Pass the CPNE the First Time!

Your CPNE is coming up and everything you’ve been working so hard for is about to be put to the test.  If you’re like most students, you’ve been studying for months but the closer you get to your testing date the more your fear and self doubt starts to take over.  Take comfort in knowing that it’s totally normal though!

You are not the only one having CPNE fears.

In fact, we surveyed over 100 random studiers about their biggest fears when it came to the CPNE and most of them were the same.  We’ve put together this list of the top seven and how you can manage them.


Care Plans

In order to take the first step towards mastering care plans, you must understand the big picture.  Care plans facilitate the nursing process and they are created to determine the most urgent, or priority interventions on behalf of you that will be carried out during your test.  In other words, a care plan serves as written blueprint to carry out nursing actions that you are assigned during your CPNE.

While there are standardized terminologies that are intended to provide consistency in the nursing world, a properly composed care plan is never approached from a “one size fits all” perspective. This is attributed to the characteristics that makes each patient’s health goals unique. Therefore, creating a care plan requires looking at the assignment you are given and pulling out the variables that impact health, such as medications, laboratory results, age, previous surgeries, in addition to other aspects however, the primary thing you look at first is what you are assigned to do.

careplanWhat does “standardized terminologies” mean exactly? This term refers to the “language” that is used to create nursing diagnoses. Worldwide, the most extensively used language is maintained by NANDA (AKA: NANDA diagnoses). The “Nursing Diagnosis Language” is continuously refined to reflect the nurse’s scope of practice. Simply put, what nurses are legally allowed to do in their role. This serves to promote the continuity of patient care.

These are some recommendations for creating effective care plans.

  • Keep it simple by focusing on the main issue which is a combination of what you are assigned that also matches what current problem the patient is having.
  • Finish each component of the care plan and move on; don’t overthink it.
  • Avoid the urge to get off on tangents such as surgical details or other items that you are not assigned to do.
  • Incorporate wording to clarify that you’re not making medical diagnoses, actual lab “interpretations,” prescribing meds, or making referrals.
  • Stick with the most obvious explanations and use short simple sentences that are direct.
  • Utilize those around you. Ask your assigned nurse or examiner.
  • Select patient cases that involve topics relevant to your current assignment.

Pediatrics

Pediatric communication is special:

Verbal, nonverbal, and electronic communication abilities vary greatly among patients and physicians of diverse generations. Pediatric medical communication has unique aspects that differ in structure, format, and content from adult patient medical communication.

Children are squirming, energetic, and rambunctious on any typical day. Toss in a day where they have to visit the doctor and chaos may ensue. Pediatric nurses play a role in calming down the little ones while they are poked and prodded. Here are few tips from the pros about how pediatric nurses can interact with kids in a fun and inviting way.

Age and cognitive considerations: Pediatric patients may range in age from newborns through adolescents. Because emotional development and cognitive abilities evolve with age, pediatric patients may be oblivious (infants), uninformed (children), or invincible (teenagers). They may be unable to verbalize (mentally impaired), intimidated (parent in the room), or just abbreviated (txt msgs).

PediatricsIn addition, a child’s concepts of bodily functioning, health, and illness change with age. Physicians may have difficulty in judging what children understand. The extent to which physicians talk to children in substantive areas is associated primarily with a child’s age, but may also be influenced by the child’s gender and family background.

Pediatric visits are particularly challenging in requiring that the physician and nurse engage in a “dance” with not one but at least two partners—parent and child—and that the physician be able to lead at times and follow at others. Typically a child’s participation in a medical conversation is limited and is influenced by the communicative behavior of both the physician and nurse to the parents.

Pediatric communication is serious:

Communication is a medical procedure and it matters. It is not limited to obtaining a history. When most effective, communication continues through physical examinations, treatments, and follow-up care.  Teaching communication skills to doctors and nurses hasn’t been easy. Learning to listen, being empathetic, involving the patient in shared decision making, and delivering patient-centered care are techniques that must be learned.

Consider using softer words—be aware of what you say; some words may have negative connotations.

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All children have fears; it’s a normal and healthy part of development. With understanding, patience and reassurance, you can help your child deal with her fears

Keep a Kid-Friendly Space:

Don’t underestimate the power of bright colors, stuffed animals, and children’s books. Kid-friendly decor makes the patient’s room a fun place instead of a scary room with a strange student nurse. If your young patient doesn’t bring his own comfort item, let him or her choose one from the playroom when available.

ATL - 600x300 v8 FBExplain What’s Going to Happen:

In age-appropriate terms, tell the child how the medicine is going to help them. If the child is young enough, use a puppet to explain or a children’s book that describes what happens during your visit. Calm them and let them know that the moment will be over soon and they will feel a lot better.

Let Parents Hold the Child:

Knowing that mom or dad is nearby will help the child calm their nerves. Instruct the parents to securely hold and soothe the young patient in a way that is not threatening or restraining, but comforting. The parents can talk to the patient before the area of care is to be performed, hug them or hold their hands during your visit. Just being there to soothe the child after the assessments or managements are done reassures the child that everything is going to be okay.

Earning a child’s trust as a pediatric nurse may be tough, but it’s far from impossible. Keeping the children and parents comfortable is the best way to ensure quality care. Keep these helpful tips in mind and your PCS will go smoothly every time.

NG Tubes and G Tubes

Some of the new words become part and parcel.  Speak to the patient in terms they understand and be able to explain what you are doing.  You will not be assigned anything complicated with regards to these tubes.  You will be responsible for observing that they are secure and looking at the surrounding tissue to make sure they are safe and free from infection and if you observe any abnormalities, you bring it to the primary nurse’s attention.

  • Flush:  using the syringe to put water through the tube to prevent it from clogging
  • Continuous feed:  the feed drip feeding through the pump for several hours
  • Nasogastric (ng):  tube goes into the nose, down the esophagus and into the stomach
  • Enteral feeding:  delivery liquid feed through the tube direct into stomach
  • Obtaining aspirated:  using syringe to pull up contents from stomach

Wounds

Fear of the unknown is the biggest wound fear. What kind of wound will you get? How big will it be? What kind of dressing will I be assigned?  Where will it be located?  Did you know that all wounds are different?  Breathe, because they are all different for every patient but the concept of wound care will not change.  Think of the structure and steps you go through in the lab with the wound simulation station.  You have a treatment record, you gather your supplies, set the supplies up according to clean or sterile, and perform the care.  It will always be that way no matter what. Your specific wound management assignment will be on the kardex.  It will be specified whether clean or sterile and the type of solution or cleansing ingredients.

WoundYou are required to have a little common sense.  About what? The nerves are coming back aren’t they?  Relax.  If you are cleaning an area, you need to have common sense about the surrounding tissue being protected, and not getting the bed or the patient’s gown wet.  You need to have common sense to look at the site and the surrounding area and simply describe what you see.  Notice if there is any drainage or any signs of infection like redness, odor, etc. and document that.  And you need to have common sense not to shock your patient with cold solutions for cleaning.  Room temperature is much more comfortable instead of cold.  If you are able to relate to these common sense points, then you will be just fine.  If you can’t, don’t sweat it.  Simply refer to the wound management section of your study guide and review your critical elements.  Also, think about a situation where you or your family member was the patient.  What would you want or expect the nurse to do with regards to wound care.  That “gut” instinct is exactly what your common sense is telling you.

Time Management

Your entire test is timed and is about how well you manage your time.  Of course, with practice, your time gets faster but you have to prepare to be side tracked along the way and bring yourself back on track.  Here are some tips for effective time management for during your test and at home.

Make a List when you are studying:

Put the most important tasks at the top, even if they're things you're dreading, and tackle them first. Include things you want to do on your list too, so you have items you're looking forward to. Try motivating yourself with a reward if you get to everything on your list.

Time-ManagementFind your productive time:

Are you a morning person or a night person? You'll be more efficient if you work when you're at your best.  When you are testing, do not switch up your routine.  For instance, if you’re a morning person and don’t normally drink coffee, don’t start the morning of the test.

Create a dedicated study time:

Set up a time devoted only to studying or homework. Shut off your phone and respond to calls or texts when your work is finished. Don't check email or surf the Web (except when you need to for the work you're doing) during this time either.

Get Sleep:

Your brain needs rest to perform at its peak. If it's time to sleep, list the things you still need to get done on the next day's to-do list and go to bed.  Find ways to calm you in the evening and soothe you in order to sleep better.  This may be aromatherapy with candles or some chamomile tea for example.  Numerous studies have linked a healthy lifestyle with work productivity. Similar to getting enough sleep, exercising and eating healthily boost energy levels, clear your mind, and allow you to focus more easily.

Create an organizing system:

Being organized saves tons of time, and you don’t have to be the most ultra-organized person in the world either. Systems aren’t complicated to implement.  Your GRID is one of those ways to stay organized during your test.  You should also create a filing system for documents. Make sure all items have a place to be stored in your home. Unsubscribe from e-mail lists if you don’t want to receive their content. Streamline, streamline, streamline

No Hospital or Patient Experience

Volunteering won't put any money in your pocket, but it could pay off in the long run. Volunteering your time in a hospital or other medical facility allows you to gain hands-on experience required for this exam. If you're interested in a certain type of nursing, volunteer work gives you the opportunity to handle real-life scenarios and learn necessary skills.  Volunteering also has another benefit: You will meet nurses who can offer advice and networking opportunities.

patientcareAfraid of pediatrics? Try volunteering at a day care facility and learn to communicate with various ages of children, change diapers, even fed them.  Another idea is to visit your Fundamentals of Nursing Book and read on the certain skills you might be assigned to perform.  If you are visual learner, then look for videos that are instructional for your specific skills required for the CPNE.

Cannot Afford to Repeat the CPNE

Mentally Distract Yourself:

Most people are not easily able to concentrate on one thought in particular.  Now add the stressors to this test on top of it. Adding this stressor of telling yourself that you can only take this test once is very difficult.  You can either channel this energy into studying more and harder or it can work on your nerves.  This is because your mind is focused on numerous things at the same time. You can relax your mind and improve your focus by distracting yourself mentally. Do something creative to give yourself some mental distractions. These distractions divert your attention away from the nervous thoughts.  They could be calming exercises or positive affirmations.

Practice Calming Exercises:

For how to stop being nervous successfully, you can try some relaxation exercises.  They might not appear to be too helpful at first, but if you continue to use them, you will notice a marked improvement in your nervousness.  Some of the best calming exercises include deep breathing, guided imagery or visualization, yoga, and progressive muscle relaxation. All of these with the exception of yoga can be used during your CPNE weekend.

ATL - 600x300 v8 FBPractice Makes Perfect So Rehearse A Lot:

Rehearsing a script or speech repeatedly helps you in memorizing it and when you have learned it completely, the chances of you forgetting it are minimized. When you know you won’t be forgetting something, your nervousness consequently starts reducing.  Knowing how to perform your critical elements through rehearsal is how you are going to succeed in taking your exam only one time.  Repetition and controlling nerves is the key.

Use Positive Affirmations to Combat Nervous Thoughts:

Try converting your nervous thoughts into positive affirmations as this reduces pressure on your mind and positively influences it, which will definitely help you to know how to stop being nervous. For instance, if you are nervous that you won’t be able to speak in front of people, then you need to give yourself a positive affirmation by saying "I can speak in front of the public."  Other affirmations could be “I am already a great nurse,” “I am going to do this,” “I can do this,” “I will pass this test.”

Accept Yourself at your Level of Skill and Love Yourself:

You need to tell yourself that you completely accept yourself and whatever skill level you have. This is a means of encouraging yourself and telling yourself that you are proud of whoever you are. When you are happy about yourself and your skills, your nervousness starts reducing. When you have studied and you are prepared, you give 110% of yourself and be proud of what you have accomplished and what you are going to do for your patients when testing.

Shift Focus from Yourself to Your Patient Care:

Try shifting your focus from yourself to the content of your PCS or patient or whatever it is you are trying to remember. You need to make yourself understand that it is this content that matters and once you realize that, your focus will be centered on it.  Safety first and prevention of injury and infection second then the rest falls into place.

What is your Objective?:

A certain object or goal is attached to everything. You need to think about the objective of the situation that is making you nervous. That goal will motivate you and encourage you to become calm and improve your performance. This will help in eliminating your nervousness.

Forgetting and Silly Mistakes

Anxiety has a fairly profound effect on your body, and causes a lot of strange and surprising symptoms. One symptom that often surprises people is that anxiety can cause forgetfulness. There are issues related to anxiety that can lead to memory loss and a general inability to remember things, and unfortunately as long as you live with anxiety you put yourself at risk for this forgetfulness to get worse.

oops-sign-751The key to making sure you're not as forgetful is simply acknowledging to yourself that you're forgetful and performing behaviors that are designed to account for that. For example, if you know you're forgetful, then when someone tells you the date of something important, you immediately take out a calendar or your smartphone and write all the information down in full.

Writing it down will help ensure you don't feel that you're going to forget it. In addition, you can then try to re-read it often and remind yourself everything you hoped to remember. This is a valuable way to train your brain to remember things easier.  This is exactly what we encourage you to do with your GRID.  You memorize your mnemonics or critical elements and from memory you get them to the GRID.  Once written on the GRID, you utilize that GRID to refer back and forth to during your PCS.  Practicing using your GRID before you test will create a habit that will be unbreakable, unshakable, and help you be successful in your test.


Having fears about the CPNE is completely normal.  Though don’t avoid or ignore what your apprehensions are about the CPNE because they won’t go away on their own. Use those fears to address your weaknesses before you test.  Keep in mind that fear is not always a bad thing.  Use your fear to keep you on your toes during your clinical weekend.  Being overly confident is just as bad as being too fearful.

Want Help Combatting CPNE Fear?

Practice makes perfect and learning through repetition will help alleviate your fears and anxiety about the CPNE.  Watch this video about how you can minimize your stress, overcome fears and pass the CPNE your first time.

This is the last time we’ll talk about this video so don’t miss out!

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Disclaimer: ATL Clinical Workshop is a private training company and is not affiliated with Excelsior College.    The purpose of our workshops is to prepare EC students to pass the CPNE and no college credit will be earned for attending either our online or hands-on workshop.

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