Tanya Freedman, CEO Connetics USA: Hi everybody, and welcome to Connetics USA, the weekly show onwards and upwards. We hold us every Friday and we are so excited today. My name is Tanya Freedman. I'm the Chief Executive Officer of Connetics USA. We help healthcare workers with jobs in the United States and we are direct hire. So we have facilities all over the United States that are hiring internationally educated health care workers.
I have with me today, Paul. Hi, Paul. Welcome. Good morning from Texas. Good morning, Paul. We also like to welcome Raymond. Hi. Welcome, Raymond. Hello, ma'am. Good afternoon from Germany. Oh, good morning from Germany. And last but not least, welcome Cyndel. Hi. Good morning. Thank you for joining us. Your voice is a little faint if you want to maybe speak a little louder. Okay, there we go. Much more. Okay, this is live, everybody. Okay, so today's topic is NCLEX. Very big topic today. We're going to be hearing some success stories from Cyndel and from Raymond. And then we've got a special treat because Paul is going to be giving a master class. We have a bonus class from Paul and everyone I know is going to benefit enormously if you have not yet passed the NCLEX exam. Wherever you are watching in the world today, please put in your name and where you're watching in the chat. I see that we have who is this? Byron? Hi, Byron, who is watching from Manila and he's saying, Hi Sir. Paul, my previous lecture from my local board. Hi, Tanya. So welcome. We also have Jonathan watching. So lots of people watching from all over the world and we're excited to get started. If you have questions about the NCLEX, please put those into the chat. And Paul or Cyndel or Raymond would be happy to help and to answer your questions. Okay, so today's topic is the NCLEX. For many nurses, this is a big topic because many people know that you cannot come to the United States without passing the NCLEX.You can't even file your case without the NCLEX.
I would suggest that anybody who is not sure how the process works checks on the Connetics USA website for our success path and that will give you some information about how to proceed. There you'll see step number one, the NCLEX fast pass. So Paul, Sandel and Raymond are going to be providing us information about how to qualify as an RN and prepare for the test. And then after that, we would set you up with an interview. We would then have your visa framework, your licensure and everything else that comes after that.
Okay, so we've got Zarin is saying Hi,Maria is also from Germany, suffered from Dubai.We've got Joe from Saudi, Maria Bellin from Riad. So people watching all over the world. This is so fun and we can't wait to get started.
So before we do that, I thought maybe we can start with some introductions and a little bit of background, Cyndel. Ladies first. You want to talk us through a little bit about yourself, tell us about your background, a short background, and then tell us about your experience with the NCLEX.
Cyndel Villaverde, PHRN, USRN: Yes.Hi, my name is I am from the Philippines originally and then went here in Canada on 2012.And I'm also a Philippine registered nurse. And then here in Canada, I'm a medical lab technician and also working inclinical research with the diabetic patients. Okay.So like Cydel, many nurses have gone to different parts of the world, but still often US is the ultimate destination. Tell us a little bit about your experience with the NCLEX exam. Yes, of course. There's so many roadblocks. However, you should persist and you should persevere in everything that you do and nothing can stop you as long as you know that this is really what you want. Okay. Worth of encouragement. Do you want to share with the viewers and your journey with the NCLEX? Because it's been quite a journey.It's a very inspirational story. Yes.I started actually taking the NCLEX after my Philippine board exam, like around 2012. However, of course, I didn't make it that time and then move here in Canada. And I started again processing my NCLEX and reviewing, of course, as usual, after several years also, I didn't make it. And then I told myself, okay, I have to move to another path, which I did study labtech.However, of course, this is really still what I want. And then 2020, I started reviewing againand continuously reviewing and practicing questions. And then I enrolled with Aspire and did my full review there. It's really not an easy test. It's not an easy task to do, but you have to do what you have to do, right? That is for sure. And so tell us what the ultimate result was. And now here I am. I passed February and you have no idea.It's really still surreal for me and I am really happy. And there are times that I couldn't believe it. And there are times that although Iknow the result already, I still cried. You really should feel pride not only for your exam, but for your perseverance, for your faith, for your stamina, and for your grit. Yeah, that's what my partner always tells me. You should practice grit every time you do. Like whatever you do, you should claim it by faith. Well, that was certainly good advice. And I'm sure that you made him very proud. How many times did you not pass before you passed with this buyer? Four, actually. Four on the fifth time, yes. Wow. What a story of inspiration. I know that every nurse that is watching all over the world right now is just applauding you and in all of you for going this journey, not giving up, and for sharing your journey here today with everybody. So inspirational. So thank you for sharing your story. And we can't wait to dig in more and hear more about your experience.
Raymond is a Connetics USA Scholarship nurse. Raymond, do you want to share a little bit about your background and your story?
Raymond Guevara, PHRN,KSA RN, Germany RN, USRN: Hello, ma'am. I started to work in the Philippines as a nurse for two years in ICU and then I decided to go to Saudi Arabia and I was assigned to Dialysis Department. But my wife told me that I must come back home to the Philippines because she cannot tolerate anymore that we are away from each other. So I decided to come back and we decided to go together here in Germany to work as a nurse. I'm currently working in Cardio ThoracicHeart Center here in Germany.Okay.And tell us about your experience with the NCLEX. Raymond. At first I am very clueless. Where should I start? Because I don't know how is the process and it is very difficult when you're doing simultaneously working while I'm studying. It is very difficult. But I cross path with Connetics and they introduced me to Aspire because they accepted me even though I'm not yet an NCLEX. Then they introduced me to apply for a scholarship so that I would have that edged aspect. So after that, I felt ready, especially after my final coaching with Sergio. And I know I can do it because I got a lot of tips and tricks.
Well, that's what we want for you. The tips and the tricks. You really have to learn how to take the exam, right? Yes. Because actually, even though how much you read, there are still a lot of questions that came out of nowhere. And you just need to depend on the test taking strategies that I really actually learned from as our end. Okay, well, we can't wait to hear more about your journey. And we're so happy for you, Raymond, that you're coming to the US and that you and your wife can be together because that's what's so beautiful about coming to the United States is nurses are Schedule A occupations of short supply. So you qualify for an EB three green card.And when you get the green card, your spouse and any children under the age of 21 automatically get the green card so you can be together, which is just living and working the American dream just to share with everybody. Also, the Connetics USA scholarship is available for all nurses. So if you do not have your NCLEX exam passed yet already, please apply to the Connetics USA website and our team will be ready to speak to you and to see if you would qualify for the NCLEX exam. Sorry for the NCLEX scholarship. This is Connetics way of paying it forward for nurses. We have gone the extra mile.We know the pandemic has been so tough with so many nurses and we wanted to do something special to help nurses to prepare to take the NCLEX exam. If you are not selected for the scholarship. Also, please don't be too disappointed because once you pass the NCLEX, you are welcome to come back to us and apply it again.
Okay, Paul, please go ahead and let's introduce yourself and tell us a little bit about your background and as well as. Aspire.
Christian Paul Biluan, DNP-S,APRN,FNP-C, CEO, Aspire RN: All right. Thank you. Thank you. Tanya. First of all, I would like to congratulate Cyndel and Raymond. Well done, guys. You've really sacrificed a lot of times about the NCLEX. I know it wasn't easy. I took mine 2008. That's like 14, 15 years ago. And it still feels every time a student takes the exam, I really feel for them because it's really a difficult exam to give everyone a background. My name is Paul. I'm currently living in Houston, Texas. I've been here for five years in Texas.I am a migrant nurse as well. Just like Raymond and Tindall, they will be migrating here soon. I came from the Philippines.I had a background with nursing education. I was an instructor for Amplitude and the local board exam review in the Philippines. I moved here five years ago. I started my program. It's called Aspire RN, where Cindy and Raymond joined. And of course, Connetics has partnered with Aspire RN to provide scholarship review for their clients for the students, which Raymond is one of our pastors. And I'm currently taking my doctorate degree and about to graduate in less than two months. Wow. Thank you. An American success story, Paul.Yes, the American dream.I know when I came over here to the States, I really wanted to earn my doctorate degree. Aside from that, I'm also a certified family nurse practitioner. And right now, I stopped working as a nurse. And I have my 100% attention to and of course, my graduate degree. And thank you for having me today, Tanya. You're welcome. We're excited to hear your class, your lesson that you have offered as a special treat for nurses all over the world to get them going with the NCLEX exam and share some of the tricks and tips that both Raymond and Cyndel have spoken about.
If you have any questions for the panel, please go ahead and put that in the chat and I will be sure to ask those questions for everybody watching.We like this to be as fun and interactive as possible.
Okay. So, Paul, first of all, before we kind of get your class and Cyndel and Raymond are going to share a little bit more about their journey. For those people who are just tuning in right now, what is the NCLEX and why is it so that's a great question. NCLEX National Council for Licensure exam. It's the RN Licensure examination. If you want to practice in the United States of America in 2015, Canada also adapted the NCLEX. So if you want to practice as a nurse in Canada, you should be able to pass the anchors before doing so. And currently, Australia is also requiring foreign graduate nurses. So if you're migrating, say, for example, from the Philippines to Australia, you would also need to take the NCLEX RN. So it's very difficult exam, but you needed to practice as a registered nurse in those countries that we've mentioned. Okay. So as Raymond has said and Cyndel as well, often international nurses feel a little clueless. They really don't have a lot of knowledge about the NCLEX. And it's really important to educate yourself about it. And that's why we do these shows onwards and upwards, because the NCLEX is traditionally the past rate for international nurses is lower than American new grad nurses in taking the NCLEX. Right, Paul? And I think we have some slides, some graphics about that. Can you maybe talk us through some of these stats?
Yes. So in the slides that I'm presenting right now, we can see that in the last three years, from 2018 to 2020, they're about average 86% to 88% US passers. If you are US educated, you're more likely to pass the eight out of ten times. But for international educated nurses, our average ranges from 43% to 44%, which means there's only four nurses out of ten takers that will pass the emphasis on so it's a little alarming if you think about it, if you're a foreign graduate nurse, which means if you were not educated inside the United States, there's more likely for you to fail the exam than actually pass it based on the data that we have right now. Okay. So this really points to the fact of how important it is that nurses know this number one. And number two can make sure to do the right course to prepare. And Cyndel is a perfect example of that because Cyndel, you took the test harmony four times, four times. And so for everybody watching, the endless is expensive. So if you think of the down and all the money that you wasted, really, and the time and the effort and the anxiety, Paul, can you share with everybody? And I think we have a graphic on this as well. The stats for repeat test takers.So for repeat test takers, it's even worse than what we have earlier. So US educated nurses have about 42% to 44% pass rates for repeat takers.Now that's even way lower for international educated nurses or foreign graduate nurses because we're only seeing 24% to 27%, which means out of ten takers, only two people will pass the NCLEX exam. So you see the repeat takers have way worse performance than first takers. So there is a study that was conducted by NCLEX that says for every time that you take the NCLEX, the less likely you are to get worse. Your performance gets worse over time. So the goal of every review program you would see,you would find, including Aspire, is to decrease that chanceof failing and increase your chance to pass. That way we don't have to be repeating your inquiry because each time might be a little worse than the previous one. And Cyndel has lived that even though she had the growth, even though she had the perseverance in bucket lows, because really, it's just so inspiring. Cyndel, your story of how you continued and persevered. But even so, I mean, if you look at those stats, it's not enough. Like, Paul, unless you really have the help to learn, as Raymond said, the tricks and tips to know how to address the exam.And you can be a brilliant nurse and not pass the exam. So it's not an indication of if you're a good nurse or not. Am I right, Paul? That's right, because it's a very difficult exam. In fact, I would say this right now. It's way more difficult than the Philippine Board examination that I used to teach. There's a lot of high level questions onanalysis, application, and evaluation level for educators.These are very tough questions that we throw into students, and Eclectic is mostly composed of that. And I admire Cindy's determination.I've seen very few students far in between in my years of teaching that have passed the NCLEX after several attempts. But I think what stood out forme for sending is their determination. And I would like to point out to everybody,if you fail the end because it's the first time, it's not the end of the world. I've had students from back in 2011 failed one time and never wanted to be a nurse in the America again in an American dream. It's up for grabs for everybody. You could have failed your NCLEX ten years ago. Come back in and let me help you. Let Connetics help you. We can get you on board again with your dream, but do not give up. Just like what Single did. She knows what she wanted. She prioritized what she wanted and she went for it. And here she is sharing her life story to us.
Very inspiring. Yeah, it really is.Cyndel, I know there's so many nurses that are looking at both you and Raymond in awe and wish that they were in your shoes right now. But you've done the hard work and now it's your time to pay forward and to share your story with others. Cyndel, let's start with you. How was your preparation for the NCLEX different this time as opposed to the other times when you took the exam? Yes. So since I'm also working full time, I set a plan.Of course, that will not compromise my review because I don't want to go through that path again. And then first I gathered my previous candidate report and check all the areas that I need to work on so I can focus on them. I trained my mind not to dwell on failures by practicing grit, because that's the only way to surpass that.And I enrolled with Aspire and make sure that every concept that we have on our student portal, I review it every day, even though I am working. Like, sometimes there are days that I'm working 12 hours, I'm still going and logging in even for just one or 2 hours so that I can still be on track. I don't want to lose all those concepts. And I attended all the live lessons every weekend.
Okay. Knowing the time difference as well, because it's Philippine time. Okay. So you had a very structured plan. What were the mistakes that you think you made the first time? I think the first time was I was not that focused because for me, I learned by if someone is teaching like the traditional teaching. So, like, an instructor will teach and then I will go and write and then listen. And those times that I did previously, there are times that I did self review as well.But it's hard because if you have questions you don't have anyone to ask, you just gather your peers and then ask questions. But really, I don't think that's enough.It's good to have guidance with our mentors like Fergie and really pushed me to all the things that I can possibly imagine that I can do. So it really worked out on me, even though I'm so nervous, given that, of course, having to take an several times. And then he told me, you know the drill already, you shouldn't be that nervous. So every time I feel that I am nervous, I just tell to myself, this is it. If I have to take 145 question, I will. That's what I told myself. Just really push it. Yeah. And having that a mentor and a teacher telling you that you're ready, I'm sure gave you a lot of confidence. Yes. There's also that test anxiety where that's a part of it. How long did you study for? I started studying back in October again and then to the end of February. Okay. Yeah. What is your biggest advice that you would say? We've spoken about kind of like the soft skills, having that determination, having the grips, the perseverance, all of those things. But in terms of the practical course, what would you say is your best advice for any nurse that's watching right now? And he's just starting to think about the NCLEX exam or had failed before. Yes. So while you're reviewing, just answer lots of questions. It's okay to make mistakes on the practice questions because that's where you learn, right? You learn from your mistakes. So by the time you take the exam, then you know what to do. You know the tricks. And then as what other people say, you don't have the right to have any expectations. 75 items. Yes, it's good to pass at 75 items, but there are 145 Max questions. You should keep continuing or else you will lose your focus and self determination as you go along. And if you think that it's 76 questions, oh, it's 80 questions and the computer doesn't stop. Right. But the thing is you just have to answer as many questions as possible and continue learning. Even though you commit mistakes in the past, that doesn't mean it defines you, right?Okay, yeah, I think that's good advice.If you're in the exam and you're getting more than 75 questions, don't allow your head to go to failure. Just keep facing forward and just keep answering the questions. And in the practice, do as many practice questions as you can.Great advice, Raymond. Can you share with us your experience? You were first time taken. As you said, you were clueless. You didn't really have much knowledge or experience about it.Can you share with everybody how you prepared? First of all? And second of all, when did you feel that you were ready? How did you know you were ready? Two questions actually. I started self review after I received my ATT that's my eligibility to take the exam. I was so relaxed because it is six months. So I just read some online review materials. I finish a lot of questions, but after that I feel that it's all rumbled. I don't know what I have studied anymore because it's not organized. And a month before my attribute expired, I decided already to take my exam. But I didn't expect a lot of problems that I have encountered. The most difficult situation that I've been is that I'm already in the airplane. I'm bound to London to take the exam because there is no testing center here in Germany. The doors are already closed and I have received a late email that my Corona or Covid was positive. I don't know what to do. I'm very confused because I feel that I need to take the exam but I don't need to lie. So I voluntarily give myself and voluntarily leave the plane even though my passport will be already soon expiring and my ATT will soon expiring. So I don't know what to do then after that I said I need to reschedule my exam before my passport will expire. I still review, but like I said, I feel like confused and then I met Connetics and that is Ma’am Joy. Then she introduced me to Aspire RN and that was really a very big help because until to the very last minute they helped me until I take the exam and my examination day. That was also my wife's birthday. What a great birthday gift for your wife. I was very nervous because if I fail I miss a lot her birthday, all the efforts, all the preparations waiting for six months just to take the exam. So during my exam, I'm already answering the questions that I reach 75. I thought I'm doing good because I encountered a lot of difficult questions because my coach told me if you are encountering difficult questions, it's a good sign. But after 75, the computer didn't stop. And then until it reached to 117. But still I didn't lose focus. Like my coach said, I just need to do my best in every question. So then the night after, I just prayed that I hope I will pass. What did it feel like when you got that notification to say that you passed? That is really unexplainable, actually, because it's very kind of feeling that I don't know if I deserve it. But yes, I passed. I can't explain it. I think you certainly deserve it because you did the work. Raymond. So Congrats. And I'm sure your wife was so excited to have that great news for her birthday, her birthday gift. But that's really what we want for everybody who's watching is to have that moment when you see that you've passed and that your new life in America can start. I think that's a great place for us to end off the first half of today's session, which is for Paul to explain a little bit about the NCLEX and Cyndel and Raymond to share their journey and share their experience, their challenges and their successes.
As I said, that's what we want for everybody watching is to pass the NCLEX because that is the step number one to getting to the United States. I see that Rania has a question about the test centers, that there isn't one in Germany. You have to fly to the UK. So Rania, our team will put into the chat the locations where the NCLEX testing centers can be taken at this time. And if you have not yet passed the NCLEX again, please apply to the Connetics USA website. We would love to share our scholarship with you. The scholarship is that we will pay for you to do an NCLEX review course. Aspire is one of our preferred vendors. We did a lot of research looking for the best vendors to help international nurses. As Paul said, many international nurses do not pass if you don't get the right tips and tricks, as both Raymond and Cyndel have shared.
So we're going to finish off this first segment, and then I'm going to be tossing it over to Paul, who's going to be taking you through a bonus class, an NCLEX class. And before we finish up, I just wanted to share some upcoming shows. We have an upcoming show in March. On the 25th, a client showcased on Oschner, a fabulous system, large system of 40 hospitals in Louisiana. In April. On the first, we're going to learn how to buy a house in the US. On the 8th is our regular immigration Q and A with our expert legal panel. On the 15th, we're going to learn about Stateside, what it's like to live in Maryland, United States. The 19th is the la for a talk show. Once a month we do the la for a talk show where we're going to be talking about self care for nurses. Very important topic. Then we have a surprise, very excited. We're going to be on the 22nd live from the UAE. We're looking forward to meeting people face to face and we're going to be doing a job fair live from the UAE. So more to come on that. And on the 29th, our pen showcase. Penn State is a magnet system in Pennsylvania. We're very excited to showcase Connetics initiatives. So please don't forget we have a free IELTS course for all Connetics USA nurses. We have our scholarship, which we've spoken about $1,000 referral fee if you send us a nurse who's passed the NCLEX. This promotion was extended until May 1. Please watch our podcast Nursing in America with the top ten podcasts worldwide. We have a direction nurse aid program, so please apply for that. If you're interested, please watch our show every week onwards and upwards every Friday. This is for global nurses coming to the United States. Everything that you need to know. And then if you are on the allied side, if you're a medic, respiratory therapist, Echo, Cardiology tech, surgery tech, etc. So we can help you as well. So with that said, I want to thank our guests, Cyndel and Raymond for joining us today, for sharing your story, for inspiring nurses all over the United States. And I'm going to hand over to Paul. Thank you, Paul.
NCLEX BONUS CLASS
We're not done. I'm going to conduct a prioritization and give you a lot of different tips about the NCLEX RN. That was Raymond Cyndel and Tanya.Tanya is the CEO of Connetics USA and Raymond and Cyndel were our students from the Aspire RN program and scholarship program under Connetics USA. So for foreign graduate nurses, if you are looking to fulfill your American dream, come over here to the United States, but you don't have a budget to take your NCLEX. We are offering scholarship program under the Connetics USA. They flash the link earlier to apply to conneticsusa.com/application. Or you can also message me on Facebook or Instagram. I'll give you my handle later. So like we said earlier, NCLEX examination is an RN life insurance examination for the United States of America, Canada and in Australia. They also require foreign graduate to take the NCLEX. NCLEX is a very difficult exam. The questions are very tough. It's high level or high order of thinking types of questions. And it's computer adaptive, which means it adapts to your ability to answer the questions. The minimum items that you can have is 75 and the maximum is 145 kwh. And next year, on April 2023, they're going to update the test bank. And we're now going to get more difficult questions. We call the new or the next generation and clicks questions. We'll talk about that in another meeting. But today I'd like to focus on prioritization types of questions. If you have been prepared for NCLEX or you want to prepare for NCLEX, you want to know about prioritization, there will be plenty of questions about prioritization in the end clock. This will be a quick lecture. I'll be flashing questions. You'll help me answer the questions. Alright? So please stay on Facebook right now. I've also shared this link in my Facebook account and in the groups that I am in. If you are here right now, can you please message in the comments box your location and what time is it right now? That way I know where you guys are coming from. I know we've seen one from Germany, I've seen one from our student from Nigeria. And I've seen some people from the Philippines don't leave yet because I have some questions and answers that we will be doing today. You're going to help me answer the questions, I'm going to give you tips and then we'll apply that to the questions that I'm going to flash on the screen. Yeah, there you go. We have Sarah from the Philippines. We have Lenny from Saudi Arabia at 05:00 p.m. There. Good afternoon. We have Ariana from St.Vincent and Granny Deans. Wow .And Adrianne from Philippines. We have Judith from Qatar, Mary from Saudi Arabia as well. We have a lot more people from Philippines,Melody from Singapore and Lou from Qatar. Wow.We're all over the world, guys. Thank you so much.Please stay with me. Okay. Even if you're already an NCLEX passer or applied for NCLEX, don't go.I want you to participate in this review.This will be very short. I only have ten questions, butthese are very difficult questions.It's prioritization. So help me answer these questions. All right. So what I'm going to do is I'm going to discuss littletips and then we'll apply that question when I flash the questions ,I'll give you about 30 seconds to 1 minute to type in the letter of your answer in the chat box. All right. Are we okay with that? We're going to type in your answers inthe chat box and then when I get enough answers, I'll explain the answer after that.All right.We have people from Nigeria, from Saudi Arabia, from UAE, and from different parts of the Philippines.Thank you guys for joining you guys already.All right, let's go to the next part of this slide. All right.We have one student that said Stephanie.She said she completed a master's degree in nursing. Congratulations. In Brazil. Wow.And seven years of experience in height. All right.Thank you for joining, Stephanie.Thank you for sharing your life story I love people that like toadvance in their careers as nurses.That's what I like about nurses.We keep going up. We keep going up.This is what this show is called It's Onwards and Upwards.So yes, go for advanced graduate degrees.I've earned my master's degree about six, seven years ago and now I'm finishing my doctorate.So keep going, keep going.And Congratulations, Stephanie, for your achievements.We have one from Jamaica as well, all over the world. And thank you guys for joining. Now let's go to the next slide.Let's talk about prioritization.There will be plenty of prioritization questions in NCLEX. These are high level questions in Bloom stocks on education. These are application or analysis or evaluation levels of questions, which means you need a good background of what the concepts are talking about. You should have mastery of concepts before you're able to answer prioritization questions.These are questions that require critical thinking and knowledge about many different nursing and medical Sciences. So before you answer prioritizations or before you even get to answer prioritization questions correctly, your foundation of the nursing Sciences or the knowledge base is important. So when I conduct my classes in Aspire RN, just like what Raymond and Cyndel had to go through in my classes, in our classes and aspire our end, we usually put prioritization lectures towards the end. We want students to build their concepts first.
I've been doing the review for almost 15 years and what I've learned is if I put prioritization at the beginning and students don't have knowledge about or the knowledge base about basic Sciences like maternity nursing or anatomy and physiology or basic pharmacology, it will be difficult to answer prioritization. So what I want you to do if you're reviewing for NCLEX is build your foundation first, which means review the main concept. You have to have the mastery of topics such as pathophysiology.You should be able to understand diseases because without pathophysiology you would not know what would be the priority or complications.You have to have an understanding of pharmacology.You have to have abroad understanding of your assessments.So assessments are very important because you should be able to determine what is normal or expected for a certain condition and what is abnormal or sudden changes for certain conditions. And of course, you also have to know your normal values, normal vital signs and every number that you need to remember for your exams.
In NCLEX, they do not tell you the lab values. So see, that's the difference between NCLEX and my Nurse Practitioner Board. In the Nurse Practitioner Board, they at least give you range for lab values, what is normal, what is abnormal in NCLEX? They want you to memorize the laboratory values. So if it gives you a question that says, oh, the patient's PTT is now about 105, are we going to continue heparin or not? So without knowledge about that, it will be hard to answer the question. So for prioritization should have foundation and mastery of the core concepts before you're able to answer prioritization questions.Well, right now this is my tip. Number one and basically every nurse knows this.Always remember to prioritize your ABCD. Right? Abcd. Abcd is a mnemonic that we lifted from the trauma nursing core competency, or TNCC. It basically says airway, breathing, circulation and disability, or neurologic disability, otherwise known as Lo C or level of consciousness changes or mental changes, orientation changes, neurologic changes. Right? So when you're answering prioritization questions, always look for is there an airway disturbance? Is there a breathing problem? Is there a circulatory problem? Is the patient on shock? Is the blood pressure low? Is the patient pale or cyanotic? Is there LLC changes? Which means is the patient confused? Is the patient disoriented Is the patient super? Is the patient unresponsive? Those will definitely be your priority.Of course, our priority is always ABC air.We breathe circulation.If you don't find any problems with ABC issues, then you go for LL or orientation changes or neurologic changes. All right?So except when the question is about CPR, if it's about basic leg support or the patient's unresponsive without a pulse, then you start CPR.All right, that's going to be for another lecture when I do my prioritization and emergency nursing lecture. By the way, I did not tell everybody I'm an emergency nurse and my background in nursing is emergency medicine. I have a good background about emergency, so I love to teach prioritization and triaged and emergency nursing, basically. So if it's talking about CPR, you start compressions first. If it's talking about trauma and there's an injury, your priority is stopping hemorrhage or controlling hemorrhage first. Other than those two, you always prioritize airway, then breathing, then circulation, then LLC changes for disability. All right, so let's see this question. So that's our first tip, right?
We have more people coming in. We have now people from Kuwait and still a nursing student. One student said he was my student from years ago. All right. I've been teaching since 2009. All right? So if you count it, how many years are those? 13 or 14 years. All right. Anyway, let's go to the next slide and let's see your answers. All right, let me read it for you.
Which of the following clients in the unit will require immediate attention of the nurse?
Is it Letter A, CHF client or congestive heart failure with cough and difficulty breathing?
Letter B, e, as Rd and stage renal disease with increasing fetal edema?
Letter C, acute pancreatitis with muscle jerking.
Letter D. Diabetes mellitus patients with ketoacidosis with glucose of 200.
All right, so what's your answer here? Abc or D? Can I see your answer? A-B-C or D? All right, this is the priority questions. All right? I'll help you eliminate those that we don't prioritize or will be last priority. Of course, all of these patients have acute problems, which means all of them have issues that we need to treat. But when you're asking about priority, which one would we need to see first or treat first. Let me remove letter D because even if it's a DKA, the sugar is 200. I'm not concerned unless it's more than 300 at the very least. But of course, we still need to treat DKA. But not a priority right now. Let's eliminate letter D.cWhat is your answer? A, B or C? All right, let me remove letter B. ER patient is not a priority right now because the pit oedema is actually expected symptom of ESRD. There's no emergency there. The patient is not going to die with that. All right? It's already expected A or C. The answer is I see a lot of letter A. Let's see if the answer is letter A.Actually, the answer is letter A. Y. Remember the tip? It's ABCD prioritize Airlines breathing patients first. All right, so answer is letter A, CHF client with cough and difficulty breathing because obviously this patient has an airway and breathing issues. All right. CHF patients are fluid overload patients. They have a lot of pulmonary effusions or pulmonary congestion because of the backup of your blood to the pulmonary spaces. This congests them and decreases their oxygenation and makes them have respiratory distress, which can be very dangerous because they can have epoxy and anoxemia. So answer is letter A. So you say you have to have a good background about pathophysiology and your assessments to be able to answer this. So answer if letter A to those who answer letter A, you got it correctly right.
How about number two? Let's see this. We should have followed patients with the nurse prioritize is it? A 31 year old female was applied to Eight out of 1028 year old male patients with type one diabetes restless and agitated 49 year old with Herp who has difficulty avoiding and experiences burning. Or these 39 year old schizoaffective patient develops insomnia constipation. Which would you prioritize? Can I remove letter D? The schizoaffective patient, because we don't prioritize psych patients unless they're suicidal. The only time you prioritize a psychiatric patient is if they're actively suicidal because they can hurt themselves. All right? And that will be very dangerous. Your safety. Let's remove letter D. Not a priority right now. A, B or C. All right. I see a lot of answers. Very good. All right, keep it coming. I want to see more answers. What are your answers, guys? Letter A is not a priority. If you have an appendectomy, you would have pain.
You just need to give pain medicine as a nurse so you don't have to worry about that. All right.
B or C? The answer is letter B. Very good.
We've applied the ABCD rule. Letter D. Disability or LLC changes.
If you have a type of diabetes patient and he
is having restlessness or agitation, you would think about DKA.
You would think about sugar is pretty high and
it's causing imbalance in the fluids and electrolytes.
When the sugar is too high. The sugar pulls out the water from the
brain and puts it into the vascular spaces. Patient starts to pee a lot,
but what happens to the brain? There will be balance of fluid.
The fluid movement or shifting causes a lot of confusion.
This we can see in patients with DKA, which is
also more common in patients with type one diabetes.
All right, so answer is letter B. All right, that is our priority.
Your next action should be to check the
sugar level and to report to the physician. All right. Answer is letter B.
Very good, guys. Number three, trivia must decide to show the following
children should be examined first by the pediatrician.
Which child with the triage? Nurse prioritize. I'll let you guys read it.
Okay, let me just message the moderator real quick. All right, so is it letter A?
Seven month old fell into a sofa. Letter B. Four year old bicycle fell
off bicycle with bleeding lacerations. Letter C.
Ltd patient or larigo trachea or bronchitis. Wheezing and Oscar patient or letter D?
A six year old child experiencing asthma has diminished wheezing.
And it's very. I couldn't see it and it's very irritable. What is your answer?
All right, I see two answers here. I see C and D. All right. Okay. I'll remove other options for you to make it easier.
Letter A is not a priority because the only thing that
it said is the patient fell and hit the head. We don't have other symptoms
that need to be prioritized. Letter A is removed.
Letter B. All right. Bleeding lacerations are not a priority.
They're lower priority unless it's arterial bleeding and the patient's developing shock.
Letter B is not a problem. The sutures can wait.
We can pack it with dressings. We have what we call an Er quick cloth.
It's a combat gauze that they use in military that has clotting factors in it.
We put it on the wound and wrap it up and the bleeding stops in three to five minutes.
That's our priority. Crd. Both of them have airway problems.
This is the trick with NCLEX, becauseyou can have two airway problems.
You can have two breathing problems.Which one will have complications first?
In short, which one will die first? C or D?
All right. Letter C. While there is a reason you have to
remember letter C has an expected symptom. We know that if they have Ltd, larigo
bronchitis, they would have wheezing, and that's fine.
All right, 30 breathing per minute is also expected because they're having trouble with breathing.
The priority is letter D. Why? Let me flash my slide. Why?
Because the child is in asthma. If you see the word diminished bread sound or
diminished wheezing, that means total or complete airway.
Total or complete obstruction of the airway. And you see irritability is an LLC changes.
It means hypoxia off the brain. Answer is D. The patient is having status as Medicos
at this point, this is an emergency. We need to give epic shot or
start the bronchodilator treatment right away.
This can be very fatal. A lot of asthma kids have died because of
status as Medicos where there is total occlusion.
The Airways now completely blocked because of inflammation
and there's no air that will move, right?
The air doesn't move. There's no bread sounds. This is very dangerous for asthma.
You see the word diminished bread sound or diminished freezing.
That's an airway compromise. That is a priority. All right, so everyone who answered
letter D got this question correctly. Question number four. All right, after receiving change of shift report at 07:00 A.m., which of these patients will you assess first? A migraine headache patient with wrenching.
Wrenching means vomiting. All right, letter B, 45 year
old with craniotomy needs preoperative teaching.
Letter C, 59 years old, Parkinson's needs swallowing assessment or letter D?
Multiple sclerosis, oral temp of 101.8 in flank pain.
Looks like a lot of them have acute issues, right?
A lot of them have acute issues. Let's remove letter B for a minute because craniotomy
that needs free up teaching is not my priority. That's a very stable patient. can also do pre up teaching. That's not my priority.
Remove letter B. All right, what is your answer? I see mixed answers here.
What is your answer? Letter A, let's remove letter A.
Nobody said letter A. Migraine with vomiting is very common.
It's expected. There's no danger there. You just stop the migraine attached.Give pain medicine. Give Reg lens.
Stop the vomiting period. We're done.
So that's not a priority.That patient can wait.You just arrived in the unit and you
got a report from the night shift nurse.Now, who do you need to see first? Crd.
Crd answer is letter. Remember, your tip is airway,breathing, circulation and disability.
Which among these two patients will have airway compromise?
I would answer letter Cy.Parkinson's patients have difficulty swallowing and the
breakfast tray is about to be served. They usually come in at seven or 08:00 A.m.
In the hospitals, guys. And those patients, when you put
the tray, they'll start eating right? You need to assess wallowing
reflexes for swallowing ability. If not, patient chokes patients have aspiration pneumonia.
You're now at risk for legal liability because family
comes in, sees the patient choking, you're starting your
Heimlich maneuver, and now you get sued.All right, that's a liability for your
answers letter C, because of airway issue. All right, you have to do letter C
first, and then you go to letter D. Patients probably having UTI.
Uti is not a priority unless it's sepsis.
We don't see signs of sepsis here except temperature.All right, answers letter C, because of airway issue. All right, it's a very tricky question. All right, answers letter C.
All right, you have to prioritize airway first. Now, second tip.
We only have three tips for today.I'm already on number two, and we have ten questions.
We're already in question number four.Tip number two is prioritize unstable patients.
When I say unstable patients, what do they mean? You admit whenever you admit patients
the first time they are unstable Why are they considered unstable? Because you need to do your nursing assessments and find your priority problems.
Worsening symptoms are vital signs.For example, a patient has a blood pressure
of 140 over 90 an hour ago. Right now, when you reach out the blood pressure, it's already 80 over 30.That's unstable. Correct. Or earlier.
The patient has a heart rate of 95.When you recheck, the heart rate is now 140.
That's unstable. All right. Complications.
For example, a patient had a post openabdominal exploratory procedure for peritzinitis, and it's now having the standard abdomen, decreased abdominal bowel sounds
and blood pressure of 90 over 40.So those are complications.The patient might be bleeding inside. Unexpected or sudden changes, right.Patient was alert, awake an hour ago.
When you came in, the patient's unresponsive. The patient is not breathing.
The patient is blue.Unexpected or sudden changes.Treatments that need to be started.
For example, the patient hasan order for bronchodilator nebulizer. All right.
But it hasn't been started yet. That is an unstable patient.
All right, so when you see all of these criteria being met, the patient is unstable.
You always prioritize an unstable patient versus patients that are stable.
All right, so let's see.Let's apply these tip number two. Two to questions.
All right, let's check question number five. A few more minutes to wrap up this meeting. Question number five. Shortly after arriving for the evening ship,
the Triage nurse evaluates several clients who came into the Er or Ed.
Which clients should receive the highest priority?
I'll let you answer this, guys. A, middle aged man diaphragm or
chest pain related to the jaw. Letter B, elderly, complaining of loss of appetite.
Letter B is stable. That's not my priority. Letter C, basketball player limping and complaining of
pain and swelling on the right ankle. That's stable.
Nobody dies from a right ankle fracture or injury or muscle pain.
Letter D, sugar 225, complaining of thirst.
That's a symptom of diabetes. That's expected. That's not worse. Worsening symptom.
That's not worsening symptom at all. That's not a complication that is expected.
Letter D is also stable. Answers letter A, what are we thinking here?
Patients probably having what, a heart attack? My cardio infarction.
That is our priority. Very good, guys. Easy. Question number six.
Which client? Thank you, guys. Thank you. Let's move on to the next one.
Which client would be the RN priority in an acute care situation?
Client with diabetes glucose of 183 days post with left casting a newly admitted
client with chest pain or client complaining of pain following surgery from hip pinning.
Apply the tip that I said, what is your priority?A-B-C or D.
I'll give you 30 seconds to answer this question.
Very good. I'm seeing a lot of participants answering letter C.
All right, so I guess we know the answer already. Letter C.
This is easy for you because I already told you new admits are unstable.
You need to do your assessments. Yes, I know letter B might have an acute issue, too.
Yes, I know letter D might have an acute issue, but they're not my priority.
I'll prioritize letter C. Very good, guys. Very good.
We're learning very well. Thank you. All right, good job, guys. Good job.
How about this question? Can you answer this for me?
Which of the following patients would you prioritize first? All right.
Lumber puncture for letter A, pain is three out of ten B, pulseless tachycardia for post.
I see 14 year old sitting at the edge of the bed with cervical implants.
I don't think a patient with cervical implants should be sitting on the side of the bed.
So there's that letter D, 17 year old anorexia with a sodium of 134.
It's a little low. Normal 135. So that's not my priority.
What's your answer, guys? Applying your tip number two,
which is prioritize unstable patients. Remember, unstable has sudden or unexpected changes.
Unexpected is letter B. Right? We're having complications here. The patient is now having V tax. Right.
And that is fatal. You have to start CPR right away. Answer is letter B. Good job, guys. Good job. Very well. All right, let's go to the last and final tip.
Thank you. When you cannot, use ABCD priority tip.When you cannot use unstable priority tip, you
now use triage prioritize using triage principles.All right, so we use triage a lot in the Er. All right. There are two types of triads that you need to know when you are in the
hospital or when you're taking your ankle. I'm sorry, two types. The regular triage or we call it hospital triage, daily triage, routine triage.
We always take care of dead or dying patients first.
When you're in the hospital and you're working
in the Med search floor and you haveseven patients, hopefully not, because that's a lot.
We have five or six patients. Med search in the Er, we have four. Right.
And you see one patient is dead or dying or unresponsive.
Unless it's DNR, that will be your priority. All right.
Your priority in the hospitals are always dead or dying patients first.
No matter what happens, your priority for regular
triaging is the dead or die patients first. Now, during disaster, the resources are scarce, which
means you don't have a lot of resources. There could be 100 patients that are
affected, but there's only like ten nurses. Right. Or there could be a blast in a Stadium.
There's 500 people affected, but there's only three Ers in the city. Right.
And all the Ers are now flooded with 80patients each when they can only handle 20 so
in disaster because of the scarcity of resources, wecannot take care of dead patients first. All right. We do severely injured but can live first. So they can live.
They are severely injured.
They probably have pneumothoraxes or they probably have
open chest wounds or open femoral fractures.Or they can have bleeding
everywhere, but they will live. All right, so you do not care
of the dead or dying patients first. You take care of patients that
are injured but can live. All right. But have the ability to live
or have the chance to live. So to cut it short, I'm going to use colors
because I think you guys are familiar with geographic colors.
We have black that are dying. I like to discuss this further when I teach emergency medicine
and I do that in my class and inspire our end. So if you guys are interested, I'll
let you know about the program later. Black.
The dead are dying. The red are the severely injured but has the
ability to leave if treated within 30 minutes. Yellows are the injured but stable, which
means their vital signs are stable. But they're injured.
Yes, they could have fractures, but they're stable, right?
They have many lacerations. The Greens are what we call walking wounded.
They might be wounded with a small laceration or a
bruise on their face or head, but they're walking.
They have the ability to walk, which means they're alert, oriented, stable vital signs ambulatory.
They are not a priority. So in the hospital you take care of
black first, the dead or dying patients, followed
by red, followed by yellow, followed by green. This is the Ena principle.
We're using the Emergency Nurses Association principle here or principles of triaged.
So you take care of black in disaster. It's different.
We take care of red first, then yellow, then green.
Last is black. A lot of people get confused. They take care of green patients first. The green ones, the walking one said, no, we don't do that.
It's called reverse triaged, and we only use it in very few situations, such as during a fire
in the hospital or in military operations. We don't use it here in
the hospital or disaster triaged. Again, for hospital, you do black, red,
yellow, green, black, red, yellow, green. In disaster, we do red. Yellow, green. Last is black.
So you prioritize Reds. The severely injured but can live. Severely injured but can live. All right.
Now let's go to question number eight. All right, question number eight.
Let's go answer this question.You are practicing annual disaster drill.
According to disaster triage, which of the following clients should be cared last?
So you look for who is the last red? Yellow, green, black. Which one has the black triage?
Come on, give the answer to me. I'll give you 30 seconds to process this.
What's your answer? I see mixed responses. I love it when we have mixed responses
because that means I can properly explain it. All right? I love prioritization.
A lot of nurses always get confused. So, you see, this is high order
of questions or high level thinking. Critical thinking.
This is application of what you've just learned.
So let me tell you this, okay? I'm going to give them colors so we can use colors.
Remember black, red, yellow, or green? Right.
For disaster last is black. Letter A. I'll give letter A red
because it's open tension Luminas. It leads along clubs. Letter B.
I'll give letter B red because it's protruding fractures.
We're talking about Osteomyelitis and sepsis here.
And of course, bleeding. Letter C, smoke inhalation injuries, area compromise.
It's also letter red. I'm sorry, call her red. Right.
Letter D. Listen, if your burn injury is more than 20%, for adults, you're automatically read. For kids more than 10%, and for Geriatric, more than 10% is automatically read.
All right? Because this can lead to fluid electrolyte, imbalance.
Patient sleep Burns will lead to shock. More than 40% of burn injuries automatically block. All right? They are more likely to die in the next five to ten minutes.
70%. Burn. Full thickness is third degree burn is very fatal.
I don't know if you guys have seen someone with third degree Burns. 70%.
I don't know if you've seen someone like this. This patient is literally burnt.
You probably could see muscles and bones at this point.
That is black. If this is the disaster, my last priority is letter D.
Because this patient is about to die. I don't want to spend my resources and use it
and not be able to treat the other patients.
All right, answers letter D. So you see, what I told you earlier at the beginning of the lecture, you have to have a good background with path of physiology and assessment
in order to answer this question. That's why prioritization is always thought last
in my aspire art and program. My prioritization lectures always lasts.
All right, I want you to master your pathophysiology, your medical, surgical,
nursing disorders first, your maternity, your obstetric, your Geriatrics, your Pediatrics.
All of those concepts before you go to prioritization, because otherwise you're not going
to be able to answer this correctly. Answers, letter D. And I've explained why.
All right, answers letter D. That's black triage. That's the last patient to be cared for.
Number nine without the last two questions. During disaster drill, which client
should the nurse priority type?The question earlier was, who took care last? Right?
Now the question is, who took care first? Who's your priority? Very good. I'm sorry.
Let me just interrupt you guys real quick. The student responded from the last question earlier that I didn't read the last word.
So, you see, it's also very tricky because if you don't read the questions carefully, you
do not get the right answer. And clicks can be very tricky. All right, now the question is,
who will you prioritize first? All right? Remember, what is our priority for disaster?
It's red followed by yellow, green glasses, black. Right. Letter.
I think we all have the same answer. Letter A is black. Right? I'm sorry. I'm sorry.
Hold on, guys. Okay, letter B and letter C are not priority.
Answer here is letter D. I'm sorry I did it last night. Twelve midnight.
So my highlighting is incorrect.Answer is letter D because it's chest
injury and the patient is restless. Let me correct this slide. Okay.
Answer is letter D, not B. All right. Letter B, if you look at it, open fracture
on the right arm and chest position with pain and inspiration, not a priority that patient can rate. My answer is because it's chest
injury and the patient is restless.If it's chest injury, we're thinking about Pneumothorax
and that can lead to lung collapse. Answer here is letter D.
You also have another determined that your restlessness
is an LLC change, which means Anoxia.
Let me correct this slide.Answers letter D.I highlighted the answer incorrectly lastnight when I did this answer. Letter D, letter D, client with chest injury and already restless.
All right, number nine is letter D because of the chest injury that's every breathing, circulation
problem and restlessness is LoC changes. So in disaster, that is our priority.
The last is letter A. All right, now this question for number
ten, you have to lift into order.I want you to prioritize them by order. All right?
You have to list them. There's no one answer. Your answer is four, but you
have to put them into order. Okay. Your answer is four in order.
What letter comes in first? What's next? What's the third? What's the fourth?
So there are four patients in Triage when you're in the Ed.
If you want to be an emergency nurse, thiswill be your everyday work in your life, right?
This is what we do everyday in Er. Do you prioritize an Ambulatory days?
25 year old male advantage at Wood irritable infant with fever, 35 years old with a
twisted ankle, Peel pulse and no deformity. Or 50 year old with abdominal pain and vomiting?
Listen to order, guys. I'll give you a few more minutes. I'll give you a minute to answer this.
We have few responses here. I love it. We have different answers. I love it.
I love it when we have different answers.That fires me up to explain it really good. All right.
All right. Let me see your opinions. What is your answer here?
And then I'll tell you my answer. We have varying answers, but I think
we got the first priority correctly Our priority is letter B.
I think most of you all got letter B correctly. That's the first one.
Letter B is our priority. Why? What are you thinking about this?
What's your pathophysiology knowledge telling about letter B? What is that?
That is meningitis, right? This can lead to seizures and neurologic compromise to kids.
And of course, when you have neurologic compromise, you
can also have breathing compromise or ABCD problems.
So letter B is number one. What is number two?
What is number two? Letter A, ambulatory. But days.
Do you see the word days means confused. If you have a head injury and
you're confused, you might have a what?
Head bleedThat's my first thinking.If I'm assessing you, I need to get a Cat scan
stats to make sure it's not a bleed, it's not a
skull fracture, and it doesn't need a trauma management.
So letter A is number two, followed by letter D.
And then last is letter C.All right, so answer is 2143 or B ADC.
All right, good job.All right, what's your score?
Can I see your score?Out of ten, how many correct answers did you get?
Your passing score should be at least seven.
But let me see your answers.Don't worry if you got three or four or five, right?
Put it in and let me see your answers.
Don't worry if you got three, four or five years.
Remember what Cindy, one of the students
said earlier, it's okay to make mistakes.
In fact, I always tell this to students. It's okay to make mistakes during the
review program because that's how you learn.You make mistakes now, which means you're notgoing to make mistakes again during the NCLEX.
Do not be scared to admit, Sir, I only got 30%.I'd love for you to get 30% so I can teach you, right? Because if in the end, once you get confused and you don't understand why you're wrong,that will be a fatal problem for you.
I want you to make mistakes now so I can teach you better. Right.
And good job.All right, a lot of you guys got seven, nine over ten.
Six, nine over ten. Very good. These are a little easier questions because I feel
like if I threw very hard questions and It will take me a while to explain them, but
you see, you get an overview about prioritization.
All right, so this will end my lecture. I've got one more slide to show. Like I said, Connetics has a scholarship program for global nurses for foreign graduate nurses outside United States. If you're from Canada, from Mexico, I'm sorry, from Europe, from Africa, and from Asia, you can log on to conneticsusa.com application and you can file your application there. And if you meet the criteria and the qualifications, you can get scholarship from Connetics. Other than that, if you already have an agency that's working with you aspire RN is also offering programs. We do have three different programs. Short past Starter is good for three months. Short Pass Pro is good for one year. And Short Pass Plus is also good for one year, unlimited. The other one, the Short Pass Plus, has an included World with faculty access for me and my faculty members. Sergio So, we can see your performance and give you personal mentorship we give personal mentorship to our students and you can follow me on Instagram at doctor nurse Paul or at aspire RN, right? So this program has been hosted by Connetics and Aspire RN. I'd like to thank Connetics USA for inviting me to onwards and upwards. I believe Connetics shows that they do regularly routinely so please follow their Facebook page. There's a lot of shows that we did in the past giving you tips of how to survive life in America as a migrant nurse. What are the tips that we can give us migrant nurses? There's tons of videos that we did over the years so please follow Connetics we do this often and if you have questions, you can also message me or message Connetics, all right. We'll be able to help you achieve your American dream.
All right.Thank you, guys for joining me today. Thank you, Tanya. Thank you, Cyndel. Thank you, Raymond and everyone all around the world thank you for staying with us for this show and I'd love to hear from you. We'd love to hear from you. Please send your messages through Ryan our direct messages or here in the comments below. We'll be reading it we'll be trying to answer questions throughout the day. All right. God bless you all and I hope to hear from you. Bye