Student Experiences
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Date of CPNE = Oct. 14-16, 2011
Name = Adrienne Franklin
Hi Rob. Here is a summary of my experience, as promised. I arrived in Lubbock, TX on Wednesday,
October 12. I drove down with my supportive daughter in tow, which made all the difference. I did
brief studying and connected with a fellow tester right before the labs on Friday the 14th. Saying I
was nervous would be an understatement and it showed in my labs; I failed two of the labs for silly
reasons. I forgot to I.D. one and forgot to check the site on another. I forgave myself, moved on and
passed them both the next day. My PCSs were great and I passed all 3 with no repeats. Your
information was prominently displayed all over my Grid! Your mnemonics kept me organized and
confident that I had not only executed the tasks at hand, but had charted them, as well. I took your
advice and, when I would enter each PCS after introducing myself and my CE, would thank the
patient and their families for allowing me to be there as a student nurse taking care of them. I believ!
e it made the patient and present company more willing to be a part of the experience and put them
all at ease. I also did the SCAB, though not out loud all the time. I could hear you saying "Side
rails up, call bell within reach....." So funny how everything came together! Oddly enough, I was
assigned Abdominal Assessment with every one of my patients. Your PPP DART was rocking the
whole weekend and helped me tremendously! (When I got home and threw away my CPNE stuff, I
kept my paper with that mnemonic haha). My last PCS was had me literally running down the hall to
hand in my work to the CE, as my pt had lots of unexpected things happen, which cut into my time.
When the CE came to me and stated "you passed!" I grabbed her and cried. It was a
feeling like no other. To all of you who are debating on whether to purchase Rob's CPNE, I say do
not hesitate. If you read the Excelsior Study Guide, know your Critical Elements good enough to
recite them in !
your sleep and use Rob's material and focus on documentation and time management, you've got
this, hands down. I had very little bedside experience, took no "hands on" workshop and
was successful my first time with no PCS repeats. Thank you, Rob. I honestly feel that, in addition to
this being your business, you genuinely care if we pass. You go the extra mile, from the free Care
Plan help to the low cost of your materials. One more thing...your Med Math helped me so much! As I
move on to bigger and better things with the CPNE in my rear view mirror, I know that I will not soon
forget all that made this possible to attain. I am happy to report that your help made the list. :)
Thanks again, Rob!!
Date of CPNE = Jun. 28-30, 2011
Name = Michael Autry
Hey Rob,
I passed my CPNE June 28-30 in Milwaukee, WI. Your mnemonics were priceless for this thing
(especially the lab simulations). I could possibly see memorizing critical elements for the PCS's, but
with the time limits on the lab sims, your mnemonics got me through. While doing the lab stations, I
was figiwa-ing and rcadrigcap-ing and singing about an australian guy that loves CD's like there was
no tomorrow (I even did the australian accent in my head).
It is really easy to just go blank when starting the lab stations, but the mnemonics were easy to
remember, easy to follow, and flowed perfect for the steps. I used your mnemonics during my PCS's
to create a grid (as you instruct), and then checked off steps as I completed them, and then later as I
charted them. I will admit that I used many resources overall to prepare, but your system was my
primary source of information, and I stuck to your teachings the whole way through my CPNE.
Students must realize that there are far more details than any one program could cover, but your
system provided the foundation of learning on which I was able to prepare for a successful CPNE.
So, of course, I must recommend that students read their official CPNE study guide (multiple times),
seek out and read as many CPNE journals as they can (on excelsior's website, on yahoo groups,
etc), and really know what they are preparing for. But, your system was a great resource, as well as
being my primary resource. I highly recommend to others that they use your materials.
ROBS RESPONSE: Excellent point Michael ! EVERY student must read the CPNE guidebook (especially the
critical elements chapters) to be 100% prepared and ready to pass the test
Thanks so much for all you do,
Michael Autry
Austin, TX
BELOW IS MICHAEL'S CPNE JOURNAL - VERY DETAILED MICHAEL ! THANKS !
I address the following CPNE journal to those out there who are preparing for the CPNE, or who are
considering using Excelsior College for their RN program. It is tough, but it can be done.
I would first like to talk about travel and hotels. I flew from Texas to Milwaukee, arriving a solid 48
hours before the test started. I rented a car. I have a GPS system that I brought with me to help with
driving directions. I had an afternoon/evening, then a full day, then a half day before having to start
the test on a Tuesday evening. I brought my practice supplies with me to the hotel, put the “do not
disturb” sign on the door, and set up my practice lab. I kept the sign on the door so housekeeping in
my hotel would not accidentally throw away any of my supplies.
I studied some, but not too much. I got plenty of sleep, studied, napped when tired, ate when
hungry, etc. I had a rent car, and again, a GPS system from home, so I made a trip to the hospital,
found adequate parking, parked, walked into the hospital, and located where I was supposed to
meet the Excelsior staff for the test. This helped me to know for sure what I was facing when going to
the hospital to start the test for real. Can you imagine spending $2K, travel expenses, taking off of
work, etc, and not finding the hospital on time and being too late to take the test?
Take no chances. Arrive early to the city, check your supplies once you are in the testing city (in
case you forgot your nanda book, etc), arrive early to the hospital each day, and plan to fly out the
day after the test is over. As I write this, I am sitting in my hotel room, having passed my CPNE this
morning, and my flight leaves tomorrow. You do not want to be stressed on the final day of testing
about making a flight home. So, if time and money permits, I highly recommend arriving to your
testing site 48 hours before the test starts, and plan to leave 24 hours after the test is over. Again,
take no chances.
Have extra everything. Arrive early. Plan ahead. This is too big to mess up over a delayed flight,
faulty directions to the hospital, spilled coffee on white scrubs, or a lost book. I brought most of my
practice supplies with me, but purchased a few items at a local pharmacy. However, I had trouble
purchasing syringes, needles, injectable medication vials. I brought IV bags and tubing with me, but I
assume these would be hard to purchase as well. So, plan ahead and make sure you secure and
pack all practice stuff you need. Also, I emptied my IV bags for packing/flying, and refilled them with
tap water in the hotel, just to prevent any problems with the airport folks checking my luggage. I also
upgraded my flight to first class. I know that is excessive, but I didn’t want to take any chances in
comfort or preparation (or at least that is what I told myself to justify the upgrade).
The first class seat sure was comfortable. I had never flown first class before, and the flight
attendant kept offering stuff. I sort of felt funny about it. But, again, I am telling myself that if I had
not been in first class, I might not have been successful. Perhaps I should upgrade to first class for
the flight home, just to be safe.
I passed my CPNE in Milwaukee, WI at St Joseph hospital June 28-30, 2011. I had no fails, no
repeats. The whole experience went pretty much like I figured it would, having read many CPNE
journals online. It is every bit as stressful as I expected, and does really test how prepared you are.
My current full-time nursing job is in Level-I Trauma. So, I frequently see major, life-threatening
traumas and medical emergencies of all sorts (car wrecks, motorcycles, gun shots, stabbings, CPR,
overdoses, heart attacks, strokes, broken bones, burns, amputated body parts, farming equipment
accidents, etc), but this experience presented a level of stress unlike anything I have seen.
I say this not to frighten or intimidate, but to give you an idea of what you are preparing for. Again, it
can be done, but you must be prepared physically, mentally, emotionally, and spiritually.
The lab simulations were tough, simply because of the time limits. The time seems to fly by while you
are being so careful to do each step just right, clear bubbles from the syringe, etc. Although I have
given thousands of IV push medications in real life, I almost ran out of time in the IV push station, just
because of how long it took to draw up the perfect flushes and med.
I had set up my practice lab in the hotel room, and just hours before the real thing, had completed
my IV push (with really drawing up water, etc) in like 6 or 7 minutes total. Then, in the real thing, it
took twice as long (just be aware of this phenomenon). I finished the IV push station with 30
seconds to spare, and passed. I finished the other lab sims in plenty of time. Also, it is really easy to
step up to start a lab sim and just go blank. So, my recommendations on the lab sims are to practice
over and over until the muscle memory takes over and you could do it in your sleep. Also, use some
sort of mnemonic. I used Rob’s Mnemonics from robscpne.com (among other resources), but Rob’s
mnemonics seemed to be right on for the lab sims. Start each station with a brief pause, and a good
deep breath, remember your mnemonic, and go to work.
I recommend practicing drawing up flushes/meds in syringes for real, as opposed to just going
through the motions with empty bottles and syringes. If you are not familiar with how to do this, find
someone who is and learn how to clear the bubbles. I also recommend getting a wound like the one
used at the CPNE (check with excelsior about ordering one). It is best to practice with what you
know you will see. Different resources I studied showed different types of bottles used when drawing
up meds. Sherri’s workshop (cpneworkshop.com) uses the needle-less adapters that are already on
the bottle, so you just screw on the syringe, and do not inject air.
This was the correct type for my IV push station, but my IM/SQ med was all needles. I got IM, so I
still had to inject air in to the first med, then air into the second med, draw up the second med, then
back to draw up the first. Sherri’s workshop shows the IM meds being drawn up with the needle-less
system where you do not have to inject air. Of course, I do not know what the other testing sites will
have, but just be aware that the equipment may vary and you should be prepared for anything. Be
sure to verbalize steps (checking ID, allergies, aspirating syringe, etc) so the examiner knows you
are doing some of these small details (my examiner sat back away from me and so I was not sure if
he could really see me aspirating for sure). Again, take no chances. Make sure the examiner
knows that you know every step and critical element.
For my PCS’s, the whole thing is sort of a blur at this point. Again, I passed all three, and did not
have to do any repeats, so I will try to offer some words of wisdom and a brief summary of my
experience. I did not get a pediatric patient, so I had a peds substitute. The CE told me that the
hospital has peds, but just didn’t have any available at that time. I know it is a major question for
some people who want to go to a hospital where they are not likely to get peds. So, I do not have a
clear answer for Milwaukee, except I will say that I don’t think any of our 6 students got an actual
pediatric patient. My three patients were all between 80-90 years old, one female, two males.
The first was the female with diagnosis of MI/hypotension/bradycardia. Had to do a wound change
on the back of her head. It was exactly like the wound care station in the lab sims, except we used a
tube gauze wrap over the top dry 4x4 pad, instead of an ABD pad and tape. The CE was very
helpful and held her hair back for me. Otherwise, I just set out my sterile field and went through Rob’
s mnemonic as it is used for the lab sim. Thinking back now, I realize that I did not label this
dressing in the real-life wound change with time/date/initials. I don’t know if the CE just let it slide, or
if she didn’t realize it either, or if it simply was not required.
I would recommend remembering to do this, just to be safe. My second patient was in with
abdominal pain/GI bleed. Last patient was in with altered mental status and CHF. Between the
three, I had a combination of the usual stuff you would expect…..abdominal assessments, neuro
assessments, peripheral vascular assessment, oxygen management, musculoskeletal management,
etc. All of the patients had mobility, fluid management, I&O, and vitals. I had to flush an IV with 3ml
of Normal Saline on one of my patients (no big deal with my experience, but be ready for this if you
have not worked with IV’s). The only one that is less expected was the wound care. Just be sure to
do the same as the lab sim and be sure to document the color/odor/consistency/amount/etc of the
drainage on the old dressing.
On musculoskeletal management, I had to do active range of motion on one of the patients. I almost
failed this one because I documented that the patient performed the AROM, and it was well
tolerated, but I did not state that he performed it “without difficulty (etc)”. The CE spoke with the CA
and they determined that my surrounding documentation was adequate, but it was close. So, watch
out for that. My patients kept refusing to let me help with repositioning and comfort measures. No
problem, just be sure to offer at least twice and to document the refusal after two offers. Be sure to
meticulously wash hand/foam upon entering/foam upon leaving/verbalize your steps/etc.
I almost slipped up during a med pass because I wasn’t verbalizing out loud my checking expiration
dates. I went back and checked before I gave the med, and apparently, no harm done. Verbalize
“side rails up, bed low and locked, call light in reach” before exiting the room. Always ask the patient
if there is anything else they need before exiting the room. In addition to placing the call light in
reach, it is also good practice to remind the patient to “push the big red button on this box” if they
need help. Basically, verbalize everything as if you are explaining it to a child. “I am checking the
wrist band (state out loud your comparison of name, birthday, MRN)” and “I am checking cap refill”
and “I am noting that pupils are equal round and briskly reactive to light,” etc.
Verbalize the results of your assessments so the CE knows you are hitting all the points. Leave
nothing to question. Again, rob’s mnemonics seem to work. I wrote out my grid on the back of the
student PCS form and checked off the parts of each mnemonic as I completed the task. I can’t
believe that this would be possible without having a list of things to be done, and without checking
items off of said list as you go. While doing vitals, always count a full 60 seconds for
pulse/respirations.
Verbalize to the examiner “start on the 12” and count out loud your first couple of pulses/resps so
he/she is counting in sync with you from the start. When doing a blood pressure, remember to only
pump the cuff up 20-30 more than the last BP reading (get the last vitals during report). I also
learned during the PCS that I only had to do 1 manual blood pressure successfully during the entire
CPNE. So, I attempted this on my first patient, but had a lot of difficulty getting a reading. After two
tries, I just used the machine, and decided I would get a manual on the next patient. Good thing,
because I then learned that you only have 3 attempts at BP per patient.
So, if I had attempted another manual, and didn’t get it, I may have failed the whole PCS. I am not
sure on this, but be aware, and look into the critical elements and procedures on vitals. I got a
manual on my second patient just fine, and then did a machine BP on my last patient. Always foam
after taking off gloves, and if in doubt, just foam and put on gloves, and then foam when gloves come
off. You can’t get in trouble by foaming or gloving too much, unless it looks to the patient like you
are treating them like they are dirty (emotional jeopardy).
One of my patients got short with me a time or two when I was doing things (“I already told them this
yesterday, y’all know I can get around okay on my own, they checked that earlier today, etc”). Just
remember to remain calm and understanding, and politely remind the patient that we perform
assessments repeatedly during the hospital stay to make sure there is no change in condition. You
can also remind the patient that if anything “we” are doing makes him/her uncomfortable, please let
us know so we can make changes or stop. The patient always has the right to refuse, and we have
to respect that (as long as our documentation backs it up).
I had to ask a patient if I might assist with repositioning a second time after he had refused the first
time, and was a little ugly about it. I just said “I know I asked you this earlier, and you already told
me no, but I am required to ask one more time, may I assist you with repositioning”. This gave the
patient the understanding that I am “just doing my job” and not here to bother him over and over. He
was actually nicer after this. Remember that the examiners, while they have strict guidelines to
follow, are still human. If you are very kind, generous, compassionate, and caring for your patient,
and if you show confidence in your speech, actions, and decisions, you stand a better chance to
have them pass you on a close call.
If you act nervous, scared, offended, impatient, etc, you are giving the examiner reason to doubt
your abilities. I could come up with tons of other anecdotal stories like these, but I will stop now.
Just remember these types of things, and read as many CPNE journals as you can. Do a gooGle
search for these. Overall, I would recommend that if you work in an acute care setting, start
practicing while on the job (foam on the way in, identify self, state intentions, practice performing
skills the way excelsior wants them, be careful not to touch the plunger of a syringe except for the
circle grip at the end, check safety stuff on the way out, foam on the way out, etc). If you do not
work in acute care, find someone who does, and get them to practice with you (they play the patient
and you perform mock PCS’s).
The PCS’s last 2.5 hours each. I usually took about 30 minutes to write my care plans, and then to
have the CE “conditionally pass this portion of the PCS.” I then would take an hour to an hour and a
half to do the implementation phase, and then the last 30-45 minutes to do charting and write out my
final care plan and evaluation. Be sure to watch the clock and don’t run out of time. I never felt
rushed, but I used almost the entire 2.5 hours for all 3 of my PCS’s. It never hurts to use all of your
time if you finish early and keep rechecking and rereading your documentation and charting to make
sure you didn’t miss anything (and keep looking back at your grid/mnemonics).
Chart when you have time during the implementation (if the patient is eating, or while the CE is
charting the meds we are giving in the computer, etc). One thing I noticed (and this is not a
criticism), is that the resources I used did not go really in depth on the process of the PCS (go to the
unit, CE and nurse give you report, write your 2 careplans, turn in to CE, CE states “by turning in
your PCS form you are indicating you have completed all critical elements of the planning phase”….,
doing the implementation phase, declaring your vital signs, sitting down to chart, CE stating “by
turning in your PCS form you are indicating you have completed all the critical elements”…., CE
leaves to review your paperwork for 15-20 minutes, CE returns and says “we need to talk to the CA
to clarify one issue with your charting”…, then wait for CA to review your paperwork etc.)
Again, read lots of CPNE journals online (on yahoo.com groups, on excelsior website, etc) to get a
good feel for how this works. Also, be sure to really read your CPNE study guide. You have lots of
waiting while your work is reviewed. Consider having a pocket bible or scripture on paper, or a song
in your head, or whatever to help you manage the incredible stress while you wait 30+ minutes for
your verdict after you finish each PCS.
The CA and CE’s were very nice, cheerful, and genuinely want you to pass. Once I got the final
“pass” on my last patient, the CA walked up with a huge smile on his face and firmly shook my hand
and congratulated me. He sat me down to finish up, told me to breath, explained the next steps, etc.
The whole time, he genuinely looked excited to be talking to me and was obviously happy I passed.
The CE’s came around and shook my hand and offered congratulations before I left.
One of the CE’s explained to me that, just like we are tested to a strict level, the CE’s are reviewed on
every student. Their boss, and their boss’s boss, etc, review every inch of the student’s paperwork
and their paperwork, in order to ensure that nobody is being too easy on students, or unfairly harsh
on students, etc. Excelsior has to ensure continuity, fairness, and calculated consistency on how
students are treated and judged on their performance. This being the case, the examiners may
come across as cold and calculating at times, but they have a strict script they must follow.
They may not “let things slide” as they will later get in trouble. But, they are human, and are happy
to pass you if you earn it. With all that being said, you must be prepared for this. The testing
representatives from Excelsior expect perfection in you, and you must give them perfection to pass.
If you do not think you are ready, you are probably not. I don’t think you could ever feel totally
ready, but if you think you are not ready but will “wing it” okay, you may not like the results.
Although I am very experienced in nursing and nursing skills, and the CPNE presented no skills that I
have not performed many times over, Excelsior has their way of doing things, their order of steps for
a skill, and they stand between you and your RN. Forget everything you think you know, and how
you practice in real life, and learn what they want. Some of it may even seem silly to you, but it is
their game, and you have to play by their rules to pass. “This is how I have always done it at work” is
not accepted as an excuse for doing something wrong.
I really can’t remember any time in recent history that I have experienced so much stress over a
couple of days (possibly if ever). This was difficult, stressful, but totally worth it once it is over. Just
be honest with yourself about your experience, abilities, ability to manage stress, etc. You can do it,
but be ready to work for it. This is a great feeling to have it done. I wish you the best in your studies.
Having completed this, I would be thrilled to help others who are pursuing the same goal.
If you have questions about details, studying, the CPNE process, etc, please e-mail me directly at:
michaelautry79@yahoo.com .
Good Luck and God Bless,
Michael Autry
Austin, TX
michaelautry79@yahoo.com
Date of CPNE = Jan. 7-9, 2011
Name = Anthony (last name withheld)
Ha. Thanks!
I'm glad I chose your DVD's. I knew a few people who took the CPNE before me, but they all went to
workshops. Money was tight after paying the new fee of over 2 grand for the CPNE, so a workshop
was not an option for me. After watching random youtube videos and doing some research I still had
no idea what to expect at the CPNE. I ordered your DVD's and quickly realized I found exactly what I
was looking for.
I pretty much followed everything on your lab sim video and the PCS video. I even went cheap and
made the play dough wound model.....worked great.
I studied for 5 weeks, which I am realizing is a short amount of time for the CPNE, and felt 100
percent going into my CPNE.
On Friday, I met the other 5 students. Some were nervous and some weren't. I was the only one in
my group who used your study material. The others had been to workshops or studied on their own.
That night I followed your lab pneumonics word for word and passed all 4 lab stations. On Saturday
everything was smooth sailing on the PCS's. Here are a few observations that you can pass along to
others:
EVERY ONE will give meds on your first PCS. Every patient that we had required getting their 9 AM
meds. This was important due to time limits. Your PCS usually started at 7:30 and ended at 10. Make
sure you keep track of when to give meds. Plus, I found it helpful to get my meds around 8:45. It
usually takes 15 minutes to get in and out of the PIXIS and get everything ready.
Practice Apical pulses. Any pt with A-fib will be assigned Apical pulse.
Take two sets of vitals on every patient.
MOVE THE PATIENT'S BEDSIDE TABLE OUT OF REACH during your PCS. I was told this trick from
a previous EC grad but I forgot to do this on my first PCS. My first pt had just finished eating
breakfast when I got in her room. On her table she had milk, coffee, ginger ale, cranberry juice and
water. She kept sipping and drinking during the entire PCS! It took me FOREVER to figure out all of
her intake! The next 2 PCS's I moved the table and It worked great. The next PCS didn't have any I's
and O's and my last one only had a little bit of water to take her meds. Obviously if they ask for it
move it within reach, otherwise out of sight, out of mind.
I had PVA on all 3 PCS's. I even had to use a doppler on one pt.
RELAX! Your CE and the pt can see if you are stressed. Have a smile on your face and do
everything with confidence.
Overall my CPNE was fairly laid back and stress-free. Everyone was nice and wants to see people
pass. The CE's are not monsters, they are normal people who are willing to answer questions and
help you...not fail you.
Date of CPNE = Dec. 3-5, 2010
Name = Mark Keskes
I just wanted to pass on my experience to others from my CPNE so that maybe they can learn from it too.
I tested in Racine, WI on Dec 3-5th 2010, it was my first time testing and I drove the 9 hours there on Thursday. I
arrived got my room and drove to the All Saints Medical Center so that I would know exactly how to get there and
back without the pressure of the normal commuting traffic. I had prepared and made my own little "wet lab" of
equipment and a scarecrow out of old clothes that I brought with me to practice before going to the exam which I did
several times Friday before reporting at 4pm (it was the same setup that I used at home).
There are uniform stores in town in case you lose or miss something, or in my case spilled a cup of coffee on my
scrub pants before walking in on Saturday. I underestimated the stress of the exam and was unable to get more than
3 hours of broken sleep Thursday night, and changed hotels in the morning. I got 5 hours Friday and 6 hours
Saturday. I did not stay with the others at the hotel suggested by the college so that I wouldn't feed off of the others
stress too.
I did not know how I would be affected by a Benadryl so I took nothing all weekend to help me sleep. Morale of the
story: Know how things affect you so that you can get adequate rest to help your stress. Rob is absolutely right about
knowing how you personally are going to manage your stress with walking, swimming, playing a musical instrument
in your room, whatever it takes to let go of it. Force yourself to eat. You need the blood sugar for the greedy brain to
function.
I made it through the labs and had no repeats on PCS's: From the disk print out the student response form and
other than the always in effect areas of care (vitals, mobility, asepsis, etc, etc) randomly pick out different areas of
care when you practice. Practice documenting what you find for each AOC. And when you leave the room if you have
the time while waiting for a doc or therapist etc. Get some of your documenting done. You can't give them too much!
Know where on the response form to put [your documentation]. The Care plan videos Rob has on here are
priceless, I re-watched them Friday and Saturday nights and it helped me.
Also, for All Saints Racine, they have a new asepsis initiative that was in effect for us. They use the pumps of foam
hand cleanser. After the initial outside of the room wash under the CE's watchful eye you will use the foam unless
soiled then its a re-wash. The new part of their initiative is this: hand cleanse between each contact.
I hope this helps and I wish you all the best of luck.
Date of CPNE = Dec. 3-5 2010
Name = Valerie Putnam
Still am in shock that I passed the dreaded CPNE. I Worked long and hard at this. Have been an
LPN for 30 years!
I purchased Rob's CPNE study packed on line. Great help. Why ? Just was a basis to get me
pointed in a direction to start the process of preparing. Also, Yes I used a Grid of sorts. Was it
helpful, you bet. Especially when you are on "time crunch'', you can look at what your wrote in your
"crib' notes or grid, or whatever is your thing is, and you don’t have to worry you forgot something.
OH wait, I take that back, Worry-- you bet I did. Each time I handed my packet in, there is a 20 min
or so wait while the CE reviews it. I would say that wait is HELL, for all other aspects of the CPNE I
felt calm. I had great confidence that I could be one of the 60% that passes the first time to test.
I opened my Study Guide for the first time in July. It was horrid at first and I felt as if I was reading a
book in some Greek format. I read the SG from the first page to the last. Not once but many, many,
many times over the last few months.Each time I saw something that I had not seen before.I made
flash cards. I worked on math problems while having a free minute at my job.I reviewed every bit of
info that I could get on-line.
Be careful there are some poor videos out there. (Vanessa CPNE is a good basis to view
[youtube video] as well as Robs). I set up my Mock Lab with my hand made Dummy.I made my own
fake arms, fake wound, and used a potato to inject. Why did I do this if I had been a nurse for
thirty years? Because it is important to get the steps down that you need to do for your lab sim.
Do it over and over and over again !
I did not buy anything fancy. I used a few pair of gloves , non sterile and reused and reused. I did
buy alcohol pads just so I had something to rip open. I made a sterile 4 X 4 from a paper towel cut to
size for the wound dressing change. I made ABD from Feminine Product "taped two mini pads
together". I made a wound from play dough as Rob shows in is series. I had one four by four gauze
that was 8 ply but I used it over and over and over again.
Actually the gauze boat was a tupperware square container with a hand printed label taped to it.
All the stuff you make or use is pretend. It just does not matter to buy expensive stuff or fancy things.
You need to know your steps. It is not important to get caught up in "will it be 12 ply or an 8 ply" or
“one gauze or 2 gauze." It is about practice the steps.My hand made stuff does not look at all like
the dummies wound at the clinic but again I was able to practice the steps.
Every time I practiced I said the steps out loud. I could recite them in the car while driving, while
attempting to drift off to sleep, while walking my dog int he woods. Review constantly.The closer I got
to the date for testing I was questioning if I had given myself enough time. After some folks write that
they study for a year I felt that I had not given it that much time. Yet for me I feel that review gets
better the closer you get to the test date. You are forced to push all other responsibilities to the back
of your mind.
I did make 3 phone calls to Excelsior, they were very pleasant staff but still would say "review the
critical elements". When I asked of the 12 ply or 8 ply, as she told me, they have no control over
what a particular hospital test site will use. Any questions like that can wait until orientation night at
your site. Tell you the truth now, I do not know what ply my gauze was .
The SG is an odd thing to get your mind wrapped around. You know AOC for goodness sake it just
means good old fashioned nursing care. But boy it was hard for me to understand that term in the
beginning.The staff at Syracuse were awesome. They were real people, all women, and they did not
look scary or mean, or stern or any other negative term. They were just nurses that needed to
observe us.
Each time that had an opportunity to praise us or encourage us before we started they would do so.
And I will say that when I faltered and had to be removed from a PCS 15 min. into it, the CE and CA
looked sick about it. Their eyes told me how they felt, but I knew better and made an error, therefore
I had to sit it out. For all the money in the world I would not want their job.
Believe me, life throws you curve balls even during the best laid plans. My father passed away 7
weeks before the exam. I hope to write a Journal and post it for anyone.
At this time if you wish to ask me direct questions feel free to write me at my home address:
mamaputnam@gmail.com
Date of CPNE = Nov 10-22, 2010
My CPNE was in Madison, Wisconsin last weekend (nov 19-22). There were 8 of us and all 8 failed.
For anyone going to Meriter Hospital, I would suggest going early to familiarize yourself with the
facility. Having spent the weekend there, talking to the other 8, most of us failed a PCS or 2 b/c we
were unfamiliar with were equipment was located.
Important to remember here is that they have what's called "Nurse Servers". It's a closet in the
hallway outside the patient room that is considered "clean". PLEASE wash your hands before
opening the door (there is a locked med box in this closet). Also, it seems the examiners in this
facility got us on our assessments not being perfect...
- i.e. respiratory (go side-to-side evenly),
- abd assessment (look, listen & feel in that exact order). I failed my pcs b/c i touched his belly b4
using the stethoscope).
One student in my group was a Dr. from Cuba so english was her 2nd lanuage and they failed her
on all! of her pcs's b/c her charting was "too vague". I don't know how to get around that one.
In the Labs, several failed b/c they went over their time limit, & on the wound station (I highly
recommend watching Rob's video on dressing the wound, it was perfect!) [In regards to the
wound station] I would pour the saline into the gauze while not wearing gloves and when opening all
the packages. Touching the bottle of saline [without gloves] seemed to fail some people.
1) Don't forget to aspirate before injections/flushes & pushes.
2) Go over the steps on mixing different meds in 1 syringe.
3) when care planning & documenting, i highly recommend putting down what's in the care plan book
WORD FOR WORD, even your charting. That's what they want, give it to them!
This facility was doing reconstruction on their pediatric/women's wing so no peds pt's there for a
while, so that will be a nice break. I hope that I was able to give someone some insight into the CPNE
& the Madison, WI area examiners. HAND GEL TO DEATH! Thanks !
Date of CPNE - June 11-13, 2010
Dear Robbie,
Just wanted to take the moment to tell you more about my individual CPNE. Firstly because mine was
midweek in Utica it seems that the hospital (Foxton's st. luke) had to temporarily reposses the rooms
the usually give excelsior (which i am told were nice big airy well lite rooms) instead we had
orientation confrence in the cafeteria (which was a little bit noisy and distracting) and labs were done
in a small utility room. My woundcare station was set up on a bed! Now for me this was no problem
because this was exactly what my makeshift lab at home looked like - but some of the ladies (It
happen to be an all female group) really freaked out! One said she took the workshop by excelsior
down in albany and there was big tables, good lighting etc. (She unfortunately did not pass - she
failed the IM/SubQ station twice) And our makeshift room in the hospital had a broken air conditioner
and half the room the lights were out and the IV piggy back station was on that side. They set up an
additional IM/SubQ station in a little closet - all in all I am trying to tell you to be aware that even in
makeshift conditions, excelsior excpects you to do the station perfectly. (I had asked the CE before
starting if I can hang my tape off the side of the bed rail since it wasn't a reg. table and she said
yes.) We had plenty of time to familiraze ourselves with the equipment i tried on the pair of gloves i
thought would fit best - and practice doing the wound on the bed to see if it effected me at all that the
station was lower than i'd practiced, it didn't. (the ca gave us a little over 20 min to orient ourselves to
the stations) The gloves were easy to slide on and the gauze was very cooperative and came apart
easy for fluffing.
Bec. of the smaller room for labs the group split into half and 1 did labs while the other oriented to
the floor. I oriented to the floor first. My pt had Spinal stenosis I did risk for injury and chronic pain
bec. he has consistanly beenrating it as a 9/10. Of corse when i went in the next day and asked how
he felt he scored it a 1/10. I kept chronic pain as my evaluation NCP diagnosis anyways bec. even
though it was controlled it was still the primary concern as the stenosis was not very advanced.
My second pt was for the books and completeky freaked me out. A 69 year old man on dialysis that
came in vomitting, naseous, was diagnosed with hypokalemia and was ready to discharge and send
home. everything was perfect with the pt. All his values were in line he moved around and did all his
care like a 20 year old. He was wonderfully nice but there was no diagnose to do. In the end I held
my breath did readiness for enhanced comfort r/t hospitalization and kept telling myself as long as i
do it well it will not fail me. other diagnosis was risk for injury. It took 20 min. for me to convice the
nice man to allow me to do comfort measures bec. he was perfectly comfortable and ready to go
home. He was discharged and left the hospital as i gave report to the primary nurse during
evaluation phase.
The third pt. was very difficuly 99 year old room with fractured shoulder -imoobilized, fracture to neck
of femur. how did she injure herself? She was fully active living by herself before the injury,
volentered with community works, soup kitchen, etc. she fell taking a leaf out of her dining room table
! she was sweet and a riot, but oh time consuming. Breakfast to 30 min! I tried to ask the CE if i can
get a CNA to help with breakfast while I did charting (there was plenty to chart but she very kindly
told me no. Anyways, took 15 min to do her mouthcare too bec. she wanted to try to do it with the
non dominante hand, etc. it took very long. than i had to do resp. management on her! I spent 15
min. talking to myself outloud on how i am going to do this. I can't sit her up bec. the shoulder
immobilizer and her painscale rated at 7 and she hadnt been medicated yet and i only had 30 min
remaining to pcs. I couldnt very well turn her onto the imobilized arm, so i would have to turn her onto
the good arm. I ask the CE what would be acceptable in this case reguarding the fact the pt would be
in pain - and of corse she tells me i have to decide. so the CE helping me we roll her towards her
good arm while trying to keep the arm as immobilized as possible and than i see the immobilizer runs
along the whole back I stick the stethoscope under get 3 feilds but the pt is in a lot of pain and there
is noway to manuever her enough to get to the last feild I rool her back in place and reposition her
while thinking what am I gonna do now. It is then that the CE speaks up and says "you know chava,
excelsior has a very quiet policy that in extreme circumstances auscultation can be done on the
front." - I was ready to kill her. After me putting the pt. through 5 min. of torture (O would have failed
myself by the way for it but she told me to just try to do it and be as quick as possible with the first
sounds of pain from the pt.) so she tells me this policy. Which I had read as one blip in the CPNE
study guide. well, the rest went quickly, and she told me i passed. It was a harrowing experience.
Not to mention I didn't know weather to include the 5 ml of maple syrup on fluid intake but decided i
should especially cause you specify what the fluid was. And than I heard the pt ask for the CE to add
milk to my pt. coffee when I was in the bathroom washing the mouthcare equipment. I came out to do
it but was too late and when I asked her how much she looked at me like I was off the wall. I told her
for I and O and that i was gonna measure the milk before adding it to the coffee. She told me it was
probably one tsp. I thought that was mean - now I know 1 tsp is 5 ml in my sleep with 4 young
children and plenty of tylonel having been given in the last year alone. But if another student with not
too much pt care acess and poor meomory of conversion rates - well - If i told you I was going to
measure it I think at least she should have answered 5ml - she was waiting for me to tell her what the
1 tsp ratio was and I promptly did so. Anyways, I really didn't mind anything she'd done by the end
when she passed me (cuz i don't think i would have if situation was switched! But I still believe I am a
very cometant nurse)
So there you go - No repeat labs, No repeat PCS. hope I didn't bore you but figured I could give you
the info and you take from it what you will. (Also, the plungers on the insulin syringes I used stuck a
little bit and it had to be rocked back and forth to loosen it (It caused me a problem the first time I
drew up and than i quickly refilled another after loosening the plunger that time.)
Oh, and I wanted to tell you that for the first 30 sec of my labs I felt lost like i didn't know where to
begin and than i told myself, you memorized rob's mneumonics SO why don't you WRITE THEM
DOWN! I did that and than it was a breeze it kept my anxiety in check and allowed me to focus on
the task. So that is my extended story. Sorry again, I hope it didn't bore you. And thank you again - I
would not have passed this test without your help!
Sincerly,
Chava K. (Kurant)
Name - Heather Santa Cruz
Date of CPNE - Mar 19-21, 2010
Hi Rob,
I just wanted to let you know that I finished my last PCS this morning at Grady and I have officially
passed the CPNE. I also wanted to thank you, not only for your website, DVD's and Ebook, but for
answering my questions (even the little ones) when I really needed to know more or I was just
anxious.
I did great on my PCSs--one CE said my documentation was "excellent". I have you to thank for that.
The only mishap was I had to re-do the wound lab sim. According to the CE, I touched the side with
the gauze. That night I practiced on the wound I made (using a different method--I personally don't
recommend the parachute method). Then, after a good cleansing cry in the 6th floor Grady
bathroom, I passed the thing that could have sent me home. After I passed on the second try, I felt
like I'd already won. Today's peds PCS was cake.
Thank you for your recommended nursing diagnosis--they were all highlighted in the back of my
book and were very handy. In my experience, acute pain was used successfully for all 3 PCS. It was
my primary for two of the three.
I'll give a little info on my experience in the hope that it may help others. Grady is a very old and worn
looking hospital in a not-so-great area in Atlanta. However, I would recommend the location to
anyone looking for a Southern test site. The CA was very comforting and knowledgeable. The CE's
were also great. They don't seem to sweat the small stuff. When I had I &O's, they never expected
me to pour any liquids into a graduate--they either told me what to put down or allowed me to
estimate (half a juice was 60mLs). I only had to wash my hands at the sink initially before each PCS,
then the "foam in, foam out" (which is Grady's policy) was acceptable every other time. Grady has a
great hand hygiene and infection control policy--I was impressed.
In my experience, as well as some other student's, the CE's seemed to prompt us to remember
certain things even if it wasn't necessary. They just did it as a courtesy. I'm not certain, but it is
possible that the CE I had at the IV push station gave me a couple extra minutes. Another student
said the same thing. It's not that they aren't strict--you better know your stuff--it's just that they don't
seem to want to fail you for the stupid things that have nothing to do with being a good nurse in the
real world. They seemed very down to Earth and practical.
If anyone is planning to go to Grady, they can email me with questions if they want to. I'd be happy to
help--I certainly know how it feels to have anxiety about every aspect of this exam.
Everyone in my group of 7 passed. It really can be done. I had to see it for myself to believe it, but it's
true. I work part time, have a toddler, and I'm 21 weeks preggo with number 2. I did this with no
Xanax for anxiety, no Lunesta to help me sleep, and no beer or cigarettes to help me relax like most
of my group members did, and I still made it through with no problems (aside from the wound). If I
can swing it, I think anyone can as long as they're prepared. I had my husband and 2 year old with
me for support and comic relief at the hotel which, for me, was great. I also brought all of my study
stuff with me--even my IV bag. I know some others have said NOT to study during the CPNE, but just
knowing my resources were available if I needed them helped a lot. Reading or practicing something
"just one more time" before the real event made me feel more confident.
Even though I did pass the wound station on the second try by practicing on the wound I made, I
really recommend buying the Excelsior wound model for anyone who is especially worried about that
station. The model is extremely shallow--almost flush with the surrounding "skin" in places. It is also
slippery. Unlike the wound I made with play doh, the gauze would not stick anywhere and could not
be tucked in nicely into corners. It behaves nothing like an actual wound, for sure.
I can't think of anything else at the moment, but please ask if you want any particular info. I would be
happy to help anyone if they have questions.
Thank you again for your great study materials. I would not have gone in so confident without them.
And I didn't get a one-time workshop for $400, I got your info, which was exceptional, that I could
watch or read as many times as needed. Plus, you were always there to answer questions. I can't
thank you enough. I (and many others out there) are very grateful for your dedication.
Heather
Name - Amy Bowers
Date of CPNE - Feb 26-28, 2010
CPNE date: Feb.26-28 I passed ONLY because of the organizational skills (mnemonics and both
DVDs) taught through Rob and a few other things I threw in, too... First, set up your lab equipment
the exact same way at home, then when you are at the CPNE, simply set the equipment up the same
way...Second, during my planning stage, I would place a number next to the AOC in the order of
which would be best (ie 1st 20 min check, 2nd Fluid Management, etc)...
Next, I ALWAYS had my grid out during the implementation and evaluation stages so I never forgot
anything...Last, for three weeks prior to my CPNE, I took a BID (twice a day) dose of Airborne to
prevent becoming sick and giving the CA a reason to fail me d/t illness. This product ROCKS!!! (I've
spoken to other students who have purchased Rob's product second hand...though you may feel as
though you are getting a price break, there are too many perks to purchase the product through
Rob: talking to Rob online, E-Books, and Study Partners.) I have been an LPN for over 5 years and
would have NEVER passed if it weren't for Rob preparing me!!!! :) Amy Bowers, GN Phoenix, AZ
Name - M. Clark-adams
Date of CPNE - UNKNOWN
Hey Rob!,
Not sure if this is the right way to email you but I wanted to thank-you cuz I passed the CPNE on the
first time and it was your videos that saved me!! The part that says " Don't forget to check the cap
refill", cuz I almost did forget. A couple of other things to, and the CPNE was in Racine WI:
It's one 4x4 for the wound center **, don't contaminate the edges or your sterile gloves, should
pass.
** Please see the FAQ tab, Q# 25 on how many gauze pieces to use **
Need to know that for the dummy buttocks, the landmarks are very,very poor. If using Vastus
Lateralis, find the middle part, where you think the knee is, and lower than you think the femur
landmark is, there isnt' really anyway to truly see/feel where the landmarks are as they are not really
there, but kinda look for the middle third.
IV push is fine, IV flow rate pretty good.
I failed two PCS on silly stuff, for some reason, it wasn't immediately clear to me that Apical pulse is
[taken under] the gown, failed. (Rob's NOTE: ALL auscultation should be done directly on the
skin or they will fail you - respiratory, abdominal, apical, etc.,) I couldn't get the manual B/P,
failed on another PCS for that. Don't have a comment to help anyone pass but maybe practice
manual B/P on a real person for a lot of practice time to make sure one doesn't fail for something
silly like that, worth a comment.
Third, YOUR video and coaching is what made me go the distance. It is so very important to not talk
yourself out of passing and trying no matter how many times you fail. As of Sat of the CPNE, I had
managed to only pass the four labs, and had to re-do two of those labs. I failed both the pediatric
and the adult PCS on Saturday. When I came back in on Sunday, I had to face three PCS's, and I
did it. I almost talked myself out of passing, and even thought of throwing the repeat labs just to "end
it" on Sat night, but all the coaching and studying that I did and comments about just getting through
it made me stand up and do my very best.
Again, Thank-you!!!
Michaele Clark-Adams
Name - R.W.
Date of CPNE - 1/29 - 1/31, 2010
I hope this information can help others out there and alleviate a little bit of their stress.
First, this exam is very regimented. The associate and examiners are there to test us and to
maintain as much neutrality as possible. Therefore, do not expect them to be overly personable and
friendly. They are always polite and cordial (or at least my experience has shown that to be the
case). I am sure this professional type atmosphere exists primarily so no one testing could ever say
there were incidents of favoritism.
Secondly, do not hesitate to ask the examiners questions!! If they cannot answer them, they will let
you know that. Always ask if an area in the patient's room is a clean area to put down a papers, if
needed. I even double checked as I found most examiners pointed this out, just to be sure. Another
question to ask is about liquid measurements while on the unit. My experience was this: I had a
patient who only drank sips of water to take medications. Nothing more for input, nothing for output.
On the area of the form where we document intake, I asked the examiner if we should measure it
and calculate, or put down "sips of water". In this instance, "sips of water" was appropriate. Be sure
to designate what it was that the patient drank. Just noting "sips" wouldn't be approved. But, check
first with your examiner about this!!!!
However, I did have an instance where an examiner wanted the urinary output to be measure in the
graduated container, and not use the measurement in the "nun's hat" in the bathroom. She told me
technically, they were instructed to use a graduated container for this. So, as you can see, not all
examiners handle things exactly the same way. I believe they follow guidelines and rules, but they
are all different people and not robots.
Also, the Clinical Associate also emphasized to us to always, always, take two sets of vital signs even
though you believe you are 100% correct! I had to retake a PCS because the examiner and I had
two different apical pulse readings. The patient had a very irregular heartbeat and I thought I heard
correctly, but, according to the examiner, I must have not. Do yourselves a favor by taking two sets.
Also, if needed, during respirations, ask the examiner if you can use the stethoscope to obtain
accurate respirations. Now, most times you will not need to do this and can just use the method of
putting your hand on their shoulder/chest to count respirations as Rob instructs. I had to because
the patient whose respirations I had to take required me to do this 4 times to get an accurate count
as he was very sleepy and experiencing apneic episodes while I took the respirations. That will
knock you out of the accuracy area quickly!! So, don't think you cannot perform something more
than once to obtain accuracy; they want those measurements correct and so do you so you can
pass the PCS.
I also had a PCS where the patient had CHF along with other issues and was not really very steady
on their feet. For the careplan, I used "risk for injury related to generalized weakness." Then, I
used safety measures I was already implementing for the interventions. I used this particular nursing
diagnosis on almost all of my patients. (as you had suggested :). On this same patient, the primary
diagnosis I used "ineffective airway clearance". (there were other reasons this was more appropriate
for this patient, and not something related to activity intolerance, I just can't recall) Yet, I was not
assigned respiratory assessment or respiratory management or oxygen management! My point here
to everyone is to do as Rob states, look over the kardex very well and you should easily be able to
come up with an appropriate care plan for your patient. In addition, even though I didn't do a
respiratory assessment or management, this is where you need to really look over the interventions
in the Mosby's book and do what is appropriate. I was able to encourage an appropriate level of
activity for this patient and to position the patient upright to facilitate ease of respiration. I believe the
goal I used was to maintain a patent airway during the course of my pcs. Don't let it throw you off
track if you are not doing a particular assessment or management area. If the symptoms fit and are
overall appropriate to a diagnosis, use it. But, think it through first. I know it seems weird to do this
and not listen to the lung sounds, but, it was correct. Don't add more work to what you are given.
Only perform the areas of care that you are assigned (just as Rob says!)
Lastly, I was assigned an abdominal assessment on a patient who had a major abdominal surgery
about 7-10 days prior (a major incision that was healing well, 2 JP drains and a biliary drain). I
verbalized to the examiner everything I was doing. I wondered about palpation given all that was
done. I verbalized that I was going to lightly palpate, which I did, and the patient slept through it! He
had not been experiencing any pain and rated it at "0", so I was safe, in this instance. Had the
surgery been within a very close time frame and the patient was experiencing pain, I would have
invoked CDM and possibly made another decision. Proceed through your areas of care thoughtfully
and methodically and you will perform better. Be mindful of the timeframe you are working in, but
don't rush as you don't want to miss anything. Follow your grid to a "T" and do not only rely on your
memory. Always refer back to your grid. Lastly, be sure to follow your grid completely while
documenting. Be sure you document on every critical element. Also, it is best to write down more
detail than not enough. Our CA had told us "if it isn't documented, it wasn't done." Also, as a last
reminder (really, this is last :) All patient rooms may not be set up the same. Be mindful of this
during your PCS and don't take room setup for granted. Always be aware of your surroundings and
where the gloves and hand gel are located. I had one patient where it was all located in the entryway
of the room. Nothing was near the bed. In another room, it was next to the patient! Be confident, in
control and aware!
Name = Adrienne Franklin
Hi Rob. Here is a summary of my experience, as promised. I arrived in Lubbock, TX on Wednesday,
October 12. I drove down with my supportive daughter in tow, which made all the difference. I did
brief studying and connected with a fellow tester right before the labs on Friday the 14th. Saying I
was nervous would be an understatement and it showed in my labs; I failed two of the labs for silly
reasons. I forgot to I.D. one and forgot to check the site on another. I forgave myself, moved on and
passed them both the next day. My PCSs were great and I passed all 3 with no repeats. Your
information was prominently displayed all over my Grid! Your mnemonics kept me organized and
confident that I had not only executed the tasks at hand, but had charted them, as well. I took your
advice and, when I would enter each PCS after introducing myself and my CE, would thank the
patient and their families for allowing me to be there as a student nurse taking care of them. I believ!
e it made the patient and present company more willing to be a part of the experience and put them
all at ease. I also did the SCAB, though not out loud all the time. I could hear you saying "Side
rails up, call bell within reach....." So funny how everything came together! Oddly enough, I was
assigned Abdominal Assessment with every one of my patients. Your PPP DART was rocking the
whole weekend and helped me tremendously! (When I got home and threw away my CPNE stuff, I
kept my paper with that mnemonic haha). My last PCS was had me literally running down the hall to
hand in my work to the CE, as my pt had lots of unexpected things happen, which cut into my time.
When the CE came to me and stated "you passed!" I grabbed her and cried. It was a
feeling like no other. To all of you who are debating on whether to purchase Rob's CPNE, I say do
not hesitate. If you read the Excelsior Study Guide, know your Critical Elements good enough to
recite them in !
your sleep and use Rob's material and focus on documentation and time management, you've got
this, hands down. I had very little bedside experience, took no "hands on" workshop and
was successful my first time with no PCS repeats. Thank you, Rob. I honestly feel that, in addition to
this being your business, you genuinely care if we pass. You go the extra mile, from the free Care
Plan help to the low cost of your materials. One more thing...your Med Math helped me so much! As I
move on to bigger and better things with the CPNE in my rear view mirror, I know that I will not soon
forget all that made this possible to attain. I am happy to report that your help made the list. :)
Thanks again, Rob!!
Date of CPNE = Jun. 28-30, 2011
Name = Michael Autry
Hey Rob,
I passed my CPNE June 28-30 in Milwaukee, WI. Your mnemonics were priceless for this thing
(especially the lab simulations). I could possibly see memorizing critical elements for the PCS's, but
with the time limits on the lab sims, your mnemonics got me through. While doing the lab stations, I
was figiwa-ing and rcadrigcap-ing and singing about an australian guy that loves CD's like there was
no tomorrow (I even did the australian accent in my head).
It is really easy to just go blank when starting the lab stations, but the mnemonics were easy to
remember, easy to follow, and flowed perfect for the steps. I used your mnemonics during my PCS's
to create a grid (as you instruct), and then checked off steps as I completed them, and then later as I
charted them. I will admit that I used many resources overall to prepare, but your system was my
primary source of information, and I stuck to your teachings the whole way through my CPNE.
Students must realize that there are far more details than any one program could cover, but your
system provided the foundation of learning on which I was able to prepare for a successful CPNE.
So, of course, I must recommend that students read their official CPNE study guide (multiple times),
seek out and read as many CPNE journals as they can (on excelsior's website, on yahoo groups,
etc), and really know what they are preparing for. But, your system was a great resource, as well as
being my primary resource. I highly recommend to others that they use your materials.
ROBS RESPONSE: Excellent point Michael ! EVERY student must read the CPNE guidebook (especially the
critical elements chapters) to be 100% prepared and ready to pass the test
Thanks so much for all you do,
Michael Autry
Austin, TX
BELOW IS MICHAEL'S CPNE JOURNAL - VERY DETAILED MICHAEL ! THANKS !
I address the following CPNE journal to those out there who are preparing for the CPNE, or who are
considering using Excelsior College for their RN program. It is tough, but it can be done.
I would first like to talk about travel and hotels. I flew from Texas to Milwaukee, arriving a solid 48
hours before the test started. I rented a car. I have a GPS system that I brought with me to help with
driving directions. I had an afternoon/evening, then a full day, then a half day before having to start
the test on a Tuesday evening. I brought my practice supplies with me to the hotel, put the “do not
disturb” sign on the door, and set up my practice lab. I kept the sign on the door so housekeeping in
my hotel would not accidentally throw away any of my supplies.
I studied some, but not too much. I got plenty of sleep, studied, napped when tired, ate when
hungry, etc. I had a rent car, and again, a GPS system from home, so I made a trip to the hospital,
found adequate parking, parked, walked into the hospital, and located where I was supposed to
meet the Excelsior staff for the test. This helped me to know for sure what I was facing when going to
the hospital to start the test for real. Can you imagine spending $2K, travel expenses, taking off of
work, etc, and not finding the hospital on time and being too late to take the test?
Take no chances. Arrive early to the city, check your supplies once you are in the testing city (in
case you forgot your nanda book, etc), arrive early to the hospital each day, and plan to fly out the
day after the test is over. As I write this, I am sitting in my hotel room, having passed my CPNE this
morning, and my flight leaves tomorrow. You do not want to be stressed on the final day of testing
about making a flight home. So, if time and money permits, I highly recommend arriving to your
testing site 48 hours before the test starts, and plan to leave 24 hours after the test is over. Again,
take no chances.
Have extra everything. Arrive early. Plan ahead. This is too big to mess up over a delayed flight,
faulty directions to the hospital, spilled coffee on white scrubs, or a lost book. I brought most of my
practice supplies with me, but purchased a few items at a local pharmacy. However, I had trouble
purchasing syringes, needles, injectable medication vials. I brought IV bags and tubing with me, but I
assume these would be hard to purchase as well. So, plan ahead and make sure you secure and
pack all practice stuff you need. Also, I emptied my IV bags for packing/flying, and refilled them with
tap water in the hotel, just to prevent any problems with the airport folks checking my luggage. I also
upgraded my flight to first class. I know that is excessive, but I didn’t want to take any chances in
comfort or preparation (or at least that is what I told myself to justify the upgrade).
The first class seat sure was comfortable. I had never flown first class before, and the flight
attendant kept offering stuff. I sort of felt funny about it. But, again, I am telling myself that if I had
not been in first class, I might not have been successful. Perhaps I should upgrade to first class for
the flight home, just to be safe.
I passed my CPNE in Milwaukee, WI at St Joseph hospital June 28-30, 2011. I had no fails, no
repeats. The whole experience went pretty much like I figured it would, having read many CPNE
journals online. It is every bit as stressful as I expected, and does really test how prepared you are.
My current full-time nursing job is in Level-I Trauma. So, I frequently see major, life-threatening
traumas and medical emergencies of all sorts (car wrecks, motorcycles, gun shots, stabbings, CPR,
overdoses, heart attacks, strokes, broken bones, burns, amputated body parts, farming equipment
accidents, etc), but this experience presented a level of stress unlike anything I have seen.
I say this not to frighten or intimidate, but to give you an idea of what you are preparing for. Again, it
can be done, but you must be prepared physically, mentally, emotionally, and spiritually.
The lab simulations were tough, simply because of the time limits. The time seems to fly by while you
are being so careful to do each step just right, clear bubbles from the syringe, etc. Although I have
given thousands of IV push medications in real life, I almost ran out of time in the IV push station, just
because of how long it took to draw up the perfect flushes and med.
I had set up my practice lab in the hotel room, and just hours before the real thing, had completed
my IV push (with really drawing up water, etc) in like 6 or 7 minutes total. Then, in the real thing, it
took twice as long (just be aware of this phenomenon). I finished the IV push station with 30
seconds to spare, and passed. I finished the other lab sims in plenty of time. Also, it is really easy to
step up to start a lab sim and just go blank. So, my recommendations on the lab sims are to practice
over and over until the muscle memory takes over and you could do it in your sleep. Also, use some
sort of mnemonic. I used Rob’s Mnemonics from robscpne.com (among other resources), but Rob’s
mnemonics seemed to be right on for the lab sims. Start each station with a brief pause, and a good
deep breath, remember your mnemonic, and go to work.
I recommend practicing drawing up flushes/meds in syringes for real, as opposed to just going
through the motions with empty bottles and syringes. If you are not familiar with how to do this, find
someone who is and learn how to clear the bubbles. I also recommend getting a wound like the one
used at the CPNE (check with excelsior about ordering one). It is best to practice with what you
know you will see. Different resources I studied showed different types of bottles used when drawing
up meds. Sherri’s workshop (cpneworkshop.com) uses the needle-less adapters that are already on
the bottle, so you just screw on the syringe, and do not inject air.
This was the correct type for my IV push station, but my IM/SQ med was all needles. I got IM, so I
still had to inject air in to the first med, then air into the second med, draw up the second med, then
back to draw up the first. Sherri’s workshop shows the IM meds being drawn up with the needle-less
system where you do not have to inject air. Of course, I do not know what the other testing sites will
have, but just be aware that the equipment may vary and you should be prepared for anything. Be
sure to verbalize steps (checking ID, allergies, aspirating syringe, etc) so the examiner knows you
are doing some of these small details (my examiner sat back away from me and so I was not sure if
he could really see me aspirating for sure). Again, take no chances. Make sure the examiner
knows that you know every step and critical element.
For my PCS’s, the whole thing is sort of a blur at this point. Again, I passed all three, and did not
have to do any repeats, so I will try to offer some words of wisdom and a brief summary of my
experience. I did not get a pediatric patient, so I had a peds substitute. The CE told me that the
hospital has peds, but just didn’t have any available at that time. I know it is a major question for
some people who want to go to a hospital where they are not likely to get peds. So, I do not have a
clear answer for Milwaukee, except I will say that I don’t think any of our 6 students got an actual
pediatric patient. My three patients were all between 80-90 years old, one female, two males.
The first was the female with diagnosis of MI/hypotension/bradycardia. Had to do a wound change
on the back of her head. It was exactly like the wound care station in the lab sims, except we used a
tube gauze wrap over the top dry 4x4 pad, instead of an ABD pad and tape. The CE was very
helpful and held her hair back for me. Otherwise, I just set out my sterile field and went through Rob’
s mnemonic as it is used for the lab sim. Thinking back now, I realize that I did not label this
dressing in the real-life wound change with time/date/initials. I don’t know if the CE just let it slide, or
if she didn’t realize it either, or if it simply was not required.
I would recommend remembering to do this, just to be safe. My second patient was in with
abdominal pain/GI bleed. Last patient was in with altered mental status and CHF. Between the
three, I had a combination of the usual stuff you would expect…..abdominal assessments, neuro
assessments, peripheral vascular assessment, oxygen management, musculoskeletal management,
etc. All of the patients had mobility, fluid management, I&O, and vitals. I had to flush an IV with 3ml
of Normal Saline on one of my patients (no big deal with my experience, but be ready for this if you
have not worked with IV’s). The only one that is less expected was the wound care. Just be sure to
do the same as the lab sim and be sure to document the color/odor/consistency/amount/etc of the
drainage on the old dressing.
On musculoskeletal management, I had to do active range of motion on one of the patients. I almost
failed this one because I documented that the patient performed the AROM, and it was well
tolerated, but I did not state that he performed it “without difficulty (etc)”. The CE spoke with the CA
and they determined that my surrounding documentation was adequate, but it was close. So, watch
out for that. My patients kept refusing to let me help with repositioning and comfort measures. No
problem, just be sure to offer at least twice and to document the refusal after two offers. Be sure to
meticulously wash hand/foam upon entering/foam upon leaving/verbalize your steps/etc.
I almost slipped up during a med pass because I wasn’t verbalizing out loud my checking expiration
dates. I went back and checked before I gave the med, and apparently, no harm done. Verbalize
“side rails up, bed low and locked, call light in reach” before exiting the room. Always ask the patient
if there is anything else they need before exiting the room. In addition to placing the call light in
reach, it is also good practice to remind the patient to “push the big red button on this box” if they
need help. Basically, verbalize everything as if you are explaining it to a child. “I am checking the
wrist band (state out loud your comparison of name, birthday, MRN)” and “I am checking cap refill”
and “I am noting that pupils are equal round and briskly reactive to light,” etc.
Verbalize the results of your assessments so the CE knows you are hitting all the points. Leave
nothing to question. Again, rob’s mnemonics seem to work. I wrote out my grid on the back of the
student PCS form and checked off the parts of each mnemonic as I completed the task. I can’t
believe that this would be possible without having a list of things to be done, and without checking
items off of said list as you go. While doing vitals, always count a full 60 seconds for
pulse/respirations.
Verbalize to the examiner “start on the 12” and count out loud your first couple of pulses/resps so
he/she is counting in sync with you from the start. When doing a blood pressure, remember to only
pump the cuff up 20-30 more than the last BP reading (get the last vitals during report). I also
learned during the PCS that I only had to do 1 manual blood pressure successfully during the entire
CPNE. So, I attempted this on my first patient, but had a lot of difficulty getting a reading. After two
tries, I just used the machine, and decided I would get a manual on the next patient. Good thing,
because I then learned that you only have 3 attempts at BP per patient.
So, if I had attempted another manual, and didn’t get it, I may have failed the whole PCS. I am not
sure on this, but be aware, and look into the critical elements and procedures on vitals. I got a
manual on my second patient just fine, and then did a machine BP on my last patient. Always foam
after taking off gloves, and if in doubt, just foam and put on gloves, and then foam when gloves come
off. You can’t get in trouble by foaming or gloving too much, unless it looks to the patient like you
are treating them like they are dirty (emotional jeopardy).
One of my patients got short with me a time or two when I was doing things (“I already told them this
yesterday, y’all know I can get around okay on my own, they checked that earlier today, etc”). Just
remember to remain calm and understanding, and politely remind the patient that we perform
assessments repeatedly during the hospital stay to make sure there is no change in condition. You
can also remind the patient that if anything “we” are doing makes him/her uncomfortable, please let
us know so we can make changes or stop. The patient always has the right to refuse, and we have
to respect that (as long as our documentation backs it up).
I had to ask a patient if I might assist with repositioning a second time after he had refused the first
time, and was a little ugly about it. I just said “I know I asked you this earlier, and you already told
me no, but I am required to ask one more time, may I assist you with repositioning”. This gave the
patient the understanding that I am “just doing my job” and not here to bother him over and over. He
was actually nicer after this. Remember that the examiners, while they have strict guidelines to
follow, are still human. If you are very kind, generous, compassionate, and caring for your patient,
and if you show confidence in your speech, actions, and decisions, you stand a better chance to
have them pass you on a close call.
If you act nervous, scared, offended, impatient, etc, you are giving the examiner reason to doubt
your abilities. I could come up with tons of other anecdotal stories like these, but I will stop now.
Just remember these types of things, and read as many CPNE journals as you can. Do a gooGle
search for these. Overall, I would recommend that if you work in an acute care setting, start
practicing while on the job (foam on the way in, identify self, state intentions, practice performing
skills the way excelsior wants them, be careful not to touch the plunger of a syringe except for the
circle grip at the end, check safety stuff on the way out, foam on the way out, etc). If you do not
work in acute care, find someone who does, and get them to practice with you (they play the patient
and you perform mock PCS’s).
The PCS’s last 2.5 hours each. I usually took about 30 minutes to write my care plans, and then to
have the CE “conditionally pass this portion of the PCS.” I then would take an hour to an hour and a
half to do the implementation phase, and then the last 30-45 minutes to do charting and write out my
final care plan and evaluation. Be sure to watch the clock and don’t run out of time. I never felt
rushed, but I used almost the entire 2.5 hours for all 3 of my PCS’s. It never hurts to use all of your
time if you finish early and keep rechecking and rereading your documentation and charting to make
sure you didn’t miss anything (and keep looking back at your grid/mnemonics).
Chart when you have time during the implementation (if the patient is eating, or while the CE is
charting the meds we are giving in the computer, etc). One thing I noticed (and this is not a
criticism), is that the resources I used did not go really in depth on the process of the PCS (go to the
unit, CE and nurse give you report, write your 2 careplans, turn in to CE, CE states “by turning in
your PCS form you are indicating you have completed all critical elements of the planning phase”….,
doing the implementation phase, declaring your vital signs, sitting down to chart, CE stating “by
turning in your PCS form you are indicating you have completed all the critical elements”…., CE
leaves to review your paperwork for 15-20 minutes, CE returns and says “we need to talk to the CA
to clarify one issue with your charting”…, then wait for CA to review your paperwork etc.)
Again, read lots of CPNE journals online (on yahoo.com groups, on excelsior website, etc) to get a
good feel for how this works. Also, be sure to really read your CPNE study guide. You have lots of
waiting while your work is reviewed. Consider having a pocket bible or scripture on paper, or a song
in your head, or whatever to help you manage the incredible stress while you wait 30+ minutes for
your verdict after you finish each PCS.
The CA and CE’s were very nice, cheerful, and genuinely want you to pass. Once I got the final
“pass” on my last patient, the CA walked up with a huge smile on his face and firmly shook my hand
and congratulated me. He sat me down to finish up, told me to breath, explained the next steps, etc.
The whole time, he genuinely looked excited to be talking to me and was obviously happy I passed.
The CE’s came around and shook my hand and offered congratulations before I left.
One of the CE’s explained to me that, just like we are tested to a strict level, the CE’s are reviewed on
every student. Their boss, and their boss’s boss, etc, review every inch of the student’s paperwork
and their paperwork, in order to ensure that nobody is being too easy on students, or unfairly harsh
on students, etc. Excelsior has to ensure continuity, fairness, and calculated consistency on how
students are treated and judged on their performance. This being the case, the examiners may
come across as cold and calculating at times, but they have a strict script they must follow.
They may not “let things slide” as they will later get in trouble. But, they are human, and are happy
to pass you if you earn it. With all that being said, you must be prepared for this. The testing
representatives from Excelsior expect perfection in you, and you must give them perfection to pass.
If you do not think you are ready, you are probably not. I don’t think you could ever feel totally
ready, but if you think you are not ready but will “wing it” okay, you may not like the results.
Although I am very experienced in nursing and nursing skills, and the CPNE presented no skills that I
have not performed many times over, Excelsior has their way of doing things, their order of steps for
a skill, and they stand between you and your RN. Forget everything you think you know, and how
you practice in real life, and learn what they want. Some of it may even seem silly to you, but it is
their game, and you have to play by their rules to pass. “This is how I have always done it at work” is
not accepted as an excuse for doing something wrong.
I really can’t remember any time in recent history that I have experienced so much stress over a
couple of days (possibly if ever). This was difficult, stressful, but totally worth it once it is over. Just
be honest with yourself about your experience, abilities, ability to manage stress, etc. You can do it,
but be ready to work for it. This is a great feeling to have it done. I wish you the best in your studies.
Having completed this, I would be thrilled to help others who are pursuing the same goal.
If you have questions about details, studying, the CPNE process, etc, please e-mail me directly at:
michaelautry79@yahoo.com .
Good Luck and God Bless,
Michael Autry
Austin, TX
michaelautry79@yahoo.com
Date of CPNE = Jan. 7-9, 2011
Name = Anthony (last name withheld)
Ha. Thanks!
I'm glad I chose your DVD's. I knew a few people who took the CPNE before me, but they all went to
workshops. Money was tight after paying the new fee of over 2 grand for the CPNE, so a workshop
was not an option for me. After watching random youtube videos and doing some research I still had
no idea what to expect at the CPNE. I ordered your DVD's and quickly realized I found exactly what I
was looking for.
I pretty much followed everything on your lab sim video and the PCS video. I even went cheap and
made the play dough wound model.....worked great.
I studied for 5 weeks, which I am realizing is a short amount of time for the CPNE, and felt 100
percent going into my CPNE.
On Friday, I met the other 5 students. Some were nervous and some weren't. I was the only one in
my group who used your study material. The others had been to workshops or studied on their own.
That night I followed your lab pneumonics word for word and passed all 4 lab stations. On Saturday
everything was smooth sailing on the PCS's. Here are a few observations that you can pass along to
others:
EVERY ONE will give meds on your first PCS. Every patient that we had required getting their 9 AM
meds. This was important due to time limits. Your PCS usually started at 7:30 and ended at 10. Make
sure you keep track of when to give meds. Plus, I found it helpful to get my meds around 8:45. It
usually takes 15 minutes to get in and out of the PIXIS and get everything ready.
Practice Apical pulses. Any pt with A-fib will be assigned Apical pulse.
Take two sets of vitals on every patient.
MOVE THE PATIENT'S BEDSIDE TABLE OUT OF REACH during your PCS. I was told this trick from
a previous EC grad but I forgot to do this on my first PCS. My first pt had just finished eating
breakfast when I got in her room. On her table she had milk, coffee, ginger ale, cranberry juice and
water. She kept sipping and drinking during the entire PCS! It took me FOREVER to figure out all of
her intake! The next 2 PCS's I moved the table and It worked great. The next PCS didn't have any I's
and O's and my last one only had a little bit of water to take her meds. Obviously if they ask for it
move it within reach, otherwise out of sight, out of mind.
I had PVA on all 3 PCS's. I even had to use a doppler on one pt.
RELAX! Your CE and the pt can see if you are stressed. Have a smile on your face and do
everything with confidence.
Overall my CPNE was fairly laid back and stress-free. Everyone was nice and wants to see people
pass. The CE's are not monsters, they are normal people who are willing to answer questions and
help you...not fail you.
Date of CPNE = Dec. 3-5, 2010
Name = Mark Keskes
I just wanted to pass on my experience to others from my CPNE so that maybe they can learn from it too.
I tested in Racine, WI on Dec 3-5th 2010, it was my first time testing and I drove the 9 hours there on Thursday. I
arrived got my room and drove to the All Saints Medical Center so that I would know exactly how to get there and
back without the pressure of the normal commuting traffic. I had prepared and made my own little "wet lab" of
equipment and a scarecrow out of old clothes that I brought with me to practice before going to the exam which I did
several times Friday before reporting at 4pm (it was the same setup that I used at home).
There are uniform stores in town in case you lose or miss something, or in my case spilled a cup of coffee on my
scrub pants before walking in on Saturday. I underestimated the stress of the exam and was unable to get more than
3 hours of broken sleep Thursday night, and changed hotels in the morning. I got 5 hours Friday and 6 hours
Saturday. I did not stay with the others at the hotel suggested by the college so that I wouldn't feed off of the others
stress too.
I did not know how I would be affected by a Benadryl so I took nothing all weekend to help me sleep. Morale of the
story: Know how things affect you so that you can get adequate rest to help your stress. Rob is absolutely right about
knowing how you personally are going to manage your stress with walking, swimming, playing a musical instrument
in your room, whatever it takes to let go of it. Force yourself to eat. You need the blood sugar for the greedy brain to
function.
I made it through the labs and had no repeats on PCS's: From the disk print out the student response form and
other than the always in effect areas of care (vitals, mobility, asepsis, etc, etc) randomly pick out different areas of
care when you practice. Practice documenting what you find for each AOC. And when you leave the room if you have
the time while waiting for a doc or therapist etc. Get some of your documenting done. You can't give them too much!
Know where on the response form to put [your documentation]. The Care plan videos Rob has on here are
priceless, I re-watched them Friday and Saturday nights and it helped me.
Also, for All Saints Racine, they have a new asepsis initiative that was in effect for us. They use the pumps of foam
hand cleanser. After the initial outside of the room wash under the CE's watchful eye you will use the foam unless
soiled then its a re-wash. The new part of their initiative is this: hand cleanse between each contact.
I hope this helps and I wish you all the best of luck.
Date of CPNE = Dec. 3-5 2010
Name = Valerie Putnam
Still am in shock that I passed the dreaded CPNE. I Worked long and hard at this. Have been an
LPN for 30 years!
I purchased Rob's CPNE study packed on line. Great help. Why ? Just was a basis to get me
pointed in a direction to start the process of preparing. Also, Yes I used a Grid of sorts. Was it
helpful, you bet. Especially when you are on "time crunch'', you can look at what your wrote in your
"crib' notes or grid, or whatever is your thing is, and you don’t have to worry you forgot something.
OH wait, I take that back, Worry-- you bet I did. Each time I handed my packet in, there is a 20 min
or so wait while the CE reviews it. I would say that wait is HELL, for all other aspects of the CPNE I
felt calm. I had great confidence that I could be one of the 60% that passes the first time to test.
I opened my Study Guide for the first time in July. It was horrid at first and I felt as if I was reading a
book in some Greek format. I read the SG from the first page to the last. Not once but many, many,
many times over the last few months.Each time I saw something that I had not seen before.I made
flash cards. I worked on math problems while having a free minute at my job.I reviewed every bit of
info that I could get on-line.
Be careful there are some poor videos out there. (Vanessa CPNE is a good basis to view
[youtube video] as well as Robs). I set up my Mock Lab with my hand made Dummy.I made my own
fake arms, fake wound, and used a potato to inject. Why did I do this if I had been a nurse for
thirty years? Because it is important to get the steps down that you need to do for your lab sim.
Do it over and over and over again !
I did not buy anything fancy. I used a few pair of gloves , non sterile and reused and reused. I did
buy alcohol pads just so I had something to rip open. I made a sterile 4 X 4 from a paper towel cut to
size for the wound dressing change. I made ABD from Feminine Product "taped two mini pads
together". I made a wound from play dough as Rob shows in is series. I had one four by four gauze
that was 8 ply but I used it over and over and over again.
Actually the gauze boat was a tupperware square container with a hand printed label taped to it.
All the stuff you make or use is pretend. It just does not matter to buy expensive stuff or fancy things.
You need to know your steps. It is not important to get caught up in "will it be 12 ply or an 8 ply" or
“one gauze or 2 gauze." It is about practice the steps.My hand made stuff does not look at all like
the dummies wound at the clinic but again I was able to practice the steps.
Every time I practiced I said the steps out loud. I could recite them in the car while driving, while
attempting to drift off to sleep, while walking my dog int he woods. Review constantly.The closer I got
to the date for testing I was questioning if I had given myself enough time. After some folks write that
they study for a year I felt that I had not given it that much time. Yet for me I feel that review gets
better the closer you get to the test date. You are forced to push all other responsibilities to the back
of your mind.
I did make 3 phone calls to Excelsior, they were very pleasant staff but still would say "review the
critical elements". When I asked of the 12 ply or 8 ply, as she told me, they have no control over
what a particular hospital test site will use. Any questions like that can wait until orientation night at
your site. Tell you the truth now, I do not know what ply my gauze was .
The SG is an odd thing to get your mind wrapped around. You know AOC for goodness sake it just
means good old fashioned nursing care. But boy it was hard for me to understand that term in the
beginning.The staff at Syracuse were awesome. They were real people, all women, and they did not
look scary or mean, or stern or any other negative term. They were just nurses that needed to
observe us.
Each time that had an opportunity to praise us or encourage us before we started they would do so.
And I will say that when I faltered and had to be removed from a PCS 15 min. into it, the CE and CA
looked sick about it. Their eyes told me how they felt, but I knew better and made an error, therefore
I had to sit it out. For all the money in the world I would not want their job.
Believe me, life throws you curve balls even during the best laid plans. My father passed away 7
weeks before the exam. I hope to write a Journal and post it for anyone.
At this time if you wish to ask me direct questions feel free to write me at my home address:
mamaputnam@gmail.com
Date of CPNE = Nov 10-22, 2010
My CPNE was in Madison, Wisconsin last weekend (nov 19-22). There were 8 of us and all 8 failed.
For anyone going to Meriter Hospital, I would suggest going early to familiarize yourself with the
facility. Having spent the weekend there, talking to the other 8, most of us failed a PCS or 2 b/c we
were unfamiliar with were equipment was located.
Important to remember here is that they have what's called "Nurse Servers". It's a closet in the
hallway outside the patient room that is considered "clean". PLEASE wash your hands before
opening the door (there is a locked med box in this closet). Also, it seems the examiners in this
facility got us on our assessments not being perfect...
- i.e. respiratory (go side-to-side evenly),
- abd assessment (look, listen & feel in that exact order). I failed my pcs b/c i touched his belly b4
using the stethoscope).
One student in my group was a Dr. from Cuba so english was her 2nd lanuage and they failed her
on all! of her pcs's b/c her charting was "too vague". I don't know how to get around that one.
In the Labs, several failed b/c they went over their time limit, & on the wound station (I highly
recommend watching Rob's video on dressing the wound, it was perfect!) [In regards to the
wound station] I would pour the saline into the gauze while not wearing gloves and when opening all
the packages. Touching the bottle of saline [without gloves] seemed to fail some people.
1) Don't forget to aspirate before injections/flushes & pushes.
2) Go over the steps on mixing different meds in 1 syringe.
3) when care planning & documenting, i highly recommend putting down what's in the care plan book
WORD FOR WORD, even your charting. That's what they want, give it to them!
This facility was doing reconstruction on their pediatric/women's wing so no peds pt's there for a
while, so that will be a nice break. I hope that I was able to give someone some insight into the CPNE
& the Madison, WI area examiners. HAND GEL TO DEATH! Thanks !
Date of CPNE - June 11-13, 2010
Dear Robbie,
Just wanted to take the moment to tell you more about my individual CPNE. Firstly because mine was
midweek in Utica it seems that the hospital (Foxton's st. luke) had to temporarily reposses the rooms
the usually give excelsior (which i am told were nice big airy well lite rooms) instead we had
orientation confrence in the cafeteria (which was a little bit noisy and distracting) and labs were done
in a small utility room. My woundcare station was set up on a bed! Now for me this was no problem
because this was exactly what my makeshift lab at home looked like - but some of the ladies (It
happen to be an all female group) really freaked out! One said she took the workshop by excelsior
down in albany and there was big tables, good lighting etc. (She unfortunately did not pass - she
failed the IM/SubQ station twice) And our makeshift room in the hospital had a broken air conditioner
and half the room the lights were out and the IV piggy back station was on that side. They set up an
additional IM/SubQ station in a little closet - all in all I am trying to tell you to be aware that even in
makeshift conditions, excelsior excpects you to do the station perfectly. (I had asked the CE before
starting if I can hang my tape off the side of the bed rail since it wasn't a reg. table and she said
yes.) We had plenty of time to familiraze ourselves with the equipment i tried on the pair of gloves i
thought would fit best - and practice doing the wound on the bed to see if it effected me at all that the
station was lower than i'd practiced, it didn't. (the ca gave us a little over 20 min to orient ourselves to
the stations) The gloves were easy to slide on and the gauze was very cooperative and came apart
easy for fluffing.
Bec. of the smaller room for labs the group split into half and 1 did labs while the other oriented to
the floor. I oriented to the floor first. My pt had Spinal stenosis I did risk for injury and chronic pain
bec. he has consistanly beenrating it as a 9/10. Of corse when i went in the next day and asked how
he felt he scored it a 1/10. I kept chronic pain as my evaluation NCP diagnosis anyways bec. even
though it was controlled it was still the primary concern as the stenosis was not very advanced.
My second pt was for the books and completeky freaked me out. A 69 year old man on dialysis that
came in vomitting, naseous, was diagnosed with hypokalemia and was ready to discharge and send
home. everything was perfect with the pt. All his values were in line he moved around and did all his
care like a 20 year old. He was wonderfully nice but there was no diagnose to do. In the end I held
my breath did readiness for enhanced comfort r/t hospitalization and kept telling myself as long as i
do it well it will not fail me. other diagnosis was risk for injury. It took 20 min. for me to convice the
nice man to allow me to do comfort measures bec. he was perfectly comfortable and ready to go
home. He was discharged and left the hospital as i gave report to the primary nurse during
evaluation phase.
The third pt. was very difficuly 99 year old room with fractured shoulder -imoobilized, fracture to neck
of femur. how did she injure herself? She was fully active living by herself before the injury,
volentered with community works, soup kitchen, etc. she fell taking a leaf out of her dining room table
! she was sweet and a riot, but oh time consuming. Breakfast to 30 min! I tried to ask the CE if i can
get a CNA to help with breakfast while I did charting (there was plenty to chart but she very kindly
told me no. Anyways, took 15 min to do her mouthcare too bec. she wanted to try to do it with the
non dominante hand, etc. it took very long. than i had to do resp. management on her! I spent 15
min. talking to myself outloud on how i am going to do this. I can't sit her up bec. the shoulder
immobilizer and her painscale rated at 7 and she hadnt been medicated yet and i only had 30 min
remaining to pcs. I couldnt very well turn her onto the imobilized arm, so i would have to turn her onto
the good arm. I ask the CE what would be acceptable in this case reguarding the fact the pt would be
in pain - and of corse she tells me i have to decide. so the CE helping me we roll her towards her
good arm while trying to keep the arm as immobilized as possible and than i see the immobilizer runs
along the whole back I stick the stethoscope under get 3 feilds but the pt is in a lot of pain and there
is noway to manuever her enough to get to the last feild I rool her back in place and reposition her
while thinking what am I gonna do now. It is then that the CE speaks up and says "you know chava,
excelsior has a very quiet policy that in extreme circumstances auscultation can be done on the
front." - I was ready to kill her. After me putting the pt. through 5 min. of torture (O would have failed
myself by the way for it but she told me to just try to do it and be as quick as possible with the first
sounds of pain from the pt.) so she tells me this policy. Which I had read as one blip in the CPNE
study guide. well, the rest went quickly, and she told me i passed. It was a harrowing experience.
Not to mention I didn't know weather to include the 5 ml of maple syrup on fluid intake but decided i
should especially cause you specify what the fluid was. And than I heard the pt ask for the CE to add
milk to my pt. coffee when I was in the bathroom washing the mouthcare equipment. I came out to do
it but was too late and when I asked her how much she looked at me like I was off the wall. I told her
for I and O and that i was gonna measure the milk before adding it to the coffee. She told me it was
probably one tsp. I thought that was mean - now I know 1 tsp is 5 ml in my sleep with 4 young
children and plenty of tylonel having been given in the last year alone. But if another student with not
too much pt care acess and poor meomory of conversion rates - well - If i told you I was going to
measure it I think at least she should have answered 5ml - she was waiting for me to tell her what the
1 tsp ratio was and I promptly did so. Anyways, I really didn't mind anything she'd done by the end
when she passed me (cuz i don't think i would have if situation was switched! But I still believe I am a
very cometant nurse)
So there you go - No repeat labs, No repeat PCS. hope I didn't bore you but figured I could give you
the info and you take from it what you will. (Also, the plungers on the insulin syringes I used stuck a
little bit and it had to be rocked back and forth to loosen it (It caused me a problem the first time I
drew up and than i quickly refilled another after loosening the plunger that time.)
Oh, and I wanted to tell you that for the first 30 sec of my labs I felt lost like i didn't know where to
begin and than i told myself, you memorized rob's mneumonics SO why don't you WRITE THEM
DOWN! I did that and than it was a breeze it kept my anxiety in check and allowed me to focus on
the task. So that is my extended story. Sorry again, I hope it didn't bore you. And thank you again - I
would not have passed this test without your help!
Sincerly,
Chava K. (Kurant)
Name - Heather Santa Cruz
Date of CPNE - Mar 19-21, 2010
Hi Rob,
I just wanted to let you know that I finished my last PCS this morning at Grady and I have officially
passed the CPNE. I also wanted to thank you, not only for your website, DVD's and Ebook, but for
answering my questions (even the little ones) when I really needed to know more or I was just
anxious.
I did great on my PCSs--one CE said my documentation was "excellent". I have you to thank for that.
The only mishap was I had to re-do the wound lab sim. According to the CE, I touched the side with
the gauze. That night I practiced on the wound I made (using a different method--I personally don't
recommend the parachute method). Then, after a good cleansing cry in the 6th floor Grady
bathroom, I passed the thing that could have sent me home. After I passed on the second try, I felt
like I'd already won. Today's peds PCS was cake.
Thank you for your recommended nursing diagnosis--they were all highlighted in the back of my
book and were very handy. In my experience, acute pain was used successfully for all 3 PCS. It was
my primary for two of the three.
I'll give a little info on my experience in the hope that it may help others. Grady is a very old and worn
looking hospital in a not-so-great area in Atlanta. However, I would recommend the location to
anyone looking for a Southern test site. The CA was very comforting and knowledgeable. The CE's
were also great. They don't seem to sweat the small stuff. When I had I &O's, they never expected
me to pour any liquids into a graduate--they either told me what to put down or allowed me to
estimate (half a juice was 60mLs). I only had to wash my hands at the sink initially before each PCS,
then the "foam in, foam out" (which is Grady's policy) was acceptable every other time. Grady has a
great hand hygiene and infection control policy--I was impressed.
In my experience, as well as some other student's, the CE's seemed to prompt us to remember
certain things even if it wasn't necessary. They just did it as a courtesy. I'm not certain, but it is
possible that the CE I had at the IV push station gave me a couple extra minutes. Another student
said the same thing. It's not that they aren't strict--you better know your stuff--it's just that they don't
seem to want to fail you for the stupid things that have nothing to do with being a good nurse in the
real world. They seemed very down to Earth and practical.
If anyone is planning to go to Grady, they can email me with questions if they want to. I'd be happy to
help--I certainly know how it feels to have anxiety about every aspect of this exam.
Everyone in my group of 7 passed. It really can be done. I had to see it for myself to believe it, but it's
true. I work part time, have a toddler, and I'm 21 weeks preggo with number 2. I did this with no
Xanax for anxiety, no Lunesta to help me sleep, and no beer or cigarettes to help me relax like most
of my group members did, and I still made it through with no problems (aside from the wound). If I
can swing it, I think anyone can as long as they're prepared. I had my husband and 2 year old with
me for support and comic relief at the hotel which, for me, was great. I also brought all of my study
stuff with me--even my IV bag. I know some others have said NOT to study during the CPNE, but just
knowing my resources were available if I needed them helped a lot. Reading or practicing something
"just one more time" before the real event made me feel more confident.
Even though I did pass the wound station on the second try by practicing on the wound I made, I
really recommend buying the Excelsior wound model for anyone who is especially worried about that
station. The model is extremely shallow--almost flush with the surrounding "skin" in places. It is also
slippery. Unlike the wound I made with play doh, the gauze would not stick anywhere and could not
be tucked in nicely into corners. It behaves nothing like an actual wound, for sure.
I can't think of anything else at the moment, but please ask if you want any particular info. I would be
happy to help anyone if they have questions.
Thank you again for your great study materials. I would not have gone in so confident without them.
And I didn't get a one-time workshop for $400, I got your info, which was exceptional, that I could
watch or read as many times as needed. Plus, you were always there to answer questions. I can't
thank you enough. I (and many others out there) are very grateful for your dedication.
Heather
Name - Amy Bowers
Date of CPNE - Feb 26-28, 2010
CPNE date: Feb.26-28 I passed ONLY because of the organizational skills (mnemonics and both
DVDs) taught through Rob and a few other things I threw in, too... First, set up your lab equipment
the exact same way at home, then when you are at the CPNE, simply set the equipment up the same
way...Second, during my planning stage, I would place a number next to the AOC in the order of
which would be best (ie 1st 20 min check, 2nd Fluid Management, etc)...
Next, I ALWAYS had my grid out during the implementation and evaluation stages so I never forgot
anything...Last, for three weeks prior to my CPNE, I took a BID (twice a day) dose of Airborne to
prevent becoming sick and giving the CA a reason to fail me d/t illness. This product ROCKS!!! (I've
spoken to other students who have purchased Rob's product second hand...though you may feel as
though you are getting a price break, there are too many perks to purchase the product through
Rob: talking to Rob online, E-Books, and Study Partners.) I have been an LPN for over 5 years and
would have NEVER passed if it weren't for Rob preparing me!!!! :) Amy Bowers, GN Phoenix, AZ
Name - M. Clark-adams
Date of CPNE - UNKNOWN
Hey Rob!,
Not sure if this is the right way to email you but I wanted to thank-you cuz I passed the CPNE on the
first time and it was your videos that saved me!! The part that says " Don't forget to check the cap
refill", cuz I almost did forget. A couple of other things to, and the CPNE was in Racine WI:
It's one 4x4 for the wound center **, don't contaminate the edges or your sterile gloves, should
pass.
** Please see the FAQ tab, Q# 25 on how many gauze pieces to use **
Need to know that for the dummy buttocks, the landmarks are very,very poor. If using Vastus
Lateralis, find the middle part, where you think the knee is, and lower than you think the femur
landmark is, there isnt' really anyway to truly see/feel where the landmarks are as they are not really
there, but kinda look for the middle third.
IV push is fine, IV flow rate pretty good.
I failed two PCS on silly stuff, for some reason, it wasn't immediately clear to me that Apical pulse is
[taken under] the gown, failed. (Rob's NOTE: ALL auscultation should be done directly on the
skin or they will fail you - respiratory, abdominal, apical, etc.,) I couldn't get the manual B/P,
failed on another PCS for that. Don't have a comment to help anyone pass but maybe practice
manual B/P on a real person for a lot of practice time to make sure one doesn't fail for something
silly like that, worth a comment.
Third, YOUR video and coaching is what made me go the distance. It is so very important to not talk
yourself out of passing and trying no matter how many times you fail. As of Sat of the CPNE, I had
managed to only pass the four labs, and had to re-do two of those labs. I failed both the pediatric
and the adult PCS on Saturday. When I came back in on Sunday, I had to face three PCS's, and I
did it. I almost talked myself out of passing, and even thought of throwing the repeat labs just to "end
it" on Sat night, but all the coaching and studying that I did and comments about just getting through
it made me stand up and do my very best.
Again, Thank-you!!!
Michaele Clark-Adams
Name - R.W.
Date of CPNE - 1/29 - 1/31, 2010
I hope this information can help others out there and alleviate a little bit of their stress.
First, this exam is very regimented. The associate and examiners are there to test us and to
maintain as much neutrality as possible. Therefore, do not expect them to be overly personable and
friendly. They are always polite and cordial (or at least my experience has shown that to be the
case). I am sure this professional type atmosphere exists primarily so no one testing could ever say
there were incidents of favoritism.
Secondly, do not hesitate to ask the examiners questions!! If they cannot answer them, they will let
you know that. Always ask if an area in the patient's room is a clean area to put down a papers, if
needed. I even double checked as I found most examiners pointed this out, just to be sure. Another
question to ask is about liquid measurements while on the unit. My experience was this: I had a
patient who only drank sips of water to take medications. Nothing more for input, nothing for output.
On the area of the form where we document intake, I asked the examiner if we should measure it
and calculate, or put down "sips of water". In this instance, "sips of water" was appropriate. Be sure
to designate what it was that the patient drank. Just noting "sips" wouldn't be approved. But, check
first with your examiner about this!!!!
However, I did have an instance where an examiner wanted the urinary output to be measure in the
graduated container, and not use the measurement in the "nun's hat" in the bathroom. She told me
technically, they were instructed to use a graduated container for this. So, as you can see, not all
examiners handle things exactly the same way. I believe they follow guidelines and rules, but they
are all different people and not robots.
Also, the Clinical Associate also emphasized to us to always, always, take two sets of vital signs even
though you believe you are 100% correct! I had to retake a PCS because the examiner and I had
two different apical pulse readings. The patient had a very irregular heartbeat and I thought I heard
correctly, but, according to the examiner, I must have not. Do yourselves a favor by taking two sets.
Also, if needed, during respirations, ask the examiner if you can use the stethoscope to obtain
accurate respirations. Now, most times you will not need to do this and can just use the method of
putting your hand on their shoulder/chest to count respirations as Rob instructs. I had to because
the patient whose respirations I had to take required me to do this 4 times to get an accurate count
as he was very sleepy and experiencing apneic episodes while I took the respirations. That will
knock you out of the accuracy area quickly!! So, don't think you cannot perform something more
than once to obtain accuracy; they want those measurements correct and so do you so you can
pass the PCS.
I also had a PCS where the patient had CHF along with other issues and was not really very steady
on their feet. For the careplan, I used "risk for injury related to generalized weakness." Then, I
used safety measures I was already implementing for the interventions. I used this particular nursing
diagnosis on almost all of my patients. (as you had suggested :). On this same patient, the primary
diagnosis I used "ineffective airway clearance". (there were other reasons this was more appropriate
for this patient, and not something related to activity intolerance, I just can't recall) Yet, I was not
assigned respiratory assessment or respiratory management or oxygen management! My point here
to everyone is to do as Rob states, look over the kardex very well and you should easily be able to
come up with an appropriate care plan for your patient. In addition, even though I didn't do a
respiratory assessment or management, this is where you need to really look over the interventions
in the Mosby's book and do what is appropriate. I was able to encourage an appropriate level of
activity for this patient and to position the patient upright to facilitate ease of respiration. I believe the
goal I used was to maintain a patent airway during the course of my pcs. Don't let it throw you off
track if you are not doing a particular assessment or management area. If the symptoms fit and are
overall appropriate to a diagnosis, use it. But, think it through first. I know it seems weird to do this
and not listen to the lung sounds, but, it was correct. Don't add more work to what you are given.
Only perform the areas of care that you are assigned (just as Rob says!)
Lastly, I was assigned an abdominal assessment on a patient who had a major abdominal surgery
about 7-10 days prior (a major incision that was healing well, 2 JP drains and a biliary drain). I
verbalized to the examiner everything I was doing. I wondered about palpation given all that was
done. I verbalized that I was going to lightly palpate, which I did, and the patient slept through it! He
had not been experiencing any pain and rated it at "0", so I was safe, in this instance. Had the
surgery been within a very close time frame and the patient was experiencing pain, I would have
invoked CDM and possibly made another decision. Proceed through your areas of care thoughtfully
and methodically and you will perform better. Be mindful of the timeframe you are working in, but
don't rush as you don't want to miss anything. Follow your grid to a "T" and do not only rely on your
memory. Always refer back to your grid. Lastly, be sure to follow your grid completely while
documenting. Be sure you document on every critical element. Also, it is best to write down more
detail than not enough. Our CA had told us "if it isn't documented, it wasn't done." Also, as a last
reminder (really, this is last :) All patient rooms may not be set up the same. Be mindful of this
during your PCS and don't take room setup for granted. Always be aware of your surroundings and
where the gloves and hand gel are located. I had one patient where it was all located in the entryway
of the room. Nothing was near the bed. In another room, it was next to the patient! Be confident, in
control and aware!
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