Accepted to RN bridge!

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FiremanMike

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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..
 

Summit

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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

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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..
 

akflightmedic

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

PotatoMedic

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akflightmedic

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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

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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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akflightmedic

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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.
 

Akulahawk

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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.
 

akflightmedic

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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

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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

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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..
 

Akulahawk

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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!!
 

SandpitMedic

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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

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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 :)
 

Akulahawk

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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...
 

akflightmedic

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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. :)
 

SandpitMedic

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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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