Wednesday, May 29, 2013

New Grads Pt. II: NCLEX, and getting a job

So now you've finished school, but there's that one last hurdle between being an AAN (Almost A Nurse) and being an RN (Real Nurse): that damned NCLEX.

I'm going to give you the best strategy I know of for dealing with it:

(1) RELAX.
Seriously, just relax. Other than doctors and lawyers, you've just completed a more stressful program and course of knowledge than most people will ever deal with. (Seriously, any whiny undergrads or grad students from other disciplines, sorry, but you come up way short. Why? Because your homework during school didn't scream at you and shit the bed, literally, so spare us your puny protests. There are math geeks, and literature geeks, but there aren't any diarrhea geeks, so just accept your lesser status on this particular totem pole.)

And if you've made it this far, after fighting to pass your pre-reqs, then to get into your program, then to keep your instructors and clinical supervisors off your back and finish all your assignments and pass your tests and classes, you've got game, or they would've shown you the door long ago.

Besides, when you're relaxed, you both learn and perform better, and you're going to need to do both.

(2) LEARN.
Get one of the NCLEX prep manuals. Ideally, one with either a CD for your computer, or a code that lets you access their website, either of which gives you the chance to take sample NCLEX tests for practice and diagnostic purposes.

Take the sample NCLEX before you spend one minute on your manual. They should score you, and tell you where your strong areas are, and your weak areas.

Once you know this, review the NCLEX and your school notes and texts on your WEAK areas. Those are the ones you can improve the easiest, and they may simply be the areas you had the longest ago, and are rusty on. Or you had a crappy instructor for that subject. Or whatever. Just focus on building up your weak areas.

After you think you've done your job studying, retake another sample test, and see how you've evened things out. Lather, rinse, repeat.

By the time you take the actual NCLEX, you'll have done at least a couple of dry runs, so it won't be a shock to you.

(3) Prepare.
The current books tell you the average breakdown of what knowledge areas each test covers, and in what proportions. Get a grasp of that.
They'll also let you know how many questions, minimum and maximum, you'll answer, and how long you have to get it done.

A word on computer-adaptive testing, which hopefully is review for you.
I was going to be one of the last years of nurses that took the bad, evil, miserable old NCLEX: two days - 14 hours, 8 on Day One, and 6 on Day Two, of old-school SAT #2 pencil bubble filling, offered twice a year, en masse, to half the graduates each year, once in February, and once in August. If you booted your attempt, you were thrown back in the waiting pool for six months for another crack.

Now, you can just try again, and take it whenever. There are mandatory waiting periods if you blow it, and max numbers in a given time period, but you can schedule it whenever, and not have to take it with 4000 other students in a giant hall like the Bataan Death March of tests. So be happy you've got it so good.

I (oops) managed to stall after graduation, and thus ended up taking the first round of adaptive tests on computer instead. And it turns out, the results were the same for passing and failing for graduates who took the torture test, or the computer test.

Read what the current NCLEX review tells you, but when it was new, it worked like this: the computer has a bank of questions, from Level A, to B, to C, to D, to F. The first three questions didn't count against you. The computer takes your answers, and based on them, decides which questions to ask. It starts with a C-level question. If you get it right, you get a B-level question. If you get it right, you get A-level. If you get the first one wrong, you get a D-level question. If you get the D-level one wrong, you move to the F-level (nurse retard) questions.
After those first three, you're live. Get a certain minimum number right, cruise along at the A-level, and it stops after something like 70-80 questions, and you aced it! Get the first three, and every other one wrong, and stay on the F-level, and blow a minimum number, and after 70-80 questions, and it shuts off, and you flunk. Bounce along from level B to C to D to C to B to C to D, and it'll keep asking questions until you either climb up and hit enough A and B level questions to pass, or you max out after 200-something, or the max time limit, and you pass. Hit max time/max questions, and stick on the D level, and you fail. Hit it just right, and get enough C-level questions right and max out on questions or time, and you may just squeak by.

Odds are, you'll be zipping through the questions, it'll shut off after the minimum, and you'll know you either aced it or flunked it.

I was astonished when my test shut down after a little over half an hour, because I didn't think I'd gotten them all wrong, but I didn't think I'd gotten them all right.

I aced it.

I talked to a dozen classmates, and we all had the same panic reaction, and we all passed.

Other important points: You may be the person who'll be bouncing along at C level. Manage your time. Figure out how long you have per question for the max number of questions. It should work out to 30-40 seconds per question, worst case. So if you hit a question, don't freeze on it and try to puzzle it out for 10 minutes. It's multiple choice. Read the question carefully. If you can whittle out two obviously wrong answers, you now have a 50-50 blind chance: make your best guess, and move along. 30-40 seconds, in reality, is a looooooong time to think about four answers. Stay relaxed, read the question, understand what answer they're looking for, and pick the most correct answer. Then move on.

You'll probably do just fine.

Some other notes: In Califrutopia at least, your initial nursing license isn't good for 2 years, it's good for up to 2 years. Your license will expire, every time, on the last day of the month, the month after your birthday, every two years, forever.
So, for example, if you were born in July, your license will expire August 31, for your first, second, twelfth, and fifty-second time renewing it. Because that's how it is.

Okay, so who cares?

You. Because if you take your NCLEX in June, your first license will go past two birthdays, and expire August 31st, in thirteen months. If you schedule your NCLEX for August 1st, your first license will also expire after two birthdays, except that'll be twenty-five months. And you'll pay the same price for that first license. And after your first license, you have to start taking CEs. So do you want a license good for a little over 1 year, or a little over 2 years? Duh.

Unless you graduate in June, and your birthday's in January, in which case you don't want to wait 8 months to take your NCLEX. But if your b-day is close after or just before graduation, you oughta to know this. The state won't tell you this, so I just did.

Now, you studied, reviewed, got a good night's sleep the day before the NCLEX, aced it, and got your results. So how do you get hired?

(4) Act like you seriously want a job.

a) Nearly everybody everywhere expects you to have an ACLS card, along with CPR. Get it. If you're going to do peds, or ER, or anywhere kids may be in your patient pool, get a PALS card too. If you'll be dealing with neonates, get NRP.
(You know which you'll need because you already asked around before you graduated, because you seriously want a job.)

b) If there's anything else you need and can get, go do it.
IV/phlebotomy, 12-lead interpretation, Bulgarian sign language, etc.
If I'm the HR person, and you've got the 5 things I know you need, and everybody else has 2 or 3 or 4, all other things being equal, guess who I'm calling back first?

c) Whatever the dominant language in your area is, besides English, learn as much of it as you can. Spanish, Tagalog, Ukranian, whatever.
If you are or can become any level of functional in it, put it on your resume. Don't BS, but if you can stumble through your Tex-Mexican Spanglish enough to do a decent assessment, let them know you can take a stab at it. If you live in NY state, FL, or within 3 states of Mexico, learn Spanish, period. I don't have time to hear how unfair it is to you (it is) or how you wish we could boot them all out (we can't); deal with reality as it is, and learn to do your job better by learning to communicate, and make sure your job applications reflect your abilities.

d) Network like a monkey on crack!
Classmates, instructors, clinical coordinators, every charge nurse you worked for in clinicals, your neighbor's cousin the doctor/nurse/tech/financial clerk/lab tech/paramedic, or whatever. Anybody who can tell you where there might be a job is your new best friend.

e) Tailor resumes for different jobs
If you'd take a job in ortho or med/surg, have resumes for ortho for hospitals with ortho openings, and resumes for med/surg for hospitals with med/surg openings, etc.

f) Get the best job you can
If you can't find what you want, take something else, and be prepared to lateral across when you've made more in-house contacts, and racked up experience. Do a great job where you are, because that supervisor is going to be your new department/hospital's first interview call. Don't sabotage yourself.
And I realize you might be making more in tips serving cocktails, but get a medical job. Show you're serious, and they'll treat you like you are. (You can always pick up waitress gigs or whatever on the side, but a great review from the night manager at TGIFridays isn't going to be worth as much as good referral from the charge nurse where they hired you as a tech while you were waiting to take the NCLEX, right?)

g) Don't give up
I hated the Catch-22 "Can't get hired without experience, can't get experience without getting hired". I also managed to graduate at the one time in 20 years they were firing nurses nationwide instead of hiring them for sign-on bonuses. Many of you now can probably relate to that.
So I papered one entire wall of my apartment with the "Thanks for your interest, we'll keep your resume on file for a year, don't call us, we'll call you" letters. Really, an entire wall. Staying a little cranky amped up my determination to get what I'd worked for. And I got the job I wanted, in the specialty I wanted, with a training program, and without working in 5 specialties I hated while I held out, and did something else in nursing to pay the bills. Tough times don't last, but tough people do. (And 2 years later, when I shopped myself around, I was the one deciding who to call back when they were begging me to take the jobs they were trying to fill. The pendulum swings both ways, sooner or later.)

h) Don't burn bridges
You could get downsized, or need an extra part-time gig, or something perfect may open up somewhere else, or just want a change of scenery. Stay cordial and connected, and the world will always be your oyster.


  1. Also excellent advice! I'm actually about to apply for a massage therapist position at a major local cancer center, if I get it, that's a foot in the door. Next spring, I'll also start applying for per diem PCA (CNA) positions around town, so that I can work all summer and even during my final semester.

  2. Oh, and re: NCLEX? I'm not too stressed about it, since I'm ridiculously good at multiple choice tests. I will certainly prepare, but I'm not going to stroke out about it, either.

  3. It feels so nice to find somebody with some original thought on this subject. Really helpful to you for starting this MCAT questions