pic of the Excelsior CPNE 22nd edition

Will the failure rate SKYROCKET because of the Excelsior CPNE guidebook 22nd edition?

Kanye West was on the Ellen show and they played a game called “the 5 second Rule” where both had to answer a question with 3 answers in 5 seconds.

Because Kanye is Kanye he did it…(in his own way) which you can see in the first 20 seconds of this clip HERE

Go ahead and watch it, I’ll wait

……..

…..

This reminds me of the 22nd edition guidebook that just came out. It gives directions on what to do (kind of) but NO REAL EXAMPLES. Imagine if Ellen was an examiner and Kanye was a student. Ellen could have failed him for not following the rules of the game even though they were poorly communicated…and this is exactly what’s the problem with this latest edition.

Here are just some of the changes that are going down:

  1. The Lab Simulation stations are now called the “NSL” (Nursing Simulation Laboratory)
  2. The Lab Simulation station will now include 2 different stations
    1. Application of STERILE TECHNIQUE station with a WOUND, a PICC line dressing OR Intermittent Catheterization (male or female mannequin).
    2. MEDICATION Administration station where you’ll be giving “up to 6 different medications via 3 routes (this is just the old IV push, SUB-Q injection, IM injection, IV Med Bag and interestingly an ORAL route as well…)
  3. You must nowPerform Hand Hygiene” before each lab sim station
  4. You must now DOCUMENT the following for each STERILE TECHNIQUE station – Pertinent data associated with clinical decision for ALL stations

Documentation for WOUND STATION:

a. Procedure performed

b. Type of wound (I’m guessing pressure ulcer, venous stasis ulcer, arterial ulcer, full or partial thickness wound or burn?…not sure)

c. Location

d.  Condition of wound bed (20% sough with 80% granulation tissue?? again, not sure what they want here)

e. Presence or absence of drainage.

f. Condition of surrounding skin (erythema?, intact?, again, I am totally lost as to what they want)

  • Assessment data for PICC line:

  1. a. Appearance (appearance of what? the PICC line itself? the old dressing covering it? the skin surrounding the insertion site???)

    b. Presence or absence of drainage (will we get this information from the appearance of the dummy or in report?)

    c. Time of dressing change

    d. PICC line length.

 

    1.  Assessment data for intermittent catheterization ( no idea what they mean here)
      1. a.Data related to urinary status (I am guessing this will be provided in report beforehand)

        b. Time of current catheterization

      2. c. Size of catheter – insert lubricated catheter 2–3 inches (5.08 – 7.62 cm) for female or 5–7 inches (12.7–17.78 cm) for male not sure on what size FR they want.

      3. You must also determine if giving medication is appropriate in the MEDICATION ADMINISTRATION station by reviewing the following:

        a. patient scenario
        b. medical record (includes treatment record, vital signs flow sheet, laboratory results, and imaging results)
        c. medication administration record (MAR)
        d. SBAR (Situation, Background, Assessment, Recommendation)

        e. Identify indication for use of each medication in relation to patient’s current clinical condition (and verbalize if its OK to give or needs to be held)

        f.  Calculate AND RECORD  the correct dose on the calculation and recording form

        g.  Label container with drug name, strength, and amount if medication is unidentifiable (not sure why you would have to do this or how they want this done)

        h.  Administer one medication at a time ( so no mixing of insulins?)

***You also now have to PRIME the IVMB primary tubing (you didn’t have to before but you do now)***

 

…AND THAT’S IT!  Super easy right ?!?! (and I haven’t even gotten to the Areas of Care section…sorry, I mean Areas Of Competency section.)

Listen, between me and you this has to be the worst written guidebook of all of them. There are:

  • NO examples of documentation
  • NO examples of what is needed to be performed
  • NO concrete guidelines
  • NO explanation

So, just like in the Ellen clip, you are pretty much on your own to interpret how all of these are to be done and the answers to give. This could be great news if you can explain WHY you did something in a different way than what the examiner thinks is correct, but it can be downright AWFUL because the examiner could just fail you for no other reason than that is what she believes to be correct.

 

Here’s my recommendation:

  • If you DON’T have a test date and are on the CANCELLATION list then by all means keep studying from the 21st edition.
  • If you DO HAVE a test date and it is BEFORE December 31, 2016 then you SHOULD continue to study from the 21st edition (and thank your lucky stars that you don’t have to test under the 22nd edition
  • If you DON’T have a test date and ARE NOT on the CANCELLATION list then just stop what you’re doing and wait for me to update the members area with all the updates. I should have these completed in 2 weeks (9/1/16 would be the estimated date of when all updates for the 22nd. edition will be ready)
  • If you fall into this last category where you will PROBABLY BE TESTING UNDER THE 22ND EDITION THEN HERE IS WHAT YOU CAN DO TO HELP YOU AND THOSE STUDENTS WHO HAVE TO TEST:
    • Call Excelsior
    • Ask them, what they want for each section
    • Ask them why there are no examples
    • BOMBARD them with questions until you get the answer you want
    • DON’T leave it up to the examiner on the DAY of the test to tell if what you know is RIGHT or WRONG. Get your answers NOW!
    • Here’s a list of questions I have (feel free to use them when you communicate with Excelsior):

 

  • Under APPLICATION OF STERILE TECHNIQUE – WOUND MANAGEMENT, what do you mean under:
    • B: “Perform Hand Hygiene”: Do you want us to wash hands with soap and water for 15 seconds OR use hand gel?
    • F 2 a: “Document TYPE of wound” is the type of wound reported to us or where do we find that information? Wounds can vary from Pressure ulcers to Venous stasis ulcers to arterial ulcers to burns to full or partial thickness wounds. Do you have any examples of documentation for this station?
    • F 2 d: “Document condition of wound bed” is that going to be given to us in report or are we to tell you by percentages of what the wound bed looks like? (i.e., 30% slough, 10% eschar and 60% granulation tissue). Are we going to be given any tools to measure or are we just supposed to “eyeball” it? Do you have any examples of documentation for this station?
    • F 2 e: “Document presence or absence of drainage” is that going to be given to us in report or will that be visible in the dummy?
    • F 2 f: “Document condition of surrounding skin” will that be visible on the dummy or will that be given to us in report? Do you have any examples of documentation for this station?
    • E4c it states to: “Prepare packing with prescribed solution”. Is this going to be in report? Do you have any examples of documentation for this station?
    • F4a is states to document “data related to urinary status”. Where do we find that information? is it in report?Do you have any examples of documentation for this station?

 

  • Under APPLICATION OF STERILE TECHNIQUE – PICC LINE DRESSING CHANGE, what do you mean under:
    • #2: Assess the appearance of the: insertion site, presence or absence of drainage, insertion date, condition of dressing, last dressing date and length of PICC line. Do you want me just to VERBALIZE these 6 things because you only want me to document 4 things which are the PICC line appearance, drainage, time of dressing change and PICC line length.
    • #3 a: “Document Appearance of PICC line”. Do you want me to document the appearance of the PICC line itself or the old dressing or the insertion site? Do you have any examples of documentation for this station?
    • #5d: Change PICC line dressing by “Cleanse Site”. What are we going to be cleansing with and will we be notified in report? What technique should we be using? the Circle out technique (where we start in the center of the PICC insertion site and then cleanse in a circular patter out) or do we use the scrubbing method (where we go in an up and down pattern from inside out of the PICC insertion point?)
    • ALSO, I don’t have access to PICC lines or catheterizations at my facility so how will I practice this? Before, I could purchase a kit with all the lab sim stations and practice at home. How can I practice these skills at home? Is Excelsior going to offer mannequins to purchase so we can practice at home?

 

  • Under CRITICAL ELEMENTS FOR MEDICATION ADMINISTRATION what do you mean under:
    • D1: “assess pertinent date associated with assigned medication (e.g. laboratory values, vital signs)”. Do you have an example of what may be given here? Do you have any examples of documentation for this station?
    • 4d: “Label container with drug name, strength, and amount if medication is unidentifiable”. What are we supposed to label the container with? Will we be using labels that we can write on? tape? sharpies? …and in what instance would we have to label the “container” with this information? Shouldn’t all the medication be labeled that we are drawing up?
    • 5c: “administer ONE medication at a time” Does this mean that there are no more mixing of insulins (Regular and NPH) and if there are 2 insulins to be given then this means that we will now give 2 injections instead of mixing and giving ONE?
    • e1a: “Administer intravenous medications as assigned” – IV Mini-Bag – “determine drug compatibility”, will there be a drug compatibility chart present in the room to check?

 

  • Under CRITICAL ELEMENTS FOR PLAN OF CARE:
    • I don’t see any examples of the planning, revised or evaluation plan of care. In the old guidebook I did and it helped to be given examples of patients as well as what kind of documentation that is required. It is very hard to determine the correct language needed. Can you please give at least one example for each plan of care?
    • Under PLAN OF CARE “promotion of teamwork” are we able to use ANY member of the disciplinary team to include in this section (i.e., the primary nurse, CNA, respiratory therapist, speech therapist, Occupational therapist and/or physical therapist?) Do you have any examples of documentation for this section?

 

  • Under critical elements for SAFE PATIENT CARE it doesn’t state that I MUST do these steps in order at the beginning of the PCS, If the patient starts stating they are in pain BEFORE I am able to ID them and I sidestep that question to ID the patient will I be failed for emotional jeopardy In another regard, if I do ask the patient, “what hurts?” just to build rapport and THEN check the ID band will I be failed for not doing the steps in the correct way listed?

 

  • Under CRITICAL ELEMENTS for numerous Areas Of Competency (AOC) you have listed, “determine learner need(s) related to ______. This can be found in Comfort Management, Fluid Management, Medications, Musculoskeletal Management, Oxygen Management, Peripheral Neurovascular Management, Respiratory Management, Skin Management and Wound Management. Do you have any examples of documentation for these areas with what would be considered “the learners needs”?

 

  • Under Vital Signs it doesn’t state if  2 or 3 sets of vitals may be obtained but in the recording section it has 1st set and 2nd set. What would be the criteria for obtaining a second set and Do we ALWAYS have to obtain a second. What is we are having a hard time and need to get a 3rd set?

That’s what I gathered from my FIRST read through. If you find something that is different then post your comment below. I will be updating the members section and splitting everything between what is required for the 21st edition and what is required for the 22nd edition. (they are VASTLY different!!). We’ve got 5 months tribe members…Let’s make it count! Also, if you have a comment please leave one below. Anything and everything helps everyone.

-=Rob

P.S. Excelsior’s mission statement is: “To provide you with supportive, personalized, and innovative ways to earn a degree and achieve your goals. We enable you to succeed with expert guidance and flexible degree options that let you build on what you already know.” (that’s not me talking, that’s straight from them @ http://www.excelsior.edu/about/why-excelsior).

If you feel they aren’t providing “supportive, personalized, and innovative ways” to help earn YOUR degree and achieve your goals of becoming an RN, then let them know!

 

 

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