Completed my 1st year as an RN! (My Advice)

 I just completed my first year as a RN! I didn't expect so many twist and turns. June 2021, I started my New Grad Residency on a Covid Floor (Gen Medicine Step-Down). From the start, I knew that Med-Surg / floor nursing wasn't my thing! After a couple of weeks, I realized that it wasn't, so I resigned. I loved the hospital, loved the atmosphere and culture. But, the unit wasn't a fit for me. I later found a job in the Emergency Department and Surgical Services. I love it, and it was more a fit for me. I'm settling in my role as a nurse and getting comfortable. I love being able to use my paramedic skills and mindset again. Your skills will be INVALUABLE in nursing. You will be MILES ahead of any new grad. People will assume that you have been a nurse for a long time. I had to get used to IV pumps, EPIC, using Pixis, and ORDERS LOL! Nursing is a different animal, and I'm working harder than when I was a paramedic. This time instead of one patient, I have 3 to 4. 

MY ADVICE:

New Grad Residencies are VERY competitive. The current nursing shortage is making it worse. There are just not that many preceptors available to train new nurses. My unit only had 4 slots, but 100 applicants. New Grad Residencies only open 2 times a year. Don't get discouraged like I did when interviewing. I wish someone would have told be to be patient. I took the FIRST job I was offered, then quit a month later. If you plan to work in a hospital, (in-patient) experience is must. I have friends that "waited" and worked at clinics (outpatient), now having a hard time finding "in-patient" jobs. It takes a learning curve to work in a hospital, if you have never worked in one. You only get X number of weeks to orient to that unit, before you are turn loose to practice solo. If you don't have inpatient experience, but you have more than 1 year nursing experience, you are NOT a new grad. 

After your new grad period, go to another system. Don't stay and take the pay raise. If you do, you will be underpaid. My base pay increased by $10/hr when I left. If I would have stayed, my raise would have been $1 for completing my residency. See the difference? 

If you are at this stage, congrats........ see ya soon! 

Happy Nursing! 

 

NCLEX ATT, Test and Results!

 I received my ATT (Authorization to Test) from the NCSBN (National Council States Board of Nursing) on 05/19/2021 (5 days after graduation). You have to go on their website to register for the  NCLEX with Pearson Vue. Once you graduate, & your degree is confirmed, the program will send the info to the State Board of Nursing (in your state). Make sure that you pay the $200 after your register to take the NCLEX before you receive the ATT. If not, you won't get it! After you receive your ATT, THEN you can schedule a test date. I originally scheduled for 06/03. On 05/28 I felt comfortable enough to take it (UWORLD, I got thru 71% of the test bank w/ a good average and landed in the 84 percentile). I passed the 1st NCLEX assessment with a "Highly Likely" to pass, and 7 of my classmate have already taken and passed NCLEX. What was I waiting for......so I did something really brave & moved my date for the next day! 

I took NCLEX on 05/28 at 09:15am. It was a beast! The 1st 8 questions I felt comfortable, then it gave me EVERYTHING I was weak in! I kept as cool as I could be! I walked out feeling defeated. How could I have had one of the highest averages in the class, passed the exit hesi, cat hesi, & Uworld assessment, & do so poorly on NCLEX? I had to wait 48hrs for results. I did NO pvt tricks or anything....just waited! This morning I got my results!

PASS! 

Let me re-introduce myself...I'm Reginald Santiago, RN, EMT-P!!!!!!!

05/14/2021 Graduation Day

 Today is my graduation. I feel "accomplished"! Hopefully you will also. You have worked hard for this day. It's here. Unfortunately, due to COVID restrictions, this is virtual. At the same time, I get to enjoy this day with my wife and family watching from their homes. As I look forward to my new beginning, was it worth it? YES! Going from Medic to RN gave me $19.85 more dollars/hr, the opportunity to advance degree & career wise. Was it worth the move? YES! It was tough as hell. Some days and test felt like it was working against me. I can say, the drive (1hr 20min) was really therapeutic for me. My mind felt clear, like I was doing the right thing. I didn't like how my previous job "forced" me to choose between school & work, BUT I needed to see that they were NOT in my corner, even when they said they were! Because I have weathered the storm, I have many career options open to me to advance. Hopefully you will see that also. 

05/11/2021 CAT HESI EXAM / Officially Finished (Paramedic to RN)

 Today I took the CAT exit exam and passed. That means I'm officially ready for NCLEX. I received my Exit letter from the program today also. We did practice for the pinning ceremony that's going to be on Monday 17th. We graduate this Friday the 14th.

Enjoy yourself! You have made it! 

Overall, it has been tough. It was more challenging than I originally thought. It's been a very humbling experience, thinking that my paramedic experience would get me though. I was a looooong way off! Take this school serious, make the time for study, and remember that you have to fight for your seat in the program (no matter where you go). If you get, respect it and work like someone is trying to get your seat! Wish me luck on the NCLEX....I wish you guys well....I'm still debating if I will continue posting after this blog!

If not, Happy Nursing & hopefully you got some insight on what the Paramedic to RN transition is like!

04/30/2021 Finished Preceptorship/Capstone

 I finished my Mandatory 120 hr Preceptorship. Overall, my experience was GREAT! I can say that the nurses & my preceptor was the best. The experience gave to a look into what the job will be. I can honestly say that I WOULD DEFINITELY take a job there and drive 1hr 30min .... That's how comfortable I felt! I wasn't made to feel "stupid" on things I didn't know OR simple stuff I forgot. My preceptor went over each patient we received, and let me take the primary role once she felt I was ready (my 2nd day lol). 

Key Points:

1. Faculty will make site visits and check on you. Make sure that your "paperwork" (Timesheet & daily goals) are up to date. 

2. Don't slack off. You never know who is watching. Where I did my preceptorship, my preceptor, charge nurse, and MANY others have graduated from the same program. Keep your phone off the floor. Uniform must be "up to par".

3. It's YOUR experience. This is the time to see if you can "handle" this dept or to single out where you want to work. Hopefully, you get the unit of your choice!

4. Have fun! 

So now, I've turned in my preceptor packet, finished my FCCE narratives, turned in my hospital badge, & picked up the study manual for the 3 day HESI Review Course next week! 

2 weeks till Graduation!!!!!!

Almost there!

04/22/2021 HESI EXIT EXAM

 Just took the Exit Hesi this morning. It's a very long exam. You are going to feel burnt out by this point, BUT HANG IN THERE its almost done. I benchmarked 921. Passing is 900, so I did by the skin of my teeth. I don't have to do remediation. I could have done better. Night shift clinicals and then trying to jump back to day schedule is kinda rough. My car broke down on me earlier this week, so I had to get a rental while getting my car fixed. Word of advice, save money before going to nursing because: 

1. You don't have to sacrifice your study time having to pay bills

2. There are ALOT of "unexpected" expenses in Nursing (Just had to kick out $35 for background check, $15 for fingerprints, $75 for license & $200 for NCLEX.....Plus I had to buy a plain white scrub top for the pinning ceremony).

3. You never know what "life" throws your way......I've spent more in car expenses in the last 6 months than 4 years. (BUT I PLANNED FOR IT)

Right now if you are reading this, you have time to save as much as you can. I saved $12,000 before my 1st day. That allowed me to work just part-time (32 hrs/week) 1st semester, (10 hrs/week) 2nd semester & (20 hrs/week) 1st half of 3rd semester & (0 hrs/weeks) 2nd half of 3rd semester. 

There are people that work full-time while attending. I'm not saying that it cant be done, because MOST of the LPNs and Medics are working full-time, BUT it reflects in there grades. 

MY ADVICE FOR THE EXIT HESI:

Its hard to prepare for! Its covers EVERYTHING. I have been doing UWORLD questions for NCLEX, so I didn't study anything in particular. Some of the questions were similar! I figured "If I don't know it now, then I'm screwed!!!!" ....I just took a chance on what I knew!

04/14 NUR 213 Finals

 I made a 90 on the final exam last week. Due to the class technically being like a 8-9 weeks format, I was able to retain most of the info. I had to "go back" and review the 1st few weeks to refresh on the material. e now have 2 FCCE (Focused  Client Care Form post). They each are about 1,000 words, very detailed assessments worth a portion of your grade. Most of the work now is focused on your boarding, preceptorship, & paperwork necessary for the school to maintain incase auditing. I have 3 shifts left on my Capstone/ preceptorship. I have an 87 average so far. 2 more exam (Exit HESI & CAT HESI).

Key Points:

* Push Even Harder

* Don't slack off because you are not finished

* Start studying for HESI Exit & NCLEX

04/02 Preceptorship

 I've had 2 shifts so far. The ER is my comfort zone (as a medic). It's a great adjustment being 1 on 1 with a RN. Not to knock my previous clinical instructors or nurses, but I can learn more because the focus is me and not a group. It's great that the nurses are really nice and helpful. Make sure that your FCCE clinical packet is filled out (goals & time sheet). Faculty WILL do a site visit to check in on you. Faculty visited me the 1st day. I passed the final module exam, and benchmarked on the NUR 213 HESI. We have the final next week, so I'm studying while compiling my FCCE narrative. Oh yeah! There are 2 narratives that have to be completed. Each has to be 1,000 words and 2 responses each. The busy work doesn't stop. At this point I can see the finish line. 8 more shifts, a final exam, RN Exit HESI & a CAT HESI. Oh yeah, these freakin narratives lol....

Happy Nursing, 

03/24 Day before the last Unit Exam for NUR 213

 Tomorrow I take the last unit exam of NUR 213. So far I have a B in this class as well. This semester has been busy. I've done 5 exams, a teaching project, a Hesi Review Course, finished clinicals, and finished the last module of nursing school. I was able to contact the preceptor for my Capstone (120 hr preceptorship mandated by the NC Board Of Nursing). I hate that her schedule is nights at a hospital 1hr and 30 min away from me, but it's ok. I'm just trying to finish. I've turned in my clinical badge (clinicals are done! yay). But, I've picked up capstone packet from school which had my new badge for preceptorship, N95 respirator, & info to set up my N95 fitting at employee health (great, another 1hr & 30 min drive). I've already applied & registered with NC Board or Nursing which covered my background check, and I went to the Sheriffs office to submit my fingerprints. Looks like its winding down. I'm having more time because all we have left after tomorrow's exam is the final, NUR 213 Hesi, RN Exit Hesi, and CAT Hesi. 

* Key Points

*Knock out your "busy work" EARLY!

*Keep your calendar Up To Date!!!!

*Don't get frustrated when you get your preceptorship, and it's not what you asked for. Even though we had a "wish list" when it came to department & location, it's up to the facility, not the school!!!!

Happy Nursing!

How to take test in Nursing School!

 As a Medic, this is one of the biggest adjustment I had to get through. I still have issues, BUT I have a good grasp on it! Unlike Medic test that formed from EMS protocols, nursing test are formed from "nursing theory". Nursing theory is listed as "rationales", and a question is formed from that rationale. Questions may invoke Maslow Hierarchy of Needs aka Prioritization,  Delegation, Nursing Care Plan Assessment, Diagnosis, Planning, Intervention, Evaluation, & Education. 

For Example:

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which is the priority action of the nurse?

1.Call a code.
2.Call the health care provider.
3.Check the client's status and lead placement.
4.Start Chest compressions. 

My Medic brain said: "Start compressions!" There are 2 correct answers. Which one is MORE right?

The answer is 3. The rationale is that "Sudden" loss of EC Complexes is imply ventricular asystole or improper lead placement! It's all critical thinking! Keyword: PRIORITY .....so my nurse brain said: "Assess patient FIRST!"

Great resources to help with test: 

www.registerednursern.com (Nurse Sarah gives great lectures to help supplement nursing instructor lectures)

SAUNDERS NCLEX-RN REVIEW BOOK! It's a great outline of each chapter and gives the highlighted rationales for each area. It also has tons of NCLEX review questions. 

Believe it or not, QUIZLET has TONSSSSS for practice NCLEX questions to review. BUT, choose the one's with rationales, so that you will understand what you are being tested on! 

These test are far from easy, but if you understand the material, think like a nurse, you will be OK!

When should I start looking for jobs?

You should start looking for jobs in January (the start of your last semester). Hospitals have "New Grad Nurse Residency Programs". They tend to hire EARLY like Jan/Feb, so if you wait too late, you may not get the positions you may want! I applied in January, and I've interviewed for Neuro Step-Down & ED at WakeMed main campus, Duke University Hospital (ER) and I still have more with WakeMed, Duke, & Vidant. The bigger hospital residency programs are more competitive, but there will be lots of hospitals recruiting your class on a set day with the nursing programs. Internal applicants tend to have better shots at getting what they want, so if you already work at a hospital, talk to the nurse manager of the unit you will be applying too. By now, you should have an idea of where you want to work. 

BIG KEY POINT: 

* Pick your preceptorship according to which "specialty" you want to work! Don't pick a L&D preceptorship if you want to work in the ICU. 

FYI UPDATE: I've accepted a job at Duke University Hospital (Medical Step-down).

What are clinicals like?

 I was thinking out "How to explain the format of clinicals!" Each nursing course has a corresponding clinical. Most of the clinicals are at the hospital. Usually 645am to 1245pm for 1 class or 1245pm to 645pm (if 2 classes that semester). Get the most from your clinicals. You CAN slack off, but TRUST me, it will catch up to you. By the time you are close to graduation, you should be able to handle 2 patients. Most of the time, it will be on a med-surg unit. If you are not a med-surg person, I get it! But, I can say that you will get to do A LOT of basic nursing duties, assessments and skills over and over on a med-surg unit. This is where you can develop your time management skills, customer service, and get familiar with charting on a basic level. Your "specialty" rotations (L&D, Mother/Baby, ED, ICU) will not begin until your 2 & 3rd semester. None of those rotations matter if you can't provide basic nursing care. Concentrate of the basics, assessment, vitals, I/O's, turning your patient on schedule, rounding, hygiene & oral care, med pass, etc. As for me, I only have 1 hospital rotation left (ED) before my preceptorship. Talk to you soon!

02/18 NUR 213 Progress

 So far its been a little over 1 month and it's still tough. I don't know how the rumor started that this was the easiest, but they were wrong. Test wise, this semester is definitely the hardest, but the rubric for percentages to pass the class is better than the previous ones. The content is critical care. I will put this in perspective for you. I've only failed 2 test (the 1st semester, but not including benchmarking for HESI). I've failed the 1 test "this" semester, worse than my first 2 fails. I passed today the hardest test this semester, but made an 82! The content as a medic is not hard. It's dealing w/ mostly critical care, BUT the exam questions are harder. I know that I will pass this semester, but the A that I was looking for, might not be in sight!

KEY POINTS:

KEEP GOING HARD! Don't pick up more hours at work because it's 1 class....It's actually 2 ( Graded Hesi Review Course).

Focus on Getting Better! Don't complain about the difficulty of the test!

It's LOTS of busy work, BUT it helps pad your grade.

Even though you are burned out, keep pushing!

01/25 Last Semester NUR 213

 So far we have been in this semester for 2 weeks and have already had 2 exams. This semester isn't worse than the last (time wise) BUT it's definitely hella busy. We have 1 class NUR 213. The 1st 8 weeks is class w/ 6 exams and a final, plus an end of course HESI. The 2nd 8 weeks is preceptorship aka capstone. We also have a team teaching project to present "twice", a HESI online review course with 15 "graded" exams, a HESI V2 exam, Exit HESI exam, and a CAT HESI exam. Nursing school does not let up in intensity.

 Our schedule is Tuesday 0645-1845 Clinicals, Wednesday (test day online at home) 0830 -12:30pm, Thursday (on campus) 0830- 1530pm. 

My take is that by now you should be "comfortable" taking nursing test. The content isn't that bad, as in this semester (Emergency, critical care, cardiology etc) you should already be familiar, being a paramedic.

I'm able to work more hrs this semester, than I was the previous. I'm only working 2 days a week this semester. Last semester was only 1 day. 

Happy Nursing,  

01/03 New Year and Preparing for the Last Semester

 This Semester cost is $1400. There is only 1 thing item that I have to buy, a virtual clinical subscription (you know Covid stuff right!). As I'm working saving money, I have to count for gas. I have class 2 days a week and 1 day clinical. I have been doing practice questions from time to time to keep my mind fresh and to try and retain as much as possible. I feel like I've recovered from last semester LOL! I have a new calendar. So, I know that this semester will be very fast paced (to prepare us for boards), is what I'm thinking. Stay tuned for more info.

End of course Review for NUR 212, NUR 113, & NUR 211!

 I had to take a week off before I wrote this post. This was a very challenging semester. I was very tired at the end. I was a little disappointed in myself academic wise. I ended with an 87 (B) in OB, a 91 (B) in Leadership, and a 91 (B) in Med-Surg. I'm normally an A student, but this semester was very unforgiving. On the 3 HESI bench mark exams, I had to remediate on 2 of them. I didn't have a great test taking day that day. We take a 4 week break for Christmas and New Years and we back for the final semester. Looking back, I think its important to prepare "financially" for this semester. Being that 4 days out of week is dedicated to nursing school, I think working full-time will hurt you this semester. We had people in class that worked full-time, and their grades showed. If I could give you any advice, start saving now so that you can work PRN instead of full-time. 1st semester (bridge course), you can work full-time, due to only a 2 day commitment. This semester was waaaayyyyyy more difficult in the context of time, assignments AND material. It was fast paced, content heavy in all classes, assignment due dates everywhere, lots of clinicals, and test were more difficult. You have your "training wheels" in the bridge course. This semester, training wheels were definitely off!

NUR 113 (OB) is very challenging. It has different terminology, and 90% of the content is ante, intra, post-partum care, & newborn. (better brush-up on your APGARS) lol

NUR 212 (Leadership). I didn't find it too challenging. Just understanding budgets, health care systems, managerial content, & terminology.

NUR 211 (Med-Surg) had ALOOOTTTTT of content. Example: Our last exam was 10 chapters. You get the point.

Overall, all the instructors are excellent, knowledgeable, & approachable. They are strict, but loving. 

One the first day, combine all 3 syllabus on 1 calendar, then look at your due dates!

 

Happy Nursing!

10/27 Almost Done with Fall Semester 2!!!!

 This semester has been challenging so far. I feel like these classes are beating me down, BUT I'm pushing. This after this week, we technically have only 3 weeks of class left before final testing. There are quite a few people failing. I'm glad that I'm not one of them. Here are my key takeaways: 

Don't let up! Keep pushing even though you are tired.

Don't sweat the small stuff! It's a lot of changes CONSTANTLY (clinical scheduling, campus visits etc), nasty nurses, nasty doctors, clinical cafeteria has the same food! It sucks, keep pushing.

STUDY, DO NOT TAKE SHORT CUTS!!! MAKE THE TIME!

Don't be afraid to ask for help!!!

OK back to studying!!!

09/25 Journey

 This semester is really tough. Lots of reading, studying, & clinical assignments. This is the toughest part of this course. Everyone keeps saying that once you are done with this semester, you are golden. I'm really struggling to stay ahead. I'm behind as we speak. I have 2 exam next week, and I still have modules to listen for lecture and chapter to go over in the book. I've kind of learned a method for studying and for testing. Do as many practice questions as you can.

My Advice:

1. DONT GET BEHIND, ITS A STRUGGLE

2. You have to manage your time

3. DO NOT WORK FULL-TIME (start saving money NOW!)

4. Lean on both classmates (LPN/Paramedic and the Traditional Students). The traditional class really helps us. Vice/Versa

5. Take time for yourself. I walk the neighborhood in the daytime to take a break from studying. 

6. Keep your goal in front of you (RN). 

7. Identify someone to be your support system. (My wife is great)

8. Have a classmate you can vent too, but DON"T GOSSIP! 

9. Whateva the instructor tells you, DO IT! DONT MAKE WAVES! Especially doing clinicals, I've seen a NO SO GREAT outcome for some!

10. You don't have that much to go!

 

09/02/2020 Journey

 It's been 2 weeks and we are swamped. I've taken 3 exams and turned in a teaching project. I passed all 3. Some of my classmates failed 1 or more exams. They were quite difficult. Juggling 3 nursing classes can be really time consuming. I'm only working 1 day a week (10 hr shift). I'm starting the get in a groove. Clinicals are kinda fun and I look forward to going for the learning opportunity. I just hate getting up that early in the morning.

KEY POINTS.

* Don't stress too much

* Find time for yourself (exercise, take breaks etc)

* COMBINE YOUR SYLLABUS TO 1 CALENDAR

* Use all the resources they give you (HELPS A LOT) 

* GET A FREAKIN PLANNER

1st Day Semester 2 (NUR 211, 113, & 212)

 We are "officially" 2nd year ADN students. We are taking NUR 211 (Med-Surg), NUR 113 (OB), and NUR 212 (Nursing Leadership). We also met the traditional students as well. We are considered "transitional" due to the bridges (LPN & Paramedic). It's total 41 students. We are being kept separate from the traditional due to class size. We will merge back 3rd semester. We are starting clinicals next week. It will be good to see UNC Southeastern Regional Hospital again. I always have a great experience at that hospital. I'm starting the OB rotation 1st, out of the cohort. The have us mixed in with the traditional group for clinicals. The energy is good! What is not good is our work load! MAN it's going to be tough! It's busy work AND lots of chapter reading. It's like 11 chapters our 1st week! Next week we have 2 test AND a teaching assignment due!

Advice at this point:

*Merge all syllabus to 1 calendar.

*Find YOUR way to navigate the chapters. The way nursing test are formatted is not by recall, but application & critical thinking. 

* Use outside resources (answer NCLEX style questions related to those chapters) 

* I'm freakin out my 1st week (so is everyone else). Keep this in mind. It was only 10 slots and you got 1, MANY people have fought and are fighting to be in your shoes.........recognize your blessing!

*Lastly, manage your time! You have to manage 3 classes to include clinicals!

WISH ME LUCK!!!!!