More than a Nurse: I passed my ANCC Board Exam

More than a Nurse: I passed my ANCC Board Exam: Well today has been an exciting day! I promised myself as soon as I finished I would write a blog for all of the other Family Nurse Pr...

I passed my ANCC Board Exam

Well today has been an exciting day! I promised myself as soon as I finished I would write a blog for all of the other Family Nurse Practitioners (FNP) in the world who have finished school and are prepping for their board exam. 

What’s on the test?

Well, I can’t tell you questions, and even if I did it would give you false hope that you would learn that one question and get that correct one out of 175 questions. You are smarter than that you don’t need that. But ANCC does give you a generic list of subjects, and the test is a mix of every single thing listed.

How did you study?

I made a plan. I work as an Emergency Room nurse so working and studying is hard to do, but I tried to make a plan and stuck to it.  I Bought three study guides: 
1. The Fitzgerald CD review Course 2011
 2.  Nurse Practitioner Certification Examination and Practice Preparation, 3rd Edition By Margret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC 
3.  Adult and Family Nurse Practitioner Certification Examination: Review Questions and Strategies, 3rd Edition By Jill E. Winland-Brown, EdD, MSN, FNP.

1.       I listened to the review course CD’s after graduation when I had spear time: at the gym, while in the shower, on road trips, etc.

2.       I took my down time (ha ha ha) and did the free on-line tests while at work.

3.       I gave myself one full month and set a test date. I told my family, my friends and Mountain Man that I needed this time to myself to study and that I loved them for supporting me in advance.

4.       In that month (when not working) I took it one section at time. I listened to the Fitzgerald CD’s, referenced my ANCC Yellow/Black book (my friend gave me) and my Physical Exam/Bates book as needed to refresh the brain. Then I would do the practice questions for that subject/section from both books. First Fitzgerald’s book, she has questions and answers with long rationales and I thought of it as a further refresher. Then I would take one of the 100-120 question tests from the Winland-Brown book. Here is another suggestion: I googled a free bubble test worksheet and made copies so I didn’t have to look back and forth and could treat it like a test. I kept a spiral notebook and wrote out why I answered a question wrong, what I needed to know, etc.  For example if it was a prostate questions, I read the rational and wrote down the evidence based guidelines.  One section a day, then that night, I would review later once again. Only one section a day. Then repeat.

5.       The week before the test, I listened the CD’s daily. Wrote out information that I wasn’t remembering so well (Anemia it’s my Achilles heel, etc.) a dry erase pen on mirrors in my bathroom and in my guest room. Then I could review, even while brushing my teeth.

6.       Four days before I re-did the free questions from ANCC, the last two review tests in the Winland-Brown book, the questions at the back of ANCC’s black and yellow book and the questions you could purchase on line. (A little overboard yes). All the while I scanned the review spiral I made and the Fitzgerald workbook that accompanied the CD’s.

7.       The day before the exam, I reviewed my notes again. Then I took a break and got a facial and some spa time. I needed to relax. I also drove to the testing center to make sure I knew where it was. Then I went out to dinner with Mountain Man.

8.       The night before the exam I took a warm shower, used my lavender lotion, took a melatonin and went to sleep.

9.      The  Morning of the exam I ate a good breakfast, spoke to Mt Man about the random things I was having trouble with (Rubella, Rubeola, what happened, when, for who, and how many pennies?). He thought I was speaking a foreign language and that’s okay.

1.   Arrived early and took the test.

How was the test? 

Long, short, and basically a roller-coaster. Some questions I knew, so easy that I re-read them twice to make sure it wasn’t a joke. Others I was absolutely in the middle of the road. I marked the ones I spent longer than a minute on and decided to revisit them. There were times I felt over prepared, other times felt like I should have covered more of that theory stuff. The therapeutic communication and NP role questions easy, the Veracity, Transference, counter transference were a little more difficult.

I took a break at about hour and half, went to the bathroom stretched and then went back in. I went over all the questions I marked. Some I changed, most I didn’t. Then I sat back took a breath and pushed end.

And I passed. 

 Fitzgerald has a free power point on her website about advocacy, legal and ethical issues (and the info is also in her CD’s) valuable information. Don’t skip over that.

Some things to mention:

 I had a few sleepless nights and I read about people not passing. At one point I almost bought another study guide. To be honest, don’t do it, you don’t need to. I also read one great blog and she said what I am saying YOU WILL PASS.  I felt as though there needed to be more positive blogs so that’s why I’m writing today. The study course I took from Fitzgerald was great, stick to that.  Don’t read negative things and make sure to take care of yourself.  Spend time each day to review a section and review what you don’t know. You are smart. You finished your  FNP, took tests, wrote papers, even did hours upon hours off free work (Clinicals right?) and now you take one test. Prepare before hand, and tell you friends and family you’re a hermit till this hurdle is over and they will understand.

By the way: I PASSED and SO WILL YOU!

My Round Table with Secretary of Veterans Affairs, Retired General Eric Shinseki

On Thursday May 24th, 2012, I was invited to a round table discussion with the Secretary of Veterans Affairs, Retired General Eric Shinseki.  There was considerable build up for this meeting. Various individuals representing the Albuquerque VA as well as Veterans Resource Center representatives from the University of New Mexico called to confirm and re-confirm my attendance.  Delivered by mail was a list of events as well as a flyer discussing the recent changes at the Veterans Resource Center. To prepare for my meeting I reached out and asked for advice or suggestions on things I should discuss. My request was met with replies ranging from benefits to disability claims as well as problems with education allowances and the GI Bill.  I noticed lots of confusion in regards to resources as well as examples of problems with the “system”; the big brother black cloud that has delayed us all at some point in our lives.

My friend Michael Wissemann, an a Army Nurse Corps officer and my company commander in Germany, suggested I say “Sir, I deeply admire the honesty you displayed during congressional hearings. It took a moral courage rarely displayed by senior DOD officials to state that we would need significantly more troops than projected by then Sec Rumsfeld. So I need to ask you sir, boxers or briefs?" A link to that is here: http://youtu.be/a_xchyIeCQw - I had to laugh at his response.

My friend Eve said “Discussing Education and Benefits seems all encompassing...Really what the VA can do - is take care of the claims backlog…It takes claims reps months to get veteran's files/records so that they can make an accurate determination of disability. Turn it around on him, Mika. Ask him what he thinks the biggest issues are and where and how can we apply pressure on the Hill to facilitate change. I never just complain or bring up issues... I always offer solutions. Ask him specifically for me, what would he have vets advocates do to help the VA?”

What Eve said struck me. I needed to come to the table prepared with solutions, not just a list of complaints. Everyone knows there is a backlog of VA claims, there is a desperate need for more manpower and that while the post 9/11 G. I. Bill is amazing, there are still problems. My friends Shawn, Kellie, Genna, Heidi, Andrea, Myke and Rachel had all outlined problems and I owed it to them to find solutions and present them. So I did my research. I talked with Patricia, a VSO representative from DAV whom I think is a very educated individual, and I spoke with UNM veterans center representatives who understood all the rules to the 9/11 G.I. Bill and Chapter 33. Then I read speech after speech and every news release I could in regards to the both disability claims and education benefit challenges.  I typed up four pages of broad based problems and 4-5 possible solutions for each.

I have to admit I was excited and slightly nervous about attending the round table discussion. I showed up on time (15 minutes early, some things never change).  I sat outside the conference room with a few other veterans I knew. Of course we waited an hour for a meeting between Shinseki and the University representatives to be completed, and then we were ushered to our carefully placed nameplates.

As I tried to take a seat and organize my notes I was greeted by VA officials asking if it was ok for my picture to be taken with Shinseki and if I would be available to be interviewed by reporters after the round table. I agreed and noticed that others were not approached. It is times like this I think that my face or positive demeanor is mistaken for one that won’t discuss tough topics.  I can only laugh; they obviously don’t know me very well.

The meeting started with Shinseki greeting us and shaking each of our hands before starting the discussion. I scanned left and right and saw that there was a wide range of veterans present. I think there were 14 total in attendance. Around the outside of our table there were seats for the representatives of various senators not in attendance as well as different VA officials and university representatives.  As I scanned my peers I noticed that only a handful brought paper and only I had prepared notes.

Shinseki opened by discussing the GI Bill (also known as the Servicemen’s Readjustment Act of 1944), the various degrees obtained by using this benefit and the challenges he faced when returning to college after Vietnam. He discussed the ability for veterans to have an unspoken communication and added in the 4 rules Army service members live by: I will always place the mission first, I will never accept defeat, I will never quit and I will never leave a fallen comrade. He then discussed the Post 9/11 G.I. Bill and the goal of that legislation for veterans today. He said, “If I were to give a speech it would be one word. Graduate”.

With that he opened the panel for discussion. My friend Patricia had recommended letting someone else start. Sure enough, a question was raised about the accessibility of class rooms for individuals with disabilities. Another veteran answered by informing him that when applying for the class there is a section to request ADA accessible classrooms.  One veteran discussed vocational rehab and internships available for veterans after gaining their degree. He stated that even after veterans do obtain their degree an internship is often required before starting into a new career field. However, those are hard to find and they often provide less pay. That can be hard for even a single solider let alone one with a family.

Shinseki discussed hiring fairs held in DC with the sole purpose of hiring veterans. He said the difference between Job Fairs and Hiring Fairs is that employers are required to have jobs available and to hire employees. An interesting concept. Many veterans groups are approached in regards to Job Fairs and advertising that the job fair is for veterans or veteran friendly. At times I personally feel as if it is just a publicity stunt to give the impression of working towards helping the veteran.

I then took the opportunity to talk to Shinseki. I opened with, “Secretary it is an honor to meet you and be here today. I do not have a specific complaint but rather would like to say that I am a success story of the post 9/11 GI bill. 13 days ago I graduated from the University of New Mexico with a Master’s of Science in Nursing and I am now a Family Nurse Practitioner.  However, after discussing with various veterans and peers there are some challenges that veterans face in terms of gaining a degree. Currently education benefits are capped at 48 months, a challenge for many. Another challenge is that when re-entering college many need refresher courses on materials like math and English, however if they do take these courses it counts towards the 48 months. In addition, many degrees take longer than 48 months; some examples are engineering and nursing schools. However, you should come to any meeting prepared with suggestions. (I picked up my typed list and Shinseki’s eyes momentarily widened). I’m an Army Nurse at heart and I come prepared.”

·         While on Active duty each service member has the opportunity to use tuition assistance to further educate themselves while serving their country. However, with so many being deployed this benefit is not being used. If this benefit is not used while on Active duty it should be transferred on top of their Ch 33 benefit.

·         Allow for refresher courses that do not count towards the 48 month allowance. 

·         Universities can give back to those who have served by providing FREE refresher courses. Universities that participate in this program can be listed in magazines or advertised through social media outlets.

·         If working towards the degree and in good standing benefits can be extended to help the veteran complete the degree. This can be helpful for any veteran working to obtain the bachelor's or advanced degrees.

I’m not sure at how many people were staring at me but I know that Shinseki was. He talked about volunteering to tutor other veterans or being a paid tutor at the university. I explained that in my case when I worked as a TA I was given a discount on the tuition that actually decreased the benefits I received with my GI Bill and it was better for me to tutor without working for the university. After I spoke three other veterans stood up and said that they actually did have problems graduating because their benefits would not cover the amount of time needed to graduate even when taking full time coursework. A gentleman working for Shinseki discussed the recent change to allow for $2000 towards tutoring for veterans and representatives from the University of New Mexico and Central New Mexico College discussed that they had free tutoring available. It struck me how quickly everyone wanted to defend their educational institution. I agree that the University of New Mexico is excellent and I could not have asked for a better place to go for graduate school. However, the problems that veterans face in the classroom are not limited to one campus or educational institution.

Another student from Muskogee, OK, discussed his difficulty with work study payments and an interesting thing happened. The vocational rehab representative echoed the difficulty in retrieving payments. Shinseki turned to a VA representative from Muskogee and asked if this was his area, to which the man replied basically “it’s not my job.” Shinseki replied he didn’t want to hear that. Instead he wanted to know why students were not getting paid and how he intended to fix the problem and asked that the solution be emailed to him by Monday morning. The room was in a state of uncomfortable silence for awhile. Inside I did a little victory dance. I loved the fact that a widget worker saying “not my job” was basically stopped in his tracks. That is true leadership.

The discussion next centered on the need for more providers at VA hospitals and outpatient centers as well as establishing rapport with patients. One veteran discussed that her husband preferred seeing a homeopathic physician and not the VA due to the long waits and short visit times provided. Shinseki talked about the expansion of outpatient veteran’s centers, the new proposed budget for the VA, increased numbers of mental health providers as well as the use of mobile VA mental health centers especially in rural environments like New Mexico.

Shinseki ended the formal discussion by addressing the difference between Post Traumatic Stress and Post traumatic Stress Disorder. He said it was unnatural for soldiers today to go to war and experience what we experience and not have stress. A truly legitimate statement. How many deployments have we experienced, how many friends have we said goodbye to, how many fallen comrade ceremonies do we participate in, how many hands do we as nurses hold before it wears a spot in our souls?  

After our discussion Shinseki presented us with coins, a gesture familiar to many of us. Then the seats and tables were rearranged for the press conference, Shinseki was led to another room to review topics discussed and again I was asked “How do you pronounce your last name.” I was given directions on where to stand next to the podium as camera men positioned themselves and reporters took out paper and pen. I stood in silence, the only student veteran in a line of VA officials. My eyes did glaze over as picture taking began. Shinseki started fielding questions from reporters attempting to address issues regarding the backlog of claims (a subject not discussed in our round table) as well as for-profit universities targeting student veterans.

As the questions came to an end and people started to disperse I walked to my bag with papers folded neatly and prepared to leave. Shinseki walked away for the busy “yes men” that surrounded him, walked up to me and once again shook my hand thanking me for being there. I thanked him and said, “I know that you recognize the need for change. People still talk about the congressional hearings and how you discussed the need for more troops. I hope you know that as a veteran and member of American Women Veterans we want to help facilitate that change.” He briefly if not slightly smiled (he is not a man of many smiles) and said “thanks, that makes my job easier.” The “yes men” looked anxious to take him back so I smiled and released his hand. I was cornered twice more by reporters asking questions about school and veterans benefits and what I saw as the need for change.  My answer: “Veterans work hard, we are leaders and we help our communities, let’s change the stereotype of what a veteran looks like and show what we really do.”

It was an interesting day to say the least. More topics were discussed and I would have to say it was a genuine learning experience. Being a voice that is heard versus being just a voice are two different things. I have come to appreciate that as a veteran I still want to serve my community, but finding that voice is something I am still learning. At the end of the day, I have to remember I am more than JUST a nurse; I am a veteran.

Another Step Forward

I realized at lunch yesterday that I haven't updated this blog in a while. Why at lunch? Well, my grandmother whom I haven't spent time with in 16 years contacted me and I found out that she reads my blog. Humbling for me. However, since I get to enjoy time with her, I think I am the lucky one. And with that a quick update and the past few months:

1. Got carbon Monoxide poisoning from the apartment I was staying at in Farmington. That was no fun. Luckily I came back to Albuquerque and finished up my clinical with two amazing Nurse Practitioners and a Physicians Assistant, all of whom taught me a great deal.

2. Cuidando Los Ninos is making great changes. Tony Pino is an AMAZING leader. He along with his development team put on a breakfast event that did well in terms of bringing the community together and raising funds for the non-profit.

3. The Youth Creating Change Film and Art Festival was a success! And lots of fun. These students really took on an incredible amount of determination and responsibility to spread the word about childhood homelessness.

4. Got nominated and choose for the top 40 professionals under 40 by New Mexico Business weekly. A Big thank you to my family, friends and  Mountain Man, for being in my life and motivating me. Emily, Erica and Tony thank you for nominating me and writing letters of recommendation on my behalf. The Celebration is June 21st.Check it out here: http://www.bizjournals.com/albuquerque/event/64991

 

5. I GRADUATED! It is official I have a Masters of Science in Nursing and am now a Family Nurse Practitioner. I will be taking my national boards this summer.

6. With my plate less full I have decided to take a wonderful opportunity and become a Board member for American Women Veterans. I have much to learn and much to do but I am motivated and excited for this next stage in life.

and 7...

I met with Secretary of Veteran Affairs, Retired General Shinseki today and discussed veterans education and benefits. More on that later. And with that I hope you enjoy the wacky pictures. More soon. ~m

Sweet Silence on a long drive...

Last Wednesday I packed my truck and made the 3 hour trek to Farmington. I was supposed to go to the main hospital that day to finish some nursing education materials and prepare for my clinical rotation. However, the… let’s say “powers that be” had still not received my electronic finger prints and I was caught in a rock and desert? Mind over matter I thought, the drive up gave me the opportunity to listen to my Family Nurse Practitioner Review CD’s and absorb the beautiful New Mexico scenery.

I arrived in Farmington and met with my land lady. A tall blonde woman who greeted me with pink roses for my small “executive apartment” I rented for the month I am here. I have to say in the world of struggling students this woman is a saint. I emailed several “executive apartment” places here asking for a deal with prices. I explained I was a student and had to go to Bloomfield. I needed a safe place to stay but I was by no means a rich executive. One gave me “one hundred dollars off” for the bargain price of 1800 (I hope you can see the irony here), however my current land lady gave me a safe place to rest my head for 1000. I swear there is a place in heaven for this woman.

A few things I have learned:

1.       1. If your shower is freezing, look at the water heater, it may be left on “vacation” mode. I can’t blame a lady for looking out for the environment.

2.      2.  Let the water run a bit…just in case sediment was built up in the pipes…

3.      3.  Never forget warm slippers and your favorite blanket, they help you feel cozy in a new place a sleep.

4.      4.   Find the gym: Mine is around the corner from my digs. 

5.       5.  all else fails find your coffee shop. I like Starbucks and yes I own stock (I don’t drink coffee but they are supper nice to us tea drinkers too)

6.     6.    Melatonin is still my friend and helps when in a new place and can’t sleep.

The week passed with little help from the powers that be. However I have to say that I did get the opportunity to meet my preceptor and she seems animated, smart and driven. All awesome qualities to have, especially when asked to mentor another nurse. In fact, when I was going through this drama of the non-help from the powers that be, my preceptor was able to make some calls and emails, and guess what? Friday afternoon I was given the thumbs up to go to the hospital and finish paperwork. (Honestly health community, why do we make it so hard?)

My weekend was: books, family, food, skiing, mountain man and laughter, but not always in that order. In the spirit of hope I am looking forward to my next week. I will keep you updated. ;)

Its a Rural World

It’s Monday morning and I am enjoying a cup of tea by my computer as the sunlight hits the window. School has been out over the holiday break, and I enjoyed Christmas at home with my family.  This week we start our “final semester”, which just being able to say is a great feeling.  When I originally took on this endeavor of becoming a Family Nurse Practitioner I was told that going to a rural clinic was mandatory. This did not surprise me, New Mexico is a beautiful state with many hidden treasures but health care is not one of them. I volunteered to go to Bloomfield; my preceptor is a PhD and is highly recommended by her peers so I decided that being in slight control of my fate was better than no control at all.

Bloomfield is a small town outside of Farmington a bigger city in New Mexico, which by some standards is still small. Both Bloomfield and Farmington have primary industries of mining of petroleum, natural gas and coal. Farmington is also known for its baseball tournaments. I don’t know much more about either city accept that when friends ask “where are you going?”. The replies I often get when I tell them include:  “that’s way out there” and “really?”. However, you have to remember that in what I call the “Albuquerque Culture” driving to Rio Rancho is considered far in some of my friend circles.

I spoke briefly with my preceptor on the phone. She gave me a list of hotels and recommended I stay in Farmington and let me know which hotels may or may not have bedbugs. It seems that as far as lodging is concerned my best bets are places that are $90 a night, which obviously won’t happen on my budget. However, one thing I did deduct while talking to my new preceptor is that she is a very busy woman. I hope that transfers to my clinic days and the experiences I will gain while being there.

I decided the best way to approach my final clinic rotation (consisting of 305 hours or 38, 8 hr days) was to jump in the car and do a “recon” of the area. (Don’t judge me but after 13 years Army the least I can do is incorporate the skills they thought me into my civilian life). I invited my man friend (I call him affectionately Mountain Man) and he surprisingly came along for the drive. I grabbed a bag, pen, paper and my trusty ipad and two bottles of water and jumped in the bat-mobile (that’s what I call my little car).  After getting a full tank of gas and some Starbucks I was caffeinated and ready to drive. And drive, and drive and drive.

One thing many people perceive when thinking about long drives through New Mexico is that is desolate. Sad to think anyone would ever use that word when describing my home state, but many think big trees constitute beauty. And I guess it is all in the eye of the beholder. My drive along NM 550 is majestic. It runs through Bernalillo and passes through San Ysidro, and Cuba before Bloomfield. The view is painted with shrub and various sandstone formations in soft hughs that engage your brain.  The drive was about 3 hrs (I was not speeding and made some stops due to my high caffeine intake lol).

When I arrived at the clinic I have to say I was taken aback. The clinic is nice, surrounded by a fence and a very small reservation. The only thing that concerned me was the sign on the gate “The health center is temporarily closed there are no providers”, not sure what to think about that. But to be honest I am nervous.

After driving to the clinic we bypassed Bloomfield and had lunch in Farmington.  We scoped out the various hotels and amenities available.  My concerns are to find a place to stay for a month, not get bed bugs and hopefully have a hot shower and internet? However, I have lived in worse areas and at least I get to work without carrying body armor daily. I am not sure yet what to think about my next challenge but hopefully a month away from Albuquerque will bring some enlightenment and experiences that I can grow from. Soon I will be starting a new career, so this next step is just another leap forward in the process. Funny how our past colors the lenses in which we see the future.

I will write more soon.
~m