Mary’s Pad

I’m taking an NCLEX review course, to prepare for the one exam that will define whether or not I am competent to practice as an RN. I have gone through three days of the course, and have five to go, and it’s been interesting.

After two years of learning about different disease processes and people’s responses to illness, and how the RN fits into the picture of getting a patient through it all; after grappling with pathophysiology and with understanding how different drugs do what they do to the body; after spending time talking to patients and learning how to interact and be therapeutic in my communications; after sleepless nights trying to deal with some of the stuff I have seen during clinical; after hours of working on my techniques, and learning to do different tasks; after all of this, and more, it’s amazing to me to sit in this review class and discover that what I know and have learned in the last two years is but a very very small part of what it will take to pass this exam. This is extremely perturbing to me, but it’s so true.

This test is about strategy! It’s about knowing how to read a question, how to break it apart and analyze it, and how to answer it by the textbook!. One of the first things the instructor told us when we started preparing is “This is a textbook exam. Forget what you have seen during clinical, forget what the nurses have told you, forget what your hospital policy says… this is textbook!”

This got me thinking. The textbook teaches the ideal, the standard, evidence-based and proven way to do things. My instructors on a daily basis strove to teach and model to me the ideal way, woven in with the practicalities of time limits and pragmatic considerations, what supplies we had, what other constraints were present. Most of the RNs I worked with told me some variation of the same thing: “I know this is how they teach you to do it, but believe me this is not how it works in the real world.”

I want to believe that we all come out of nursing school vowing to do everything we’ve been taught, and to do it by the book, and I want to believe that those who stick to this resolution far outnumber those who break the rules and cut corners. But from what I’ve seen, I can’t really say that that’s true.

Nonetheless, back to the NCLEX. I have to think by the book, and for this exam at least, it has to be about strategy, and about test-taking skills. This irks me to no end, but I have no choice if I want a license to practice. So for the next five days I am going to sit and learn how to take an exam. And then I will come back and one day tell you what I think about standardized testing.