Clinical-Judgment Skills

Research shows that fewer than 25% of nursing school graduates have the skills and abilities to do the job. happyNCLEX training addresses this preparation-to-practice gap. Read: Crisis in Competency (2017)

See new question formats NCSBN is introducing for NCLEX-RN HERE on NCSBN.org

 

How does happyNCLEX work?

QUESTION: How much time do I need to learn problem-solving skills?

JOAN: I recommend 3-4 hours of practice daily, ideally, 4-5 days a week over several weeks. No more than 4 hours a day of prep is needed or recommended.  The average minimum time needed for new graduates is 8 weeks. Repeat testers usually require 12-14 weeks. If you have a fullt-time work schedule and family responsibilities, I will help you fit in training.

Training is set up for you and easy to follow. No planning is required. Training is delivered through demonstration and guided practice, live and on-demand. I arrange meetings on your schedule.

I hold your hand throughout training until you are ready to let go and test strong. You improve as you go and you know when you are ready. Evaluations are provided.

Learning and practicing clinical-judgment skills is a process like learning any new skill. It takes daily practice over a period of several weeks. Training is low stress and testers actually enjoy the training. 

If you have a test date soon and cannot reschedule, contact me for a private coaching session: [email protected]

 

QUESTION: How do you teach critical thinking?

JOAN: I follow the NCSBN Test Plans. I teach you to read questions using the NCSBN model. happyNCLEX training reduces anxiety, helps you to understand the question clearly, and puts you in the right place to apply your knowledge. You learn to process information the way you will on the job. This skill set is easy to learn but like any skill, takes practice to improve.

happyNCLEX curriculm is designed using NCSBN Clinical Judgment Measurement Model.

 

QUESTION: What do I need for training?

JOAN: You need internet access with the ability to stream video and join live webinars, have a test date, or at least, have your ATT or be in process to obtain Authorization To Test. If you are a nursing student preparing for an exit exam or you’re waiting for your ATT, contact us to help you decide the best time to start.

You will need to purchase one text that also includes an adaptive Qbank for home practice and evaluation. You will get a publisher’s discount code when you register for happyNCLEX training. The text we use is Developing Clinical Judgement by Donna A. Ignatavicius (Elsevier Evolve)

International Nurses need a functional level of English in oral, comprehension, reading, and writing skills. To request a language assessment, email [email protected] or call/text 727 967 1891

 

QUESTION: I am interested in your program; however, I’m currently waiting for my ATT to retake the NCLEX for the 2nd time.  I still don’t have my ATT, but hope to receive it in the next few weeks. Would it benefit me to purchase your program now, or wait until I receive my official ATT?

JOAN: If you don’t have an ATT, let us know before you register and we’ll help you decide the best time to start training.

 

QUESTION: I just need to know if I will be able to access the training and coaching at my available time, which will be evenings after work everyday?

JOAN: Yes! Group Coaching demonstrations are held at different times to meet the needs of members and all are recorded so you don’t miss anything. Training is self paced and personal coaching keeps you motivated, on your time.  I am here with you daily. You are not left on your own. I do one-to-one meetings throughout your training, as needed.

 

QUESTION: So you don’t study anything… Right? So from what I understand you learn problem solving skills.

JOAN: You learn in a way that allows you to retain new  information effectively. NCLEX is not an academic test.  The way you studied for academic exams in nursing school- by listening to lectures, note taking, and cramming- doesn’t help you to prepare for a professional licensing exam.

happyNCLEX training is delivered by demonstration and guided practice- the way you would learn any new skill with a coach. You will learn new content and concepts every day while learning to let go of the need to know everything, because it is impossible to know everything. happyNCLEX trains you in the problem-solving skills you need for a professional licensing exam and continuing education. It’s an essential switch to make. 

Research shows that fewer than 25% of nursing school graduates have the skills and abilities to do the job. happyNCLEX training addresses this preparation-to-practice gap. See Crisis in Competency (2017)

 

QUESTION: I’m worried that if I don’t pass this time… My mind is not concentrated, I don’t know why… I don’t know if the material I’m using enough. Using Master RN, Lippincott, Kaplan, Saunders

JOAN: The more materials you use the more confused and scattered you get. And research shows, the more materials used, the lower the pass rate. Practicing questions on your own might have a negative effect.  If you don’t know how to approach questions, you are simply getting better at missing them. To practice effectively, you first need to learn how to handle questions using the cognitive skills outlined in the NCSBN Test Plans. 

 

QUESTION: I have a question about the 2-4 hours a day and 4-5 days a week coaching. It would be hard for me to do that since I work full time different hours everyday. Is there a way to do this 4 hrs a day, 3 days a week? I am a repeat test taker and I work 12-hour shifts. I graduated many years ago and have taken the NCLEX 4 times so I know that I need help. 

JOAN:  Do no practice on the days you work 12-hour shifts. Practice consistently on free days and add extra weeks if needed.

 

QUESTION: What if I reschedule and want more time? How does a possible extension work? 

JOAN: I’m flexible with end dates within reason. Some members need more time because of work and family. That’s fine. You can also pause your membership if needed in case something unexpected comes up. You most likely won’t need more than 14 weeks if you are consistent with practice and paying attention. International nurses might need more than one cycle, depending on English-language skills. 

 

QUESTION: I don’t have much time. I just need help with critical thinking because I’m able to eliminate 2 but then I have 2 left to choose and I often I choose wrong. There are many questions I don’t know the content and don’t know to break it down to answer them right. I test in less than 3 weeks.

JOAN:  You’ll get the basics in a few weeks but most testers who start training with a plan to test in a few weeks, soon realize they need more practice to be performance ready. Taking time to practice problem solving will be the difference between getting above passing or bouncing at near/below.  If you have limited time because your ATT is set to expire, we can discuss adding private coaching.

Schedule a consultation: [email protected]

 

 

Who is Joan Palmeri?

More questions?

email: [email protected]

call/text 727 967 1891 

 

 

What is NCLEX Content?

Let’s clear up confusion about NCLEX Content. 

Nursing school is CONTENT based. The NCLEX is CONCEPT based.

NCLEX is not a test of academic knowledge. Your ATT proves you have a knowledge base. NCLEX tests if you can think.

Clearly, it is impossible to know everything. Nursing is an ever-expanding body of knowledge and you will be faced with something you don’t know when testing. Are you able to make a critical decision with the limited information given?

NCLEX is designed to test if you can process information, if you can control your emotional response and use problem-solving skills to make a clinical decision based on the limited information given in a question. 

NCLEX is a professional exam that tests “entry-level mental competence.”

NCLEX tests skills and abilities. You can’t study the way you did for academic tests when you were a student. Instead, train to manage each question, each situation, and the exam performance overall. 

happyNCLEX training follows The NCSBN Clinical Judgment Measurement Model and is delivered by demonstation and guided practice, live and on-demand..

Learn to approach questions the way they are written and evaluated, using Bloom’s Taxonomy for the cognitive domain. This skill set is required for NCLEX as well as nursing certification exams, job interview testing, and continuing nursing education. Your investment in learning critical-thinking skills for NCLEX retains its value throughout your nursing career.

It’s so easy when you make the switch from study to practice, from student to professional.

End the cycle of study-fail-study-repeat and learn to apply critical thinking to NCLEX.

happyNCLEX training details

See how learning problem-solving skills helped these testers.

More information on NCSBN Clinical Judgment Measurement Model

How to Get Out of NCLEX Hell

Does your nursing school curriculum include critical-thinking skills training? 

NCLEX evaluates your ability to use clinical judgment because most entry-level nursing tasks require critical judgment and decision-making skills.

Do you know how to clearly identify what NCLEX style questions are asking? Are you able to use problem-solving skills to get to the correct answer step by step? Are you able to make an educated decision comfortably or do you get stuck second-guessing yourself?

There’s a big difference between getting stuck at near passing and testing above the passing standard and it is determined by your ability to use higher-order thinking.

NCLEX questions are designed using Bloom’s Taxonomy for the cognitive domain. Do you know how to solve NCLEX problems this way? (see page 4 of the nscbn test plan – 2019 RN) (PN test plan page 4 also)

If critical-thinking skills were not taught across your nursing school curriculum, you’re at risk for repeating NCLEX.

The good news is, you can catch up in 12 weeks. Here’s how.

 

 

How to Control Distracting Thoughts

Is your brain a tornado of conflicting thoughts about NCLEX?

Past attempts unsuccessful? Worried how you can make it this time?

Are your thoughts racing? Is there a voice in your head telling you all kinds of fearful things? Saying you can’t do it, you’ll never do it?

Who is that crazy person in your head? It’s not you.

You can teach yourself to observe that speaker in your head. Are you going to let someone talk to you like that? These thoughts are simply unchecked thinking. Check in. Look at the thoughts. Aren’t they crazy?

YOU are not your thoughts. YOU are the witness to your thoughts. YOU are the witness to your thoughts, your emotions, and everything you experience. Pay attention. Miracles are everywhere.

What is your mind telling you? What is the truth?

Thoughts about the past or the future create anxiety. The way to manage this is for our minds to be active or relaxed in the moment. When we’re engaged in solving a problem, we have just the right amount of anxiety to keep us alert. When we let our minds relax, our brains get refreshed to think clearly and creatively once again. 

How do we control the thoughts about the past and future that can torture us and cause all kinds of misery?

If there’s one book I could require you to read it’s this one.  This is the single most helpful guide to using your head. Available in all public libraries and about $10 for the Kindle version if you want to buy it.  The Untethered Soul by Michael Singer. 

You’ll learn that those thoughts are not you. YOU are the witness to your thoughts. Singer teaches us how to manage this in a clear and effective way. You will no longer “get into getting bothered” but instead you’ll learn to “get into getting free.” 

Here are 3 short talks by Michael Singer to help you to control distracting thoughts. Sign up for free access

Were you taught not to ‘pass the buck?’ 

This misinformed teaching creates confusion for NCLEX testers. 

Here is just one recent example:

Question #36: (Copyright F.A. Davis)

Mental Health: #36. A young child, Joey, was admitted to the pediatric unit with a fractured jaw, bruises, and multiple cigarette burns to the arms. The mother reported the father hurt the child. A man comes to the nurse’s station saying, “I am Joey’s father; can you tell me how he is doing?” Which statement is the nurse’s best response?

  1. “Your son has a fractured jaw and some bruises but he is doing fine.”
  2. “I am sorry I cannot give you any information about your son.”
  3. “You should go talk to your wife about your son’s condition.”
  4. “The social worker can discuss your son’s condition with you.”

 

Student Question: For mental health management, question #36, I thought that sending the father to speak to the social worker about his son was ‘passing the buck’. Please if possible explain again why that will be the answer. For answer #2, I thought that the nurse shouldn’t give any info because he hurt the kid. And if he did, then he didn’t care much about the kid to hurt him in the first place.

 

What would you do? What is the nurse’s best response?

“Passing the buck” is one of the worst things taught in test prep! Healthcare is a TEAM effort. You cannot manage care alone. This is the social worker’s role, not the nurse’s role and you are required to assign this task appropriately. If you chose #2, what are the chances you have a violent man who doesn’t like that answer? You just put yourself, your staff, and your client in danger. #2 is not a true statement. At this time, it’s uncertain if the father has legal rights (most likely) or has lost his parental rights in court because of a past incident (possibly.) Clearly, he needs to be referred to the social worker. 

The keyword is BEST so the question is asking you to choose policy, not opinion.

The correct answer is #4.

The definition of “passing the buck” is to shift blame on someone else because you didn’t take responsibility to make a critical judgment. You are responsible to delegate and assign when appropriate.

I can’t stress enough how important it is to let go of the misinformed teaching to ‘pass the buck.’ 

Focus on learning the rules of delegation and assignment. This begins with knowing what your priorities are.

Were you taught not to ‘pass the buck?’

Find Flow After a Fail

“Not Yet” Joan Palmeri, NCLEX Whisperer

Just experienced an unsuccessful attempt at NCLEX?

How are you feeling right now? Devastated? Frustrated? Angry? Are you an emotional wreak because you’re experiencing this as a traumatic event? You’re most likely physically and emotionally tired, worn out, overwhelmed and generally useless after a fail.

Recognize your need to recover. Be the nurse right now for yourself. Let yourself feel what you feel without letting your mind judge the feeling or define you. Every feeling is temporary.

recovery

Today you are the nurse and the patient. Nurture yourself. Heal yourself.

Here’s research-based advice for getting yourself back in the game and across the finish line with a PASS.

EXERCISE: You need 20-30 minutes of exercise a day. Not to be “bikini ready” but simply to be healthy. Not only is it bad for your heart to carry too much extra weight for your body type and frame but what’s important for you right now is that exercise increases stress-reducing hormones and is the best mood balancer available. You have been bombarded with stress hormones. You need to counter that. Go for a morning walk. Put on music and dance. Go to YouTube and search for free exercise videos. Try something new: Yoga, Pilates, Zumba. Do something different for exercise every day. Do it first thing in the morning so you don’t procrastinate. Get up earlier than everyone else in your house if necessary.

NATURE: Get a touch of nature every day. This is easy on a morning walk. Every inner city has a park. Grow some houseplants. Wrestle with the dog. Pet the cat. A connection with nature is a connection to your true self. Shakespeare said, “One touch of nature makes the whole world kin.” This is your way back home. A way back to your true self.

EMOTIONAL WELLBEING: Stay in the moment as much as possible. Don’t go too far into the past or the future. Both past thinking and future thinking create anxiety. Train your mind to quiet down and focus by practicing daily meditation. Make time to meditate and you will see how much more free time you’ll have. Your thoughts will stop racing and you’ll be able to see a thought and ask yourself, “What purpose does this idea serve? What is this idea in my head that is trying to sabotage me? This is anxiety talking. I’m letting this go.” Avoid contributing your energy to these illusions.

Practice gratitude which is proven to change brain chemistry. Wake up every morning and say it out loud: “I’m thankful to be alive. I’m thankful for this delicious cup of coffee. For my family. For my eyesight. I’m thankful to be part of a prep program that is helping me clear my head to be able to think clearly!” Writing down something you’re thankful for everyday is even more effective.

FOCUS ON THE NEW EXPERIENCE: When you become a licensed nurse, you will help your patients adapt to dealing with many changes in their lives. Some will have to learn to walk again after a trauma, learn to speak again after a stroke, learn to adapt to lifestyle changes after a heart attack, learn to live with sobriety after detoxing from drug and alcohol abuse, and many other life-changing situations. How will you help your patients cope? By embracing what is new. You need to let go of the way you “studied” in the past and start to prepare like a pro. You are in training. Commit to it cheerfully. Smile and remind yourself that growth is a process, sometimes painful, but the outcome is sweet.

Begin today by focusing on your whole self. Know this is possible. Know that all it takes to pass the NCLEX is for you to be in good physical and emotional shape so you can think clearly.  Once you feel you’re strong and happy again, you can go on to the WORK PHASE.

 

work

 

The work phase begins with cleaning up the past. Pack up your nursing school books and old prep materials. Store them away, all the while being thankful for the learning they gave you.

Clean up your prep environment at home. Create a clean, uncluttered, quiet space where you can do your Home Practice with no distractions. Try to create an area that is as dull as the test center will be. Just you and your computer. This is where you will rehearse for a strong NCLEX performance.

Once your prep area is set, take yourself out on a date. A date with yourself (not with your lover, your BFF, or your kids.) Take yourself out to a movie, to window shop, browse a book store. Go ice skating at a local rink, to a museum, take a ride on a Ferris wheel, go out for ice cream- anything that will make you happy. The idea is to show yourself some love and appreciation. This activity will also open up your creative mind- a part of your brain that doesn’t get much exercise in nursing school (which is mostly memorization.) I date myself every week. It keeps me sane. You’ll be more in touch with yourself and more refreshed to begin working again.

Recognize the need to increase reading comprehension skills and speed for NCLEX and improve these area by reading for pleasure every day. Research shows reading detective novels is highly effective in building reading skills as well as enhancing critical-thinking skills for standardized tests. Sue Grafton has a great series that starts with A is for Alibi and goes through the alphabet. Available in libraries. Get on it.

Once you’ve organized your prep environment and had some “me” time, you’ll be ready to move on to the FLOW PHASE.

 flow

Flow is a high-energy experience with something you can pour your heart and soul into. Is it nursing? If so, your approach to NCLEX prep needs to be relaxed and full of curiosity and passion.

Every question is a patient. It’s not some horrible thing that’s testing your knowledge. It’s a living, breathing human being who needs you. See a patient in the questions. Even if it’s a straight knowledge question testing lab normals, see that data and imagine who the patient is. Male or female? How old is s/he? Infant, toddler, teenager? Is it a young single man? A 35-year-old married woman? A 75-year-old widower? Once you have a person in mind, SEE their health/wellness. What do they need? How can I help? Is there a life-threatening situation here? Do I need a physician? Using your imagination this way opens up your intuition. Soon you’ll just know what someone needs.

Flow is the state where we have no thoughts about the past or future because we are totally committed to the present moment. Athletes know this when they’re practicing their sport. Musicians know this when they’re playing their instruments.

Remember when you first learned to drive and had to think about everything? Seat belt. Adjust mirrors. Look four ways. Hyper-alert. Then once you know how to drive, you just get in the car, put on the sunglasses, turn on the music and go. This is the process of learning any new skill. First you are aware of how to do it. Then with practice, you find your flow. 

 

Contact Joan Palmeri directly at [email protected]

 

Why You Can’t “Study” for NCLEX

NCLEX is a professional licensing exam, not an academic exam.

The biggest mistake I see repeat testers making is continually trying to “study” for NCLEX.

In college, most nursing content needs to be memorized. You listened to lectures, read textbooks, took notes, crammed, and spit it all back on a test. And it got you through nursing school.

NCLEX tests your ability to process this information to make informed decisions.

NCLEX requires you to make the transition from student to professional.

If you’re still trying to study for NCLEX, what are you studying? The entire content of nursing knowledge?

That’s crazy when you think about it.

You will never know all the content in the field of nursing, EVER. Why would anyone think you can learn all the content that can possibly come up on your exam by test day? No wonder NCLEX seems overwhelming. Yet it’s the easiest exam of your career.

SEE MORE HERE

 

 

 

 

 

How To Stay Sane

Are your thoughts racing?
Is there a voice in your head telling you all kinds of fearful things? Saying you can’t do it, you’ll never do it?
Who is that crazy person in your head?
It’s not you. 
You can teach yourself to observe that speaker in your head. Simply watch the thought.
These thoughts are simply unchecked thinking. That crazy voice we all have in our heads.
Check in. Look at the thoughts. Aren’t they crazy? Are you going to let someone talk to you like that?
YOU are not your thoughts. YOU are the witness to your thoughts. YOU are the witness to your thoughts, your emotions, and everything you experience.
Pay attention. 
 
This is why I wholeheartedly agreed with Carrie Fisher when she said, “I’m very sane about how crazy I am.”

What is your mind telling you? What is the truth?

 

Surviving a Break Up

Did s/he walk out days before your test date? How can you possibly focus on prep when everywhere you look is a reminder? It feels like crap. You feel like crap. It’s exhausting. (Please adapt pronouns “he” or “she” here to suit your situation.)

The angry voice in your head says: “He knows I’m focused on testing but he’s only thinking about himself! I should be happy to get rid of someone so selfish! Good thing I found out now. Selfish creep!”

Anger is a natural reaction to loss. Our impulse is anger because we feel powerless. Anger, we feel, will give us status again. Anger is a defense against what is perceived as betrayal. Then revenge follows, some sort of face-saving impulse comes up feeling a need to punish. And the way back to trust is a long road. It’s not pretty. 

The sad, sad voice in your head tells you that you need him, your life is empty without him. Every day stretches long and sad before you.

The truth is, we don’t need someone to make us happy. True happiness comes from within. But you know that. How can you get yourself back when you feel he took a part of you with him?

How can you speed up the healing or at least compartmentalize the pain to focus on testing?

Here’s what’s worked for me:

Spend a full day blowing out your emotions. Feel what you feel. Play all the music that makes you nuts. 

Go on, go nuts! Close your door. Scream, cry, dance! Let yourself feel what you feel. Let it out. 

 

Then wake up the next morning with the intention to be your ex’s friend. Yes! Trust me, it’s the only way. Tell him you understand that this form of relationship isn’t what he feels he needs right now. And that’s okay. You are both individuals with different needs. Tell him you’re feeling a little sad and that you’re vulnerable right now. Ask him to be kind. You give him what he needs, he gives you what you need. Tell him your goal is understanding. Peace. Friendship.

Understanding is the most loving action there is. Saying, “I don’t love you” is really saying, “I don’t understand you.” Be the mature one. Seek understanding. Give him time to understand himself.

When you find your mind distracted thinking about him, stop. Close your eyes and send out a prayer for him. Wish that he’s at peace. Wish that he finds true understanding.

And nurse yourself. Be your own best friend.

Focus on NOW for now. Increase your morning exercise time. Add a second meditation session to your day. Get a new haircut. Clean out your closet and put your best clothes upfront. Get dressed everyday in what makes you feel the most fabulous. Listen to upbeat music- no more angry or sad love songs. Try to stay off social media as much as possible until after test day. No matter how tempted you are to snoop at his social-media activity, just don’t. It will only make you crazy.

Realize you won’t get over this in a day. There will be days when you wake up crying. It happens and it can happen for a long time. What works for me is to simply allow it. Cry. And when the tears stop, what helps me is to remember that everyone has a limit when it comes to intimacy. This limit can expand as we get older, but right now your ex hit their limit. They need distance, they need space, their freedom at this moment is a higher priority to them than intimacy. They need more time to grow and that is all it is. Your ex might never get there. If they start a new relationship they’ll hit that limit again and either be challenged to grow or they’ll withdrawal again. There’s nothing we can do about it. Everyone is responsible for their own intimacy issues. I’ll cry when I cry. It won’t kill me. I’m not afraid of my feelings. My feelings show me my infinite capacity to love.

I also recognize that intimacy is tricky. We all have days when we need to disconnect and have some quiet, alone time with ourselves- “me days.” Everyone needs time to retreat, to rest and recharge. We need our alone time for insight and creativity. Some people need more of this than others. Give “me time” to yourself when you need it. When you are in a new intimate relationship, remember to respect your partner’s need for “me time” too without taking their withdrawal personally. 

Keep a picture of your future self in your mind, always. You are a healthy, vibrant, loving and lovable badass nurse. You’re so busy saving lives you hardly have time for all the potential lovers you’ll soon be meeting every day! When you decide you’re ready for intimacy again, and you feel ready to make room for love in your life, move over and sleep on one side of your bed, making room for love to sleep beside you. Then wait for the miracle to present itself. Miracles are everywhere. We just need to be in the right emotional place to see them. 

Ready to let your emotions rip? Here are some of my favorite break up recovery songs. What are yours?

This one works every time Ex Factor

My sad break-up favorite is Never Can Say Goodbye

And when I’m really pissed off, there’s no better song than You Oughta Know

The greatest full break-up album of all time, Beck’s Sea Change

 

 See also: “Relationships are hard, but why?”