Ep #14: Board Exam Prep: Managing Life’s Curveballs with Anna Miller [NP STUDENT]

Welcome to Becoming a Stress-Free Nurse Practitioner, a show for new NPs and students that want to pass their board exam the first time and make that transition from RN to NP as seamless as possible. I’m your host Sarah Michelle. Now, let’s dive into today’s episode.

Hey friends, today I’m going to introduce you to a member of my wonderful team, quite literally my right-hand woman in my live study group program, Anna. Anna and I both know from personal experience that life can sometimes complicate board preparation and so we’re going to spend this episode discussing lots of those external factors can that impact the board preparation process.

Pregnancy, moving, and testing during Covid were all things that Anna encountered and so she has been an excellent resource for our live study group participants and our student communities as well. And on the flip side of that I spent the last six months prior to boards getting married, moving, and then had my exam rescheduled four separate times. Between the two of us we have all the expertise on managing life before taking your exam.

So, Anna, welcome to the show. I am positive many of our listeners right now are experiencing at least one of the things you were going through in that final month of board preparation. So can you just kind of paint a picture for our listeners of what your life was looking like right before you took boards? And I know we’ve talked before and you said you were even traveling to other states to finish up your clinical hours.

Anna: Yeah, definitely. So first, thank you so much for having me. Hopefully, some of this advice about, you know, having just an overwhelming, crazy life prior to boards makes your listeners feel a little bit better.

And like a lot of your listeners are probably feeling right now, my life was a little crazy leading up to boards. And to put that in perspective I had been working PRN at the hospital until I had quit due to having to move. And I was in my third trimester of pregnancy, I was planning on graduating, taking boards, moving across the country because my husband was being restationed all within a month. And then Covid hit.

Sarah: Literally all the things.

Anna: All of the things. So everything just got shuffled around. A little bit stressful, all the plans changed. I was hoping with all of that to be able to take my boards prior to graduation, but per my school I was not permitted to take boards early because not all of their grades and were turned in and stuff yet. So I was determined to take them as soon as I could, literally days after graduation.

In order to handle that crazy life I ended up doing my entire semester of clinicals and coursework within the first about six to seven weeks of the semester. So luckily, I was able to work ahead in class, do all of my clinicals full time to finish everything. I know I was doing like my assignments and my workups on my lunch break from clinical. And we all know how much of a struggle finding clinical sites can be.

So all of this included me traveling to a completely different state for about three and a half weeks in order to complete my pediatric rotation. It was definitely hard to keep focused because pregnancy brain is so real y’all. But you have to be determined. And if you’ve gone through NP school then I know you have that determination in you.

Sarah: Yeah, absolutely. It sounds like your life was absolute chaos. Not even a little bit of chaos but all of the chaos.

Anna: All of it.

Sarah: And for those of you out there who aren’t in my live study group program we talk about it in out introduction, like me and Anna went to nursing school together actually. And I know we are both type As and we grin, grind, grind. And so I was most definitely the same way, I wanted to the test as soon as possible, I wanted to get it all behind me, I wanted to find a job. Like I was ready to also do all the things.

Anna: Definitely, get all the things done as soon as possible. And like I said, I was 35 weeks pregnant at this time and so I was terrified of going into labor before having this behind me and then having to study with a newborn. That was just not in my plan.

Sarah: You were going to knock everything out before, which we’ll definitely talk about in this episode too because that’s a very common question. But before we get there can you kind of walk us through how you structured your study plans since you knew you were going to be having all these massive life changes?

Anna: Yeah, so I mentioned I worked ahead to submit all my schoolwork by the midterms and so from that point I really developed a calendar for myself over the last like six to seven weeks or so of the semester. And including in that I had a week off for moving, I had a couple of days off when I had planned to walk at graduation, you know, pre-Covid. And I took pretty much every weekend off of studying because I just knew I wasn’t going to study then.

And this might be simplifying, but it was kind of an intense calendar. I know Sarah saw a picture of it. But essentially, I broke down my time frame, so that six to seven weeks, and then I took all of the subjects, so you know, the cardiac, and the respiratory, and the professional role, and I assigned them a few days each.

So if it was a smaller section, I only did a day or two, if it was a longer section, I did more. And on my assigned study days I only scheduled studying for part of the day, and this was just because my brain literally could not handle anything else. So sometimes this was only two to three hours, sometimes I could do five or six hours, with breaks in there of course. And that included all of my scheduling of days off.

During the days I had scheduled to study I reviewed the content over the assigned subject. And I just used, you know, whatever materials or books I had at the time, and then I did specific practice questions over those subjects.

And then I also allowed myself a day each week to catch up on whatever I didn’t finish earlier. And also to take a practice test of comprehensive questions. I learned that the more practice questions I did, the better I felt. And then I also just liked having a day to catch up on whatever I didn’t finish because then I wasn’t stressing myself out studying during the week and worrying about now getting stuff done.

And then in about the last week and a half or so before I was scheduled to test, I gave myself time to just review everything very briefly and take a few practice tests, and then pretty much relax the rest of the time. Although, if you ask my husband, he might tell you a little bit differently on that relaxation part.

Sarah: Yeah, my husband was like, “You were the opposite of relaxed before you took your exam.”  But you made so many good points in your study calendar, which I definitely saw on Facebook. That’s actually how we reconnected a little bit, I was like, “Oh my gosh, she is so pulled together, like she’s got it broken down by day, by question, by subject.” I’m like, “Anna has this down, I have to talk to her.”

Anna: That is what I had to do in order to just manage literally everything that was going on. It was like, “All right, these days I am moving. All right, this day I’m going to take a break from moving and do this one thing and that is it.”

Sarah: And I really like too that you set some realistic expectations and that you always took time for breaks. Because I think a lot of students kind of get in this rat race of like, you’ve got to prepare, prepare, prepare, prepare. But you can only run on that steam for so long before you totally burn yourself out. And so accounting for those breaks ahead of time is what keeps you going.

And anyone that ever talks to me, I’m always talking about the quality of your studying instead of the quantity of your studying. And so if you’re going to get two to three great hours in, that’s what you should be doing instead of studying for 10 hours, when really after hour three you weren’t getting anything anyways.

Anna: Yeah, definitely. I definitely learned that the hard way, way back in nursing school trying to cram for some exams. And I just learned that does not work for me not pregnant, when I had better focus, so with everything going on, I just knew that was not an option.

Sarah: Yeah, absolutely. I wish I’d learned more in nursing school. I was still grind, grind, grind. Still running the rat race myself up to my exam. And then I took my exam and I’m like, “Why was I running a rat race?”

Now, I see students all the time talking about pregnancy brain, which I don’t know personally, obviously, and feeling like they’re having difficulty grasping concepts in those last few months of pregnancy. So how were you kind of able to maintain your focus to prepare for boards, while also being so incredibly pregnant?

Anna: So, related at least to my pregnancy experience specifically eating really healthy and staying hydrated was key for me. I did not feel good if I wasn’t like frequently snacking and drinking water, or if I was just eating like complete junk. And then the other thing was taking those frequent mental breaks. That was key for my success. The exam is just as much a mental game and an anxiety management as it is actually knowing the content.

Like I felt pretty confident coming out of NP school about the content itself. But it was how to prepare for that long of an exam. How to put all of that content to real use in these questions. And then taking those mental breaks, I mean, for you that might just look like closing your eyes for a minute between questions here or there during the exam. Or getting up to take a quick break to pee because you’re eight or nine months pregnant during the exam, which I definitely had to do.

But for me that also looked like creating that manageable study schedule to keep myself on track with those catch-up days, with those days off. And it’s almost like making a to-do list. Like you write down everything on your to-do list and even if it’s a mile long you automatically feel so much better and so much less stressed just having a plan.

Sarah: I absolutely agree on the mental piece. The exams are long, like they are so mentally fatiguing and so if you don’t go in with the expectation like once you question 100 and you were so amped before you got in there anyways, you can just feel so exhausted. Versus if you had kind of prepared for that mental fatigue, really thought through that anxiety piece, maybe done a couple of like practice sets of questions that are 175 questions or 150 questions. Like whatever that looks like, whichever exam you guys choose, it could have really helped you out before you ever got into the room.

Anna: Yeah, definitely. I had actually done that several times, take at least 150 questions, 175 questions and practice because it’s exhausting. And I, even with practicing, still found myself during the exam like going really slow at first. Like reading every single word and then just getting so tired that I was like, “I cannot keep doing this. I have to go back to how I’ve been studying, how I know I’ve been testing and taking all these practice tests, and like stop letting the anxiety and that mental game get to me.

Sarah: Yeah, it sounds like you went back to your list of tangibles to be like, “I know I prepared in this way, I know I’ve done this many questions. Like I know I’m ready to take this test.”

Anna: Yes. And, you know, getting the test done before having a baby was such a good motivation for me also to stay focused and just get through those 175 questions because I was just ready.

Sarah: How do you feel about before versus after having the baby? Because people ask that on the page, obviously, like I don’t have true perspective. But I know what my like instinctual opinion is.

Anna: So, at least in my opinion, 10,000%, I recommend taking the exam before the baby if you can. Like I cannot stress that enough. I tested within that same week I graduated because I wanted to be absolutely sure that I had the board exam past me when it was time to give birth. So it ended up being about three and a half weeks prior. And luckily, I didn’t go into labor any earlier than that.

And I will say I do know that it’s not possible for everybody to test prior to delivering. Some people already have young ones or have a big family, but everything can still be so manageable either way. I actually just talked to one of the students in our live study group last night who is being a complete rock star finishing school and studying for boards with a six-month-old right now. And she is so determined to not let that delay anything. And it’s amazing to watch.

But for me personally I loved that after my daughter was born, I could focus only on recovering, and bonding as a new family, and learning how to take care of a newborn.

Sarah: And just being present and engaged too. Like not having your focus split all the time because you know you have something looming over top of you. That’s kind of always my perspective. Like if I were going to be a new parent, I would not want that exam looming in the background all the time like, “I’ve got to get back to this.” So then you can just spend time with your baby.

Anna: Definitely. And when you have a brand-new baby, you don’t get a whole lot of sleep either. And I know also, for me, getting a good night’s sleep and getting that rest is imperative for my focus. And so I just knew I would be a little bit more of a hot mess had I waited until after

Sarah: Yeah, absolutely. Sleep is so crucial to me, I can’t live my life without sleep.

Anna: No, me neither.

Sarah: Now, kind of with your expertise and experience that you have now teaching the live study groups with me, is there anything you wish your student self had known about board preparation prior to testing?

Anna: That’s a great question. I think I kind of figured it out as I was going. And I mentioned this earlier, I cannot stress enough how important it is to one, find a good review material that works with you. And then to do all of the practice questions.  Like you just cannot underestimate how valuable doing practice questions, and going through and reading rationales, practicing taking 175 questions at a time. All of that is so key to success, I think.

Because at first, I was so focused on just taking notes and reviewing my notes. But then it came to practice questions and I was having difficulty applying it. So I really wish I had started off more doing the practice questions.

Another thing is I also wish I had started reviewing. I know I studied early, and I took like all these weeks off, but I wish I had studied like that intense prior to clinicals ever starting. I feel like there were certain clinicals I showed up to that I was just like a deer in the headlights. And then I’m like studying for boards and like, “Oh, my preceptor asked me this and I didn’t know the answer then, but I do now.

Sarah: I had that same feeling actually, once I got into review material, I’m like, “I wish I’d had this before clinicals.” Like I thought back to my very first clinical and she was asking me about treatments for pneumonia. It was literally like my second day there and I’m like, “I just learned this in class, but I can’t like piece it together that quickly.” And, you know, there’s so many nerves of being on the spot too, like you know it, but you don’t know it.

But I feel like if I had done a good review that would have kind of given me some confidence, then I could have walked into clinicals a lot clearer and feeling a lot better about myself.

Anna: Yeah, definitely. And I think when you’re in clinicals and you’re having that, you know, real experience, putting it into practice, that’s going to help solidify that information even more.

Sarah: Yeah, absolutely. And there’s so many little mnemonics and memory tools and things you can use. Like, obviously, we have one for pneumonia so I’m always like, “I wish I knew mad lung before I went to that clinical.”

Anna: Yes, definitely. I’ll never forget the time that my preceptor asked me, I think it was about a patient with osteoporosis, and I suggested Flomax, and she just looked at me like, and I was like, “I mean Fosamax.”

Sarah: I knew the answer.

Anna: I knew it, I’m just saying the wrong drug. And she just gave me this look like, “This patient, no, we’re not going to give her Flomax.”

Sarah: No, it is so hard, especially like your very first clinical too. Like once I warmed up a little bit, I got better in clinicals and I could be more decisive and have that confidence in my decision making. But that first one, I mean, she was very much like quizzing me all the time and that Socratic method does not work well for my brain.

Anna: No, and maybe it was just my first clinical, but I feel like my first clinical instructor was my most intense out of all of them also.

Sarah: Same. Yeah, I was like, “I don’t know if this is like a me perspective or.” 

Anna: Right.

Sarah: And then thinking back on the exam, and you’ve now taken both exams, how do you feel overall about it? Like do you feel like you were underprepared, you were over prepared? Like what did you think?

Anna: So at the time I felt like I was not, you know, I couldn’t do enough studying. There’s always going to be something you don’t know, especially things are changing every single day. So going into my exam I was still a little stressed, but now looking back, oh, I was so over prepared.

Sarah: Me too. Me too, so much.

Anna: And my husband was telling me that the entire time. He was like, “You are ready to take boards. You could pass if you took them today.” And I was like, “No, I have two more weeks in my schedule. Like I have to, I have to get this done, and this done, and I still have two more practice tests to take.” But I would always, always rather be way over prepared than underprepared.

Sarah: I absolutely feel the same way. I remember like when I walked out the exam, and clearly just like feeling like, “Oh my gosh, why did I do all the stressing? Like, why did I have all this anxiety? Why did I make myself miserable? I made my husband miserable.”

Anna: Yes. And then you just have at least that sense of relief finally like, “I could have been feeling this way for weeks now.”

Sarah: Yeah, absolutely. I think for me, like the stress just accumulated so much quicker and the anxiety was so much higher because like every time I got ready to test, I never knew if I was going to actually test because it kept getting canceled and canceled.

And I’m pretty sure I told you, but there was one time it was canceled, and it was rescheduled to Dubai. Like the country, Dubai. Like on the other part of the world Dubai and I couldn’t reschedule it. And so there was just so much [inaudible] that kept building too. And my husband’s like, “I wish you could just take this exam today. I just wish you could take this exam today.”

Anna: Yeah, I remember you had an absolute nightmare experience getting your exam scheduled. Mine had gotten rescheduled a couple of times. I was scheduled take it in Kentucky, and then I had to reschedule that because Covid delayed my move. Then I rescheduled in Colorado, and then all the sites shut down. So I ended up taking it at home within like the very first week they offered remote proctoring. But it all ended up working out.

Sarah: Yeah, we all passed boards, some people take it at a testing center, some people get to take it at home. It was not in my cards.

Anna: No, but you got there.

Sarah: Yep, I got there, that’s all the matters. I finally got to take my test. And kind of as a bonus question, I always like to throw bonus questions in the end. Since you do teach the live study groups with me, what do you feel like is the biggest mistake that you see students making consistently?

Anna: I think the biggest mistake people make is trying to cram, specifically the day before the exam, but even the week before the exam. Like I know that doesn’t work for me personally. But the day before the exam you know what you’re going to know at that point and your mind needs rest. We talked about how much the exam is that mental game.

And I’ve seen students, you know, up on the Facebook page or messaging us at 2 or 3 in the morning when they test at 9am the next day. And at that point you’re just confusing yourself and scrambling and getting things jumbled when you know this material and you just need the rest so that you can apply it when you take your exam.

So I really, really highly recommend taking the day before the exam off. You know, I know some people like to rewrite their dump sheet, or just rewrite notes, or maybe listen to parts of your crash course again, and all of that is fabulous. But most of the day you need to do some self-care, you need to relax, you need to not stress about the exam, because that is just going to end up hurting you.

Sarah: If you’re staying up till 3am, anyone out there listening, if you are staying up till 3am you are only feeding your anxiety and you’re going to walk into your exam tired. You’re going to be tired enough by the middle of your exam and the end of your exam, you do not want to contribute to that ahead of time.

Anna: Yes, this is your permission, if you need to hear it, to take the day off.

Sarah: Yes, please relax. Please, you know, if you are going to do something, do it early in the day so you can take the afternoon off, you can try to sleep that night. Because if you’re staying up until 3, I’m thinking of one particular live study group participant right now that stayed up till 3am. And I was like, “Girl, what are you doing? Like, you know, you know this stuff. Like, come on now, you just got to do it and you just got to sleep before you go do it.”

Anna: Yes, you need to rest and prepare your brain.

Sarah: Yes. No, I mean, I cannot imagine how exhausted she walked out of that exam. Because when I talked to her, she was so excited and then she was like, “I’m so tired.” I’m like, “How could you not be tired after what you just did?”

Anna: Yeah, you stayed up so late. But I mean, overall, I feel like especially with the live study group participants specifically, they have such a good manageable schedule that as long as they stay on track with it, it’s really hard for them to make a major mistake before the exam. And so as long as they are having that mental break, and taking that self-care, staying on track, not letting that anxiety get the best of them. We’ve seen pretty good success.

Sarah: Yeah, we’ve seen really awesome success. Like we have a 100% pass rate currently if you complete all the courses, come to all the live session, answer all of our practice questions, if you do all the things you’re supposed to do. It’s when people fall through the cracks and they don’t finish their study calendar, then it becomes a little bit more difficult to pass.

Anna: Yes, and let me tell y’all the study schedule, at least that we have in the live study group, is even pregnant Anna manageable.

Sarah: I like it.

Anna: Everything is so broken down, like so easy to digest, like small segments every single day. You can do it even with a crazy, overwhelming life.

Sarah: And there are some days too, because the way that the live study groups work on the study calendar is it’s broken down by topic each week.

And so like week one is all cardiac and respiratory. And so I think there’s a day that week, there’s one day you only watch 10 minutes of video. So it’s a very bite sized calendar because we want you to be able to digest and absorb the information instead of just constantly trying to absorb, absorb, absorb and overwhelming yourself and then ultimately not taking that information along with you.

Anna: Yeah, definitely. And that’s why I had to personally spread out my study schedule too, is because nothing against those two or three day long reviews. But those are all day, every day for a few days and I just can’t learn that much information in two or three days. It does not work for me.

Sarah: No, like by the end of our four-hour live study groups people are tired. I cannot imagine doing three straight eight-hour days, like my brain would explode, I think.

Anna: Yeah, and I just wouldn’t retain it.

Sarah: Yeah, it’s just not the same level versus like you have two weeks to prepare and then we meet up for our four-hour segment. And then you get another two weeks to prepare, we could do another four-hour segment. And so you really get that time in the live study group program to pull things together.

Anna: And it’s a lot more applying it. Which is kind of what I was mentioning in doing those practice questions too, is you’re applying the information that you’ve learned over two weeks. You’re not just getting all of this information in a couple days and then being like, now apply it on your own.

Sarah: Here you go, out into the world.

Anna: Yeah.

Sarah: Yeah, absolutely. Anna, thank you so much for coming on the show. I was so excited to talk to you because I was like, I need to get like a, I don’t want to say a pregnancy episode out there. But I was like, I need to address the pregnant population or those who are overwhelmed because they have a lot of life stuff going on. Because I think it can feel really isolating. But there’s other people out there that have done it before you and they’ve done it successfully. So I wanted to be able to display that success.

Anna: Yeah, thank you so much for having me. For all of those people who are just so overwhelmed, you just need to have a plan and you need to know yourself. And, you know, even if you’re working, or you’re pregnant, or you’re taking care of kids, or you’re getting married or, you know, life is just crazy.

Life does not stop throwing you curve balls when we’re graduating NP school. It would be so nice if it did, but it doesn’t. But you guys can do it. If you just take those bite sized chunks, know yourself, make that study schedule, join a review, anything like that, it is, I promise, not nearly as intimidating as you think.

Sarah: That’s what it really all boils down to the end of the day, you know your clinical content, you manage your anxiety, you’re going to pass your exam. Like that is what it is.

Anna: Exactly. Yeah, those are the key takeaways. There’s nothing else that you need to do.

Sarah: Well, thank you so much. And to everybody out there listening, I’ll be talking to you next week.

As an extra bonus, friends, if you’re looking for support, no matter what phase of your nurse practitioner journey that you’re currently in, I have communities available for both students and new nurse practitioners. In these communities we work to uplift one another and grow this profession together every single day. Links to join will be included for you in the show notes.

Thanks for listening to Becoming a Stress-Free Nurse Practitioner. If you want more information about the different types of support we offer to students and new NPs visit https://www.npreviews.com/resources. See you next week.