CPNE - August 6-8, 2004

Racine, WI

Thursday the 5^th:

I had to take today off from work in order to travel to Racine.  I was too nervous to eat breakfast so I thought I’d pick up lunch later into the trip.  About 2 hours into my 7 hour drive I started crying uncontrollably and hyperventilating.  I know all of this; I know I can do it, so why am I being such a freak?  *sigh*

I stopped once along the way – approximately half way – to get gas and pick up lunch.  I didn’t even eat ¼ of the meal I ordered from McDonald’s.  It just didn’t sit well on my stomach – kind of funny considering I could wolf down the meal in under 5 minutes, normally!

I made it to Racine without difficulty.  The traffic got really heavy around the portion toll roads, but it was nothing unbearable really.  I just cranked up the music and sang like a fool!

Before arriving at the Racine Marriott, I stopped to fill up the gas tank again.  Those prices (especially for those of us dumb enough to drive an SUV) are nothing more than highway robbery!

On arrival the doorman opened the door for me, and offered to carry my luggage – little did he know how long I had been driving.  Carrying the luggage in (over 2 trips) was a welcome change from sitting!  They put me in a NICE quiet area – back of the hotel on the top floor.

I knew that I needed to eat something, so I walked down to the hotel restaurant to order dinner.  The price was a shock!  And what the hell is pretzel bread?  No, I don’t want any, thank you!  I was only able to eat my small crock of soup, and about 5 bites of salad.  At this point I’m starting to stress over the fact that I’m not eating well (normally I eat like a hog under stress).  I hope I don’t get sick while I’m here!

I returned to my room and started unpacking.  I received a call from my mom – I let her know that I made it ok.  Then I got the obligatory pep-talk that most parents seem to think you need to hear.  I know she means well, but… *ergh*

I wanted to do something to relax, so I ran a HOT bath and soaked for awhile.  I actually fell asleep while I was in the tub!  Not good!  I finished up and got out, and put on my pajamas.  I figure that I’ll hop into the bed, review my Critical Elements for the Sim Lab, give myself a manicure, and fall asleep watching the TV.

Tomorrow I plan on sleeping in (if possible in a hotel), trying to find a restaurant close by and eating a lunch that has more protein than carbohydrates (assuming I can eat anything).  I don’t want the sugar rush from the carbs to come crashing down while I’m doing my lab check-offs!  I have to be in the hotel lobby by 1545 (3:45 pm)so the hotel shuttle can take me to the hospital.

I was hoping that I was able to hook up to the Internet while I was here, but they want $10 for every 24 hours of use of the high speed service.  Don’t think so!  I don’t want to mess with the dial up option because I don’t want to bother with the software or pay for the phone calls to dial a local number.  The wireless Internet isn’t working with my card, so I give up…  Probably is better that I’m not online anyway…  So – here’s to getting some studying done, relaxing, and getting a good (?) night of sleep.  I hope I can eat tomorrow!

~ A little later ~

Did I say QUIET or GOOD night of sleep?  What on Earth was I thinking?  There is some sort of tournament in town and there was a HUGE group of teenage girls slamming doors, and a herd of them was running up and down the stairs squealing, screaming, and attacking the innocent ice machine around the corner from my door.  They were bickering endlessly about a game of “Tag” that only the herd leader seemed to know the rules of.

It’s amazing how many people nowadays seem to think it’s OK to let children roam around unattended.  I know I was a bored teenage girl at one time, but I never roamed a hotel and acted like an ASS. My mother would've been all over me like a cheap suit and snatched me bald-headed...

At any rate, the warm bath was a good idea.  I’m pretty well relaxed, considering…

Friday the 6^th:

I woke up at 1000 (10 am) and showered.  By time I got moving, showered, and dressed it was lunch time.  As I opened my door to leave I noticed 2 newspapers on the ground before my door.  Nice of them to try, but I have no desire to pay the extra money per day for each newspaper.  I stopped at the front desk on my way out cancelled the papers and asked to be credited for the 2 that were at my door.

I managed to find a Dairy Queen and picked up some food to take back to the hotel.  I almost caused a couple head on collisions on the way back, as the turn lanes are marked really funky…  I got back ate about half of the meal as I was watching something on the History Channel about Adolf Hitler.

I cracked open the CPNE Study Guide and threw away all the pages I knew I wouldn’t need; what to wear, what to bring, etc…  I pulled out the pages regarding the Sim Labs, put them on the table, and put everything else away.  I read through the Labs once, then I hand wrote all the Critical Elements for each lab.

I took a small break by getting out my 2 uniform pants, 2 tops, lab coat, and ironed them.  This was funny to me, because I do NOT iron.  When I finished, I went back to the table and read though the Labs several more times.

Now it was time to go downstairs and meet the hotel shuttle van.  I was surprised to see that there were 4 of the other CPNE students there as well.  We made small talk, and all talked about how nervous we were.  When the shuttle van pulled up, we found out that the 6^th student was staying there as well, but would be taking her own vehicle to the hospital that night.

We got to the hospital and waited in the main lobby for the 6^th student and the CA.  Once we were all there the CA introduced herself and took us downstairs to the Conference room we would be using.  She pointed out the cafeteria where we would all meet on Saturday and Sunday morning.

The CA was very nice and friendly.  She could completely sympathize with our stress levels.  In fact, she told us that the CA’s and CE’s all had to take the CPNE, under the same conditions in order to become part of the Excelsior CPNE staff – being observed by their own peers, no less!

Once we were all settled she read through all the required paperwork with us (found in the appendices of the study guide – exact same thing, word for word) and made sure we all understood what was going on.  This was nerve-wracking because our 4 lab stations were set up in the same room – so as she read, our attention kept wandering away.

A small word of advice – IGNORE the lab stations.  Trust me, you’ll see why in a moment.

We had to do the photo identification.  She compared our drivers licenses against the photo attached to the application packet we sent in.  We received our nametags, and drew cards to be assigned to “teams”.  The “team draw” also determined how our PCS events would occur.  My draw determined that my events on Saturday would be: PCS 1) Pediatric, PCS 2) Adult.

I don’t recall the exact order in which the last little bit was done, but it’s not that big a deal, really!

She took us to each lab station and explained how each one should be done.  Pay attention to this.  Watch what the CA does *hint, hint*.  At this point, there will be a laminated card at each station which has the Critical Elements on them.  We all got to spend 15 minutes looking at the lab stations.  Take about 3 minutes at each station to look at the supplies, etc...  If there is something you’ve not worked with before, then OPEN the package and look!

The time was up, so the CA and the CE’s came into the room, one team of 3 students and 3 CE’s started directly with the Sim Lab, and the other team went to the floor for orientation.

I was part of the team that went to the floor for orientation.  The CE showed me were all the supplies, utility rooms, bathrooms (keep this area in mind), water fountains, and nurse stations were at.  Take your time to look at everything, handle it, turn it off, or make it do whatever it is that it is supposed to do.  This is YOUR test.

I received my PCS form (they also called it a Kardex) which contained information about my first assignment.  My first assignment was supposed to be PEDS, but the census was too low, and what was left was “inappropriate”, so they substituted an Adult.  I had time to go through my patient’s chart to get information to help me later on.

My assignment included Mobility, Fluid Management, Vital Signs, Medications, Neurological Assessment, and Personal Cleanliness.

We headed back downstairs to start on the Sim Lab.

I started with the IV Meds (IVPB).  Everything was going along just grand, until it was time to regulate the drops per minute.  It felt like it took FOREVER to get it to flow right.  Every time I took my hand off the roller clamp it seemed to change.  I finally got it where it needed to be, and it was verified at the right rate.  I signed the bottom of the Lab MAR and declared I was done.  WRONG!  Even though I signed at the bottom, I forgot to initial next to the “Med Order”.  The CE and CA went ahead and gave it to me and asked me to go ahead and put my initials at the top.

Rattled, I went to the Dressing Change next.  I was doing everything exactly as I was supposed to – it was going along great until time to put on the sterile gloves.  The package kept flipping up and curling – and this brand was not the same size 7-½ that the gloves back home say are a 7-½!  I told her I wanted to get a new pair of gloves and I started over.  When I was cleaning the wound, I was a little stumped because my mannequin was at an odd angle.  The legs were UP and the waist was DOWN.  So, following the theory, “clean to dirty”, I verbalized why I went from the bottom of the wound (up in the air) to the top (down on the bottom) – so dirty saline wouldn’t flow back over the wound.  I finished and declared I was done.  She had to discuss the wound cleaning technique with the CA.  The CE and CA went ahead and gave it to me, but the CA reinforced that it should be top-to-bottom when cleaning a wound.

At this point I started to sweat, but I sucked it up and went on to the IM/SC lab.  I was doing great, pulled up the first med and verified it fine, pulled up the 2^nd med and HUGE air bubble.  To expel the bubble made the dose improper.  *sigh* At this point the sweat just started rolling down my face and my glasses fogged up.  I started over, again!  Everything worked great this time, and I finished up.  I was thrilled to NOT hear the CE say she needed to talk to the CA about something.

I had a few minutes to sit in the hallway (more students had come back to the lab – more students than stations).  I only had the IVP left to go, I *knew* I could do it.

I went back in and started the IVP lab.  Everything was great until I was pushing the “med”.  For some reason the Heplock had some sort of problem.  As I was controlling the rate of my push (had to give mine over 2 minutes) the Heplock had some sort of back suction and pulled in a bunch of med.  Startled, I demanded my CE look at it.  I did NOT have my and on the plunger, yet the med still continued to push in.  She said I could start it over again.  Everything was going great, I threw away my syringes, and signed/initialed the Med MAR in the correct places.  I declared I was done.  FAILED!  Why?  Because I threw the needle-free syringe into the TRASH instead of the SHARPS box which was literally sitting right in front of my face on the desk.  I could NOT believe I did that!  I was SO mad at myself.  I chalked it up to being rattled from the suction problem on the Heplock, and was glad I had a chance to repeat the lab on Saturday.

The shuttle van picked all 6 of us up (the 6^th student let her husband take her car) and brought us back to the hotel.  I wasn’t hungry, but ordered a small pizza from Dominoes Pizza.  I sat on the bed reading through my Fundamentals textbook, and flipping through my Carpenito’s book.  I *stink* when it comes to Care Plans, so I was at a complete loss.  I filled out my Care Plan as best I could, and read through my flash cards on the Critical Elements.  I tried to sleep but couldn’t.  As a result, 5:30 am came VERY quickly (I wanted to make sure I had time to review my flashcards before going downstairs to the shuttle).

Saturday the 7^th:

All 6 students were shuttled back to the hospital.  We meet in the cafeteria.  I *tried* to eat something (small serving of scrambled eggs/cheese/ham – Denver eggs).  I figured my body needed fuel.  WRONG move for me (I normally don’t eat breakfast). With all of us sitting there in our whites, knowing WHY we were there, I felt even more nauseated...

We went up to the floor and the 1^st PCS started.  My CE sat in the corner and tried to stay out of my way and be as unobtrusive as possible.  I had decided that after the 20 minute checks I would do my assignments one at a time.  Part way though my first assignment, the breakfast tray arrived.  I took the time to do some charting.  After the patient was done, I went back in and finished everything else I was assigned except meds.  I charted while I waited for the med time to arrive.  After meds were given, I finished my charting and turned in my PCS form.

After I turned in my form with only 3 minutes to spare, I went down to the bathroom and promptly vomited.  I went and sat down and waited for my outcome.  The waiting is the worst part.  I was thrilled when the CE came up to me and said, “Congratulations, you passed!” and then gave me a BIG hug.

I went down to the conference room/lab for the required break time.  I took a drink of water and ate a Reese’s Peanut Butter Cup from the dish of candy the CA had set out for us.  The students started filtering in with the CE’s.

Time came for my 2^nd PCS, an adult.  My CE told me that she wasn’t sure which patient I would get, that she’d let me know after the unit orientation.  She walked me around and showed me everything I needed to know.  The patient she had originally picked for me was back on the unit, so that’s who I got.  She gave me the PCS form.  I signed it, and we went over my assignment.

As I was planning, I couldn’t get the chart for awhile because the nurse, and then a doctor had it for a bit.  Approximately 4 times, the CE had to walk back over to me and tell me something had changed.  Finally she said that she would accept NO more changes from them, and that we would leave my PCS form the way it was: Mobility, Fluid Management, Neurological Assessment, Comfort Management, Oxygen Management, and Vital Signs.

When I finally decided on my Care Plan, the CE approved it, and my implementation phase started.  *OH MY* My patient worried me because English was her 2^nd language, and she was Aphasic from a stroke.  Fortunately my CE spoke her Native Language, so she was able to translate for me at times.  I also put this CE to work for me.  (Turn, hold, do this…)

When I had finished, I went out to chart.  I was horrified to realize I forgot to check hydration status and the patient’s pupils for PERRLA.  I tracked down my CE in a hurry, went in, completed it, and came back out to finish charting.

While I started on the Evaluation Phase, I realized my priority diagnoses didn’t work the way it was written.  I changed a small portion of it and finished my evaluation.  I told my CE I had changed the care plan, and she assessed it.  I looked it over to make sure everything was filled in (don’t leave any blank boxes).  I declared myself and turned in my PCS form.  I went to get a drink of water and went back to the area where I had charted and sat down.  My CE told me it would take awhile, that because I had altered the care plan the CA had to look at it, and she was busy with another situation.

It felt like an eternity.  Finally the CE came back and said, “Congratulations, you passed.”  I almost threw up on her feet, right then and there.  I managed to maintain, and walked back to the conference room.  Now I knew I had to repeat that one failed lab.  I could see it all STEP-by-STEP in my mind, so I knew I would pass it.

As other students were returning we heard rumors that 1 of the 6 was gone.  This made me a little uneasy, but I took a deep breath, smiled, and visualized the lab AND the success in my mind.

I ended up with the same mannequin arm for the IVP, so I planned on hanging on to the plunger and not letting the med get sucked up quicker than I was supposed to push.  I finished, threw the syringes in the SHARPS box in front of my face, signed/initialed the MAR form and I was DONE!  I passed.

Now my labs were all passed, my PEDS PCS was passed, and my 1^st Adult PCS was passed.  The CA came over and told me that they went ahead and gave me the PASS on the 2^nd PCS because they knew where I was going with my thought process, that it was obvious where I was headed.  However, after I had altered the Care Plan, I forgot to remove a line from the Evaluation portion and not to do it again.  The CA said, “You’ve come out really strong and are doing great.  Try to remember to recheck your Evaluation Phase, don’t let this happen again.”

At this point, 4 of us were finished so we returned to the hotel.  It felt GOOD to know I only had 1 PCS left to do, but I was still a nervous wreck.

Somehow 3 of us decided to go to Dairy Queen to eat.  We knew we weren’t supposed to talk about the CPNE, but we talked about nothing other than the CPNE during dinner.  Again, I only ate about half of the meal.  One good thing about not eating is the fact I’ve apparently lost some weight, and my uniform pants fit properly now…

After returning to the hotel, I decided to take a nice long hot bath.  After putting on my pajamas I got my things ready for tomorrow morning, and packed up everything else.  I hadn't thought about arranging for a late checkout, so I have to pack up the SUV tomorrow morning and drive myself to the hospital.  That’s not too bad.  It’s better than checking out, leaving my things at the hotel, and having to find a shuttle back to the hotel and gather my things from the front desk.

So - here I sit.  It’s 8pm and my head is pounding.  I feel permanently nauseated. I’m trying to review the flashcards but just can’t seem to focus.  I did get up long enough to pack all non-essential items so the checkout will be easier in the morning.  I give up; I’ll just fall asleep to the sound of the television.  For some reason the History Channel is obsessed with Hitler this weekend.

Sunday the 8^th:

I got up early enough to shower and pack my things.  I also took advantage of the “Express Check-Out Option” that the Marriott offers.  Pretty nice feature, that!  After taking my items out the SUV, I returned to the lobby to wait with the other students until their shuttle arrived.  I drove myself to the hospital, and managed not to get lost or get myself/others killed in the process!

I managed to beat everyone there so I went to our meeting area in the cafeteria, bought a parfait to eat and a bottle of water to drink.  I attempted to focus myself and review the flashcards again, but just could not get my mind to settle down.  Besides, the other students were arriving and the CA came to sit with us.  She was really trying her best to put us at ease and entertain us, bless her heart!

Finally all 6 of the students were assembled and ready to go.  I can’t figure out where the rumor of 1 being gone started the day before…  The CA told us that for some reason, students seem to be more relaxed on Sundays and started making careless mistakes.  I kept thinking that I was more nervous today than the other 2 days combined, even though I only had 1 PCS left to complete.

I had Mobility, Vital Signs, Fluid Management, Respiratory Management, Medications, and Pt Teaching co-assigned with Medications.

Everything was going fine, but I had a lot of other little things as part of the assignment.  I was so tired and so stressed out that I *almost* forgot to check my pt’s Heplock within the 20 minute time frame.  I covered quite nicely, I think…  I had finished the majority of my PCS, so I decided to chart and wait for med time to arrive (0930).  This made me a little nervous as I had to do the teaching on a med afterwards and chart and be finished by 10 am (the end time for my PCS).

I gave the meds without difficulty and gathered some information for the patient teaching session.  Then in walked a doctor with me only having 15 minutes left.  I was FREAKING OUT.  As the CE and I stood in the hallway waiting I asked if she would give me some extra time as a result.  She said she would add on 5 minutes!  The doctor left, I did the patient teaching, and then came out and charted like a fiend!

I turned the PCS form in with 1 minute to spare.  I followed the same pattern as before by going to the bathroom, getting a drink of water, and sitting down and tearing apart every thing that I did and charted in regards to the PCS.  The CE came in with the form (I thought I was going to cry) and then asked me to verify something I wrote – she couldn’t read it…  *whew – still in the game*  A few minutes later she came back in and said, “Congratulations, you passed!”  Then I really did start crying.

We walked back down to the conference room.  I got a big hug from all my CE’s and the CA.  The CA asked if I would consider being one of the people in the “peer program”, gave me a card to fill out with my name, phone number, and email address.  She gave me a letter that looked like the typical form letter; “Congratulations – now you can expect – now you should do”.

Other students started arriving.  There were 4 of us (the group of 6) that had passed, 1 had failed the CPNE that morning during his 3^rd PCS, and the 6^th student was still testing.  The 4 of us that had passed left the test site.  We were all kind of stunned that it was all over.

I don’t remember much of the 7-hour drive home, but I’m glad to be home.  I am SO worn out. You have NO idea how badly I wanted to throw the study guide out the window on the way home, but I was afraid I'd kill someone with it!

At any rate - I hope this helps! Congratulations to those who have passed the CPNE, and good luck to those who will be taking it soon!

Andrea Howard