PreNursing – The Mature Student Nurse

Considerations When Choosing Nursing Programs

It’s the time of year when many students are getting acceptance letters to nursing schools, and I’ve seen posts on discussion boards asking for advice on choosing a nursing school. Since I lived in an area where there were many Nursing school options, I had to filter through and determine which programs were the best fit for my family and me. In this post, I offer advice on what to consider when choosing nursing schools and insight into how I chose my nursing program.

Accreditation & BRN Approval

First and foremost, ensure the programs you are applying to are accredited and approved by the Board of Registered Nursing. In the US, you can visit your state’s Board of Nursing “Education” section to search the list of approved nursing programs. The BRN divides the list of programs by pre-licensure programs (LPN, ADN, BSN, and entry-level Master’s of Nursing program) and advanced practice programs. If you’re even wondering which schools offer nursing programs, the BRN list is an excellent overview of approved programs in your state.

You do not want to spend tuition and time at an institution that the BRN hasn’t approved because you won’t be able to sit for your licensure exam (NCLEX). The BRN will list programs with full and conditional approvals. Consider how a conditional approval may affect you if, for some reason, the BRN removes their program approval before you graduate. Can you ask the school or program why they received conditional approval and what they are doing to ensure full approval? I shied away from newer programs and didn’t apply to conditionally approved ones. I sought only fully approved and established programs because I didn’t want to take my chances with enrolling in a conditionally approved program or a program that could easily dissolve.

NCLEX Pass Rates

While visiting your state’s Board of Registered Nursing website, search for NCLEX pass rates (For California, where I obtained my degree and license, the website is https://www.rn.ca.gov/education/passrates.shtml). The pass rates provide a sense if the program you’re applying to adequately prepares its students for the NCLEX, the exam required to earn a registered nurse license.

Graduation Rates

Consider on-time graduation rates for your potential schools/programs. Per the amended Higher Education Act (HEA) of 1965, colleges must publish information regarding graduation rates, retention rates, and student diversity.¹ Due to the National Center for Education Statistics (NCES) definitions, graduation rates for people with second degrees or who have already attended other postsecondary schools aren’t necessarily part of a school’s published on-time graduation rates.² However, whether you are pursuing Nursing as a second or first degree, I think graduation rates are something to consider and request from your potential school or nursing program. If your nursing program does not readily share graduation rates, you can also view graduation rates at the following NCES website: https://nces.ed.gov/collegenavigator/.

Graduation rates are essential to consider to manage your expectations. If you’re choosing a nursing program because it’s shorter than others, but their on-time graduation rate is 50% or less, you run a 50% or greater chance of spending more money and extending the amount of time to earn your degree to get your nursing license. There is a private, for-profit university known for not having a waitlist for their nursing program here in Southern California, so many students apply and attend. They can start nursing school quickly instead of getting waitlisted or possibly rejected from other less expensive, competitive programs. The program is over $100,000 for the projected three years it takes to get a BSN from this for-profit, private university. The three years are appealing over traditional four-year bachelor programs despite the cost. However, the for-profit university’s on-time graduation rate is as low as 38% for their Los Angeles campus. When talking to nursing alumni from this university, many agree that it’s easy to get held back a semester and that the program can take longer than expected. However, the additional cost and time are worth it for program graduates because it was an avenue to get their nursing degree when other options were limited.

I’m not saying to shun schools with low graduation rates. Consider graduation rates, so you know what to expect. It’s better to be aware of potential costs up-front than to be surprised when you need to spend more time and money than what the program advertised.

Tuition

An obvious consideration when applying to schools is tuition. How much of a student loan will you need to attend school, or can you avoid taking a loan? For what kinds of financial aid are you eligible? (Second-degree holders do not qualify for pell grants). Can you afford private schools? Public schools are far more affordable but can also be more competitive.

Do you have grades, work, or volunteer experience that make you a competitive candidate? Do you need to repeat pre-requisite courses to increase your GPA and become a more desirable applicant? The extra time to repeat pre-requisites might be worth it if it saves you tens of thousands of dollars in tuition fees. (CAUTION: Be careful with re-taking courses or exams because some schools only accept a certain amount of repeats or will only accept a repeated course or entrance exam like the TEAS if it’s after or within a specific timeframe).

Program Length

The duration of the program is an important consideration. If you’re not working while going to school, that extra time in school is potential income lost. It is ACTUAL income lost for people with a prior career like me. Like most people looking to switch careers, I wanted an accelerated program to work as quickly as possible in my newly chosen profession. I didn’t want to be in school for four years to switch careers. Since I already had a bachelor’s degree, I was eligible to apply to accelerated Bachelor’s of Science in Nursing (ABSN) programs. In my area, these ABSN programs range from 12-24 months.

Location

Consider the location of your nursing school. Are the programs to which you’re applying local? Will you need to spend an hour or more commuting to school? Some of my classmates moved from one part of Los Angeles to another part of Los Angeles to avoid traffic that would add to their commute. Can you carpool with someone to allow you to take the carpool lanes and make your commute more bearable? Other cohort mates moved across the country to attend our ABSN program. All the nursing schools I applied to were within a reasonable drive from my home.

The school I chose happened to be the farthest from my house. When I started nursing school, I was lucky enough to discover one of my cohort-mates lived in my neighborhood, so we agreed to carpool. She became one of my best friends, and we used the carpool time to study and quiz each other (or vent about our lives as the only moms in the program).

Clinicals

If you can, try to find out where the schools do their clinicals. You can ask the program staff or alumni. Doing clinicals at hospitals or areas you wish to work offers excellent exposure to potential employers. The pandemic limited clinical rotations, so the recent years’ clinicals may not represent what is typically provided in a nursing program. However, you know a program is decent if they were able to send their students to good clinical locations amidst a pandemic. Also, keep in mind the places of clinicals may add time to your usual commute to school, and some may occur during the evening or night shift. Knowing this information upfront helps manage expectations.

Impressions of Alumni & Working Nurses

Talk to alumni about the programs you’re considering. Some questions you could ask:

Do they recommend going there?
Did alumni feel adequately prepared by their program?
How long did it take to graduate?
How much did it cost them vs. the advertised tuition?
What attracted them to their program?
What do they feel were the pros and cons of their program?

Talk to working nurses you trust and respect. How is working with new grads from particular schools or programs? Do some nurses seem better prepared than others? What are working nurses’ impressions of students from that school/program when they do clinicals? Do they have program recommendations? Would they recommend their alma mater?

As I shared in a prior post, I networked with others before I applied to ABSN programs and before I accepted the offer to attend my school. Talking to others about the various schools assured me that the schools I applied to were a good fit for me. My top choice school would change from time to time, but all schools I applied to were great options for my family and me.

My Choices

After working hard to make sure I’d be a competitive nursing school applicant and getting straight A’s on all my pre-requisites, I got accepted into three ABSN programs lasting 12 months, 15 months, and 24 months. The cheapest program was the 15-month program from a public university, while the 12-month program at a private university was more than twice the cost of the 15-month program and the most expensive, by far. The 24-month program tuition was slightly higher than the 15-month program but had the longest duration. I chose the 15-month program to save money and time and figured the additional three months it would take to earn my degree over the 12-month program would be worth my sanity. Additionally, the 12-month program had much lower NCLEX pass rates, making my choice even more straightforward.

Although this post was prompted by someone considering nursing school offers, ideally, all the above considerations would be made BEFORE applying to nursing programs. Whether you’re sifting through nursing school offers or selecting which schools to send applications to, I hope this post helped. Please share in the comments below if you have other considerations or advice to contribute when selecting a nursing program. Thank you for reading, and good luck on your journey!

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Footnotes:

Per the National Center for Education Statistics, “The overall graduation rate is also known as the “Student Right to Know” or IPEDS graduation rate. It tracks the progress of students who began their studies as full-time, first-time degree- or certificate-seeking students to see if they completed a degree or received a certificate within 150% of “normal time” for completing the program.”
The National Center for Education Statistics (NCES) notes that “students who have already attended another postsecondary institution, or who began their studies on a part-time basis, are not tracked for this rate.”

Career-Change Networking Tips: Questions to Ask

As a follow-up to my blog post last week, I thought I’d share some general tips and questions to consider when networking with others if you’re interested in switching careers. Scroll through the slides below for my tips!

Do you have any additional tips for networking or questions to ask others when considering a career change? Drop a comment below if you have something to share that you found helpful for you!

Considering a Second-Career? Connect with People in that Profession!

A friend recently asked me how I switched careers as a working mom. She was considering switching careers, so she wanted to know about some of my steps before becoming a nurse after years of working as an engineer. Some advice I gave her:

Talk to others in your profession of interest.
Ask them about their experience, challenges with their work, how they like their jobs, and their favorite part of their work.
Inquire about the education or training they completed to get where they are and how they got their job.

Before entering nursing school, I did these things to get an idea of what nursing was like and what I needed to do to become a nurse. To put it simply, I networked.

Build on your connections: Talk to Others You Know.

I talked to all the nurses and people in healthcare I knew. I had a couple of cousins who were nurses. Aside from periodically picking their brains at family gatherings, I asked if we could meet for lunch to discuss nursing. I asked them what they liked and disliked about nursing. I learned how they chose and got accepted to their nursing school and how long it took them to complete their programs. They shared how expensive their tuition was. I asked their impression of the various programs and the graduates their hospitals tend to hire.

If I had any nurse acquaintances, I tried interviewing them, too. I reached out to nurses I met from my mom’s club and nurses I knew from church. I offered to have coffee with them to discuss nursing. I had an old friend from college who had a friend that went through an ABSN program, and I asked my friend if I could reach out to her. My friend put us in touch, and I was able to ask her questions about her accelerated nursing program. I reached out to EVERYONE I knew who could give me some perspective on the nursing profession or nursing school.

Form Connections: Talk to Others You Don’t Know.

I even reached out to nurses I didn’t know at all. I joined a MeetUp for nurses. I explained my interest in nursing and my desire to meet more working nurses. When I’d go to my personal doctor’s appointments, I’d talk to MA’s, phlebotomists, and nurses and ask them how they like their job, what training they went through, and if they had advice for aspiring nurses. I even reached out to a nurse in my neighborhood’s Facebook Buy Nothing group. She graduated from a nursing program to which I was applying. I eventually became friends with her and was able to request her to review one of my nursing school application essays. (Sidenote: When I experienced my first death after a code blue, my nurse friend from church recommended I view a TED Talk given by a nurse about grief. The TED talk speaker turned out to be my neighbor/friend from my Buy Nothing group!)

Strengthen Your Connections: Continue to Network.

All nurses and even non-nurses I approached to discuss healthcare and nursing were supportive of me. All were willing to answer my questions. As I started to meet more nurses or people in healthcare, I felt I was getting a more accurate picture of Nursing.

I first heard the brutal truth about nurse burnout during my second Nurse MeetUp event. The host of the MeetUp, Cara Lunsford, didn’t want to scare or discourage me, but she also wanted to acknowledge the challenges nurses face and support working nurses. Until that meetup, I didn’t realize the nursing shortage wasn’t just that not enough people were entering nursing school. Cara shared that a lack of nurses also exists because many nurses leave the profession. The MeetUp was a nurses’ week event, and Cara’s company, Holliblu, hosted a free screening of the 2014 documentary, “The American Nurse.” I thought it was excellent exposure to various facets of nursing and the potential challenges I would face as a nurse. Since then, now that the world has experienced the COVID pandemic, I think more people are aware of nurses’ working conditions and burnout. My continuation to network emphasized that it’s good to learn as much as you can about your area of interest – the good, the bad, the ugly – before deciding whether or not it’s for you.

Join Professional Organizations or Online Groups

After meeting with my nurse friend from church, she suggested I join a professional nursing organization’s Facebook group. She was part of a local chapter of the American Association of Critical-Care Nurses (AACN). I asked to be part of the Facebook group before I was even in nursing school. Because I was part of the Facebook group, I learned about and attended a sponsored event with AACN during nursing school, even though I wasn’t an official AACN member. I spoke with critical care nurses who provided unsolicited but valuable advice on where NOT to work after graduating from nursing school. Eventually, I became a paid member of AACN as a nursing student. (Hint: Membership fees are cheaper if you join professional organizations while still a student. Also, professional memberships are good to put on your resume as you apply to new grad jobs.)

Volunteer

Before I became a nurse, I tried immersing myself in the working environment of a nurse. I reached out to a former co-worker and fellow engineer who volunteered at a hospital before she joined a full-time MBA/MPH program. Her volunteer program, COPE Health Scholars, seemed rigorous and offered excellent training. It was more than simply pushing patients in their wheelchairs or bringing them water. Volunteers took vitals, assisted CNAs with patient activities of daily living, and participated in codes, as allowed by their certifications. I learned about the program through her, and I applied. I passed the rigorous application process and training and got accepted into the COPE Health Scholars program while working as an engineer. I volunteered throughout my pre-requisites, nursing school applications, and until my ABSN program started. I met many more nurses and worked with patients in various units. The program further cemented my desire to become a nurse, gave me valuable clinical experience, and helped with my nursing school applications. Perhaps even more beneficial for a handful of other volunteers, the program helped them recognize that healthcare was not for them.

Return the Favor: Give Back

Seize networking opportunities, but don’t be an opportunist. When networking, it’s not just about what you can take from others. If you want to build relationships and good faith, offer something in return. Share your wealth with others. Your wealth is not just monetary wealth – you have skills, time, knowledge, experience, connections, and resources. Some examples of how I tried to reciprocate with others I networked with:

I offered to buy lunch or coffee for nurses who agreed to meet with me.
When my entrepreneurial MeetUp host inquired about corporate sponsorship or contacts, I gave as much insight as possible about the company that employed me as an engineer. Even though my work experience was in the consumer products sector, my former employer led a campaign to support nurses and the nursing profession.
I signed up to volunteer at AACN community service events and got some of my nursing school classmates to join me. (AACN eventually canceled these Spring 2020 community service opportunities due to the pandemic).
When another mom’s club member approached me to explore nursing as a career change, I readily met with her during a study break.
I put my friend, who is exploring a career change, in touch with the one person I knew who worked in her field of interest.

I have to admit I always found the term “networking” intimidating, but it’s something I had done before changing careers without realizing it. I hope what I’ve written provides examples of how you can network – or connect with others – to explore a second career. I’d love to hear about ways you network, what’s worked/didn’t work, and what you thought was helpful! Good luck on your journey!

How I Scored in the 99th Percentile for TEAS – and how you can too!

If you’re pursuing Nursing, you may have heard of the TEAS because some Nursing programs require applicants to take it and submit their score as part of their application. TEAS, or the Test of Essential and Academic Skills, is a standardized, nation-wide exam administered by Assessment Technologies Institute (ATI). Like many nursing programs, my BSN program uses the TEAS as a screening tool for their candidates. The minimum TEAS percentile my program considered was 80. However, some of my cohort classmates shared that they scored 95-99 percentile overall on their TEAS, well above the minimum for my school. If you want to apply to a competitive program and be an attractive applicant, you must do well on the TEAS. For this post, I’m sharing my tips for how I scored in the 99th percentile when I took the TEAS in Fall 2018.

My Biggest, Most Important Tip: Know Your School’s Requirements!

My most important tip is to know your school’s requirements. If a school in which you’re interested in applying is offering a Nursing forum or information session, attend the session to understand the admissions requirements and clarify questions you might have. Some schools do not require the TEAS for admission. Other schools do not require the TEAS until you submit an application and they give you an invitation to take the TEAS. Some schools require the TEAS but will only allow students to take it once in a six month period. Some programs will not take your best TEAS score in their application timeframe; they will take the first score in the allowed timeframe. Understand your prospective school’s admission policies.

One other perk I discovered while attending Nursing School Information sessions before taking the TEAS is one school offered a discount code for ATI TEAS study packages. However, the biggest reason to attend an information session (or speak to an admissions officer) is to clarify admissions requirements and any stipulations the school or program may have regarding the TEAS exam. This is particularly important if you’re applying to multiple schools since each have their own admissions policies.

Tip: Complete your Pre-Requisites

When I took the TEAS, I had completed all my Nursing School pre-requisites (except for Philosophy and Religion). My Anatomy & Physiology and Chemistry prerequisites definitely prepared me for the exam. Completing my pre-requisites was particularly helpful because the TEAS emphasizes Science. (The TEAS covers Science, Reading, Math, and English and Language Usage. For more information, visit https://www.atitesting.com/teas/register/). I had taken the pre-requisites within the year so a lot of the material was recent for me, and I was grateful that the exam material was a review of what I already learned.

If you’re not done with your pre-requisites, do not get discouraged – other students online said they took the test and did fine without completing their pre-requisites. However, they spent a lot of time teaching themselves and learning the material for the first time.

Tip: Use a study guide practice exam to focus your efforts

I invested in the yellow Mometrix study guide since it was so highly recommended by people online. My time was limited, and I had no intention of reviewing and reading the entire study guide. Instead of studying each chapter, I took a practice exam in the book to identify my weak areas so I could focus on them. I only reviewed the topics or areas where I scored low from the practice exam. After I felt I studied sufficiently, I would take another practice exam. I would continue to use my lowest scores (and wrong answers) to guide me on what I should study. After studying some more, I would take a different practice exam. I would continue this process until there were no more exams in the study guide to take.

My answer sheets for all my practice exams. I would time myself and give myself the same amount of time as the TEAS for each section. I would then review my incorrect answers and study those topics a little more.

Tip: Use your library to access study guides for FREE

I eventually ran out of practice exams in one book, so I used multiple study guides to prepare for the TEAS. My library had TEAS study guides available both online as ebooks and hardcopies. Take advantage of your public library since it is typically a FREE resource! Research availability and reserve your TEAS study guides early because these books can be in high demand! There was a waitlist, but I was able to place some study guides on hold and have them sent to my local branch weeks before my TEAS exam, which gave me plenty of time to prepare.

Tip: Use study tools according to your style of learning

Take advantage of any or all the tools that will help you learn or retain the material you need for TEAS! I know I’m a visual and kinesthetic learner. Flash cards are often an effective way for me to study. I do well when I write/design my own flash cards and study from them. I kept my flashcards from Anatomy & Physiology and used some of them again when studying for TEAS. Another study tool that I thought was helpful was “The Anatomy Coloring Book”. I actually used this during Anatomy & Physiology pre-requisites. It helped me learn and understand various systems of the body. I think it’s a great resource to have regardless of the TEAS, and I even referred to it recently while in Nursing school to review the kidneys and urinary system for Pathophysiology.

Other learning tools I found useful were YouTube videos from Khan Academy and
Armando Hasudungan (a doctor who is also an incredible artist). Many students today use YouTube to supplement their learning, so take time to explore which channels best complement your learning style. Another popular tool is Quizlet, where you can create and share electronic flashcards and quizzes for yourself, but also where you can view other people’s flashcards and study guides. (WARNING: Be cautious when using shared content or YouTube – sometimes material other students post is not the most accurate).

Now that I’m in Nursing school, I watch the YouTube channels for NRSNG and RegisteredNurseRN. While these are resources geared for Nursing students, take advantage of their Anatomy & Physiology reviews in preparation for the TEAS. If you are an auditory learner, you could also listen to NRSNG Radio.

Since starting Nursing school, I have also discovered Picmonic – a great tool for visual learners and for folks who can use stories and pictures to remember concepts. It would have been nice if I knew about them earlier because they have lessons for Anatomy and Physiology! You can try Picmonic for free with one lesson per day. If you want to view more lessons, a subscription fee is required.

There are many tools beyond study guide books to help you prepare for the TEAS – take advantage of them and use the ones that suit you best!

Tip: Invest in practice exams from ATI

While the study guide practice exams were certainly helpful, I found the ATI practice exams to be a little more detailed than what was in the Mometrix or McGraw Hill study books – which helped me on my actual TEAS exam. The practice exams also summarize the areas needed for review and provides a study plan. The review topics correlate directly to chapters in the ATI Study Manual (which I did not have), but still gave me enough information for me to focus my review using the materials available to me.

The online ATI practice exams are structured the exact same way the computerized TEAS exam is structured – with flags, countdown timer, and calculator embedded into the exam. Like the online exam, you can flag questions you would like to review in your practice exams before submission. The actual TEAS test and practice exams allow you to easily revisit flagged items at the end of a section so you don’t have to toggle back and forth through all the other questions. I’m the kind of person who always double-checks my exam and doubtful answers prior to final submission, so I found the flagging feature helpful. I also liked that the practice exams were modeled after the actual computerized TEAS exam, so I had an idea of what to expect on exam day.

Tip: Find out if your TEAS exam will be computerized or not.

The TEAS was offered at one of the universities to which I was applying via computer. For my TEAS, I was in a computer lab with a proctor, and each student had a computer. What’s nice about the computer version is the sections can all be taken at your own pace, within the allowable timeframe. Currently, students get 64 minutes to complete the Reading section, 54 minutes for Math, 63 minutes for Science, and 28 minutes for English and Language Usage. Each student gets the same amount of time to complete each section. However, if you finish a section early, you don’t have to wait for the time limit to end before moving onto the next section. The times are all tracked on your computer so you can’t exceed the alottment, but you can easily move on once you’re done with a section.

Some people I know hate taking tests via computer, so they purposefully signed up for a test center offering the paper version of the TEAS. (However, if you plan to continue with Nursing, I believe the NCLEX is on computer, so you might as well get used to computerized tests)! It’s always good to minimize surprises on test day, so find out if your exam is offered on paper or computer to set expectations. Plus, if you take a paper exam, you’ll need to find out what kind, if any, calculator you’re allowed to bring!

Tip: Follow ATI on Facebook

ATI offers live video tutoring sessions for the TEAS. They also offer TEAS workshops via Facebook. If you can’t join live, you can view recordings. This is another FREE tool I recommend you use to prepare for the TEAS.

Tip: Do NOT take the TEAS as practice

I discourage students from taking the TEAS for practice. For some Nursing programs, you are unable to retake the TEAS until six months after your prior TEAS. Some students think they will take the TEAS for practice and simply retake it if they do not do well. They may come to find this is not possible for the program to which they are applying. Use the study guides and ATI practice exams for practice – not the TEAS! Your goal is to do well when you take the TEAS the first time. Save yourself the agony from having to study again and save money on your test registration fees! It is possible to take the TEAS once and do well. I did, so I believe it’s possible for anyone.

Personally, I relied on doing well on my TEAS (and pre-requisites) because my undergraduate GPA was low. It was so low, it fell below some school’s admissions requirements. I got a 4.0 GPA on my pre-requisites, but I knew I also needed to do well on my TEAS to get into my accelerated BSN. I guess it worked, because I got into my top choice nursing school! If I did it, you can too!

Hopefully, my tips and experiences are helpful and encouraging. I didn’t number them because I don’t think any one is necessarily more important than the others (except for knowing your nursing school’s requirements – definitely do this first)! If you have found something useful in this post or on my site, please share it with others! If you’ve taken the TEAS and have other TEAS tips to share, I welcome them! Please also let me know if there are other topics you’d like for me to discuss. Thanks for reading!

Clearance Checklist Complete!

This list makes me giddy…and is a sign that I’ve completed my background check & clearance for school!

I’m a checklist person, and this list is so satisfying! Anyone else use checklists and feel happy when all tasks are completed? Completed checklists instill a feeling of accomplishment and productivity for me. I love the visual cues and color-coding, too! No “Incomplete” reds or “In Review” yellows here! I mean, just look at all that “Complete” GREEN!

My to-do list for my background check and clearance for my nursing program is finally complete! Some of the things I had to do or submit before school started were a criminal background check, drug screening, immunizations and titers (immunization records were not enough), CPR/Basic Life Support Certification, Hospital Fire & Life Safety certification, physician’s physical examination and respirator clearance, and HIPAA Certification. I had many items on my list already done since I volunteer at a local hospital, but there were many school-requirements not needed by my volunteer program or that were about to expire. Even if I had the task or item complete, it took time to scan and upload all the documentation and more time for the background-check company to review and “approve” the submission.

TIP: Gather and electronically scan all your immunization records because immunization requirements (or waivers) are standard for working in a hospital setting. Have your certifications available too. An instructor advised me that I would need to provide these items regularly since each hospital/clinical site has their own clearance process and some things must be done annually or periodically as a healthcare worker. Having these records readily available and organized saves time and allows self-tracking of upcoming expiration dates.

If you already collect and organize your documentation, I’d love to hear what organization system you use! How do you keep track of tasks you need to accomplish? Share your tips in the comments below!

My Encounter with Discrimination in Healthcare

On my volunteer shift in the Emergency Room recently, I (along with many other staff members) overheard a heated discussion between a male patient and one of the charge nurses behind patient curtains. The patient was trying to clarify he wasn’t demanding a white nurse, but that he insisted on having an older female nurse. He did not want the black male nurse assigned to him. After the charge nurse explained his request would not be granted, he passionately responded that he wanted someone with more experience; to him, that implied an “older” nurse. The charge nurse assured him that his nurse had many years of experience. The patient assumed his nurse would be a woman because he thought all nurses were women. He argued he had been to the hospital numerous times and proclaimed, “I’ve never had a male nurse!” After some back and forth, the patient confessed he didn’t want a man handling his penis to insert a urinary catheter.

The whole interaction was interesting to me because I am an an older nursing student. When I become a new BSN grad, I will have relatively little experience but will be older than many new graduates. Age does not correlate to relevant work experience or skill-level. Many working nurses I encounter while volunteering may be younger than me, but have many more years of nursing experience. This patient erroneously believed an older nurse would automatically have more expertise in a common procedure than a young nurse.

The encounter was not only an example of ageism, but sexism. Yes, there seems to be more female nurses than male nurses. The patient was adamant that he never knew male nurses existed. The patient was an older man, so it’s quite possible his earlier experiences with nurses in a doctor’s office or hospitals were with female nurses. The demographics are changing, however, and quite frankly, I think that’s a good thing. We need healthcare professionals to be as diverse as the patients they serve. This patient needed a gentle reminder that experience, not gender, make nurses more skilled at procedures.

The black male nurse eventually did what needed to be done for the patient. A while later, the man graciously reported to the charge nurse, “He did a great job!” The patient continued to loudly and excitedly share what a surprisingly wonderful experience he had with his nurse. The same staff that overheard the earlier conversation and I looked at each other and smiled in amusement. Happily, it was a great teaching moment for the patient, but also for myself.

I’ve read about patients getting discriminated against or experiencing implicit bias from their providers, but healthcare professionals also experience discrimination from their patients, and the interaction I witnessed was a reminder of that. I have yet to have a patient make discriminating remarks directed towards me, but I know that may happen one day. I’m not quite sure how I’ll react, and I wonder if I’ll learn anything about this in my ABSN program. I want my patients to have the best experience and outcomes possible, but does that mean I should ask to be removed from their case if they don’t like me and are therefore uncomfortable due to my race, age, gender, or orientation? In accommodating a prejudiced patient’s request, are we enabling discrimination or giving them better care by making them comfortable? It’s a complex issue.

Luckily, the interaction I witnessed de-escalated and had a good outcome. What if the patient became more hostile instead of agreeable? Would he have been assigned another nurse? What if the patient thought his nurse did a terrible job? Are there hospital policies for situations like this? I really respect the charge nurse and nurse in the situation, who remained professional and respectful throughout the whole interaction. For me, I learned how a nurse should respond to a prejudiced patient: Be respectful but firm, and assure the patient they are in good care. I hope to maintain my composure and act the same way, should I ever encounter a similar situation with a patient.

Called to a New Plan

I went to church Sunday morning with my family and saw the devotional booklet “Our Daily Bread” offered in the vestibule. I hadn’t seen one in a while, but became familiar with them through my mother and relatives from the Philippines, who used them regularly as a daily devotional. The booklet highlights a bible scripture each day and provides a reflection based on that reading. Feeling like I needed to focus more on my spirituality beyond church (it’s so hard sometimes to focus in mass with a rambunctious defiant toddler!), I grabbed one. The bible passage and reflection for that day (April 28, 2019) spoke to me. Because of that, I wanted to share it and invite you to read it at https://odb.org/2019/04/28/gods-retirement-plan/# .

At this moment in your life, what might God be calling you to do for His greater purpose? What new plans has He placed in your path?
Our Daily Bread (April 28, 2019)

The reflection was a great reminder of my second-career journey. Becoming a nurse is the new plan God has placed in my path. I feel I am called to become a nurse to better utilize my talents for His greater purpose. Do you ever feel like you’re on the right path because of the all the “signs” God places before you? You may not have the sign of a burning bush like Moses, but do you feel called to do something, even though you’re uncertain of how exactly you’ll accomplish what you sense you must do? Are you continuously driven towards a vocation without knowing how or if you can really make it happen? And, somehow, a path reveals itself? I feel this way about Nursing – really, I do!

Every step of the way, I feel like God has aligned things for me to allow me to get into Nursing school. If I had waited even one month to look into pre-requisites, I wouldn’t have been able to take the classes I did or complete them before the application cycle. If I had waited one week before researching how to get volunteer clinical experiences, I wouldn’t have become a COPE Health Scholar in a local hospital. If I were in a different volunteer program, I wouldn’t have been able to take patients’ vitals, witness biopsies, circumcisions, C-sections, vaginal deliveries, or perform chest compressions on patients who have coded. God placed people and experiences in my life, to allow me to grow in my compassion, abilities, and skills as a future nurse. Somehow, things aligned or confirmed and re-affirmed my choice to purse a career change. God placed the desire in my heart to consider nursing years ago, but He did not call me into action until now -when I have the social, emotional, and financial support I didn’t have before. His timing was perfect. I prayed to be able to serve God in whichever way He willed, and nursing is where I have now been lead. I have a peace and joy in my heart when I think about my [future] career, but I am still open to God’s vocational plans for me in my life.

Are you called to something new or to continue when you were about to quit? I encourage you to be open to new possibilities or to where God might be calling you. Explore what or where that is, and if you’re called to act, pursue it whole-heartedly. Like Dr. Warwick Rodwell discovering the ancient statue in the Lichfield Cathedral in the “Our Daily Bread” reflection, you could be surprised with the treasure you uncover.

Photo from
https://www.lichfield-cathedral.org/downloads/lichfield-angel.pdf

My Five-Step Guide for Selecting & Taking Nursing PreRequisites

When I decided to become a nurse, I researched various nursing schools and programs and quickly discovered before I could even apply or be eligible to attend a program, I needed to complete pre-requisites (classes required BEFORE Nursing school entry). The nursing programs I considered required anywhere from 7-12 pre-requisites. Common pre-requisite courses include Anatomy and Physiology (with lab), Microbiology (with lab), and Chemistry. However, some schools require Public Speaking, Ethics, Religion, or other courses unique to their program.

While some schools take into consideration courses completed as part of a bachelor’s degree, other nursing schools do not accept any courses if they were not completed within the last 5 or 7 years. So even though I took numerous chemistry classes as part of my Chemical Engineering degree, since it was greater than 5-7 years ago, I had to retake chemistry! Overall, while I was annoyed at first, (re-)taking chemistry was helpful because it introduced me to some cool classmates and teachers and provided a nice review to help prepare me for the TEAS (more on that in another post!).

It is CRITICAL for applicants to know what schools and specific programs they wish to attend because pre-requisites vary – even within the same school – across different programs. As I shared, I took Chemistry with Lab at my local community college to satisfy a pre-requisite requirement for a state university. However, the community college offered two different Introductory/General Chemistry courses and some nursing programs require the Introduction to General Chemistry course instead of the Introductory Chemistry course. After spending an entire summer in Introductory Chemistry lecture and lab, my lab partner discovered the course we completed was not eligible as a pre-requisite to her desired nursing program. The community college guidance counselor had told her that the course was accepted at her school of choice. Even the course description for our chemistry class stated “This course is designed for Nursing and other Allied Health majors”. Unfortunately, when the class ended, my friend discovered that her program did not accept the chemistry class we worked hard to complete.

She called me in a panic when she learned of the news because I planned to apply to the same school. My heart stopped when she told me – I had spent so much time researching the classes I was taking and ensuring they counted as pre-requisites – could I have been mistaken? My ability to apply to nursing programs in the Fall was contingent upon the completion of my carefully scheduled pre-requisites. After some back and forth, we discovered the accelerated BSN program at the state university accepted the chemistry course we completed, while the traditional BSN program (at the same school!) did not. I felt terrible for her. Fortunately, she did well in our class, so her GPA was not adversely affected, and I’m sure the knowledge she gained will only help her when she takes the other General Chemistry course. She shared she was in no rush to apply to nursing programs, so having to take an extra chemistry class did not affect her plans too much.

Unlike my friend, I couldn’t afford taking classes that did not count as pre-requisites. I was working hard to complete as many pre-requisites as possible in order to apply to Nursing programs by Fall 2018. It was tricky and definitely not easy, but I completed thirteen pre-requisites within a year while either working or volunteering. I got accepted into three different accelerated Nursing programs, so my hard work and meticulous planning paid off. Below are some steps that I recommend and used myself to navigate what pre-requisites to take for nursing:

Step 1: Identify the specific nursing programs in which you are interested in applying.

Knowing where you plan to apply dictates which pre-requisites to take and possibly when to take them. Many programs will not allow you to apply unless you complete all science pre-requisites. Some programs will allow you to apply without completing pre-requisites so long as you show progress that you will complete the rest of the pre-requisites before the program begins. However, even if you can apply to programs without completing all pre-requisites, having more pre-requisites completed (and obviously doing well in them) makes you a more attractive applicant than others who have not completed their pre-requisites.

Step 2: Understand the pre-requisites for each nursing program and list them in a spreadsheet

I listed all the programs in which I was interested and listed all the pre-requisites required for each program. Like a typical nerd-engineer, I created a spreadsheet with this information. By doing this I was able to quickly identify which program had the least or most requirements and which programs had overlapping pre-requisites. I also used the same spreadsheet to compare program costs, duration, and other entrance requirements. It gave me a good overview that I could reference periodically.

a snapshot of my pre-requisites spreadsheet

Step 3: Before taking a class, check with your prospective program if they accept the class as a pre-requisite

Of course you can take pre-requisites from the college or university which offers your prospective nursing program. Doing so guarantees that your program will accept your pre-requisites. To save money, however, many opt to take their pre-requisites elsewhere, such as a community college. Or, some students, like myself, may need to take pre-requisites at a college that offers evening and weekend classes to accommodate work or family schedules. If you take a class offered elsewhere than the college where your nursing program belongs, ensure the classes transfer and can count as pre-requisites for your program.

Some colleges have links or list what classes they accept to fulfill pre-Nursing requirements. Others will allow you to specifically contact them to ask if a class meets their requirements. Contact the program administrator or director to inquire if they accept a class as a pre-requisite. Be prepared to share the accredited school’s name where the class is offered, the course name and number, the number of units, and course description. You can also follow this process to verify if any previous course you completed counts as a pre-requisite.

I recommend verifying pre-requisite equivalency and printing out proof of this for each class taken as a pre-requisite. Sometimes equivalencies change, but at least you’ll have evidence that the class you took was considered equivalent when you took it. Plus, doing this for myself gave me a quick reference and peace of mind in moments of doubt and panic (like when my friend contacted me about our chemistry class).

TIP: Keep your pre-requisite syllabi. My Anatomy & Physiology II professor recommended keeping syllabi from all my pre-requisites. Luckily, I didn’t have to resort to using any past syllabi, but having syllabi is helpful to have on-hand in case your prospective school wants to review a class you took and needs more than the general catalog description.

TIP for Californians: Use http://www.assist.org . It’s a helpful website “that shows how course credits earned at one public California college or university can be applied when transferred to another”. If you plan to apply to public college or university in California for your nursing program, you can verify if the pre-requisites you are taking at a California public college/university are accepted by your program.

Step 4: Determine where and when the classes are offered, and create a corresponding class schedule

I created a GANTT chart outlining when certain classes were offered and the schools that offered them. This was important in realistically understanding the earliest I could apply to nursing programs and how much it might cost me to complete all the pre-requisites. I knew I wanted to complete 13 pre-requisites in one year, but not all classes are offered throughout the year nor do they perfectly stagger with one another. I had to figure out if I could take classes online (some nursing programs do NOT accept online courses for certain pre-requisites), which schools offered the courses I needed, and when my schedule would allow me to take in-person classes.

After considering my budget and schedule, I limited myself to taking pre-requisites at my local community college and at National University. Both are great options that I recommend to others. At the community college, I appreciated knowing exactly what courses transferred from the college to other state schools via assist.org and the extremely affordable tuition. Some community college courses even used free online textbooks! At National University, I liked the small class size, that each course was only 1-2 months, the evening and weekend schedules for in-person classes, and the fact that most all my classmates were pre-Nursing. In addition, most of the National University students had worked before or were currently working, so could appreciate pursuing Nursing as a second-career.

I evaluated each of my pre-requisites and figured out when they would be offered at either the community college (preferred, cheaper choice) or National University (approximately 10 times the cost of community college courses). Some classes offered at the community college (Anatomy & Physiology) required pre-requisites (Biology), so it was easy to choose National University for such classes. Using the GANTT chart, I calendarized each pre-requisite class I planned to take, the school offering the class, and the specific discussion section(s) I wanted, once the class schedule became available.

My GANTT chart for Nursing Pre-Requisites

Step 5: Execute according to your planned schedule, and adjust as needed.

As soon as I was able to register for classes, I immediately enrolled prior to the semester, quarter, and/or month. I never had a problem getting into the classes I needed. (Although, a friend shared whenever she had the issue of being wait listed at her community college, she would still attend class and eventually get enrolled). I also captured the anticipated nursing school application deadlines in the GANTT chart, so it would be clear which pre-requisites would be completed before applications were due.

By creating my GANTT chart, I could get a sense of my anticipated course load throughout the year and see where my classes overlapped. I was able to see that I had the opportunity to take the Chemistry class earlier than I originally planned as well as some Philosophy courses (pre-requisites unique to one program). Instead of taking Chemistry in the Fall semester, I took it in Summer. This allowed me to squeeze in an extra Philosophy class in the Fall and gave me a good review of Chemistry before taking the TEAS in November. (TEAS TIP: Completing your pre-requisites before the TEAS makes TEAS preparation easier)!

Due to work and my overall schedule, more often than not, I ended up taking condensed courses. Even though National University offers classes that are only 1-2 months in duration, the community college also condensed classes. Classes normally a semester long were only 4-6 weeks when I took it. I would not have purposely scheduled my pre-requisites this way, but 1) it allowed me to complete thirteen pre-requisites in only one year, and 2) this prepared me for the rigor I will likely experience in my accelerated Nursing program.

While my schedule was rigorous, I had the full emotional and financial support of my family. With their support and understanding, I was able to study enough to get A’s on my pre-requisites while either working or volunteering in a hospital. My undergraduate GPA barely met minimum Nursing school requirements, so I knew I had to do well in my pre-requisites to stand a chance in getting accepted into any prospective programs. With God’s grace and a lot of hard work and effort, I was able to excel in my pre-requisite courses which helped me get into several accelerated Nursing programs.

Overall, you will need to decide what you can or cannot handle and what resources you need to stick to your schedule. Keep in mind that many nursing programs will not consider applicants with C-grades for their science pre-requisites. Additionally, accelerated nursing programs are extremely competitive, so having a good GPA on pre-requisite courses is advantageous. Maybe you’ll need to cut back on work hours or find childcare to give you time to study. If neither is possible and you’re drowning in schoolwork and unable to do well, perhaps consider a lighter course load. Not only do you want to complete the correct pre-requisites, you want to do well in them, so adjust your schedule accordingly!

Pathways to Nursing

If you have wondered about becoming a registered nurse (RN) but have not started to really look into it, you may not know what kind of education or degree you need to become an RN. There are various pathways to nursing. Each individual must consider which path is best for his or her unique situation. However, all pathways (in the US) eventually lead to the National Council Licensure Examination (NCLEX), which is the exam that ultimately determines whether or not someone becomes a registered nurse. Regardless of your background or degree, all aspiring RNs must pass the NCLEX in order to become a licensed registered nurse. Now that you know the NCLEX is the common gateway to obtaining an RN license, let’s discuss the three pre-licensure degrees you could obtain prior to taking the NCLEX: the Associate Degree in Nursing (ADN), the Bachelor of Science Degree in Nursing (BSN), and the entry-level Masters Degree in Nursing (MSN-E).

Rn_degree

ADN

You do not need a BSN in order to become a nurse; you may become an RN with an Associate’s Degree. Many ADN programs are only a couple of years long and are a fraction of the cost of BSN programs. Unfortunately, many ADN programs are known for their two-year waitlists and are just as competitive to enter as any other nursing degree program. If you can get into an ADN program, however, this is a great affordable option to become a nurse.

Many wonderful and established nurses I know have ADNs. Numerous facilities and hospitals do indeed hire new-grads with ADNs. However, certain hospitals have (or desire) magnet status and require a large percentage of their nurses to have a BSN, and thus prefer BSN graduates. Other hospitals may require nurses with ADNs to pursue a BSN within a certain timeframe from their date of hire or require 20 years of experience for ADN graduates. Some hospital nurses with ADNs acknowledge that they are able to work in their hospital or hold their supervisory role because they have many years of experience. They notice that most of the new hires in their hospital are BSN graduates.

ADN to BSN

As a result of this push to have a nursing workforce filled with BSN degree-holders, there are many RN to BSN programs designed specifically for nurses with ADNs. There are hospitals that will reimburse or partially pay for their nurses with ADNs to pursue BSNs. If you do not mind working while going to school or extending the time you spend in school to get a BSN, getting an ADN first may be the most economical way to eventually getting a BSN. It is not necessary to have a BSN to work as a nurse, but having an advanced degree may make you a more attractive candidate when applying for competitive jobs against those with similar work experience.

BSN

If you decide to get a BSN directly, you can apply to traditional 3-4 year programs. Program costs vary and depend on whether or not you attend a public or private school. There’s a general sentiment that nursing programs in public schools have lower acceptance rates than their more expensive private school counterparts.

If you have a bachelor of science in a non-nursing field, consider applying to an accelerated BSN program, which lasts only 1-2 years. The shorter program time can be worth the cost if you start working as a nurse sooner. Your opportunity cost of income lost while you are in school could be minimized with a shorter program length. However, such condensed programs are intense and “accelerated”, as their name implies.

MSN-E

If you have a non-nursing bachelor of science degree, you also could consider applying to entry-level Master of Science in Nursing (MSN-E) programs, which are typically two years duration. Maybe you don’t want to spend time getting a bachelor degree in Nursing; you’d rather go straight into a master’s program because you ultimately desire to be an advanced practice nurse. If you want to be a nurse educator or clinical nurse leader, many entry-level master’s programs are perfect for you. However, if you want to become a nurse practitioner, entry-level master’s programs that I’ve reviewed are not applicable towards becoming a nurse practitioner – a second graduate degree would be required.

If you want an MSN, do not feel pressured to obtain one immediately. You can become a registered nurse with a lower degree. Just as ADN graduates can get their BSNs after becoming an RN, BSN graduates can also further their education after obtaining their license to get advanced degrees in nursing.

Begin with the End

It’s important to think about your longer-term goals as you consider the various pathways to Nursing. Always “begin with the end in mind”, as Franklin Covey suggests. If you want to work in a magnet hospital as a new grad, perhaps you will want to bypass the ADN option for nursing. If you want to work as an RN as quickly as possible, consider the ADN or accelerated BSN options. Take into account private schools without waitlists. Research the job requirements for RNs at the places you would like to work or the requirements for your dream nursing job. Job postings typically list education and experience required for each position and can give you an idea of the degree(s) you should target.

Very simply, an RN is someone who has passed the NCLEX with either an ADN, BSN, or MSN-E. You now know there are many degree programs that can lead you to become an RN. Knowing what you want to do as a nurse, how quickly you want to get there, and how much you are willing (or able) to spend will help decide which route may be best for you. Regardless of what route you take, please ensure the nursing program you choose is accredited. Good luck on your journey!

Disclaimer: I speak only from my own personal experience and am not an expert in all things Nursing. If you know of other pathways to nursing and becoming an RN, I would enjoy your feedback. I invite readers to share any information or comments that would be helpful to others!