Where should I start? I've been promising people some documents and as soon as I'm done dumping my brain onto the blog, I will make those available!
My documentation online conference has been going great. Joanne, the Excelsior staff member that monitors the theory exams was the moderator. What can I say, Joanne is wonderful! She is always full of positive and encouraging comments! I am definitely over charting and I believe it's due to being taught to 'cover my ass' at work. At work I chart the same thing in multiple places. The CPNE - you don't have to do that! Rather than complaining as to how confusing it is, I'm going with it! Do what you're assigned, where it's assigned! I will post the documentation I submitted and Joanne's feedback.
The skills conference is going ok as well. Basically, it's various scenarios that you respond to in a discussion format. It divides up the areas of care into modules and spreads it out over 4 weeks. Honestly, I could take it or leave it. I am trying to get my money's worth and will be posting any and every question I can think of about the areas of care there.
I spent the morning doing my 'workshop' things and decided to put together a PCS this afternoon. I really want to get a working grid/mnemonics going for me. After all, the clock is ticking! Ugh! ROAD BLOCK! I sat down to do page 99, Carlos Lopez in the study guide. I am trying to work really hard with my 'initial thoughts' so I can get this stuff down on paper. I wrote down in a list form my areas of care. Ok, how do I want to organize this in a grid? Yeah.....nightmare! I moved on to the care plan. First diagnostic thoughts - Acute Pain and Risk for Infection. Acute Pain I rolled out with no problem. Back in LPN school in 02' I used Risk for infection all the time. Why am I struggling with it now? Whatever, I struggled, I got frustrated and it was 3:40. 20 minutes before my scheduled phone call with a Excelsior staff member.
I took a break (I really could have used a vodka diet), cleared my head and organized my questions. When I answered my call, it was kind of confusing with where to start (despite my nicely outlined questions). The person on the other end also works as a clinical evaluator. Sorry if this post gets a little awkward as I don't want to name the faculty I spoke with. I was asked how my studying had been going and what help did I need.
I started with the labs. I honestly feel the labs is one of the most controlled environments we can have during this exam, and would love to say I have them all perfected. I explained that I was struggling with the IV push. Why do my syringes keep lunging forward? Response - "we recommend you rock the plunger back and forth, and that should help." Ok, huh, that's what I'm already doing. She then advised me to try some different syringes. We'll see what I can get my hands on.
My latest thing is during the planning phase, should we always use 'actual diagnostic' codes as opposed to 'risk for diagnostics.' I read somewhere that we can always go from an actual problem to a risk, but never from a risk to an actual. That question turned into this answer:
Advice was to always go with an actual problem if possible. Risk for injury can be used for almost all children. There's almost always an impaired mobility or risk for fluid volume issue. I explained about trying to put together a 'risk for infection.' care plan. At workshops they recommend for us to stay away from that one because almost all patients in the hospital setting receive antibiotics. That was kind of the conclusion I came to when creating that care plan. Do not use pain if the patient has not recently reported pain or has been medicated for pain in the past hour.
Contraindications - will they all be communicated on the kardex? YES!
When to report to the RN - immediate change in condition.
What reference books can we bring? Drug/Care planning and that's it! I asked about looking up labs and she advised that it would be foolish to do so. They're not playing games with peoples labs and anything we perform, shouldn't affect the labs.
20 minute check (I hate that this has turned into 'slang' term just about every where.) This is what is expected in the first 20 minutes: wash hands, ID the patient x 2, Gloves - check site, gel hands, compare rate/solution to the kardex.
Last question - my fear of dealing with unknown tubes. It was advised that I refer to the policy/procedure manual or ask the staff RN. Apparently the staff RN can tell/show us anything.
For care plan scenarios, I was advised to use "Chuck's careplans" on cpnex.blogspot.com. When submitting them to Dr. A, we can even refer to them as Chuck's scenario #4. That eliminates loads of work! I'm going to email Dr. A and ask if it's the same for the ones in the study guide and Excelsior's orientation DVD book.
The conversation was done by 4:15. I really needed a vodka/diet.
All day I had been toying with the idea of paying for Sherri Taylor's online cpne workshop. I know it's not directly from Excelsior, but I was just feeling like I need more resources. I did it, and I'm so glad! In 15 minutes, I learned so many nitty gritty details that I had been seeking. It costs $150 /month. I already sent an email to the cancellation email saying I only wanted it for a month and received notice back that it had been set up. This is the first 'outside Excelsior' product I highly recommend. The website is Sherri Taylor's Workshop and click on the tab 'online workshop.'
At this point, the only thing I don't have for my CPNE prep is someone critiquing my skills. I may make some videos for peer review!!
Tomorrow is another day and I'm hoping with my new access to Sherri's site, I can start it off a little better!
Review to the right side of the page for links..........more documents to follow.