Wal-Mart and the 22nd edition of the Excelsior CPNE guideline

What you don’t know can lead to failure. BIG failure… This is what happened to Sam Walton, the billionaire creator of Wal-Mart. In the 1940’s he opened up a small “discount” store that went on to make $250,000 in profit. When it was time to renew his lease the owner of the building said …

“Sorry, Sam. I’m not going to renew your contract AND I’m also going to take over your business.” “You did the hard part of opening up and getting this business going so thank you and please get your stuff out.”

 

What a kick in the ass that must have been!

 

Thankfully (or not thankfully, depending on your opinion of Wal-Mart), Sam Walton opened up another store and was now much more careful about what was in the WRITING of the contract. By realizing that it’s what in the legal copy of the contract he was able to push ahead and be successful.

So what happens when you don’t even have the writing of the contract? How can you know what is correct and what isn’t? The answer is “read the fine print”, and that is what I am going to show you today…

Let’s take a look at the difference between what is in the writing of the 22nd edition for a simulation lab station and what is in the fine print…

Example: Insert An Intermittent Urinary Catheter

Here are the steps:

 

  • 1} Drape mannequin before procedure
  • 2} Cover mannequin after procedure
  • 3} Select correct catheter size
  • 4} Apply sterile underpad
  • 5} Cleanse urinary meatus with swab
  • 6} Discard cleansing materials in appropriate container
  • 7} Position urine receptacle
  • 8} Insert lubricated catheter 2–3 inches (5.08 – 7.62 cm) for female or5–7 inches (12.7–17.78 cm) for male
  • 9} Withdraw catheter
  • 10} Dry perineal area with underpad
  • 11} Discard supplies

 

Seems pretty easy right?

WRONG!

If you did it just the way they laid out, you would FAIL and here’s why…

Excelsior is ALSO using the fundamentals of nursing books as references to these nursing stations you’ll be performing.

More specifially, these books:

Treas, Leslie S; Wilkinson, Judith M. Basic Nursing Concepts, Skills & Reasoning
&
Hinkle, Janice L.; Cheever, Kerry H.. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (Brunner and Suddarth’s Textbook of Medical-Surgical)

 

So, what kind of steps are listed in the fundamentals books as opposed to the 22nd edition guidelines? Plenty! and here’s a quick side by side comparison. (referene taken from Treas, Leslie s: WIlkinson Judith M. Basic Nursing Concepts, Skills & Reasoning page 1048-1051

Excelsior 22nd Edition

  • 1} Drape mannequin before procedure
  • 2} Cover mannequin after procedure
  • 3} Select correct catheter size
  • 4} Apply sterile underpad
  • 5} Cleanse urinary meatus with swab
  • 6} Discard cleansing materials in appropriate container
  • 7} Position urine receptacle
  • 8} Insert lubricated catheter 2–3 inches (5.08 – 7.62 cm) for female or5–7 inches (12.7–17.78 cm) for male
  • 9} Withdraw catheter
  • 10} Dry perineal area with underpad
  • 11} Discard supplies

Fundamentals of Nursing

  • 1} If you are right handed, stand to the patients right side. if you are left handed, stand to the patients left side (when you use sterile gloves your dominant hand will remain sterile and your non-dominant hand will be used to touch non-sterile objects, rendering it non-sterile).
  • 2} Drape mannequin before procedure with blanket.
  • 3} Put on Non-Sterile Gloves.
  • 4} Wash Perineum.
  • 5} Remove Non-Sterile Gloves.
  • 6} Wash Hands.
  • 7} Open Sterile Catheter kit.
  • 8} Apply sterile underpad.
  • 9} Lift Privacy drape blanket.
  • 10} Put on Sterile gloves.
  • 11} Place fenestrated drape over meatus that was included in catheter kit.
  • 12} Open PVP swabsticks that was included in sterile catheter kit.
  • 13} Open lubricant that was included in sterile catheter kit and apply to bottom of sterile catheter kit.
  • 14} Open plastic from catheter that was  included in sterile catheter kit (if present) and lubricate the first 1-2″ for a female patient and 5-7″ for a male patient.
  • 15} If female – place your non-dominant hand above the labia and with your thumb and forefinger spread the patients labia, pulling up at the same time to expose the meatus. If the labia slips back over the meatus, it will be considered contaminated and you must repeat the cleansing procedure. If male – place your non-dominant hand and retract foreskin (if applicable). If the foreskin retracts it will be considered contaminated and you must repeat the cleansing procedure.
  • 16} Clean the meatus – If female cleanse in downward motion from front to back with 3 strokes – First stroke to far labia majora, Second stroke to near labia majora and 3rd stroke down the center. For males cleanse in a circular motion of the glans and partially down the shaft.
  • 17} Throw away PVP swabsticks in trash. Do not place on sterile kit or field.
  • 18} Place receptacle between legs of patient to collect urine.
  • 19} Insert already lubricated catheter – 2-3″ for females and when you see urine insert another 1-2″.  For Males insert 7-9″ or until urine flows.
  • 20} remove catheter slowly (slow removal of catheter promotes complete drainage).
  • 21} Move urine receptacle out of the way to avoid spilling.
  • 21} Dry with previously placed underpad.
  • 22} Discard catheter and gloves.
  • 23} wash hands.
  • 24} Drape with blanket and return patient to comfortable position.

 

WOW!! That’s a lot of writing to comprehend, but it comes down to a statement Excelsior made to a tribe member. The statement went like this:

 

“The CPNE is a competency based test and as such the guidebook will not be listing the exact steps to follow. The test is and always has been a test to show basic level of nursing competency…”

 

So there you have it my friend. It’s YOU against THEM, Mano-A-Mano, the FINAL stand….but wait…

  • It’s not just you…
  • It’s not a single person against these odds…
  • It’s not one person against an empire…

 

You’re a RobsREVIEW tribe member!… and baby, that’s a great thing because not only am I working for you day and night but the entire tribe members are constantly searching and finding the BEST, most EFFICIENT and FOOL-PROOF way to conquer this test so that YOU can finally become an RN and live the life you want!

It’s kind of hard to remember both the 22nd edition critical elements and what the fundamental nursing books require (especially when you’re heads about to blow up from stress of just being at the CPNE test site and trying to pass…)

I already incorporated what EXCELSIOR WANTS (their critical elements) and what the FUNDAMENTALS BOOKS REQUIRE (all the other nursing steps). Since I combined both of these factors together, you now know you are GUARANTEED to pass when you just follow the simple steps (and I really made it simple).

Imagine someone working for you 24/7 to get you the best possible way to accomplish something…well, that’s what’s happening right now!

If you haven’t already done so, take a look at Chapter 1: AOC mnemonics and other chapters as the 22nd edition changes are already reflected all over the site. Hang tight, we’re getting you to your destination as fast and efficient as we can

-=Rob

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