Sunday, September 25, 2011

Expecting To Fail

First week at the fellowship was orientation, skills checkoff, EHR training, and probably failing a test.

One whole day was devoted to a "Performance Based Development System" assessment. It's a computer based test that's supposed to see how good I am at thinking like a nurse. It gave various patient situations, either by text, image, or video. In every case I'm supposed to figure out what is wrong, and write down every single thing I'll do in response. In the right order. After only one viewing. In a very tight time limit.

We are not expected to pass.

Since we're all new grads, no one expects us to have the full nursing skill set yet. The fellowship leaders say it takes about one full year of real-life hospital nursing to get there. The point of this assessment is to note what skills we have already, and where we most need practice and assistance.

Me, I'm great at recognizing situations and calling up facts. If you show me a post-op ortho patient with sudden chest pain and shortness of breath with hemoptysis, I'll correctly say "suspected pulmonary embolism" and tell you that I need to immediately put her on O2 (to start with). But where I'm weak is on policy and prioritization. I know PE is an urgent situation, but how urgent exactly? Is this a situation where I go page the physician, or do I stay in the room and call for the rapid response team? It depends largely on the patient's status and vital signs-- which the video helpfully avoids giving me-- so there is no rote, textbook answer for me to call up.

For this exam I tried to err on the side of caution, so I probably wrote to call the RRT when I should have been paging the doctor, and paged the doc when I could have handled the situation with independent nursing actions. We'll see what they tell me about that. The tests have to be read and graded by live humans, so I won't find out how I did until next week.


  1. Do they still have the Win/Win, Win/Lose, Lose/Lose section?

    I actually almost failed because I numbered my interventions (1, 2, 3...) instead of writing in paragraph form ("First I would...then I would..."). Gotta love live humans.

  2. Seriously? Crap! that's exactly what I did! The example answer was in the form of a bulleted list, and I decided to number my list so they could more easily match each intervention with its rationale. I hope they're at least reasonable about it.

    And, yes, they still have the silly win/lose social interaction bit. I ran out of time trying to complete that one. I carefully planned out my time for each question, but the final audio clip refused to start when I clicked the button. :/