World watch it, it's Nurse Kim

Me celebrating NCLEX passage

 On Wednesday at approximately 11:45 AM, after taking the NCLEX, answering 75 questions in about 45 minutes, I officially became an RN.  This has been a long and difficult road, the nails in the pavement being people that told me that this was something that I could not do, the gaping manhole the middle of the sidewalk being the hours spent as a CNA doing you-don't-want-to-know to get the tuition money to pay for this, and the crap in the middle of my path that I had to jump over being a little pile of poo named Jodi K.  But here I am, Kimberley Anne Gray, RN.  Doesn't rhyme, but it does have a much nicer ring to it.

The RN exam is truly a great exam.  They use something called "Computer Adaptive Testing" (CAT) that allows you to basically as as few of the questions as possible.  Back in the day, you would have to travel to a test site, book a hotel room, and then sit in a room with about a hundred others and take a long, written, paper-and-pencil exam.  You would turn it in, wait several months, and then finally get your result.  Totally lame.

Today, what happens is that the questions are scored in terms of difficulty.  There is a midline that indicates the lowest level of competency for a new RN.  Your first question is slightly below the midline.  If you get that right, you get a harder question.  If you get it wrong, you get an easier question.  The computer will try to pick a question that it feels you have a 50% chance of getting right.

You have a minimum of 75 questions, and a max of 265.  If, at the end of the 75 questions, you are above the minimum competency line, then you are granted a pass and the test cuts of.  Or, if you are well below the minimum competency rate at 75 questions, then the computer shuts off and you are granted a fail.  If you are around the line, then the computer keeps firing questions at you until it is either out of questions or your are well above or below the line for 60 questions.

So, while you are taking this test, your are constantly asking yourself "Am I getting easy questions or hard questions?"  Because, if the questions are easy, that means that you are bombing the test.  Of course, the questions might also be easy because you are incredibly smart and you think that they might be easy.  Or they might be easy because the person who grades the test deemed them hard when they are actually pretty easy.

In other words, trying to gauge your progress by the difficulty level of the question is kind of pointless.  You just have to wait for the results.

The results are available after 48 hours of starting the test.  The NCLEX testing crew really has us here, because they can really charge whatever they want by asking for a "Quick Results Fee" ($7.95 by Internet, $9.95 by phone) and they know that they will get that fee.  They didn't get mine, however!!  Nope, because after checking to see if my results were available, I finally just checked the OR BON (board of nursing) online registry the next morning to find that I had already been added.  OR BON rocks!!

If you don't believe me, then click here.

Now I just need to find a job.

MRSA the Superbug and the VERY BAD IDEA

So the other day I am chatting with an RN on a case.  She told me that a patient was put on a course of Vancomycin.  I asked her if the patient had MRSA, which is a condition that can only be treated by "Vanco" (as the drug is affectionately called).  She told me that no, the patient doesn't have MRSA, but rather that the hospital tends to put people on Vanco on admit as part of thier protocol, and then take them off if the cultures come back negative.

For reasons discussed below, this is a VERY BAD IDEA.

This is an interesting link that describes the problem from a different aspect:
Superbug’ patient treated at MGH


I wrote the following letter to my friend Cherelle Jackson, who is a Samoan Journalist:

Hey sweetie! How ya doing?



Listen, I came across this article and I thought about Samoa. You see, Samoa, along with many other counties in the developing world tend to offer antibiotics over the counter to anyone that asks. People will self-diagnose and take the antibiotics when they are not needed, or worse yet, they will take just a few pills and stop taking them when they feel better.

This causes the bacteria that the antibiotics are trying to kill become "resistant". (Please forgive me if you know this already.) Basically, you are killing all the bacteria that are weak and are left with just a few strong bacteria. (This is why you start to feel better a few days after taking an antibiotic.) However, if people stop taking their antibiotics at this point, then the "strong" bacteria will multiply and reinfect the person. After a few generations, the bacteria becomes resistant to the antibiotic and the antibiotic stops working.

The real scary thing is that some "bugs", like MRSA (Methicillin-resistant Staphylococcus aureus, methicillin is an antibiotic and staphylococcus aureus is the name of a bacteria,) are already resistant to all but a few antibiotics. If they become resistant to the few antibiotics that are left, then we will truly have a pandemic on our hands!!!

The reason that I think that you should write about this is that your audience includes a lot of the people in the Pacific Islands that are part of the groups that tend to misuse antibiotics. If people were to only take antibiotics that are prescribed by a doctor, and take ALL the antibiotics, then this would help to slow the problem-- hopefully until newer, stronger antibiotics are developed.


Anyway, I really think that there is a story in this and I think that this is information that is vital to know. Tell me what you think.

Love,

Kim