.. It's now been made online due to covid, so that should be interesting..

After that, it's 5 clinical rotations, nursing pharm 1/2, and "human growth and development"..

It's fine, I'm not in a super rush, as I've said I'm stuck in my pension system for just over 5 more years, should all line up with the end of NP school..


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## Carlos Danger (Apr 19, 2020)

Akulahawk said:


> This is correct. California requires concurrent didactic and clinical experiences. As an example, if you're doing Peds in class, that same semester/quarter you must have Peds clinicals. This requirement doesn't just affect Excelsior students, it also affects some other US and overseas students as well. Philippine students have been impacted greatly by this, not all, but many.
> 
> If a nursing program basically follows the basic California pattern for didactic/clinical experiences, it'll likely be OK enough for its students to be licensed by California. Excelsior doesn't (and won't) follow this pattern, so their students are SOL for obtaining a California nursing license. I'm not saying that Excelsior is or isn't a good program, just that their graduates WILL be limited in where they can work (not California).


While California is the only state that absolutely will not license any Excelsior grad (who enrolled in the program after Dec 2003), a handful of other states do have additional requirements for Excelsior grads.  I've heard Maryland makes this very difficult and requires a lot of out-of-state experience or a lengthy in-state preceptorship which can be very hard to arrange. Georgia only grants licensure to Excelsior grads if they had clinical experience (paramedic, LPN, etc.) prior to starting the Excelsior program. Other states will only license an Excelsior grad after a period of time practicing as an RN in another state, or after obtaining a higher nursing degree (BSN or MSN) from a school the than Excelsior.

Don't count on what I'm saying here to be accurate because this stuff changes; I'm just presenting it as an example of things that a potential Excelsior nursing student needs to consider.

The Excelsior website has some info on this, but the best source if current info is the BON of the state(s) where you plan to practice.

Excelsior College list of state board requirements


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## Peak (Apr 19, 2020)

I think it is also important to remember that there is a distinction between having a nursing license and being competitive for certain jobs (especially within critical care), especially as a new grad. Having your medic will certainly be helpful in many cases, but a questionable nursing program can ruin than advantage and much more very quickly.


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## E tank (Apr 19, 2020)

MackTheKnife said:


> Pardon the late reply, but stand your ground.  I had my didactic and clinical instructors telling me ad nauseum that I was a nursing student and couldn't do what a medic does.  I reminded them I know how to stay in my lane and knew I was a student.  One clinical instructor wouldn't let it go and I pulled her aside and told her nicely to f**k off. And guess who got asked by the floor nurses to start IVs on their hard sticks?????



Not to derail the thread (I will anyway), and since we're talking nursing instructors, my med-surg clinical instructor (nursing text book author, DNSc, etc.) told me at end of semester evals that I lacked the "intellectual curiosity" to be a nurse. When I told her my plan of transitioning off of the ambulance to a flight job, this wave of relief went across her face and she says "ohhhh....I was worried you'd be working in a hospital..."


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## GMCmedic (Apr 19, 2020)

E tank said:


> Not to derail the thread (I will anyway), and since we're talking nursing instructors, my med-surg clinical instructor (nursing text book author, DNSc, etc.) told me at end of semester evals that I lacked the "intellectual curiosity" to be a nurse. When I told her my plan of transitioning off of the ambulance to a flight job, this wave of relief went across her face and she says "ohhhh....I was worried you'd be working in a hospital..."


My wife was virtually ignored and written off as a medic in nursing school while the CNAs of the class were highly favored by the instructors. 

That all changed when it came to clinicals, she excelled at assessments, skills, and bedside manner and the favorites of the class all struggled.


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## Summit (Apr 20, 2020)

The dismissal of EMS knowledge is far from universal in nursing school.

I received a lot of respect for being an EMT while in nursing school from profs (BSN). It seemed unwarranted and confused me since I never made a habit of mentioning it. Sometimes I was asked for my perspective based on my EMS experience. Another example: nursing fundamentals lab I was asked by the prof if I'd be comfortable helping sign off my classmates on auscultating BPs with the dual scopes. I was so I did.


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## Peak (Apr 20, 2020)

Many of my nursing school instructors did not look on my EMS experience favorably, especially the ones who have been out of practice for years/decades and used teaching to get away from bedside.


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## FiremanMike (Apr 20, 2020)

I am slightly nervous about the preceptor interactions, but my plan is to just keep my head down, not make waves, and get through this..

I need a solid reputation when I apply to NP school..


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## E tank (Apr 20, 2020)

FiremanMike said:


> I am slightly nervous about the preceptor interactions, but my plan is to just keep my head down, not make waves, and get through this..
> 
> I need a solid reputation when I apply to NP school..



I wouldn't put too much stock in these anecdotes....just more of a source of amusement even at the time they happened, at least in my case. And your competitiveness when you do apply for advanced practice training will be more of a function of your experience/ performance as an RN more than your time in undergrad.

ps...in my case, the fact that I was a dude probably rubbed some instructors the wrong way a lot more than my EMS background. It worked to my advantage with others tho.


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## Peak (Apr 20, 2020)

FiremanMike said:


> I am slightly nervous about the preceptor interactions, but my plan is to just keep my head down, not make waves, and get through this..
> 
> I need a solid reputation when I apply to NP school..



My clinical instructors and preceptors were all great, that being said they were almost all ED or ICU nurses getting that side hustle.

I have a distinct memory of my first med pass giving IV zofran. I was so afraid of getting I trouble that I did that ridiculous two minute push counting whatever number of seconds after each 0.2 ml line on the syringe. My clinical instructor was a adult CVICU nurse, she essentially asked me if that’s how I give zofran on the ambulance (obviously not), because we don’t have time for that in the hospital. I leaned real quick that there is a big difference between class/lab and clinicals.


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## Akulahawk (Apr 20, 2020)

It's awesome when you are in a program that actively looks favorably upon EMS experience. Many do not, at least initially, look so favorably upon this. Mine was initially somewhat ambivalent about this as they seemed to be wary about EMS folks doing the "I got this, I know this..." thing and not necessarily doing nursing the way they're being taught. Once it was clear that I wasn't one of those, they began to look to me for an EMS perspective as they saw me as a bridge between worlds. I probably had more problems being male in nursing than a Paramedic going to nursing school.


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## akflightmedic (Apr 20, 2020)

I graduate in three weeks. I intend on writing up a very long story of the journey.


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## FiremanMike (Apr 21, 2020)

akflightmedic said:


> I graduate in three weeks. I intend on writing up a very long story of the journey.



what are they doing about this semesters clinicals?


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## VFlutter (Apr 21, 2020)

It seems to be the trend is that many nursing instructors lack the bedside clinical experience of the subjects that are attempting to teach. I did not have many instructors with prior critical care experience. 

I was a monitor tech in nursing school and spent 24hrs a week starting at EKGs and then had to sit through an EKG class taught by an Med-Surg instructor whom had never worked on a telemetry floor. It was challenging for everyone involved. 

Unfortunately you do not see many stellar critical care nurses go back to teach at nursing programs. If they have the desire to teach they tend to go back to a unit as an educator.


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## Summit (Apr 21, 2020)

Being a nursing academic does not pay that well and is dominated by a culture that does not typically mesh with a critical care mindset which tends to be a critical thinker who mostly lives in the real world.

Now, clinical scholars, clinical preceptors, and nursing lab instructors tend to be much more likely to be CritCare/ED types.


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## akflightmedic (Apr 21, 2020)

My single largest frustration is they say "we need to teach you how to critically think"...yet that is all I have done throughout the program and have suffered for it. They do NOT like any independent thinkers, challenges, comments, or discussions which deviate from the mantra of "Nursing is the greatest thing ever and it's our calling".


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## Summit (Apr 21, 2020)

Nursing academia involves critical thinking in the confines of academia


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## akflightmedic (Apr 21, 2020)

Being ever the businessman/entrepreneur, this experience has given me many ideas. First and foremost, I would love to start my own private nursing program which specializes in ER/ICU...or even just call it critical care. The students will get all the foundational knowledge and exposure of course, but then all core lectures, classes, etc will be geared towards churning out Critical Care Nurses. 

I think it can be done. Tell me it can't and that will be the best way for me to ensure it does.


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## ffemt8978 (Apr 21, 2020)

akflightmedic said:


> Being ever the businessman/entrepreneur, this experience has given me many ideas. First and foremost, I would love to start my own private nursing program which specializes in ER/ICU...or even just call it critical care. The students will get all the foundational knowledge and exposure of course, but then all core lectures, classes, etc will be geared towards churning out Critical Care Nurses.
> 
> I think it can be done. Tell me it can't and that will be the best way for me to ensure it does.


It can't be done...at least not for a profit.


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## Peak (Apr 21, 2020)

One of the biggest lies in healthcare is the nonsense that is taught in nursing school about nursing theory, nursing diagnosis, and so on with a distinct separation from the practice of medicine.

When you come into the ED I’m not triaging you an ESI 2 because you are at risk for impaired perfusion or whatever other NANDA BS, I’m concerned that you are having a MI, disection, PE, et cetera.

When I check your labs in the unit I’m concerned that you are hypokalemic from acute polyuric renal failure and as a result throwing ectopy, not some at risk of fluid balance shenanigans.

Many of the oldy moldy nursing school instructors still live in that mindset. They think about nursing diagnosis, as if these students haven’t taken a year of A&P, several semesters of chemistry, and several semesters of biology In addition to the pathophys and pharmacology you take in nursing school. It certainly isn’t the same depth as medical school but we can certainly talk about a patients medical problems.

I then get newgrads or practicum students in the EDs and Units and I have to get them to think in a real and modern way about the patients medical problems.

There is no nursing theory text in any department or unit I work in. We use peer reviewed nursing, pharmacy, and medical sources (particularly online) when we have a question. We use lexicomp and micromedix as our first two references for drug information, those nursing school pharm reference books have no place in our practice. We look at our xrays when they are shot, and the docs regularly ask us how their film looks before they can see it in PACS. We look at head ultrasounds as their being done, and head CTs while the patient is still in the scanner. We make vent changes based on gasses, and give fluids based on labs and invasive monitoring.

For some reason that I don’t fully understand there is a culture outside of critical care that x is the nurses job, y is the doctors job, z is so and so’s job. That just doesn’t work in emergency and intensive care, we are all there to treat patients.

Summary of rant: I didn’t enjoy the didactic portion of nursing school.


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## akflightmedic (Apr 21, 2020)

You have summarized well. It boggles my brain how these programs are conducted. I have held my tongue for nearly two years (outside of class). In class, I have been the absolute sh*t stirrer. I did not start off that way, however it came to a point where I could not remain silent. And then I was a target...it disgust me how they all preach this solidarity BS, yet they will chew you up and spit you out if they can. It is brutal. I speak not only from my perspective, but from several very close friends who had similar experiences at different schools in different states. It is endemic.


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## VFlutter (Apr 21, 2020)

I also feel that being a male nursing student was polarizing with instructors, either favored you or despised you. No in-between.


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## Summit (Apr 22, 2020)

There's real world
There's school world
and there is also NCLEX world

Also there is NREMT world TJC world etc

They are all parallel universes with varying resemblances to reality.

NANDA started as a good idea to allow nursing to bill separately instead of being part of the room charge. Academics seized it as a tool to be different from medicine. It can be taught in a non-totally useless way particularly for those new to healthcare. But it usually is used as a "only nursing cares" drum to beat on.

EMS mindsets find nursing theory and NANDA more painful than the average nursing student (who still find it painful).

Nursing theory is the most painful of all wastes of time. The problem isn't that nursing theory lacks male theorists. The problem is that most females cannot understand the underlying inanity and just parrot **** back like everyone else. Ever been forced to watch a the nursing theorist Jean Watson care theory meditation video and wonder what the **** she was smoking? Then your nursing professor tells you stories about getting high as **** with Jean Watson? People who enjoy nursing theory eventually become nursing professors starting the cycle of abuse all over again (not a nursing invention, but not shocked that nursing academics love APA).

The good news is that most nursing schools keep the total ******** to 10-20%. They teach heavy didactic knowledge and science that is applicable to real world practice even you have to warp your mind to cow-tow to NANDA care plan **** that you will never see again in your life once you pass NCLEX. And whoever invented APA formatting should have been involuntarily committed.

I experienced very little anti-male bias in nursing school, and all of it was from OB profs/former OB nurses.


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## E tank (Apr 22, 2020)

akflightmedic said:


> Being ever the businessman/entrepreneur, this experience has given me many ideas. First and foremost, I would love to start my own private nursing program which specializes in ER/ICU...or even just call it critical care. The students will get all the foundational knowledge and exposure of course, but then all core lectures, classes, etc will be geared towards churning out Critical Care Nurses.
> 
> I think it can be done. Tell me it can't and that will be the best way for me to ensure it does.


 
Then it wouldn't be "nursing school". The nursing accreditation bodies would require more generalist training (peds, OB/G, med-surg), you're there, you know the deal. But with that would be all of the nursing theory stuff that the suits with the big scarves and hair dos love to talk about.

It was a real shame when the hospital based system of training went away. No nonsense. Far more practically and knowledge/skills based and if someone wanted to go on for a degree, more power to them.


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## akflightmedic (Apr 22, 2020)

Oh I am well aware....it would conform to the accrediting bodies, however it would always be taking you to the next level, real world application and critical concepts. Would not be a school for the un-motivated...


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## Seirende (Apr 22, 2020)

Summit said:


> The problem is that most females cannot understand the underlying inanity and just parrot **** back like everyone else.



Excuse you?


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## ffemt8978 (Apr 22, 2020)

Seirende said:


> Excuse you?


Was wondering how long it would take for someone to respond to that.


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## VentMonkey (Apr 22, 2020)

Seirende said:


> Excuse you?








Seriously though, this thread just confirms (for me) why, especially at my age, I have no desire to get my RN.


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## ffemt8978 (Apr 22, 2020)

VentMonkey said:


> Seriously though, this thread just confirms (for me) why, especially at my age, I have no desire to get my RN.



Even if it is at @akflightmedic 's school?


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## FiremanMike (Apr 22, 2020)

VentMonkey said:


> View attachment 4920
> 
> Seriously though, this thread just confirms (for me) why, especially at my age, I have no desire to get my RN.



I have zero desire to be an RN, but I have a desire to move to the practitioner level.. 

Even though medical school isn't impossible in your late 40s and residency isn't impossible in your early 50s, I want the chance to slow down at some point before I die, so I've resigned myself that it's not going to happen in this lifetime.  I'd seriously consider PA school, but ffs the pre-reqs are EXACTLY the same as for medical school, hell some PA schools even require an MCAT.  If i'm going through all that trouble, I'm not going to limit my career and earning potential as a PA.

So that leaves NP school.. which despite the fact that it has damn near nothing to do with being an RN, requires an RN..


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## Summit (Apr 23, 2020)

Seirende said:


> Excuse you?


Ah I see how that line comes across. Not how it was meant.

To clarify:

Most females student nurses cannot understand the underlying inanity of nursing theory, just like the males cannot, because it is b*llshit. We all have to parrot it back in order not to be failed by dogmatic nursing profs.

Almost all nursing students (regardless of gender) see b*llshit as b*llshit but will cow tow to dogma to get through school.

The few who don't consider it BS are at high risk for becoming nursing professors.


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## Summit (Apr 23, 2020)

ffemt8978 said:


> Was wondering how long it would take for someone to respond to that.


Don't see why anyone would wait to call that out. 

It was a poor writing on my part and came off very much not how intended.

That should be called out for clarity.


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## Seirende (Apr 23, 2020)

Thanks for explaining


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## GMCmedic (Apr 23, 2020)

VentMonkey said:


> View attachment 4920
> 
> Seriously though, this thread just confirms (for me) why, especially at my age, I have no desire to get my RN.


If I could go get my RN and just go straight to RN pay without doing the 3 years ICU/ER experience, I would do it. I have -37 desire to work in a hospital.


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## DesertMedic66 (Apr 23, 2020)

GMCmedic said:


> If I could go get my RN and just go straight to RN pay without doing the 3 years ICU/ER experience, I would do it. I have -37 desire to work in a hospital.


Some flight programs allow a paramedic to nurse bridge. For my current company 4 years of full time flight medic experience counts as 2 years of full time RN. So you would only have to do 1 year in the ER/ICU as a nurse.


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## akflightmedic (Apr 23, 2020)

Well while I plug away on business stuff in the background, I managed to be offered a direct to ER position with no internship program with the understanding I would need precepting and orientation as long as needed. They also gave me half of my total paramedic experience as "nurse experience" for wage determination. So I am coming in as a 13 year nurse pay wise....nice eh? I also interviewed with the ICU director at the same time and she agreed to allow me to per diem in the ICU as well. 

I suggested and they tried to accommodate me with a full time hybrid ER/ICU position, however that was tanked due to potential conflict when it came to mandatory weekends/holidays. So best case scenarios is FT ER with PD ICU...

The goal of all this is at the end of 1 year, I will have 2 years experience on paper. 1 in the ER and 1 in the ICU....Travel Gigs here I come.


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## Carlos Danger (Apr 23, 2020)

DesertMedic66 said:


> Some flight programs allow a paramedic to nurse bridge. For my current company 4 years of full time flight medic experience counts as 2 years of full time RN. So you would only have to do 1 year in the ER/ICU as a nurse.


That's exactly how I transitioned from FP to FN. To be honest, I think it's kind of a short-change. I was the first person who ever did it at my program, and CAMTS did not at the time have any experience requirements, so I was kind of an experiment. I did perfectly fine as a flight nurse, so of course I didn't realize at the time the significance of the shortcut. However, when I left flying for a while and went to work in a real, high-acuity ICU, I was pretty humbled at how much I didn't know about critical care. And that was after about 6 years of flying full time, a couple years of part-time ED nursing experience, and after holding my FP-C, CCEMTP, CFRN, and CCRN credentials for several years. It's just one of those "you don't know what you don't know" things. 

It's entirely possible that others are much smarter than I am, or learn much quicker than I did, and therefore may have a different experience. But assuming the whole purpose of having both a paramedic and a nurse on the crew  is to draw on the specific _backgrounds _that those different professions brings to the table, I think cutting down too much on the experience is not ideal. There are some things that you can only get from time on the job.


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## VFlutter (Apr 23, 2020)

The hard truth is that the vast majority of HEMS is not critical care nor provides critical care experience.  You may get great critical care education and exposure but nothing that will substitute bedside experience or make someone exceptionally competent.

I know there are many bases that likely go a year without seeing any invasive hemodyamic monitoring, mechanical assist devices, titration of 6+ drips, true ARDS, etc. Flying a vented septic shock on Levo is the tip of the iceberg.

I've had flight nurse friends whom are prior ER nurses apply for CRNA school and be appalled to find out many do not consider it critical care experience. Most who went to an ICU to get experience were surprised the learning curve was much steeper than anticipated.

While I am on a soapbox I also think ER experience should be specifically level one or two (maybe)


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## Peak (Apr 23, 2020)

VFlutter said:


> I've had flight nurse friends whom are prior ER nurses apply for CRNA school and be appalled to find out many do not consider it critical care experience. Most who went to an ICU to get experience were surprised the learning curve was much steeper than anticipated.
> 
> While I am on a soapbox I also think ER experience should be specifically level one or two (maybe)



Having worked in Level 1s, undesignated centers, and about everything in between I strongly disagree that you get better experience at a level 1 or 2 center.

To start trauma designation does not correlate to medical acuity, states do not require you to see x number of sick medical patients to designate.

Trauma is also one of the easiest things we care for. Especially in EMS and in the ED trauma care is pretty straightforward.

Nursing in a large level 1 means that you do little more than charting and organization. A trauma (and similarly themed for a very sick patient or a code) gets you attendings, residents, fellows, PAs, and so on from the trauma service, general surgery, and the unit. Your ED techs are typically providing what is left of the ‘nursing’ care not done by an attending or medical trainee. Typically pharmacy is drawing and mixing at the bedside, lab collects and sends off samples, et cetera.

Location also plays a big role. A rural center that has high volume is going to likely provide a better teaching experience despite being a lower trauma designation than an urban level 1 where there are multiple centers and patients are quickly taken to OR. As a simple analogy I get a much bigger price of the trauma pie when I’m only sharing with 4 other people instead of 20-30. Also keep in mind that a large number of traumas seen in a level 1 are transfers and have already had a fair bit of stabilizing by the 911 agency, outside ED, and transporting EMS.

It takes much longer to make your way to the trauma bays in a level 1 than a lower designation. It is easy to get stuck in fast track and the medical pods for years before you earn the seniority to work the traumas.

To the ED versus Unit bit, both are critical care just in different ways.

In the ED or EMS the vast majority of patients are not sick, we just have to prove it so we can discharge/treat and release them. A small number of patients are sick, but as they are typically completely unstabilized rapid recognition and treatment is mandatory. Most patients do respond well with basic stabilization, even if they are very sick. I’ve certainly had some patients we end up maxed on 4+ pressors and aggressive vent settings in an hour or two in the ED, but this is incredibly rare.

In the unit patients are (usually) very sick, although also they are typically much more predictable and sudden unexpected decompensation is very rare. Typically I know much more about my patient clinically, and we usually have a pretty good idea of how to manage patients. It is important to remember that not all unit patients are on the verge of death, and there is a fair number of patients who can easily be tripled and still be a pretty slow shift. Like EDs various units will see very different levels of acuity, and depending on the nursing and medical structure can present very different learning experiences for nurses.


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## VFlutter (Apr 23, 2020)

Peak said:


> Location also plays a big role. A rural center that has high volume is going to likely provide a better teaching experience despite being a lower trauma designation than an urban level 1 where there are multiple centers and patients are quickly taken to OR. As a simple analogy I get a much bigger price of the trauma pie when I’m only sharing with 4 other people instead of 20-30. Also keep in mind that a large number of traumas seen in a level 1 are transfers and have already had a fair bit of stabilizing by the 911 agency, outside ED, and transporting EMS.



I do concede that is very much regional and not black and white however generally speaking you do not get the same exposure at a rural facility. You very well may get better experience stabilizing patients with less resources which is great. "Fair bit of stabilizing" is relative and again regional. Most rural ERs I have been to do not routinely place central and A lines, REBOA, hold ICU patients for hours, etc and transfer out patients as quick as possible.



Peak said:


> To the ED versus Unit bit, both are critical care just in different ways.
> 
> Most patients do respond well with basic stabilization, even if they are very sick. I’ve certainly had some patients we end up maxed on 4+ pressors and aggressive vent settings in an hour or two in the ED, but this is incredibly rare.



In most cases there is a distinct difference between ER stabilization and ICU level care. Rapid recognition and stabilization is a key skill in HEMS the 4+ pressor patient experience is more heavily relied from nurses and the rapid stabilization is part of the medics wheelhouse. 

Again, maybe I am biased as we do a heavy amount of high end critical care. ICU to ICU transfers are a large portion of our flight volume. Some bases primarily to scene flights and ER to ER which is less of an issue.


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## Peak (Apr 23, 2020)

VFlutter said:


> I do concede that is very much regional and not black and white however generally speaking you do not get the same exposure at a rural facility. You very well may get better experience stabilizing patients with less resources which is great. "Fair bit of stabilizing" is relative and again regional. Most rural ERs I have been to do not routinely place central and A lines, REBOA, hold ICU patients for hours, etc and transfer out patients as quick as possible.
> 
> 
> 
> ...



Most large urban centers are not routinely placing invasive lines either, those that are mostly a function of teaching residents not nurses.

What do you thing Level 1s are doing for most of their transfers that wasn’t done PTA? I’d say 80-90% of the transfers I saw were basically just a basic assessment, maybe a CT that hadn’t been done, basic X-ray, and sending them off to OR/unit/floor.

I’m instantly suspicious of anyone that tells me that they have performed ICU care because they have held ICU patients in the ED. Extended hold times are a reflection of poorly organized health systems who value keeping patients ($) over what is typically in their best interests (transfer to an outside hospital with open ICU beds). It also reflects that said hospital needs to increase bed capacity or improve throughput, but hasn’t for some reason.

I don’t disagree that most flight programs need the nurse to provide an ICU skill set more than ED, at least in systems that run medic/nurse.

There is going to be a lot of program variability, but most programs are not transferring the sicker ICU patients. When the sickest patients are moved it’s normally done with a lot of planning, a specialty team, and taking additional specialized staff.


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## Akulahawk (Apr 23, 2020)

Peak said:


> I’m instantly suspicious of anyone that tells me that they have performed ICU care because they have held ICU patients in the ED. Extended hold times are a reflection of poorly organized health systems who value keeping patients ($) over what is typically in their best interests (transfer to an outside hospital with open ICU beds). It also reflects that said hospital needs to increase bed capacity or improve throughput, but hasn’t for some reason.


Then allow me...  Have I performed ICU level care in the ED? Yes, on the ICU hold patients we've had. Have I performed _good_ ICU care? Not a chance. It's not that I'm a bad ED RN, it's that I'm not an ICU RN. That being said, I do the best I can to get my patient over to the ICU where the experts can provide the care that I am just able to muddle through. Thankfully we usually don't have extended ICU holds in the ED. Those few times we do, we actually try to bring an ICU RN to us. We're good at what we do, but we recognize that we're not an ICU.


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## FiremanMike (Apr 29, 2020)

So I have to buy an $825 online textbook package that I bet I never use..

I'm not buying their "nursing equipment bag" complete with bandage scissors, hemostats, and a ****ty double tube stethoscope.. LOL

I am looking forward to wearing pajamas to clinicals though!


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## Missourimedic38 (Apr 29, 2020)

Anyone on here work as an ER Paramedic before nursing school?


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## FiremanMike (Jun 12, 2020)

Can anyone comment on how much nit-picking there is on these exams, or is that program specific?

I'm plowing through these chapters (9 chapters by Monday) and trying to get a feel for what I should highlight versus what I can skim..


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## MackTheKnife (Jun 13, 2020)

FiremanMike said:


> Can anyone comment on how much nit-picking there is on these exams, or is that program specific?
> 
> I'm plowing through these chapters (9 chapters by Monday) and trying to get a feel for what I should highlight versus what I can skim..


I won't say nit-picking, but you have to change the way you think/approach questions. You might read a question and one of the four answers is the definitive answer in the mind of a medic. But you have to think like a nurse instead.  I'm sure you've heard by now the acronym ADPIE- Assess, Diagnose, Plan, Intervene, Evaluate.  Assessment is usually going to be the first thing you do, so that will be somewhere in the answers. And there is usually more than one correct answer, but only one is the MOST correct.
Good luck!


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## akflightmedic (Jun 13, 2020)

Select all that apply....can kiss my arse!!

Such a stupid, stupid question format. LOL


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## MackTheKnife (Jun 13, 2020)

akflightmedic said:


> Select all that apply....can kiss my arse!!
> 
> Such a stupid, stupid question format. LOL


I had 19 SATA on NCLEX!


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## FiremanMike (Jun 13, 2020)

So far the unit practice questions haven’t been horrible, some “check all that apply”.. most have taken more effort to decipher than much of my college up until now..

I don’t do well with questions like “what is the second step of the critical thinking process”..  I do better with “describe the importance of the critical thinking process”


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## MackTheKnife (Jun 14, 2020)

FiremanMike said:


> So far the unit practice questions haven’t been horrible, some “check all that apply”.. most have taken more effort to decipher than much of my college up until now..
> 
> I don’t do well with questions like “what is the second step of the critical thinking process”..  I do better with “describe the importance of the critical thinking process”


Don't forget Maslow.


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## FiremanMike (Jun 14, 2020)

MackTheKnife said:


> Don't forget Maslow.



I actually enjoyed and absorbed quite a bit from my Psych and sociology classes, I’m guessing that’ll help?


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## akflightmedic (Jun 15, 2020)

Yes....because the correct NURSING answer will cater to those needs prior to other needs we as Paramedics deem more important.


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## FiremanMike (Jun 15, 2020)

Excellent tip, thanks!


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## ffemt8978 (Jun 15, 2020)

akflightmedic said:


> Yes....because the correct NURSING answer will cater to those needs prior to other needs we as Paramedics deem more important.



This point bears repeating.


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## Capital (Jun 16, 2020)

Also, remember that nursing school exams are looking for the answer that only works at NCLEX Memorial Hospital. You have to leave real world answers behind for now. So aggravating


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## FiremanMike (Jul 10, 2020)

So I'm 5ish weeks in, this semester is a transition to RN and a pharm class.. So far it hasn't been terrible..

There are a LOT of homework and exam questions that are essentially "What about XXX order/med in this patient would require you to question the doctor on their order"..

Next semester begins my first clinical rotation (med-surg).  Supposedly only one of the hospital systems opened up to students (3 in the area), and they're still not sure how it will all play out.

One interesting thing I found about nursing school vs medic school.. There is no actual required number of clinical hours in nursing school.  Not that they would do it (hopefully) but I could technically have 0 hours of clinicals, the only requirement is that the nursing program attests that I am competent in a clinical setting.


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## Carlos Danger (Jul 10, 2020)

FiremanMike said:


> One interesting thing I found about nursing school vs medic school.. There is no actual required number of clinical hours in nursing school.  Not that they would do it (hopefully) but I could technically have 0 hours of clinicals, the only requirement is that the nursing program attests that I am competent in a clinical setting.


Yep. I became an RN without a single day of nursing clinical, through the old Excelsior program. You did have to be actively employed in a clinical setting, and there was a 3-day clinical exam at the end of the program that was absolutely brutal. Most graduates at that time were LPN's, which I think is really who the program was originally designed for.

Maybe you'll get lucky and at least have to do less clinical than you otherwise would. Some clinical experiences aren't bad at all. There is plenty to learn from a good preceptor.


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## FiremanMike (Jul 10, 2020)

Carlos Danger said:


> Yep. I became an RN without a single day of nursing clinical, through the old Excelsior program. You did have to be actively employed in a clinical setting, and there was a 3-day clinical exam at the end of the program that was absolutely brutal. Most graduates at that time were LPN's, which I think is really who the program was originally designed for.
> 
> Maybe you'll get lucky and at least have to do less clinical than you otherwise would. Some clinical experiences aren't bad at all. There is plenty to learn from a good preceptor.


I’m obviously ok with getting some clinical experience, but given my planned path, RN clinical time is unlikely to be hugely impactful to my ultimate practice environment..

I briefly looked into excelsior years ago but still had a lot of pre-reqs to do and at the time wasn’t 100% sure on my end game.  By the time I figured it out the local CC opened up their program.  I figured it’d be better to go with a known program..


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## Summit (Jul 10, 2020)

FiremanMike said:


> One interesting thing I found about nursing school vs medic school.. There is no actual required number of clinical hours in nursing school.  Not that they would do it (hopefully) but I could technically have 0 hours of clinicals, the only requirement is that the nursing program attests that I am competent in a clinical setting.



I'm not sure what school you are in, but operating under that model will prevent initial licensure in certain states.


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## FiremanMike (Jul 10, 2020)

Summit said:


> I'm not sure what school you are in, but operating under that model will prevent initial licensure in certain states.


I believe everyone is getting substantial leeway right now due to covid, it was just a few months ago that they allowed a bunch of nurses and docs graduate early.  My wife has a nurse at her facility who worked for a full 2 months before she could get in to take her NCLEX..


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## akflightmedic (Jul 10, 2020)

Yep...extensive leeway. My final semester was virtual clinicals.


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## PotatoMedic (Jul 10, 2020)

akflightmedic said:


> Yep...extensive leeway. My final semester was virtual clinicals.


Fully online nursing program in the future!


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## akflightmedic (Jul 10, 2020)

Based on my experiences of the past two years, it should definitely be trialed with those who already have experience...and I do not mean like Excelsior. But there is zero reason it could not be online.


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## FiremanMike (Jul 26, 2020)

As I'm studying for semester 1 finals, with questions that are supposed to ultimately prepare me for the NCLEX, I find it frustrating that questions and answers seem to be designed to test your ability to know exactly what they're asking versus whether you know how to complete a task..

i.e. - Which of these instructions would you give for XXX to ensure patient safety - Answer A, B, and D are all appropriate actions, but don't relate to patient safety.. 


And pharmacology.. Those questions seem to be irrelevant minutiae to me..


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## FiremanMike (Jul 26, 2020)

Pearl of wisdom - Any answer that contains some form of "Tell me what makes you feel that way" or "Help me understand why you're upset" is automatically the correct answer..


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## akflightmedic (Jul 26, 2020)

Jump through the hoops man...its their rigged game and it doesnt mean crapola once you graduate. 

My NCLEX shut off on question 60...I will never see a Careplan again. I am loving the ER RN life...but man, the past two years were freaking painful, illogical and most times downright stupid.


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## Akulahawk (Jul 27, 2020)

Those questions and answers that are in an "NCLEX style" are all there to get you to figure out how to parse the questions so that you can easily look at an NCLEX question and correctly answer it. One of the secondary benefits of those questions is that the professors can get a good idea how well the class is grasping the material, partly because there are sometimes multiple "correct" answers, but typically only ONE "most correct" answer. Incidentally, I also passed the NCLEX with my exam shutting off at the minimum. Knowing how the system does the scoring, that means my answer scores were never below a "fail" line and was consistently good enough to meet the "pass" rule at the minimum score. The same goes for anyone that passes these kinds of adaptive tests at minimum score. Even a single question past the minimum means the system wasn't entirely certain you met passing standard at some point, so it has to ask another question. 

Yes, you will see a care plan again, but you won't have to do them the same way you do them in nursing school. That is a bonus in and of itself! The whole point of doing those care plans is simple: get you to prioritize that care which is important and what to basically look for, along with learning what meds are typically prescribed in certain situations so you can act as a backup to the physician in making sure the meds are prescribed rationally.


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## akflightmedic (Jul 27, 2020)

Let me clarify...in my facility and where I work within my facility, I will never see a Careplan again.

When I was on clinicals, the floor nurses just ticked off they reviewed them. (This was a different facility). They themselves stated repeatedly they never use them and never do anything with them aside from ticking the box in the system. 

Anywho...in my bubble, they are long gone. As for the style of questions, it is supposed to help you critically think or develop those skills. That is a challenge when you come with experience and have already found "your flow" in patient care and already have a working base knowledge of the real world healthcare.

For example...I have three questions which pop out as I argued them passionately and I only "won" a reversal on one of them.

1. You have a patient returning from PACU, what is the FIRST thing you do?

Two of the choices I threw out immediately, then I had to choose between assessing LOC and applying pulse ox.

Well, I chose assess LOC because in my mind I would be doing this "Hey Mr. Smith, how are you? John, can you open your eyes, I am applying this to your finger, John?"

So that is assessing LOC FIRST...but the correct answer was apply pulse ox. (Always, always use ABCs no matter what you think, you do ABCs first!)

2. The question clearly described a person hyperventialting by action and blood gas.

Easy to throw out two choices as always. I then had either have the patient breathe in a paper bag, or calmly talk the patient down and slow their breathing.

Of course I chose calm them/coach their breathing because that is what I have done for the better part of my career as that is most effective and most recommended. Even every Evidence Based Medicine article I pulled up supported my position. The paper bag is NOT recommended. Sure it works but it is NOT best practice. 

But....they want you to breathe in a paper bag.


3. This is the one I WON!!!  

You are called into a room where a patient is complaining of shortness of breath. What is the first thing you do?

Again, threw out two, left with sit them up or apply nasal cannula.

The answer was apply nasal cannula. I argued this question till I was blue in the face. I said you would never not sit a patient first, as that may be all they needed without further intervention. They stuck to their ABC response and I could not find any source aside from common sense and experience that you sit them up first as it is least invasive. Heck, you take any non-medical trained person from the streets and put them in a room with grandma who says they cant breath, our first natural human reaction is to sit them up!!

Anyways, I argued and argued. Then one day on clinical, this same instructor was in a room where a patient complained of SOB. I was SO SO SO happy...when the first thing he did was sit the patient up to further eval. He did this reflexively.

Finally, out of two years of nursing school and a bazillion challenges...this was the one and only question reversal I won.

Long story short...."they" say they want you to critically think and use best practice. However, when you come with those skills and use them, "they" really do not want that. I wish I had more progressive school/instructors, however their methods are dated and they are stuck in an old school way of teaching nursing.

Jump through the hoops, then "you do you".


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## FiremanMike (Jul 27, 2020)

I'm fine with critical thinking, and I'm fine with transitioning to a "nurse mindset".. Honestly care plans don't even bother me THAT much, but here's an example of a study question from our guide this week..

What is the best way to minimize discomfort caused by the instillation of ear medication?
A. Warm the eardrops to room temperature
B. Wear treatment gloves during the application process
C. Ask the patient to sit while introducing the medication
D. Use a cotton-tipped applicator to remove any visible cerumen

The answer is A.  You'd do all of the rest of those things too (maybe not B), but only A addresses the patient's discomfort..

Like I said, it seems more about knowing exactly what the question is asking versus what you'd do..


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## FiremanMike (Aug 8, 2020)

Welp, 1 semester down out of 5..

I ended up with B's in both classes (pharm and the 'transition' course).  I'm not particularly happy about that, but the grading scheme is rough.  Only 150 total points for each class, homework is worth almost no points, meaning exam questions are worth about .75% of your final grade.. Plus the cutoff for A's is 92 there... It makes it very difficult to pull an A..

I *think* I have my study methodology down, which really involves spending hours doing the practice questions on elsevier.. I don't really care for this method, but it's what it is for now.  So far in college, I've found my best learning and retention comes from classes that starts each block with extensive study guides that must be filled out.  I'll take the first week of that unit to get that filled out and then pour over it until the exam.. Sadly it doesn't appear this program uses study guides :/

Clincals start next semester, every Friday evening for me on a med surg floor..


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## Akulahawk (Aug 9, 2020)

Grading in nursing school tends to be a bit tougher than what you might be used to. That being said, once you know how your program does its grading, make sure you do follow that... and that they do too. While your program may not use a "study guide" they may have some kind of outline that will show you the basics of how things do work and what you'll basically be doing every week. Not having a study guide does make things more difficult. You should also start getting a feel for how much work is required for achieving each letter grade, then determine what you are comfortable with as far as grade you are willing to earn. Then put in that much work. In my case, given that I had to work full time through the program, I found it easiest to accept a "B" grade most of the time. That was the best balance for me for study time, work time, sleep time, and class/clinical time. I was able to graduate with honors along with a few awards, but had certain circumstances been different, I could have graduated with high honors. I don't regret it. I made it all work, I got my degree, I passed the NCLEX the first time at minimum questions, and I found a job reasonably quickly in a specialty that I wanted. 

Just remember that because of your background, you'll be able to do patient assessments MUCH faster than most of your classmates, just remember to do the assessments the way the professors/clinical instructors want you to do them. My first patient as a 1st semester student nurse only took me about 3 minutes to do my "usual" assessment the way I knew how to do them. The way they wanted it done took about 30 minutes and then a whole lot of figuring out where in the computer to chart it all... Now my assessments take but a couple minutes and charting doesn't take too much time. My advice, don't bang your head against walls or pull your hair out because they want it done "their way." Just do it their way and get through the program. Then develop your own way and it'll certainly be a hybrid of what you do now and what you'll learn in nursing school. It's gonna be interesting. Maybe good, maybe bad, but definitely interesting!!


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## SandpitMedic (Aug 11, 2020)

Akulahawk said:


> My advice, don't bang your head against walls or pull your hair out because they want it done "their way." Just do it their way and get through the program.


Bingo


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## FiremanMike (Aug 11, 2020)

I'd like to think I'm far enough along professionally that I can recognize the game for what it is and play along... That said, I'm sure there will be times when this is hard


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## Akulahawk (Aug 11, 2020)

FiremanMike said:


> I'd like to think I'm far enough along professionally that I can recognize the game for what it is and play along... That said, I'm sure there will be times when this is hard


Yes, and when that happens, just remember what was quoted just above your post... Sometimes we forget when we get lost in the weeds of studying...


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## akflightmedic (Aug 11, 2020)

FiremanMike said:


> I'd like to think I'm far enough along professionally that I can recognize the game for what it is and play along... That said, I'm sure there will be times when this is hard




Quoting for posterity. I thought and said the same...I did not succeed at this endeavor. I know my instructors were so happy when school was over.


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## FiremanMike (Aug 11, 2020)

Are there any good podcasts out there for nursing students?


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## SandpitMedic (Aug 11, 2020)

FiremanMike said:


> Are there any good podcasts out there for nursing students?


There’s a really good one called “don’t forget to wipe front to back.” 😆😆😆


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## akflightmedic (Aug 12, 2020)

I highly recommend the youtube channel RegisteredNurseRN....she really does some amazing videos and explanations. If you can get past her accent, she was a tremendous help through nursing school, especially with prepping for exams and NCLEX.

And as always, Kahn Academy for back up.


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## DesertMedic66 (Aug 12, 2020)

akflightmedic said:


> I highly recommend the youtube channel RegisteredNurseRN....she really does some amazing videos and explanations. If you can get past her accent, she was a tremendous help through nursing school, especially with prepping for exams and NCLEX.
> 
> And as always, Kahn Academy for back up.


She is one of my go to for references on YouTube


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## OceanBossMan263 (Dec 15, 2020)

Has anyone currently enrolled in the Excelsior program gotten the low down on their new clinical education component? 

I see that they are adding some clinical education, but will also be voluntarily pulling out of ACEN, but retaining accreditation through Middle States and NYS Board of Regents


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## MackTheKnife (Dec 15, 2020)

OceanBossMan263 said:


> Has anyone currently enrolled in the Excelsior program gotten the low down on their new clinical education component?
> 
> I see that they are adding some clinical education, but will also be voluntarily pulling out of ACEN, but retaining accreditation through Middle States and NYS Board of Regents


Be careful. ACEN is the gold standard of accreditation.


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## OceanBossMan263 (Dec 15, 2020)

That is definitely going to hurt them.

What else will hurt is the realization after the last 2 semesters by the mainstream programs that there is a lot of learning that can be accomplished remotely. It's not out of the question for most if not all didactic material to be delivered remotely with only in-person attendance at labs and clinical. In theory, schools could even branch out on their clinical affiliations and enlist facilities farther from the physical university.

My funeral director program worked the same way... all didactic material online over 2 years followed by a 2-week capstone of clinical embalming labs and board review.


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## Summit (Dec 15, 2020)

Excelsior has initial practice limitations in a lot of states. This may cause them to have those restrictions in states where they don't, or lose ability to gain licensure period as some states required you graduate from an ACEN or CCNE accredited school to get licensure. Excelsior grads already cannot license in CA last I looked.


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## Akulahawk (Dec 15, 2020)

Summit said:


> Excelsior has initial practice limitations in a lot of states. This may cause them to have those restrictions in states where they don't, or lose ability to gain licensure period as some states required you graduate from an ACEN or CCNE accredited school to get licensure. *Excelsior grads already cannot license in CA last I looked.*


This has been the case for quite a long time. If you're an Excelsior grad from the VERY early 2000's or prior (there's a specific cut-off date), then you might be able to get licensed in California. I just don't recall if the cut-off involved completing Excelsior's program by that particular date or if a California RN license had to be obtained by an Excelsior grad by that date. 

In any event, the limiting factor by California is ensuring that didactic material and clinical experiences of the same subject are done concurrently. This is what bit Excelsior and also bit (and continues to bite) grads from non-California schools (especially the Philippines).


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## Summit (Dec 15, 2020)

Akulahawk said:


> This has been the case for quite a long time. If you're an Excelsior grad from the VERY early 2000's or prior (there's a specific cut-off date), then you might be able to get licensed in California. I just don't recall if the cut-off involved completing Excelsior's program by that particular date or if a California RN license had to be obtained by an Excelsior grad by that date.
> 
> In any event, the limiting factor by California is ensuring that didactic material and clinical experiences of the same subject are done concurrently. This is what bit Excelsior and also bit (and continues to bite) grads from non-California schools (especially the Philippines).


Yes and it also continues to bite them in other states that impose requirements that they find some other state to go work in for a while before they can be allowed to license in the restrictive states. Many of these states (eg Co) also hold the requirement that you have to graduate from a accredited school as I mentioned. The accreditation issue may permanently block licensure in many states.


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## Carlos Danger (Dec 17, 2020)

Akulahawk said:


> This has been the case for quite a long time. If you're an Excelsior grad from the VERY early 2000's or prior (there's a specific cut-off date), then you might be able to get licensed in California. I just don't recall if the cut-off involved completing Excelsior's program by that particular date or if a California RN license had to be obtained by an Excelsior grad by that date.





Akulahawk said:


> This has been the case for quite a long time. If you're an Excelsior grad from the VERY early 2000's or prior (there's a specific cut-off date), then you might be able to get licensed in California. I just don't recall if the cut-off involved completing Excelsior's program by that particular date or if a California RN license had to be obtained by an Excelsior grad by that date.


I’m pretty sure that as long as you enrolled in the Excelsior program by December 2003 then it doesn’t matter when you graduated; you are good.

For a while they were allowing people who enrolled after that to still be licensed as long as they jumped through hoops, but at some point they stopped that and now my understanding is that there is no way that an excelsior grad can ever be licensed in CA unless you were enrolled before 12/2003. Which is too bad, because the program actually attracted a lot of very strong candidates.


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## Akulahawk (Dec 17, 2020)

Carlos Danger said:


> I’m pretty sure that as long as you enrolled in the Excelsior program by December 2003 then it doesn’t matter when you graduated; you are good.
> 
> For a while they were allowing people who enrolled after that to still be licensed as long as they jumped through hoops, but at some point they stopped that and now my understanding is that there is no way that an excelsior grad can ever be licensed in CA unless you were enrolled before 12/2003. Which is too bad, because the program actually attracted a lot of very strong candidates.


The underlying regulations that California applied to Excelsior have actually been on the books for quite a long time prior to being applied/enforced against Excelsior students. About 5-ish years after they enforced the rules against Excelsior, they had a kind of "epiphany" moment and realized that they'd better enforce those rules generally (lest they give Excelsior an opening for appeal) and that's when it became a LOT more difficult for BSNs from the Philippines (in particular) to get licensed as an RN here. Do recall that it's not the depth or completeness of education that the California BRN is concerned about, it's the "concurrency" requirement of clinical and didactic subjects. If Excelsior were to be able to change things around enough to satisfy the concurrency requirements, their students might be able to get licensed in California. Unfortunately, given what Excelsior's model seems to be, I think that's going to be extremely difficult of an undertaking.


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## akflightmedic (Dec 17, 2020)

The ONLY place you can work in CA as an Excelsior grad is at the VA hospitals. I am happy I decided to never complete the program, I started two different times in the past 20 + years...LOL.

And just a few years ago Hutchinson CC was one of the best kept secrets for online Medic to RN. But now everyone knows and that wait list is very deep. I am sure there are other CC who have a similar program, just need to dig hard to find it.


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## Carlos Danger (Dec 18, 2020)

akflightmedic said:


> The ONLY place you can work in CA as an Excelsior grad is at the VA hospitals. I am happy I decided to never complete the program, I started two different times in the past 20 + years...LOL.
> 
> And just a few years ago Hutchinson CC was one of the best kept secrets for online Medic to RN. But now everyone knows and that wait list is very deep. I am sure there are other CC who have a similar program, just need to dig hard to find it.


If you had finished it after starting it 20+ years ago, you'd be able to work in CA as an Excelsior grad. In fact after a year of nursing experience there is no state in the US that you wouldn't be able to work.


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## akflightmedic (Dec 18, 2020)

True story...but there are far more Excelsior attempts or failures than there are grads....LOL. Self study and motivation is freaking hard, especially when I was younger! LOL

I did the traditional route at a very affordable local CC, I quit looking for shortcuts or bridges because none of them seemed all that much faster or easier and amazingly enough, I got the program done. Yep, as I said before, nursing school in general sucks, especially when experienced, however its all over now and the two years flew by.


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## DrParasite (Dec 18, 2020)

Carlos Danger said:


> If you had finished it after starting it 20+ years ago, you'd be able to work in CA as an Excelsior grad. In fact after a year of nursing experience there is no state in the US that you wouldn't be able to work.


I was going to ask about this... so (hypothetically speaking), if I am a medic in NC, and do the excelsior program to become a nurse in NC, pass the NCLEX and any other exam that is needed, and work for 2 years as a nurse at a hospital, I wouldn't be able to move to Ca and become an RN in a hospital in Los Angelas?


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## akflightmedic (Dec 18, 2020)

No you would not and it actually details all that on the Excelsior website itself. They have links and had to disclose it to all of its students. CA is one of states which requires your original school records, not just a license and experience from another state.






						Excelsior College
					






					www.rn.ca.gov
				






			https://www.rn.ca.gov/pdfs/forms/excelsiornewsrelease.pdf
		




			https://www.rn.ca.gov/pdfs/forms/excelsiorcourtdecision.pdf
		




			https://www.rn.ca.gov/pdfs/forms/ncsbn-clininstruct.pdf
		


I assume you are trying to mention the "Apply for license by endorsement"...and here is the link, and when you complete these two steps, you will be denied approval.






						Licensure by Endorsement
					






					www.rn.ca.gov
				





Completed "Verification of License" form or Nursys® Verification Application if your board of nursing participates in Nursys®. International graduates must also submit a "Verification of License" form from the board of nursing where the examination was taken (Page 12)
*NOTE: Nursys® verifications expire 90 days from the date of request. Please do not request your Nursys® verification prior to submission of your endorsement application or it may expire before your file can be fully evaluated.*
"Request for Transcript" form(s) completed and forwarded directly from your nursing school(s) with certified transcripts (Page 13)
And other states who do NOT accept Excelsior...

*California*, Virginia, Georgia and Maryland *do* not *accept* graduates from *Excelsior* Nursing School. According to *Excelsior*, *California's* Board of Nursing, prior to 2003, did *accept Excelsior College* graduates; but since that time, the state only accepts graduates from traditional nursing programs.

And even those who completed Excelsior prior to 2003 are a Case by Case evaluation


The Board of Nursing in Alabama indicates that graduates with significant hours of RN experience may apply for endorsement by the Alabama State Board, but each candidate will be evaluated on a case-by-case basis.

California stipulates that Excelsior ADN graduates who enrolled on or after December 6, 2003, may apply for endorsement, but they will be evaluated on a case-by-case basis.

There are internet rumors of "I have a friend who..." or "a colleague did..." attesting that they were Excelsior grads and gained endorsement, however both of these rumors were on forum boards, had no facts or names or first hand experience....and both stated they accomplished this with help of a lawyer, threats of a lawsuit, and one individual doing a rapid BSN online to aid his case. 

So can licensure happen by endorsement after getting experience in another state as an excelsior grad...?? Maybe...but the CA BON seems to indicate not.


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## akflightmedic (Dec 18, 2020)

Even more detailed hurdles to include extra clinical hours, etc to gain State licensure if Excelsior grad....exists in many states aside from the ones already mentioned above.









						States That Exclude the Excelsior Nursing School Degree | Synonym
					

Excelsior College School of Nursing, a New York based, accredited online nursing school, is an aggressive program for adult learners who have significant clinical health care experience. Recipient of the 2008 through 2011 National League for Nursing Center of Excellence in Nursing Education...




					classroom.synonym.com


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## FiremanMike (Dec 21, 2020)

Years ago before hybrid/blended online courses became so popular, excelsior was probably the only real option for medics.

Now, pretty much every RN program has a blended track which only requires 1-2 days per week in person.  Anyone with a flexible schedule should be able to commit to that without any problem.  Even if you have a more rigid work schedule, you should be able to get it done using vacation time and trades.

In short, there is literally no reason to choose excelsior anymore.  We’ve all heard the horror stories of the difficulty of the program, high failure rare, and states that refuse to license you, so why take the chance?


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## akflightmedic (Dec 21, 2020)

Well stated Fireman...even the "full time" community college program I attended which had no bridge, no hybrid schedule, was VERY manageable.

Freshman year I had lectures on Mon and Wed from either 0800-1200 or 0900-1300 and then a 12 hour clinical on Friday.

Senior year I had lectures on Tues and Thursdays similar times as above with a 12 hour clinical which was assigned and it would be on Monday, Wed, Fri or Saturday...you knew which day was yours well in advance. The only really busy time was when we did our 6 weeks of Psych rotation because those were 6 hour days, so you had clinical 2 x a week instead of the usual one.

*And the lectures were not mandatory, only the clinicals were!

I completed this traditional brick and mortar program all while working through depression, the sale of my large company, significant financial life changes, sale of marital home, sale of second LLC tied to ex, a divorce, lawyer proceedings every week either tied to divorce or the prior main company I owned, working full time and part time jobs in both EMS and hospital, and still found it very manageable.

Just saying...if you only have half of those stressors or less, and already have some healthcare experience, you will do just fine. Do not wait for the short cut, do not take on higher than needed expenses. By going to CC, you can also get federal loans if needed. Couple shift trades here or odd adjustments of your work schedule temporarily, you can get it done.

My entire nursing program start to finish cost me LESS than 15K !!
I am now in my BSN program. Again, I chose a small CC option and the program is online. This BSN will cost me less than 10K.

I took a full time ER staff position as a new grad RN. My base wage is $35/hour. Once you add my night shift differential, my weekend differentials, I am now close to $40. And I often pick up call back shifts and contract shifts, sometimes both combined. And if I plan it just right, I can be on overtime and then pick up CB/CP combined and easily put myself in the $110/hour range.
*Contract pay is $8 more an hour. Call Back is time and half. So if I am on OT and pick up the CB/CP shift I am making MORE than triple time per hour.

My whole point of sharing money is to motivate those on the fence. The long term return for nursing school is significant!! Short term discomfort for amazing gain. And do NOT overpay for your education. There are very affordable options and very flexible schedules. You will make a lot of money, you will have many job options and tons of career pathways. And you do NOT have to give up EMS.


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## FiremanMike (Jan 12, 2021)

Ramping up for next semester, tuition due tomorrow and class starts next week.  I have two 7 week blocks of peds then psych, and my last pharm class runs through the whole semester..


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## Akulahawk (Jan 12, 2021)

FiremanMike said:


> Ramping up for next semester, tuition due tomorrow and class starts next week.  I have two 7 week blocks of peds then psych, and my last pharm class runs through the whole semester..


Peds is usually both awesome/fun and heartbreaking. Psych can be an eye-opener, especially in terms of learning "therapeutic" conversation. You'll learn to remember details of a conversation with a patient (client?) because you'll have to chart on such details.


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## Peak (Jan 13, 2021)

FiremanMike said:


> Ramping up for next semester, tuition due tomorrow and class starts next week.  I have two 7 week blocks of peds then psych, and my last pharm class runs through the whole semester..



If you get the chance do your peds clinicals in a high acuity PICU, NICU, or Peds ED. There is a big difference between taking care of kids who are mildly sick and can't be at home versus those who are actually critically ill and you make a substantial difference for. In my opinion if people want to do peds to just play with the kids, they should have done child life.


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## Akulahawk (Jan 13, 2021)

Peak said:


> do your peds clinicals in a high acuity PICU, NICU, or Peds ED


Definitely THIS!!


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## FiremanMike (Jan 13, 2021)

Peak said:


> If you get the chance do your peds clinicals in a high acuity PICU, NICU, or Peds ED. There is a big difference between taking care of kids who are mildly sick and can't be at home versus those who are actually critically ill and you make a substantial difference for. In my opinion if people want to do peds to just play with the kids, they should have done child life.


Sadly, it's covid time..

I only get three clinical shifts, weeks 5-7, and we have little control over where we're going.. :/


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## Akulahawk (Jan 13, 2021)

FiremanMike said:


> Sadly, it's covid time..
> 
> I only get three clinical shifts, weeks 5-7, and we have little control over where we're going.. :/


As did I when I was doing clinicals. At least our destination was a peds center and they do have a PICU and NICU and a Peds ED. Placement for our rotation there wasn't up to us. We were told where to go and when to be there...


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## FiremanMike (Aug 15, 2021)

Still plugging away.. Spring ‘21 semester did not go well.. I’m ready to say it out loud, I failed the first Peds exam so bad that I was told I should withdrawal to avoid the F..   It was a HUGE blow to my ego, and while I still maintain there was a disparity between the curriculum and the exam, but I own my part which is that the shortcuts that got me through med surg did not work for Peds..

So I dropped peds and second block (maternity) so I could focus on just pharm 3 for the semester, took psych this summer and approached it completely different..  I worked my *** off, didn’t get even a minute behind, and did I mention I worked my *** off?  Still couldn’t pull the A, but passed handily and ready to finish this off..


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## Capital (Aug 15, 2021)

So many nurses I went to school with also had to repeat/redo a class, it happens. I love your attitude though, that is priceless! That kind of self-reflection and honesty is what I love working with, it means I can trust you. Kick *** this fall


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## FiremanMike (Dec 24, 2021)

Just finished up my Peds block, the one I failed back in the spring.  Ended up failing the first exam by 2 questions which put the pressure on bad for the final.  Spent the entire block stressed but especially the last 4 weeks.

Left the final exam positive I failed.  I even told the instructor on the way out that I didn’t think I pulled it off.  I needed a 59/75 to pass, ended up a with a 66/75 and passed to move on to the final semester.

A huge sigh of relief for sure, and the day after the grades came out, I realized how stressed I had been.  I felt like a new person.

I’m told last semester is kind of a “bring it all together” and NCLEX prep, definitely lower key than everything before it.  

I’m nearly there!


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## MackTheKnife (Dec 24, 2021)

FiremanMike said:


> Just finished up my Peds block, the one I failed back in the spring. Ended up failing the first exam by 2 questions which put the pressure on bad for the final. Spent the entire block stressed but especially the last 4 weeks.
> 
> Left the final exam positive I failed. I even told the instructor on the way out that I didn’t think I pulled it off. I needed a 59/75 to pass, ended up a with a 66/75 and passed to move on to the final semester.
> 
> ...


Congratulations!


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## Capital (Dec 25, 2021)

Congratulations!! Enjoy the break and then finish strong 👨‍🎓


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## MackTheKnife (Dec 25, 2021)

FiremanMike said:


> Still plugging away.. Spring ‘21 semester did not go well.. I’m ready to say it out loud, I failed the first Peds exam so bad that I was told I should withdrawal to avoid the F.. It was a HUGE blow to my ego, and while I still maintain there was a disparity between the curriculum and the exam, but I own my part which is that the shortcuts that got me through med surg did not work for Peds..
> 
> So I dropped peds and second block (maternity) so I could focus on just pharm 3 for the semester, took psych this summer and approached it completely different.. I worked my *** off, didn’t get even a minute behind, and did I mention I worked my *** off? Still couldn’t pull the A, but passed handily and ready to finish this off..


Re-read this post and the shortcuts popped out at me. Not sure which one(s) you're using, but be careful as they can give some success which can lead to a false sense of confidence. My cohort used them with some degree of success, but taking notes and highlighting text was the winner for me.
As a medic, I had to change my thinking from "what do I need to do?" to "what is my assessment?" You know, ADPIE. I failed my first med-surg exam (55!) because I was thinking like a medic. I quickly figured it out and did fine.
Proud of your perseverance and drive. Keep it going, brother! BTW, what school?


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## FiremanMike (Dec 27, 2021)

MackTheKnife said:


> Re-read this post and the shortcuts popped out at me. Not sure which one(s) you're using, but be careful as they can give some success which can lead to a false sense of confidence. My cohort used them with some degree of success, but taking notes and highlighting text was the winner for me.
> As a medic, I had to change my thinking from "what do I need to do?" to "what is my assessment?" You know, ADPIE. I failed my first med-surg exam (55!) because I was thinking like a medic. I quickly figured it out and did fine.
> Proud of your perseverance and drive. Keep it going, brother! BTW, what school?


The shortcuts I used were that I didn't read the chapters or listen to the recorded lectures, I just blasted the end of chapter questions and elsevier EAQs, I also half-*** did my homework assignments.

This "worked" for med-surg, but was a dramatic failure for peds.

I tend to keep my identity somewhat private, but it is a community college program in the midwest.  A well respected program in the area, but as I'm finding as a student, it's not without it's issues.

As for thinking like a medic vs RN, I think I've finally found the words to describe the difference.  Medics learn about a small amount of disease processes, how they can kill you, and how to prevent them from killing you for the 30 minute transport.  RNs learn about many more conditions, how they can kill you, but then how people live with them for days/weeks/the rest of their lives.  What medications they might be taking, what medications those medications might interact with.. How one condition interacts with another.. How a condition changes XX about your body, and how to assess to catch early signs/symptoms of those conditions, and finally what education techniques you can give your patient to try to prevent conditions from becoming worse.. 

I know there are RN students who are capable of breezing through school and somehow making it without understanding that level of depth, but it's just not how my brain works.  I can't answer a test question unless I understand the full depth and can put it together in my head.


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## mgr22 (Dec 27, 2021)

FiremanMike said:


> As for thinking like a medic vs RN, I think I've finally found the words to describe the difference.  Medics learn about a small amount of disease processes, how they can kill you, and how to prevent them from killing you for the 30 minute transport.  RNs learn about many more conditions, how they can kill you, but then how people live with them for days/weeks/the rest of their lives.  What medications they might be taking, what medications those medications might interact with.. How one condition interacts with another.. How a condition changes XX about your body, and how to assess to catch early signs/symptoms of those conditions, and finally what education techniques you can give your patient to try to prevent conditions from becoming worse..


Based on that, how much additional training do you think community paramedics need compared to conventional medics?


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## FiremanMike (Dec 27, 2021)

mgr22 said:


> Based on that, how much additional training do you think community paramedics need compared to conventional medics?



That's a complicated question and based entirely on the design of the program.  Could range anywhere from just identifing risk factors and linking people up with community resources which really needs nothing on up to a program with medical director oversight where the CP is going out and trying to un-**** their patient and the 40 different medicines they're on from 3 different providers, then I'd say an RN.. 

Our CP is closer to the latter, and I tell him regularly I think he'd benefit from RN school, but he doesn't have the energy..


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## MackTheKnife (Dec 28, 2021)

FiremanMike said:


> The shortcuts I used were that I didn't read the chapters or listen to the recorded lectures, I just blasted the end of chapter questions and elsevier EAQs, I also half-*** did my homework assignments.
> 
> This "worked" for med-surg, but was a dramatic failure for peds.
> 
> ...


Again, what nursing school?


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## FiremanMike (Dec 28, 2021)

MackTheKnife said:


> Again, what nursing school?


Again, I like to keep somewhat anonymous on Internet forums. Naming my college pretty much outs me as my resume is pretty unique in my area.

It’s a community college in the Midwest


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## MackTheKnife (Dec 28, 2021)

FiremanMike said:


> Again, I like to keep somewhat anonymous on Internet forums. Naming my college pretty much outs me as my resume is pretty unique in my area.
> 
> It’s a community college in the Midwest


Are you on the FBI's Top Ten Wanted List?


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## akflightmedic (Dec 29, 2021)

Leave Hutchinson CC alone! He wants to be anonymous....


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## FiremanMike (Dec 29, 2021)

MackTheKnife said:


> Are you on the FBI's Top Ten Wanted List?


I just don’t want anyone to ever complain to my city about something I did or said online..


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## HardKnocks (Dec 29, 2021)

FiremanMike said:


> Just finished up my Peds block, the one I failed back in the spring.  Ended up failing the first exam by 2 questions which put the pressure on bad for the final.  Spent the entire block stressed but especially the last 4 weeks.
> 
> Left the final exam positive I failed.  I even told the instructor on the way out that I didn’t think I pulled it off.  I needed a 59/75 to pass, ended up a with a 66/75 and passed to move on to the final semester.
> 
> ...


Good job

From a fellow OG..lol

Isn't 50 the new 30????


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## FiremanMike (Dec 29, 2021)

HardKnocks said:


> Good job
> 
> From a fellow OG..lol
> 
> Isn't 50 the new 30????


I'll let you know after I lose this weight and get back in shape after nursing school.

I'm going to invent a new diagnosis - Nursing School induced Metabolic Syndrome..

The nursing diagnoses would be "Imbalanced nutrition, Impaired Social Isolation, Imbalanced alcohol consumption, and Anxiety aeb a complete inability to communicate with other people in the week leading up to exams"


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## E tank (Dec 29, 2021)

FiremanMike said:


> I'll let you know after I lose this weight and get back in shape after nursing school.
> 
> I'm going to invent a new diagnosis - Nursing School induced Metabolic Syndrome..
> 
> The nursing diagnoses would be "Imbalanced nutrition, Impaired Social Isolation, Imbalanced alcohol consumption, and Anxiety aeb a complete inability to communicate with other people in the week leading up to exams"


I think someone beat you to it a few decades ago...called that 'dorm butt'....


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## DrParasite (Dec 29, 2021)

E tank said:


> I think someone beat you to it a few decades ago...called that 'dorm butt'....


I believe that's called the freshman 15...


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## FiremanMike (Dec 29, 2021)

DrParasite said:


> I believe that's called the freshman 15 25...


Fixed that for yah.. lol


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## HardKnocks (Dec 29, 2021)

"Imbalanced Alcohol Consumption" = I usually balance my alcohol consumption with an In N Out Burger in the other hand.....


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## MackTheKnife (Feb 1, 2022)

paramedic5555 said:


> FiremanMike I'm kinda late to the post but wanted to say congratulations, this is awesome! My name is Reggie and I also went thru a Paramedic to RN Bridge program and graduated in May 2021. Best of luck to you man and please reach out if I can help or answer any questions for you. I blogged my way thru Nursing school at Paramedic 2 RN Journey and also recently started a Youtube channel, The Paramedic 2 RN Guy as a way to give back by sharing my journey. I hope everything has gone well for you!


Quizlet.com is a great resource. Just saying.


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## FiremanMike (Mar 25, 2022)

Well I am in the final stretch, about 6 weeks to go and I’ve scored high enough on exams 1 and 2 that I can miss nearly half the questions on the final exam and still pass.

Two weeks ago I applied for a part time ER nurse position, a tricky predicament as getting a new grad position in the ER isn’t super common but getting a new grad position with the ability to only work part time hours is even more uncommon.  Within 6 days of my application I had a phone interview, an in person interview, and a job offer (pending licensure, obviously).  As much as I’d love to leave the FD now to dive head in to my next career, the difference in pension from today and just a short 3.5 years from now is about $40k per year for the rest of my life (or my wife’s life, whoever dies last)

I will reserve my closing thoughts on this overall journey until after my pinning ceremony.  While it’s highly unlikely I’ll fail my final, which is over EKGs, mass casualty/triage, ACLS, and acid base balance, it is possible and I don’t want to jinx it.


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## MackTheKnife (Mar 25, 2022)

FiremanMike said:


> Well I am in the final stretch, about 6 weeks to go and I’ve scored high enough on exams 1 and 2 that I can miss nearly half the questions on the final exam and still pass.
> 
> Two weeks ago I applied for a part time ER nurse position, a tricky predicament as getting a new grad position in the ER isn’t super common but getting a new grad position with the ability to only work part time hours is even more uncommon.  Within 6 days of my application I had a phone interview, an in person interview, and a job offer (pending licensure, obviously).  As much as I’d love to leave the FD now to dive head in to my next career, the difference in pension from today and just a short 3.5 years from now is about $40k per year for the rest of my life (or my wife’s life, whoever dies last)
> 
> I will reserve my closing thoughts on this overall journey until after my pinning ceremony.  While it’s highly unlikely I’ll fail my final, which is over EKGs, mass casualty/triage, ACLS, and acid base balance, it is possible and I don’t want to jinx it.


You applied but aren't sure after interviews and a job offer? Why don't you finish school, pass NCLEX, and then apply in 3.5 years???


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## FiremanMike (Mar 25, 2022)

MackTheKnife said:


> You applied but aren't sure after interviews and a job offer? Why don't you finish school, pass NCLEX, and then apply in 3.5 years???


I’m going back to 24/48 at work and going to work part time as an ER nurse until it’s time to retire from FD


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## Carlos Danger (Mar 25, 2022)

FiremanMike said:


> Well I am in the final stretch, about 6 weeks to go and I’ve scored high enough on exams 1 and 2 that I can miss nearly half the questions on the final exam and still pass.
> 
> Two weeks ago I applied for a part time ER nurse position, a tricky predicament as getting a new grad position in the ER isn’t super common but getting a new grad position with the ability to only work part time hours is even more uncommon.  Within 6 days of my application I had a phone interview, an in person interview, and a job offer (pending licensure, obviously).  As much as I’d love to leave the FD now to dive head in to my next career, the difference in pension from today and just a short 3.5 years from now is about $40k per year for the rest of my life (or my wife’s life, whoever dies last)
> 
> I will reserve my closing thoughts on this overall journey until after my pinning ceremony.  While it’s highly unlikely I’ll fail my final, which is over EKGs, mass casualty/triage, ACLS, and acid base balance, it is possible and I don’t want to jinx it.


Almost like deja vu reading this, lol.

My first nursing job was a PT position in a level 1 trauma center ED, which I did while still working FT as a flight paramedic. They were super reluctant to hire a new grad nurse into the ED - especially part time - but made exception due to my extensive EMS experience. I remember thinking "not sure why there are making a big deal out of this; I've been doing this crap for years, in even harder environments". Turns out, my ignorance could not have been more profound and I struggled in that role for quite a while. I eventually did OK but then moved on to the SICU where I also struggled a fair amount, but made my way and learned a ton about taking care of really (REALLY) sick patients.

I am sure you will do fine - but the challenge is not over. And ultimately you will be super glad that you did this. Good luck on your last few weeks!


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## FiremanMike (Mar 25, 2022)

Carlos Danger said:


> My first nursing job was a PT position in a level 1 trauma center ED, which I did while still working FT as a flight paramedic.
> 
> They were super reluctant to hire a new grad nurse into the ED - especially part time - but made exception due to my extensive EMS experience. I remember thinking "not sure why there are making a big deal out of this; I've been doing this crap for years, in even harder environments".
> 
> ...


We had those same discussions in my interview and I have the same fear of overconfidence. 

I am eager to start practicing and learning all the ER has to teach me but very nervous about how much I still don’t know.

Thanks for the encouragement!


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## Carlos Danger (Mar 25, 2022)

FiremanMike said:


> We had those same discussions in my interview and I have the same fear of overconfidence.
> 
> I am eager to start practicing and learning all the ER has to teach me but very nervous about how much I still don’t know.
> 
> Thanks for the encouragement!


You'll do fine, man. Seriously. Nervous is good, and you will have some crappy days here and there, but there's nothing to dread.

Like I said, you will ultimately be really glad that you did this.


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## MackTheKnife (Mar 25, 2022)

FiremanMike said:


> I’m going back to 24/48 at work and going to work part time as an ER nurse until it’s time to retire from FD


Thanx. Your post wasn't clear. This clears it up. Good luck to you. The organized, frenetic pass in the ED will suit you well. Most floor nurses can't handle it.


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## Akulahawk (Mar 29, 2022)

MackTheKnife said:


> The organized, frenetic pass in the ED will suit you well. Most floor nurses can't handle it.


I tend to agree! I'm a firm believer in the idea that ED nurses are the Squirrels of the Nursing world. People that have worked in EMS probably are much more accustomed to rolling with whatever comes along than floor (or ICU) nurses do... In my ED, we occasionally have Tele nurses come down to provide care for our Tele patients that have to hold in the ED. Most of them just can't handle having a new patient drop into one of their assigned rooms... There are a few that love working with us and jump in to help whenever there's a need!


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## MackTheKnife (Mar 29, 2022)

Akulahawk said:


> I tend to agree! I'm a firm believer in the idea that ED nurses are the Squirrels of the Nursing world. People that have worked in EMS probably are much more accustomed to rolling with whatever comes along than floor (or ICU) nurses do... In my ED, we occasionally have Tele nurses come down to provide care for our Tele patients that have to hold in the ED. Most of them just can't handle having a new patient drop into one of their assigned rooms... There are a few that love working with us and jump in to help whenever there's a need!


It's funny to see the tele nurses lose their minds when they see what we have to do. Like getting two or three rescue patients at once and having to get them triaged, hooked up to the monitor, get lines started, call a Code Stroke and/or a Code STEMI. Or just two or three lazy people who called rescue cause they thought they'd get seen quicker.


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## Akulahawk (Mar 31, 2022)

MackTheKnife said:


> It's funny to see the tele nurses lose their minds when they see what we have to do. Like getting two or three rescue patients at once and having to get them triaged, hooked up to the monitor, get lines started, call a Code Stroke and/or a Code STEMI. Or just two or three lazy people who called rescue cause they thought they'd get seen quicker.


The one _good_ thing about having Tele nurses sent to help out with the ED Tele hold patients (they're admitted, awaiting in-patient room availability) is that those nurses get a _good _look at what ED nurses do and why the reports we give are _not_ like what they are used to when getting/giving report. They also begin to understand why when we say that we were busy, we were _really_ busy dealing with something because when we're not busy, we're still quite busy doing stuff. I will say that I'm often quite in awe of their ability to do time management as that's much of their day, but in the ED, we do priority management instead... 

As to the lazy people that call the Rescue, well, they _do_ get seen quicker by triage and a Provider, but quite often they get bounced out to lobby/chairs so they get taken care of in accordance with the severity of their problem. Some patients come in, get seen, get frustrated, leave, call 911, get transported to the other side of the ED, only to end up back where they started...


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## MackTheKnife (Apr 1, 2022)

Akulahawk said:


> The one _good_ thing about having Tele nurses sent to help out with the ED Tele hold patients (they're admitted, awaiting in-patient room availability) is that those nurses get a _good _look at what ED nurses do and why the reports we give are _not_ like what they are used to when getting/giving report. They also begin to understand why when we say that we were busy, we were _really_ busy dealing with something because when we're not busy, we're still quite busy doing stuff. I will say that I'm often quite in awe of their ability to do time management as that's much of their day, but in the ED, we do priority management instead...
> 
> As to the lazy people that call the Rescue, well, they _do_ get seen quicker by triage and a Provider, but quite often they get bounced out to lobby/chairs so they get taken care of in accordance with the severity of their problem. Some patients come in, get seen, get frustrated, leave, call 911, get transported to the other side of the ED, only to end up back where they started...


ED RN: "I'm calling report on John Doe"
Floor RN's first question: "How's their skin?"


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## FiremanMike (Apr 1, 2022)

MackTheKnife said:


> ED RN: "I'm calling report on John Doe"
> Floor RN's first question: "How's their skin?"


During my med-surg clinical, my hand-off reports are what gets criticized the most by my instructors because it's not a proper SBAR..  In my head I'm thinking "I've been giving hand-off reports for 20 years now, I know how to communicate" but I just gotta play the game lol


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## MackTheKnife (Apr 1, 2022)

FiremanMike said:


> During my med-surg clinical, my hand-off reports are what gets criticized the most by my instructors because it's not a proper SBAR..  In my head I'm thinking "I've been giving hand-off reports for 20 years now, I know how to communicate" but I just gotta play the game lol


I hear you! I got the same sh*t along with, "remember you're a nursing student, you can't do medic stuff" ad nauseam! I finally told my instructor to STFU in polite terms.


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## Akulahawk (Apr 1, 2022)

MackTheKnife said:


> ED RN: "I'm calling report on John Doe"
> Floor RN's first question: "How's their skin?"


The ones that get sent to work with us... yeah, they learn we don't bother with that unless it's immediately pertinent. IOW: Skin? Check... they've got theirs...


FiremanMike said:


> During my med-surg clinical, my hand-off reports are what gets criticized the most by my instructors because it's not a proper SBAR..  In my head I'm thinking "I've been giving hand-off reports for 20 years now, I know how to communicate" but I just gotta play the game lol


Same. Had to learn to play the game. Including: Can't do medic stuff...


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## E tank (Apr 1, 2022)

With the EMR nowadays, handoff reports should pretty much consist of "got any questions?"


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## Akulahawk (Apr 1, 2022)

E tank said:


> With the EMR nowadays, handoff reports should pretty much consist of "got any questions?"


You'd think so...


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## MackTheKnife (Apr 1, 2022)

E tank said:


> With the EMR nowadays, handoff reports should pretty much consist of "got any questions?"


It should but it doesn't happen.


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## FiremanMike (May 5, 2022)

Tuesday morning I took my last exam in nursing school and am officially done.  Final grades haven’t posted yet but I am well above passing.

All that’s left is the NCLEX!


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## DrParasite (May 5, 2022)

FiremanMike said:


> Tuesday morning I took my last exam in nursing school and am officially done.  Final grades haven’t posted yet but I am well above passing.
> 
> All that’s left is the NCLEX!


That's awesome!  

random question:  do grades in nursing school count?  I know the NCLEX is the nursing board, which you want to pass, but if you have a 70 average or a 95 average, does that matter?  do employers require new nurses to submit transcripts?  or ask for proof of GPA?  do they rank you by grades, and publish a numerical ranking?

I remember in EMT class, as long as you passed every exam, no one cared, as long as you passed the state exam.  and after you got your first paying job, no one cared what your grades were, or where you went to school. 

I was wondering if that was how nursing school was.


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## FiremanMike (May 5, 2022)

DrParasite said:


> That's awesome!
> 
> random question:  do grades in nursing school count?  I know the NCLEX is the nursing board, which you want to pass, but if you have a 70 average or a 95 average, does that matter?  do employers require new nurses to submit transcripts?  or ask for proof of GPA?  do they rank you by grades, and publish a numerical ranking?
> 
> ...


No transcripts required, but C is 76-83, B is 84-91, A is 92+.  You must have a 76 to pass and you must also have a 76+ average on your exams.  So if you had 100% on all your homework/quizzes/projects but only a 75.9% average on your exams, you still fail that class..


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## FiremanMike (May 5, 2022)

Oh, and fail two classes and you’re out of the program.  It’s added stress and anxiety for the sake of.. “that’s how it was for us” I guess?


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## Akulahawk (May 5, 2022)

DrParasite said:


> That's awesome!
> 
> random question:  do grades in nursing school count?  I know the NCLEX is the nursing board, which you want to pass, but if you have a 70 average or a 95 average, does that matter?  do employers require new nurses to submit transcripts?  or ask for proof of GPA?  do they rank you by grades, and publish a numerical ranking?
> 
> ...


In order to get through nursing school, you have to pass the coursework. That's a given. Once you graduate and you're ready to take the NCLEX, it's like the Paramedic exam... basically pass/fail. The NCLEX went to CBT testing a LONG time ago and you want to be consistently "above passing standard." If you're AT or BELOW standard in any area, the computer will ask you more questions until it's satisfied that it's found your limit. If you're above passing,  you pass. If not, you don't. The NCLEX CBT exam is about determining (within a certain confidence interval) that you possess sufficient knowledge and ability to BEGIN to be nurse. If you're consistently above standard for the entire length of the exam, the computer could shut off the exam at 75 questions. That's the minimum. Any number of questions beyond minimum means you had some area that you were a bit weak in, so the computer had to ask additional questions to determine pass/fail. You could also get chosen to do the entire exam, but that's a random thing, but that takes HOURS to do. 

However, once you pass the NCLEX, nobody cares (or knows) what you scored on it, because the grading system doesn't do a "score." If you pass, you pass. Where your grades come into play is if you decide to further your education beyond Nursing School. In my case, I have an ADN. I also have a Bachelor's but not in Nursing... My transcripts would need to be evaluated for possible entry to either an BSN or MSN program if I choose to go further in the nursing education. My employers couldn't care less what grades I got. All they care is that I have a pulse and a valid RN license...


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## MackTheKnife (May 5, 2022)

DrParasite said:


> That's awesome!
> 
> random question:  do grades in nursing school count?  I know the NCLEX is the nursing board, which you want to pass, but if you have a 70 average or a 95 average, does that matter?  do employers require new nurses to submit transcripts?  or ask for proof of GPA?  do they rank you by grades, and publish a numerical ranking?
> 
> ...


NCLEX is a pass or fail exam. The maximum number of questions is 265. 25 questions are experimental and don't count. I got 75 questions in 50 minutes when the computer shut down, I passed. If you get to 265, you pass. The questions are A, B, C, D and you pick the "most correct" answer. Then there are SATA, Select All That Apply". These are the tough ones. Nothing from school applies.


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## DesertMedic66 (May 5, 2022)

It’s the same testing process as NREMT…


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## Akulahawk (May 5, 2022)

MackTheKnife said:


> NCLEX is a pass or fail exam. The maximum number of questions is 265. 25 questions are experimental and don't count. I got 75 questions in 50 minutes when the computer shut down, I passed. If you get to 265, you pass. The questions are A, B, C, D and you pick the "most correct" answer. *Then there are SATA, Select All That Apply". These are the tough ones*. Nothing from school applies.


I think the actual time it took me to do the 75 questions themselves was just under an hour. Walking into and out of the testing center was certainly less than 90 minutes. That was definitely an experience... Though I must say that if you get to 265, you're highly likely to pass... but going that far means you're right on the bubble between pass/fail for the entire exam. Oh, and you just _had_ to bring up the SATA questions... I completely _loathe_ them. They're just T/F type questions but... you must choose wisely for all. 

Oh and it was quite a surprise when the computer suddenly stopped the exam...


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## akflightmedic (May 6, 2022)

And here is the Pro-Tip for finding out if you passed NCLEX the very same day.

All of us waited a couple hours after, but you can probably do it sooner. However, once you have completed the test, log into the Prometric testing site and attempt to schedule yourself to take the NCLEX again. And yes, it will have you enter your CC info again, you will choose a date...and then when you hit submit, it will say something like "sorry, you cannot sign up right now" or something like that. If you get this message, you PASSED! 

If you do not get that message and they charge your CC, you failed. LOL

The above method was mentioned in several online forums, my class tried it. The results were 100% accurate for us.


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## FiremanMike (May 6, 2022)

akflightmedic said:


> And here is the Pro-Tip for finding out if you passed NCLEX the very same day.
> 
> All of us waited a couple hours after, but you can probably do it sooner. However, once you have completed the test, log into the Prometric testing site and attempt to schedule yourself to take the NCLEX again. And yes, it will have you enter your CC info again, you will choose a date...and then when you hit submit, it will say something like "sorry, you cannot sign up right now" or something like that. If you get this message, you PASSED!
> 
> ...


I’m not especially worried about it.  We do practice exams throughout final semester.  Apparently if you get over 800 on the final, you’re likely to pass, I got almost 1100..


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## akflightmedic (May 6, 2022)

Yes, but I wanted to know NOW!!! LOL


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## FiremanMike (May 7, 2022)

akflightmedic said:


> Yes, but I wanted to know NOW!!! LOL


how long do results take normally?


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## akflightmedic (May 7, 2022)

Depends on your state BON as they have to review/accept the results and then issue your license.


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## Akulahawk (May 7, 2022)

akflightmedic said:


> And here is the Pro-Tip for finding out if you passed NCLEX the very same day.
> 
> All of us waited a couple hours after, but you can probably do it sooner. However, once you have completed the test, log into the Prometric testing site and attempt to schedule yourself to take the NCLEX again. And yes, it will have you enter your CC info again, you will choose a date...and then when you hit submit, it will say something like "sorry, you cannot sign up right now" or something like that. If you get this message, you PASSED!
> 
> ...


This system can be very accurate but you do need to wait a couple hours first. Your test needs to be verified a 2nd time before this becomes 100% accurate. I suspect they transmit tests every hour so... therefore just wait an hour or so before you try this. Big downside of this "trick" is that it does put your funds at risk every time you do it. If one evaluation says you didn't pass and the 2nd verification evaluation says you have and you try this between evaluation passes, the system will take your money and they won't refund it if they later determine you've actually passed. That being said, if you've failed, at least you've pre-paid for the 2nd attempt! Don't attempt this trick more than once because you can fail, get charged a couple hundred dollars, and on 2nd eval still fail, and you can get charged yet a 2nd time... 

The older way was less risky. They had you schedule an exam and then pay for it. If it wouldn't take you to the CC entry page, you passed... then they got wise and had you enter your CC before scheduling the exam. So if your card isn't charged, you pass...


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## Capital (May 10, 2022)

Congratulations! Just keep doing some Kaplan or UWorld questions everyday until the NCLEX and you'll do great!


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## FiremanMike (Jun 12, 2022)

And after this morning, I am officially a licensed RN!


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## MMiz (Jun 12, 2022)

FiremanMike said:


> And after this morning, I am officially a licensed RN!


Congratulations!


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## Akulahawk (Jun 19, 2022)

FiremanMike said:


> And after this morning, I am officially a licensed RN!


Congratulations!


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