Today, I wrote my final exam. The one that everything else has led up to - my dreams of nursing, the time I wasted believing I could never get into nursing school, the hours and hours and years and tears I've spent upgrading my prerequisites, researching, cramming, and composing term papers in the library. It could all mean nothing if I couldn't deliver the goods on today, of all days.

Many of my readers are American and may not understand the differences between the Canadian Registered Nurse Exam (CRNE) and NCLEX. Ours is a pencil-and-paper exam that focuses a lot more on the "art" of nursing versus specific pathophysiologies and interventions. It is notoriously psychosocial and tricky. Canadian-trained nurses tend to do very well on the exam, with overall pass rates of about 85-95% depending on the year. Foreign-trained nurses have a much lower pass rate and I can understand why. We've spent 4 years getting used to the nursing language used on the exam. If someone has poor English reading comprehension, or they aren't expecting the terminology or technicality, I think it could be very difficult to succeed. And, unlike the NCLEX, those writing the CRNE have only 3 attempts before they must either retake nursing courses or do something else entirely. To make it even more stressful, results arrive by mail after 4-6 weeks. That's a loooooooong wait.

I officially completed all of my degree requirements as of April 30. I finished my final preceptorship in inpatient cancer care. Oncology was a special place to work but I don't think I have the inclination to devote myself to it full-time. Floor nursing is hard, no doubt about it, and exhausting, with insane hours of 5 12's in a row. Then there was the emotionally draining aspect. I gave everything I had to my patients. I would build up a relationship with them and their families, and then they would die. This happened a LOT. There were no happy endings in inpatient care. I didn't see any miracles. I know I did right by my patients and their families, and I gave them the best care I knew how, but all I would do is come home and cry. Everyone tried to help me "reframe" how I felt, but it wasn't that. I know there is a certain honor to being present in someone's final hours. I felt that honor myself. But it doesn't change the fact that you grieve their deaths. In a lot of ways, health care is about the cure, the rehabilitation, the moving forward, and I really needed to see that at least once in my experience, but I didn't. I know some nurses embrace the palliative part of the lifespan. Maybe I will, one day, but not now.

As far as employment, I was hired about 2 months before graduation. I now have a permanent position in the Emergency Department where I worked as a student (undergraduate nursing employee) and could not be happier! I have a GREAT team with an awesome culture and support from a nurse educator who actually knows her stuff and still picks up shifts as a flight nurse.

Back to the CRNE. I've been dreading today for weeks. I simultaneously couldn't wait to get this exam behind me, and couldn't bear the thought of EVERYTHING riding on it.

Although I registered for the exam back when I applied for my temporary practice permit in February, it wasn't really "real" until a couple of days ago when a couple of my nursing pals and I went to the convention center where we would be tested. It is a formidable place with cinder block walls and an eerie/horrible hum from the fluorescent lights. Then my heart shriveled up and ran away.

I studied for the exam, but not intensively - more of an overall refresher for myself about the "usual suspects" in chronic diseases (COPD, DM, CHF, cancer), as well as things outside of my usual practice such as obstetrics and mental health. I found it helpful to just read over powerpoints from my nursing classes. Luckily I still have all of them on my computer :) I did the CNA readiness tests and scored 81-87%. In fact I never scored below a 76%, even on the Mosby practice exams which are much more specific. I sat down the other day and was determined to learn how to interpret ABGs. And I did, even passing a pop quiz from the respiratory therapist working with me the other night! Good thing, too, because I needed that skill :)

Yesterday I just did tons of practice tests and made myself nauseated with anxiety. I finally made myself get down to the barn for a nice, technical dressage lesson and I felt a million times better. Riding has been an important distraction for me for the last couple of years. It's hard to worry about school when you're concentrating on your heels, legs, seat, hands, and everything in between, as well as trying to get that nice round frame on the bit from your otherwise-stroppy schoolhorse, know what I mean? ;)

After I got home, I puttered around and got ready for this morning. I was in bed by 2130 and had some broken sleep until 0530 this morning when I just couldn't sleep anymore. I picked up one of my nursing buddies and we headed down to the convention centre. We arrived for 0700, half an hour early. There was assigned seating, so we were in no panic about that. I'd gotten a heads up about the testing center being a little cold, so I was wearing not one but two wool sweaters, the outer one being an approximation of a wooly mammoth, and I'm glad I did because I was really cozy throughout the test.

It was a very long and grueling (length-wise) test. There are 200 multiple-choice questions and 4 hours to complete them in. Time management is notoriously an issue for test-takers. Many people do not finish within the allotted time.

I found the test to be more than fair, and certainly less difficult than some of the practice tests I did. In the first 50 questions, I was laughing to myself, thinking "this is it? What was I so worried about?" There were definitely a couple of really tricky questions with 4 right answers but only one right priority. On the whole, though, I think my experience in Emergency prepared me for this test extraordinarily well and I flew through it, finishing in just under 3 hours including review.

Not everyone felt this way, of course. Many of my classmates (including my carpooling friend) were in until the time was up, even guessing on the last 5-10 questions. A lot of people thought the test was very hard.

Only time will tell how I really did, and I look forward to being a Registered Nurse by my birthday in mid-July!