Things to Expect During and After RN School in the U.S.
Hopefully by this point in the student’s life of school, work, family, and friends, he or she has been able to strike a balance amongst them all. All of these areas of life are important to maintain and all have differing priorities and time requirements. Nursing school classes will require more time than prerequisite classes and, for many students, be more stressful as well. Part of the reason for this is the two parts of nursing school: didactic coursework and clinical hours. Here is what to expect during and after RN school.
“Didactic” is a big fancy word meaning textbook coursework and classroom lectures. Being present and prepared for classes is a vital part of the nursing student’s life. Reading and, more importantly, comprehending textbooks and handouts is the key to passing exams and understanding how to keep patients safe. The main goal of nursing school is to teach a new nurse graduate how to keep patients safe. The nursing student learns early on that the golden rule of nursing is to “do no harm.” Didactic and clinical hours help teach this vital cornerstone of nursing.
Unlike prerequisite classes taken prior to nursing school this program requires clinical hours. These are state required hours accrued during the nursing program and must be fulfilled in order to sit for the licensing exam upon graduation called the NCLEX-RN. Often clinical hours are accrued at nursing homes, rehabilitation facilities, and hospitals. They require a lot of energy in attitude, intellect, and physical exertion.
The nursing student is required to maintain a pleasant, accommodating, and helpful attitude with even the worst bedside tasks and tolerate staff nurses who may be rude, demanding, and unwelcoming. Some staff nurses love nursing students, are kind to them, and embrace the opportunity to share knowledge. Sadly, others do not like the hassle of having to teach and choose to use students as free labor instead. Many facilities try to assign nursing students to those staff nurses who enjoy teaching, but sometimes the student has to tolerate a staff nurse who is having a bad day.
While staff nurses may only be assigned a nursing student for a short time the school provides a clinical instructor who supervises the students. This person is usually a great resource, enjoys teach nursing students, and will help protect the students from any negativity from the staff. The student can learn an enormous amount from the clinical instructor. Plus, because they are employed by the school any student complaints are usually addressed promptly.
Clinical hours may be both intellectually draining and stimulating at the same time. Didactic coursework discusses topics in an abstract way, but clinical hours intertwine classroom materials with real life. Learning about a disease process from the safety of a classroom and actually meeting a person and caring for this person who has the disease makes it “real”. The compassionate side and the technical side come together and we learn how to care for the person as a whole, otherwise known as holistic health. Honing this skill is what makes a nursing student into a competent Registered Nurse.
Physically clinicals can be exhausting. Nursing students learn how to turn and move patients in bed, transfer them out of bed, and lift and move in ways one never thought possible . This, alone, can cause physical exertion, not to mention back injuries. The amount of walking, especially in big hospitals with long hallways, is often more exercise than the average human achieves in a day. For fun, wear a pedometer and see just how many steps are accomplished.
When the mentally challenging didactic portion of nursing school combines with the demands of clinical hours, the nursing student can find him or herself a bit overwhelmed, not to mention exhausted. Especially if the demands of work, family, and friends are high which adds to the stress.
Balance, Time Management, and Priorities
Balancing work, family, and friends during nursing school can be especially difficult. Since quitting work isn’t always an option and ditching friends and family is not a good idea, time management and prioritizing are the best methods to use to balance these responsibilities.
Time management during nursing school is accomplished by being prepared and ready to learn in each lecture and for clinical hours. If work and family and friends are time consuming during non-school hours, be sure to find time during the school day to study. During lunch breaks and even during lectures are good times to read textbooks, make index cards for memorization, and prepare for exams. Time management is all about prioritizing important tasks. Work with your schedule to make time.
Prioritizing important tasks and deprioritizing unnecessary tasks from one’s life is a vital part of student life. Determine what is important now and what can be put-off until after that difficult exam is finished. Create a calendar with all the exam dates and assignment due dates and be sure to check it at least a week in advance to prepare. Block out study time and even schedule time for friends and family to help balance the busy schedule. Feeling and being prepared for each class and for each exam will relieve stress and improve GPA.
Working During RN School
Most students would choose not to work during school but, sadly, work is a reality for many students. Because of the increased demands for study, lecture, and clinical hours, many nursing students will want to decrease the amount of hours he or she works, if possible. Some employers offer education reimbursement and depending on the situation the student may qualify for more money in student loans than tuition requires, leaving extra for living expenses.
Taking Care of Yourself
Maintaining a healthy body, mind, and soul is important, although difficult during nursing school. The demands of didactic and clinical hours plus outside responsibilities may prove to leave little time for self-care.
Here are a few simple things the student can do throughout the busy day to maintain balance:
- 3-minute meditations, can be done during school hours on a coffee break, find a quiet place, maybe the car, close your eyes, and take slow deep breaths, setting the intention of clearing your mind
- Eat nutritious food, this helps to properly nourish all those overworked brain cells and keep you focused
- Take a daily walk, just a 10 minute walk around the neighborhood will improve brain function and cardiovascular health
- Limit alcohol intake, not only will this improve body but also the health of the student’s mind
Nursing schools now require high GPA’s and have strict admission requirements. Students who have been accepted already know the best ways each individual studies and learns. Most will have no problem balancing the challenges of nursing school while maintaining their outside responsibilities. And most will survive and graduate with flying colors, ready and willing to join the ranks of registered nurses. So what happens after graduation?
Getting Licensed as a Registered Nurse
The National Council Licensing Examination for Registered Nurses, or NCLEX-RN, is a nationally accepted and state-mandated examination. Nursing programs are designed to be as challenging as they are because the NCLEX-RN is challenging. The NCLEX-RN is challenging because it is the best way to determine if a nursing graduate comprehends enough about patient care to be safe! And, remember, nursing school teaches students how to be safe nurses. So, in theory, the nursing school graduate has learned enough to pass the NCLEX-RN simply by graduating the RN program. So, try not to fret. That being said, if the graduate feels like he or she needs more assistance with studying help is available online and in the classroom.
Registering for the NCLEX-RN All things NCLEX-RN may be found on NCSBN.org, this is the National Council for State Boards of Nursing website. This council is the regulatory body for the NCLEX exam. Here the graduate can read about eligibility, deadlines, and will find his or her program code which is necessary to register for the Exam. Registration is completed on Pearsonvue.com with this program code once the state board of nursing has given authorization.
Pearson Vue is the company responsible for arranging a time and place for the graduate to take the NCLEX-RN, as well as the NCLEX-PN, which is for graduates of the Practical Nursing (PN) program. Many nursing programs assist graduates in completing the necessary steps to taking the Exam upon graduation.
Upon graduation, the graduate must:
- Submit an application for licensure/registration to the state nursing board
- Meet the eligibility requirements to take the Exam
- Register and pay for the Exam on pearsonvue.com
- Receive eligibility from the state nursing board
The last step of receiving eligibility from the state board of nursing will render an Authorization to Test (ATT) via email. Once received, the graduate has about 90 days to take the Exam. Once the ATT is received the graduate can register on Pearsonvue.com and set a time and place.
About the NCLEX-RN Exam
The NCLEX-RN is a Computerized Adaptive Test (CAT) meaning as questions are answered correctly the computer will ask a more challenging question. If a question is answered incorrectly the computer will ask a less challenging question. This does not mean that if the last question is “easy” the graduate has failed the Exam. The way a question is determined to be more or less challenging is subjective. A question that is challenging for one graduate may not be for another. The Exam ends when the computer has determined with 95% confidence that the graduate has performed either above or below the passing standard. The Exam can has as few as 75 questions or as many as 265, depending on the performance of the graduate. The maximum time allowed to complete the Exam is 6 hours.
The Exam is organized into 4 main Client Needs categories with subcategories which may be found at ncsbn.org and are listed below.
(Please note: The term “patient” has been replaced with “client.” This is mostly a scholarly ideal taught in some nursing programs and used on the NCLEX Exam, however, this has yet to catch on in the professional environment.)
- Safe and Effective Care Environment
- Management of Care
- Safety and Infection Control
- Health Promotion and Maintenance
- Psychosocial Integrity
- Physiological Integrity
- Basic Care and Comfort
- Pharmacological and Parenteral Therapies
- Reduction of Risk Potential
- Physiological Adaptation
Of these main categories the graduate will need to demonstrate an understanding of the Integrated Processes:
A scientific, clinical reasoning approach to client care that includes assessment, analysis, planning, implementation and evaluation.
Interaction of the nurse and client in an atmosphere of mutual respect and trust. In this collaborative environment, the nurse provides encouragement, hope, support and compassion to help achieve desired outcomes.
Communication and Documentation
Verbal and nonverbal interactions between the nurse and the client, the client’s significant others and the other members of the health care team. Events and activities associated with client care are recorded in written and/or electronic records that demonstrate adherence to the standards of practice and accountability in the provision of care.
Facilitation of the acquisition of knowledge, skills and attitudes promoting a change in behavior.
The Exam is really testing critical thinking skills and the graduates thought process. Does the graduate understand basic nursing processes and how to arrive at a safe and reasonable solution to problems? Some items may be memorized, such as medications, but the main idea of the Exam isn’t to test memorization it is to test critical thinking skills.
For these reasons, studying for the Exam shouldn’t really be “crammed.” During the nursing program the student should be sure to pay attention, attend classes, and study. Nursing school has prepared the student for the type of thought process and critical thinking the Exam is testing.
Exam Day Preparation
- Show up rested. Be sure to get a solid amount of sleep the night before to allow the brain to work at it’s best
- Eat a hearty meal before the Exam. Although the graduate’s nerves may be tense the body needs a healthy meal to function properly.
- Get to the exam location early. At least 15 minutes early, if possible. This allows the graduate to relax for a minute before the exam.
- Bring everything you need, such as ID and anything else that is required. The graduate won’t be able to take the test if he or she doesn’t have the proper items.
- Take your time, but not too much time! During the Exam, be sure to read the questions thoroughly and understand what the computer is asking before answering. That being said, only 6 hours are allowed, so be thorough but efficient.
Receiving Exam Results
This may take anywhere from 48 hours to 6 weeks depending on the state board of nursing where the graduate lives. This may be determined by visiting the state board of nursing website.
Post Exam Career Search
Hooray! Once the graduate receives his or her nursing license from the state board of nursing he or she may begin apply for a job!
Hopefully throughout the nursing school program the nurse was exposed to many types of facilities and areas of nursing. The nurse should have a general idea about which type of nursing he or she prefers. Hospitals, long-term care facilities, home health, school nursing, ambulatory care, physician’s offices, and more are popular options. The nurse should aim for his or her preferred area or nursing then work down the list from there.
Ideally, during nursing school, the nurse was able to network with unit managers of facilities he or she would like to work. The luckiest new graduate nurses will be able to email the manager and have a job.