#76 Inside the RNC-OB Exam: Expert Insights & Prep Strategies

Sarah:
Hi, I’m Sarah Lavonne and I’m so glad you’re here. Here at Bundle Birth, we believe that your life has the potential to make a deep, meaningful impact on the world around you. You, as a nurse, have the ability to add value to every person and patient you touch. We want to inspire you with the resources, education, and stories to support you to live your absolute best life. Both in and outside of work.
But don’t expect perfection over here. We’re just here to have some conversations about anything birth, work, and life. Trying to add some happy to your hour as we all grow together. By Nurses, for Nurses, this is Happy Hour with Bundle Birth Nurses.
I have a group of powerhouse women here today for this episode, and we are going to talk all things RNC, but there’s something real sexy about the people in the room. One, we have Jen and Heidi who are RNC OB class instructors. They are our experts at teaching the RNC Review course. So if you don’t know, we did actually launch, it was a year in the making, we launched a new RNC OB Prep course. And we’ve already had our first one, if you were there, thank you so much for being a part of it. We have three more coming next year in 2025.
So I have both of them here, but I also have another powerhouse, Whitney is with us. And she actually is our sneaky sauce and she works for the NCC and helps write your test questions. And so Jen and Heidi are here to … we’re going to talk all things RNC. But they’re going to jump in and we’re just going to have a conversation all about the RNC OB, sexy questions, sneaky questions, understand the exam, and get as much out of Whitney as we can, legally-

Jen:
Legally.

Sarah:
To know about the test and help us prep.

Heidi:
Legally, of course.

Sarah:
So you can use your discretion, Whitney, but we want to talk all things RNC. And sort of get the inside scoop about the test. And for those of you that have your RNC already, this is a fun little recap of how it all works. And those that don’t, hopefully this will help you understand what you’re getting yourself into along the way.
So welcome to the podcast, all three of you. And we’re excited to have this conversation.

Jen:
I think if you don’t realize how small labor and delivery nursing is like, I don’t know where you’ve been. Because this-

Heidi:
It’s pretty small.

Jen:
This podcast actually goes back a few years, right? Because we all met … Whitney, you want to tell the story? We all originally met in Idaho.

Heidi:
Yeah. So picture this, three labor and delivery nurses walk into a bar.

Jen:
In Boise.

Heidi:
Instead of a bar, it’s actually a fetal monitoring instructor course.

Sarah:
Same, same. Truly.

Jen:
Yeah, same thing, basically. It is, yeah.
And this was really interesting because I was doing my teach back to be an instructor trainer. You two are becoming instructors. And then we also had in that class, so we had nurses from Idaho, Washington, Oregon, Utah, Montana, and was it Nevada or California?

Whitney:
I feel like it was Nevada. We were all really close.

Jen:
It was Nevada, yeah. We were all there. And so we were just like, “Oh my gosh, what a crazy small world.” And so we all meet and everybody was like, “Oh, this is so great. This is so crazy. What a nice class.” And then fast-forward, was it that January?

Whitney:
I think so. Yeah.

Jen:
You and I run into each other at an AWHONN event in Southern California. We’re trying to find a place to eat and we just kind of like stick together and we find ourselves in a booth at this Mexican restaurant that only has one size of Margarita. And so she and I are chatting and I’m like, “Okay, well tell me about yourself. What are you into? What kind of stuff? And what makes you unique and such?” I like to dig in deep with people and all of a sudden Whitney says, “Oh, I’m a subject matter expert for the NCC.” And my jaw just goes like, will you tell us … and of course, at that time I just asked you a million questions. I was like, “They’re real people that exist?”

Heidi:
We were like, who are these people?

Jen:
Who are these people?

Heidi:
[inaudible 00:04:20].

Jen:
And then it’s like you, it’s this person. Right. It’s just this nurse from Montana, who’s our same age, same years of experience. And you’re writing our RNC questions. So just tell us all about it. Tell us about you. Tell how you got involved with the NCC.

Whitney:
It’s a journey for sure, and I felt the same way. I am just a nurse from Montana and it’s so wild to have any involvement in that. And it’s still a very under the radar thing, I feel like. And just every now and then when I’m talking with somebody about the exam, I’ll kind of put a plug in there of, you know, I do help with this, but I don’t work for the NCC, I volunteer for them. So it’s a national volunteer position. But I am a labor and delivery nurse, diehard. That’s the only thing I will ever do.
I’m a nurse educator currently, and I love the education piece of it. Way back in … gosh, I took my initial RNC in 2014. And so I’d been practicing-

Jen:
That was me too. And Sarah, too.

Sarah:
Same. Yeah.

Jen:
In class of 2014.

Sarah:
I know, we were right there doing it together.

Whitney:
That’s awesome. I very much so way back, the organization I worked with had brought in a prep course. And it was really for charge nurses and I was still just a couple years into my career and I kind of had to weasel my way in because I was not a charge nurse. And all but, I think, two of us were. So I kind of weaseled my way in, got the day off of work and it just worked out. So I took the prep course and really quickly took the RNC because I knew I just needed to do it and get it done. Plus having the letters behind your name, those were the first letters besides your nursing degree and it was really cool for me. So that was a huge highlight.
I did my fetal monitoring the year to follow. But every three years or so, you have to do your reassessment. So your continuing competency assessment where they see how you’re doing. How much have you retained in three years? What areas are you thriving in? And what areas do you need more practice? And that’s something, too, that I think is good to talk about. I was just talking about a couple girls at my organization about how that competency works. But I did my retest in 2017 and you paid a research and I did pretty well. And so then you just have the minimum amount of CEs that you need to get for that next three year period. But it was shortly after that, somebody from NCC reached out really based on how I did on that continuing assessment.

Sarah:
Meaning you did really well.

Jen:
Really well.

Sarah:
Yeah.

Whitney:
I did do pretty well.

Jen:
I mean, I did okay on the test.

Sarah:
Brilliant.

Jen:
I just like turned heads at the NCC.

Sarah:
Right?

Whitney:
Well, I remember just taking it, working and you’re just in it and then wow, okay, that’s great. So somebody had reached out and asked me if I would be interested in being an item writer. And so that’s kind of one step of being a volunteer for the NCC is there are item writers all over the country that are bedside nurses and educators and all sorts of different people who come together to write the questions. And so there’s really strict criteria, so you have to do an item writing course that the NCC provides.
And I did talk with people there just to know how much we can share and what we can talk about. But there’s a really strict process for how you write the question. As you all know, if you’ve taken the RNC, they provide you with this document that kind of shows you like … I bet you two are very well versed in the document with the prep course. But it tells you how the exam is broken down and what percentage is labor and delivery and which percentage is high risk and things like that. So they’ll kind of spit out, we need more questions in professional development or we need more questions in high risk. And so then they’ll put those out to the item writers.
So I did this little course that the NCC provides, it teaches you how to write the questions and that’s really important. I think there’s a standardized way that they are written. And then you submit those and that’s kind of a step one of the process and then the questions will go on. So I started doing item writing, I want to say Fall, Winter into early 2018, so 2017 into 2018. And I did that for a while. Because I think I became an inpatient team in April or so, of 2018. And so I did item writing for a couple of months and it turned out that they needed somebody on the inpatient obstetric content team.
And so the way that the team is broken down, I think there’s … gosh, like probably nine to ten of us. Is they pick you or pick people by region. And so it’s important that when we develop the exam, we’ve got people from the West Coast, we’ve got people from the East Coast, and we’ve got people from the different regions in the nation. Because it’s no surprise, we practice a little bit differently. And you and I had a conversation, Jen, when you had done your continuing competency, like, “Oh gosh, there were so many questions on this one weird thing and we never see that. Do you guys see that?” But that’s some of what we talk about. So there’s a couple of us for the West, and so they had an opening and needed somebody from the West. And so I was asked to be a part of that.
So it goes a couple different ways here. So if you are interested in being involved with NCC and kind of doing any of this work, definitely connect with mentors and colleagues and people who are involved with NCC, and just talk to them. What their experiences are, start to engage and that kind of gets the ball rolling. But there’s also a volunteer section of the website. So you can go to the NCC website, it’s really clear where it says, like where you want to volunteer. Make sure you have a current and nice CV that you can upload, and then you can put in your areas of interest/specialty.

Jen:
What a great professional development that I don’t think anybody thinks of doing. Literally, it did not [inaudible 00:11:07] until you said you did this. I had no idea that … I didn’t know if it was just this one or two retired nursing school professors. [inaudible 00:11:17] I imagined. It was just like, we retired from the bedside and we still just want to make [inaudible 00:11:25] want to write really challenging things. But how many item writers are there? Just to give a sense.

Whitney:
Oh gosh, I don’t know. Probably a hundred.

Jen:
A whole lot.

Whitney:
I bet there’s more than that. I should have asked. I didn’t ask that. But item writers will kind of come and go too. Because it’s simple, but it’s not easy, I would say. You have to pick questions and you have to write them in the right way. And it’s kind of specific.

Sarah:
Can you tell us how they’re written? What is the way? What makes the questions different than other questions out there?

Whitney:
So there’s a standardized way to write them, I would say. It’s not like what the question is asking, but there’s a certain way that they do the answers, as far as organizing, so that it’s just always done the same way. So it’s a standardized way of writing it. They talk about punctuation and pronouns and capitalization, different things like that.

Jen:
Like a style guide, almost.

Whitney:
Yeah, yeah, exactly. And if-

Jen:
They always have three answers.

Whitney:
Yes.

Jen:
Okay.

Whitney:
Things like that. I am not a super book smart, I love to write exam type of a person, I would say. I’m passionate about the content and what comes out on the other side. So you really have to be somebody who loves to be in the weeds and in the books and really paying attention to how the questions are written. Because that matters going forward. Does that make sense?

Jen:
Oh, I think that’s a totally safe thing to say. Everyone’s got strengths and stuff, but also I wonder how would you know if you liked it or not, unless you gave it a try? Who’s sat around and written hundreds of test questions-

Sarah:
Other than you guys.

Heidi:
I don’t think that’s anything floating on most people’s vision boards. Like I want to write [inaudible 00:13:22] question. Everyone’s like, I want to stay away from test questions. So how many questions on average are you writing and submitting?

Whitney:
Yeah, good question. So they ask that you do a couple a month, maybe two to three a month to submit. They want to have a pretty continuous bank of questions coming in because they kind of go through this funnel. And it is cool, once you get the hang of it and you get a feel for how you can write the question and they’re like, “Okay, we need more high risk.” You can pull out your best textbooks and your best references and things like that and dive into high risk. Honestly, something that you have encountered recently at the bedside. What’s something you’ve struggled with? Or something you’ve encountered? Or didn’t know that’s really important to your practice.
So they do really encourage real life experience and pulling it in. I’m not just going in there and pulling it out of nowhere, this crazy question. We do see those. However, the ones that really are impactful are, yes, I had this really scary situation or this hemorrhage and we had this weird thing and this med is contraindicated with this med or something like that. So they like you to reflect back on your recent practice and if there’s anything like that. But they usually have you do two to three questions a month or so. And then they might be good for a while and then they might need new ones. The test is always evolving. And NCC has a several different exams and so they need a lot of questions from a lot of people.

Jen:
Tell us about … because now you’re on this bigger team … you’re on this small team, but with a bigger role. You just said that we have to update this, right? We know we’re not doing stuff that we did 10 years ago or 12 years ago. And so how does that shake out?

Whitney:
Yeah, so it’s really cute, and this is very sexy, as well, y’all sit around the table for two days, two full eight hour days. We’ve done a couple on Zoom and whatnot because of COVID. And you go question by question by question. And we read them and you want to make sure that the content is current, that it’s relevant, that it really is reflective of best practice, like what we’re doing. And you’ll get someone like, “No, we do not do that anymore. That is super old practice. You don’t do that.” Or you’ll have things where I’m like, “No, we never see that.” And then somebody on the East Coast is like, “Oh, we still do that very regularly.” So then you have to weigh in like, is this something that really should be a part of it?
So making sure when we’re on this content team that the content is current, it’s relevant and it’s really going to give you an accurate assessment of bedside practice and that you’re sharpen on it.

Jen:
How often does that happen?

Whitney:
We haven’t met in person in a couple of years. But we meet … now I feel on the spot about it, probably a yearly or so. The thing is though, that we’re always in communication with NCC. They’ll send out things throughout the year of like, here’s 50 or 100 questions. Can you all go through and review them? So our in-person, let’s go through the exam in full is, gosh, I want to say every year or so. It’s been a little weird with COVID. So we did get to go and be together in the same room and then we’ve had to do it online. But maybe like once a year or so, maybe two years. I’m sorry, I don’t have a better, more clear answer for that.

Jen:
I mean that seems pretty reasonable. We are only taking it every three years.

Heidi:
So how many versions of the tests are there? Or can you not divulge that?

Whitney:
There’s a couple. Really besides like actual questions, there’s not a lot that I can’t share. But there are a couple different exams. So not everybody is getting the same exam. So we go through, we develop them, we update it, we kind of change it. We review all of the questions. So submitted by the item writers, we go literally question by question and check for grammar, spelling, all these different things. That it’s written the way it’s supposed to be written, that it’s still relevant, something that makes sense. And it’s funny because when we recently met, we’re kind of going back and forth on this one question and then somebody was like, “How is this actually a reflection of the smarts of a bedside nurse?” And we’re all like, “Oh yeah.” We just got so in the weeds on the other stuff. Where somebody was like, Hey this is … and we’re like, yeah, we should probably-

Jen:
Down some rabbit hole. Yeah.

Whitney:
Yeah, this is a weird thing you probably don’t need to know to be a certified bedside nurse.

Jen:
You got to talk about that in a minute because we just did our first class and some of the questions … so put a pin in that one because I got to ask you some of these things that I was like, every nurse does this though. We get down this trajectory. Well Heidi’s the queen of the rabbit hole for sure.

Heidi:
I am.

Jen:
But it was so surprising to get all of the questions that people had during the class. And then we’re answering them and you’re like, “I had to look up one of the words. I didn’t even know what it was.” It was just like … you know? So you’re saying most of the stuff is going to be your … it’s not going to be way. If you’re having to Google the word, it may not be on the test.

Whitney:
Well, what I will say to that … okay, so there’s a few things I want to talk about before we are going to get down a little rabbit hole. But I would say I was just having this conversation with a few people who are going to test soon and it is a reflection of how good, how prepared all the things for being a bedside nurse. And it’s really meant to be that next level. And so you can’t just come to work for two years, do your job, go home, come in and test, and have a high chance of passing-

Jen:
Yes.

Whitney:
Unless you are very good at test taking, maybe. Maybe. Because we get certified for a reason, it shows our dedication and our passion to what we do. We put a little extra effort in. You’re kind of like a notch … a little bit notch higher. So yes, it’s a reflection of this body of knowledge that you should have by practicing at the bedside for at least two years, and that’s in the testing criteria and however many hours. And I really recommend preparing and studying for it in the books, in the resources. Because you’re going to come across those words where you’re like, “Man, if I hadn’t read that textbook, I wouldn’t have probably understood the question.” So there may be some of those things. So definitely do your prep work. There’s a whole list of resources that they provide to go look at and I really recommend doing that, as well as what you do every day at the bedside.

Jen:
Well, and when we were making the class, we basically just … we ordered all of the textbooks. But most of them like Heidi and I … I mean, we had most of them. So it’s not like it’s something that you’re just investing in for your test. These are kind of like those. Or you can answer practice questions, that provider comes to you, tries to get you to do one thing. Or your manager has a question, you have a question about the policy. These are really fundamental.

Whitney:
Yeah, there’s a couple different forms of it. The other part of it is that there are practice questions or pre-test questions embedded in there. And so you know that so many of the total questions are going to go towards you pass or fail. And some of them are kind of put into the exam that aren’t going to count against you or for you. And you may remember those, like that was super weird and off the wall, that may have been one of those pre-test questions. Pre-test isn’t the word I want, but they’re ones that are not an actual part of the exam.
And those are put in there so that people taking the exam are testing them. And so we then, when we sit around this table and go question by question, there are metrics. And so there’s a lot of metrics built into it where we can see how well a question has played out in testing. And you don’t want it to be too easy and you don’t want it to be too hard. So yes, everybody gets this question right. That’s probably not the best question because you do want it to challenge a little bit.
You also don’t want those questions that everybody’s getting wrong. It makes you think about why is this written the way it’s written? Or something with this question, you kind of want it … there’s some metrics in there that we look at. So it’s important to know there’s a couple different forms of the exam and that there are some questions kind of embedded in it, that we’re kind of seeing how they play. If they play well, they can move forward and be one of the actual questions on future exams. And that was what we were working on this year, was working on a newer form of the exam.

Jen:
I remember you and I were talking about this because I just taken my re-cert and it was, there was a bunch on this one topic and you were like, oh. So how do they ultimately decide something? You’re like West Coast, we are barely doing that. But Midwest, South, East Coast, everyone else is doing it and it might still end up on the test. Do you think that’s a pretty small part or it happens?

Whitney:
Yeah.

Jen:
Yeah, okay.

Whitney:
I would say it’s pretty small. But it’s also something that I’ve heard of. Whatever you and I were talking about was like, oh yeah, I remember hearing about it, but we just don’t do it. So you will have heard about it, you will know about it. It will be something that as a bedside nurse or maybe you see it on social media, people are using this thing or doing this thing. They won’t be totally out of the blue, really wacky, strange things. That would be so rare that that would not make the exam.

Jen:
Okay.

Whitney:
We have those too, we’re like, absolutely not, that is not really being done or seen or talked about outside of this tiny little spot. It won’t make it.

Heidi:
I’m picturing you guys all sitting around this table like survivor style, like sitting there with your questions. And then you read your question and then it’s like, okay, we’re voting on it and this question has been voted off the island.

Whitney:
Yeah.

Heidi:
But I think it’s reassuring that there is a lot of thought that goes into it that it’s not just like these hoity-toity sitting in their retirement throne just typing away like, oh, I’m going to get these [inaudible 00:24:45]-

Jen:
You’re going to get those nurses.

Sarah:
Right.

Heidi:
I can’t eat the young at the bedside anymore, but I’m still going to get them from afar. That it’s, no, it’s like someone actually super relatable and likable and somebody that you’d want to hang out like with writing those questions. And I think that’s kind of a reassuring thing.

Sarah:
Imagine little CIA officers all covert throughout all these units. Who on your unit is a test question writer?

Jen:
You were ask who’s … find a mentor’s involved with the NCC. And I was like, where? Do people self-identify?

Sarah:
Are you one of them?

Jen:
I felt like you were letting me in on like the biggest-

Sarah:
Do you have a secret?

Whitney:
Do they self-identify? And that was when you asked me to do the podcast, yes, I would love to speak on it. But I was really careful of what can I share and I don’t want to overstep those boundaries. So I did reach out to my friends at NCC to be really clear on what things … and that’s exactly it. And you and I had pre-discussion, had this, Jen, where I was like, cool things that you can do in addition to what you do. And so they would love for it to be talked about. I think for me it is a really important thing that I was asked to do. The work you do is really important. Of course you have to sign … keep everything confidential. We work in a secure platform when we log in and review things and make edits when we’re not meeting in person.

Sarah:
Secret society.

Whitney:
Yeah, we don’t … I don’t know. Self-identify is so funny. It is really smart people. There’s authors, and editors, and professors, and faculty positions, nursing leaders and educators. But if you go to the NCC website, you can see at the bottom there’s like a NCC leadership. And it will kind of tell you who is on the teams. And so yeah, it’s just one of those things. It’s like you kind of do it and it’s the work. But definitely don’t go around like, “Hey, I write your test.”

Jen:
Badge.

Heidi:
You have your NCC coffee mug in the nurse’s station.

Whitney:
I actually do. I have a little ceramic one. But yeah.

Heidi:
You do? Well where is it?

Jen:
I know. She’s got wine in it right now.

Heidi:
Why are we not seeing it?

Jen:
You’re all around this table and you’re talking about the questions. Has there ever been a time that somebody was so passionate or went to the mat for their question? Or does anybody ever get really tied to their question? Or is everyone pretty take it or leave it?

Whitney:
Okay, so most of us at the team, at the content team table, I don’t think I would remember the questions I wrote, honestly. But that’s our focus. So there’s item writers writing the questions put in through this funnel, that comes to our funnel and we’re looking at the questions. And so you probably wouldn’t remember if you wrote it or not. Sometimes people will feel really strongly about what is being asked. But maybe we’re having some back and forth. And so what they will do is offer to or reassign it, like I’m going to take this one and I’m going to rewrite it. And then we’ll resubmit it and we’ll try it again.
So if they feel like the content or what the question is asking is really important, we can rewrite it or we can edit it. Do we need to update the reference? All of those things are looked at. Ultimately sometimes they’re like, yeah, let’s just rewrite the question. Whitney, do you want to take this one? Sure, sounds good. And then I’ll resubmit it at a later date. So we do still write them. But as far as there’s hundreds and hundreds and hundreds of questions that we go through. I’m not sure you would ever actually identify what questions you wrote personally.

Jen:
No one’s ever gone that hard for a question. It’s just kind of like everyone’s pretty chill it sounds like.

Whitney:
Yeah, yeah.

Jen:
It’s not as dramatic as I have in my mind.

Whitney:
It’s very not sexy. I am so sorry to go against the grain with … we’re sitting around a table, we’re reading the questions, you’re having too much coffee, trying to stay peppy. They’ve got the screen and we’ll take turns reading the questions out loud, so it keeps our blood moving. But it’s a lot of brain power and looking at metrics and checking grammar. And at the end of the day you’re exhausted. But NCC treats you really well and they take good care of us for doing this work and volunteering.

Jen:
All right, NCC, we like that.

Heidi:
Yeah. Yeah. Little shout out to NCC there. So talking a little bit about the exam, do you want to talk through how it’s scored? Because we had some questions in the chat when we did the class of people asking, “Should I answer every question? Is it okay to skip a question and come back? Or if I’m just totally guessing on it, is it even worth guessing? Because I may just get it wrong and it count against me.” So can you talk through that a little bit?

Whitney:
A little bit. Yes, answer every single question. Because like I said, some of those weird ones, those off the wall ones may be those ones that are just kind of put in to see how they play. But it’s really important that you answer every single question. And don’t leave them blank. If you need to come back to it, I think that’s fine. I think that if you put a lot of energy and intention into preparing for the exam, trusting your gut goes a long ways.
If you think back to your NCLEX days where it’s don’t overthink it or if you’re going back and forth, just you’ve got to pick the one that you were drawn to initially. And there will be some that make you question what is more right, maybe. But you’ve just got to answer every single question to the best of your ability. If it’s something that’s really funky, just keep in mind, okay, maybe this is one of those that’s just put in here to see how it does. And don’t overthink it. If you spend too much time on a single question and you’re mulling it over and you’re mulling it over, I would come back to it. But just trust your gut. We’re all different test takers and so I think it just depends on how you are in that space. But ultimately it’s how many do you get correct.

Jen:
And I don’t think NCC tells you they’re cut off.

Whitney:
No, I don’t think so.

Jen:
I don’t think so. We don’t know. We have no idea.
So we were writing some practice exams and stuff like that. We have experience, I’ve taken now the test and three or four re-certs and trying to do some practice tests. But in that, we were also doing some reading and research just on best tips and things like this. So I don’t know if you can tell us if these are true or not. But these are some of the advice that we heard was one that I heard was that if there’s … out of the three choices, if there’s two choices that are opposites, like true opposites, one of those is more likely to be the answer, not that third one that’s not really involved.

Whitney:
Not true.

Jen:
That’s not true, okay. The other one that I heard was is that if there’s an answer that is more scientific sounding versus uses very casual language, it’s most likely not going to be the one with very casual language.

Whitney:
Yeah, not true.

Jen:
That’s not true.

Whitney:
So keep in mind, these are literally people like myself … for so many people that I work with love Bundle Birth, and so we’ll be listening to them. But I’m the one walking around, coming down the round on my people who are orienting and teaching fetal monitoring. So think about, it’s people like me writing these questions. There’s not that much thought of scientific versus casual versus this. We do have a standard way to write the questions, however that would be way more way energy than any one person has to put in there.

Jen:
To think about it. Okay, glad we’re asking it.

Whitney:
Once they’re submitted, we don’t change them drastically. You could update the grammar, update the punctuation, or update the reference. Or maybe reword one little thing in there. But we’re not changing them in any weird way. What is submitted by the item writers a lot of times is a great question and we put it into play.

Jen:
I had another question about questions. So when I did my last thing, there was … because when you re-cert, you just do it at home on your computer. So when we retest, we have … there’s questions. And there’s some that are very right and wrong because they’re like based on science, right? There’s an exact right answer. But when it gets to the more soft ones, it’s harder.
And so I remember reading a question along the lines of like, after the baby’s born, the dad says, “Hey, I’m so worried my wife doesn’t seem interested in the baby.” And so the three answers are something like, explain how that’s normal or have them point out nice things about the baby. And you’re like, “Okay, well one seems right, one’s not right.” And then the third answer might be like, well prepare him to be a single father because … it’s something like, so you’re like … so what happens when somebody picks not the one that’s right, not the one that’s like, eh, it’s not right, but it’s like it’s wrong, but it’s not like that … it’s wrong. And then what happens to the people who just pick the most wrong one? Is it like you’ve just fail immediately [inaudible 00:35:02] get your license.

Heidi:
You’re banned from NCC for life.

Jen:
For life.

Whitney:
If it’s wrong, it’s wrong.

Jen:
Okay. There’s not gradation of wrong.

Whitney:
No, no. And on your continuing competency assessment outline, where they’re like, okay, Jen, here’s your education plan. You may have a few more CEs you need to do in professional development or whatever category that is.

Jen:
Normal.

Heidi:
I’m just like picturing they’re being like, oh, so close but not quite right. And like a yikes.

Jen:
A yikes, right. It’s like put the baby up for adoption. You’re like, what? Who would pick that one?

Whitney:
Right? But you think about … so it is more of the softer response. But ultimately, what is the question asking? It’s telling us what we know happens after birth and they want to talk all about the things, and then they do this and they do that. So it’s asking something specific. So what in your mind type of response from this partner, husband, or whoever would make the most sense when you know what to identify in that stage of labor? There’s no less wrong, more wrong-

Heidi:
Red flag.

Whitney:
Yeah, if you don’t get it right, it’s wrong. And then that’s the one part I wanted to circle back to at the beginning is, when you do these continuing competency assessments, so I think people put a lot of energy and intention, like we talked about, into preparing for the exam. And then you’re like, “Yes, awesome. I passed.”
And then you go back to the bedside and most of the time, unless this is required for your job, the people who are testing are really smart, dedicated people who care about their practice, they’re passionate. So they’re going to be well-prepared when they go into their continuing competency assessment. But when you do that in three years, if you do choose to keep up your certification, you take this competency and it plans out for you how well you did. So if it’s been a little while, or maybe now I work at more of a low risk organization and I haven’t done as much high risk. And I didn’t do as well on that section, it’s going to say, “Hey, Whitney, you have 15 CE’s due in high risk or newborn.” Newborns always one I feel like I might have a few more in because innately I spend less of my time with the newborn.
But how you do on those continuing competency assessments impacts your education plan. And when we were talking about this at work earlier this week, we’re like, “Oh, that’s actually really good to know because you don’t just pay to re-cert and it’s a one and done.” They want to make sure that you’re staying sharp in all areas. And if you’re really missing the mark in fetal monitoring, you may have more CE’s in your education plan that need to be specific to fetal monitoring in order for you to be able to say, “Yes, I have my RNC OB.” So they’re really focused on making sure that we maintain it and that we’re studying the things that maybe we’re not as good at or whatever. So I think that’s important for people to know too. And it’s also reassuring because it keeps us sharp.

Jen:
I think it’s reassuring to the public. You’re an RNC, that means not just like I took some tests like 20 years ago, but that-

Sarah:
You’re keeping up.

Jen:
I’m on a journey. This is who I now am. It’s an identity.

Whitney:
Yes. And I will also say, I have taken a competency assessment rushed with all my million kids in the background. Like, okay, hold on, five minutes, I’ll start dinner. My husband’s cooking dinner and I’m super distracted and it’ll show. It’s a reflection, I’m like, oh. Because then now you have maybe more CEs and things where if you sit down and you focus and you apply yourself, it’s going to be a really good reflection of what you should work on for the next couple of years. So yeah, definitely make sure you’re ready for that. And I wouldn’t say study, it wants to see where you’re at to help you know what to study. But just be in a place where you can focus and do your best.

Sarah:
How different is the competency exam from the actual RNC exam?

Whitney:
I think they’re pretty similar. The way the questions are written, the content, it’s pretty similar. There just won’t be those practice questions in there. You know what I mean?

Jen:
What your recommendation would be for people taking their competency. I feel like people are going to be like, oh, I want to score really well and may want to study for it. Versus just sitting down and taking it, so it gives an accurate reading of where you’re at and then can better guide what you need to study. Because for you, I feel like, okay, you use newborn stuff as an example. If you’re like, oh, I know that that’s not one of my stronger areas because I don’t do that in practice very much. And then you sit down and study and memorize a bunch of stuff and you’re able to score well on the exam. But that’s not really going to help you out in practice.

Whitney:
Yeah, for sure. I don’t know anybody, honestly, who has time to study for the re-cert. And once you’re three years in and you’re like, “I’m just doing it and keeping it up.” And you get pay a differential or something like that. But for sure wouldn’t study for it. Exactly what you just said. And then you do have a minimum amount of CEs that you have to do anyways. So rather than cram ahead of time, you’re still going to have, gosh, 10 or 15 CEs baseline.

Jen:
I think it’s 15.

Whitney:
Okay. That you need. And then that will be more if you do terribly or something like that. But it is really interesting to see for yourself what areas you’re not quite as strong with. But for me, I mean I have a growth mindset anyways. I feel like I love to learn and I’m continuously doing things to learn. But that’s where you can be like, gosh, yeah, I’m struggling with newborn. Maybe I’ll go do this thing that’s on newborn assessment.
And NCC offers all of those things. So you can pay 19 bucks and get an article and take a quiz, but they will plot them out. Son if I need CEs in the newborn space. Or at AWHONN, if you go to national convention, maybe you pick a session on newborn, something I’m not super drawn to. I want to go to labor, high risk, I want to go to maternal transport, fetal monitoring. I love those things. Maybe you pick a newborn session, you’ll get your CEs for NCC and those are the things that stretch and grow your brain, right?

Jen:
Well, I think that’s a good point because you take the test and then you have the next three years to get all those CEUs. So it’s not like … even if you got, I think, the most possible, I think what is it? Like 45 or something is the max CEs, you’ve got three years to get them.

Whitney:
Yep. Unless you save your competency assessment for the very end and you don’t know where you have to have your CEs. So be careful [inaudible 00:42:43]-

Jen:
I’ve done that. But I go to so many conferences, it’s never worked … it’s never been to it … but it’s stressful at the end when you’re digging through emails.

Heidi:
Oh my goodness. Yeah, no, I did mine pretty quickly as soon as my renew cycle started because I’m such a control freak that I’m like, that would be my worst nightmare. So I think my renewal is in June of 25 and I already have all my stuff done because I’m like, I can’t … that would stress me out.

Whitney:
And you’re cramming it in at the end, are you going to actually retain the newborn things that you’re supposed to be retaining? Right? You’ll probably do bad on newborn next time too. So really that’s where we’re investing in our learning.

Heidi:
Put the work in.

Whitney:
Yeah, you got it.

Jen:
If you were to give somebody advice who was like, “Why do I even need the RNC?” What would be the biggest benefit to getting certified? Just personally even, as Whitney, if you were my charge nurse and you’re like, “Listen up, go get your RNC.”

Whitney:
Oh yeah. Like you are a bad B, right? I am smart and I’ve got it and better than others. It’s just that thing and you can put the letters behind your name. But it just shows you’ve kind of taken an extra step. So for me, I think I told you I had to kind of weasel my way into the prep course and there was probably maybe eight that took it. Not very many of us tested, like two or three. I’m like, you just wasted this thing, but I was able to … you get paid differentials and things. It looks really good on your CV. It certainly can help with career development and opportunities. And when people see letters like that and know that you’ve gone through this process and that you’ve passed the exams, they know that you’re committed to learning and you’ve got this passion for what you do. And that just speaks.
So being able to walk around, I was only a couple years into practice with my colleagues who had been practicing for a long time and having that. You get recognized, like people know you’ve got it, you know what I mean? So whether you do it for pay or career development, it does make you a better nurse, a stronger nurse. Ultimately, we’re looking at safer, better patient outcomes. Because we’re educating and keeping our nurses well-educated and trained as they go. But it’s just something that’s pretty awesome to have behind your name.

Jen:
I read this article that was saying that patient awareness of nursing certification is at an all-time high. And if you think about them coming into somewhere like labor and delivery, because all of our patients are like baseline, they’re a little freaked out. The hospital is bright lights, strange people, you’re giving birth. So our nervous systems are already a little bit, but I read that patient awareness of certification and what it means for nurses is that an all-time high. And when they’ve queried them, it’s pretty universal that patients prefer a certified nurse. So thinking about from their nervous systems, it’s like it is a little bit of a gift we can also give back to our patients of like, I got you.

Whitney:
Oh, for sure. And you’re keeping up on it and you’re going the extra step. Yeah, that’s so interesting. I mean, we know our patients are coming in more informed and well-education, and they’re a lot of times telling us, “This is what I would like to see.” And that’s really interesting to hear about the certification piece and I believe it. I think it’s never going to hurt. It’s only going to help and make you stronger and build from it. And if you’re fortunate enough, you can get your organization to reimburse for it and things like that because it is a little bit of an investment. But totally worth it.

Jen:
I like what you said, it’s like it can never hurt. We got that question, right Sarah? About like … I can’t remember how they phrased it. But basically, if I have my certification, is that going to make me more liable in a lawsuit? I know if everyone can see Whitney’s face right now, because she also … so Heidi and I do expert witness work. And Whitney also does expert witness work also, another cool thing that she does.
I don’t know about you guys, I feel like I don’t really see … one, it’s rare that I see a nurse who is certified involved in a plaintiff’s case.

Sarah:
Interesting.

Jen:
It is. And I think it’s over everything that Whitney just said. It’s like you know your niche, and a lot of those nurses are also really well-respected on their units. They tend to be more leaders, people people look to, maybe their training. And so I think units with lots of certified nurses, I guess I just don’t know that I see it that much.

Whitney:
Yeah, I mean I can’t say I have seen it. But that’s something that’s commonly talked about if you are involved in a lawsuit is asking if you’re involved with your national organization, things like that. So those things matter. Being a member of AWHONN and having your RNC, they notice and it definitely is that extra step, like they know. And I would agree with you, I’m not sure I have seen that.

Jen:
I can actually specifically remember one just because she was certified and her answers were so far of she was saying like, “Oh, a nurse doesn’t need to know that.” And it was things that I’m like, “I know that a nurse needs to know this because I know what NCC has listed.” And this was not a little thing, like a rabbit hole like we were talking about. It was a basic principle of labor and delivery, moderate, very … I don’t know. It was something just so basic. And I was like, “Oh, I know and you know.” And that was the only time I can ever think of one.
And I don’t think that she really didn’t know. There’s a bunch about depositions are stressful and things like that. But that was the only time I can actually think of that I noticed somebody was certified. Because it was just so deviant from what I know, even on the exam. So I think it must’ve just been a stressful deposition for this nurse or something, but-

Whitney:
Sure. Or you get your RNC and then it goes on your badge or it goes on whatever. But it does expire. And so nobody puts the expiration on there. Whereas if you need it for your place of employment or a pay differential, you have to have your card in there with an expiration. So who’s to say she didn’t test one time and never re-cert or something like that.
So there are nurses who are … what is it? Governed in from a long time ago for different certifications that don’t exist anymore. So if the test is gone and it doesn’t exist anymore, you can kind of keep those credentials. But that’s a different generation of nurses. The RNC OB, that’s not the case. There’s no grandfathering in. But there’s none of that for the RNC OB. But we can look at CVs. I’ve never really thought about it, but there is an expiration. So I’ve only used it at my place of work where you need to be like, “Yes, I have this.” And I’ll get the pay differential because I have it and it’s not expired. But maybe that’s something we’ll start to see is let’s see your car to make sure your RNC is not expired or something. I don’t know.

Heidi:
And I think too, not to freak people out because people are going to be like, “Oh my gosh, I don’t want this to come up on a lawsuit.” The only thing that it’s really going to change is if you are ever deposed and it’s looking at what a reasonable and prudent nurse at the same point that you are at would do in a similar situation. So the only way that that question is going to change is what would a reasonable and prudent nurse with their RNC OB do in this situation? And that’s what the standard is and that’s what the expectation is. And if you’re putting in the work to up level your practice and study and be an expert in your specialty, chances are you’re not going to be ending up in a lawsuit.

Jen:
It’s so rare, anyways.

Heidi:
Yeah, it really is.

Jen:
So we did our first RNC class. And obviously we’re not asking to endorse our class or anything like that, but we do know-

Sarah:
Feel free though.

Jen:
You love me and Heidi. And so she and I were teaching different parts of it, and then when Heidi was teaching, I was in the chat. And we wrote down everybody’s questions because it’s this eight hour class, I’m like, how do you get labor and delivery into eight hours? There’s no time for questions. And so we took all the questions and now we’re writing out the answers back to these people.
But it really gave me a good … I mean, I think it gave us, right, Heidi? Kind of insight into where people’s brains go that helped us connect different points for them. Part of the section was on normal uterine development and how the uterus works, giving people some framework. And one of the questions was … what was it? It was on a bicollis and how that affects positioning. I had to look up bicollis because I’m like, I know what bicornet means, which is having a deep septum kind of taking two parts. But I didn’t know that bicollis, which means two cervix. I was like, I don’t think that’s going to be on the test. But I was like, but let’s go there. And then helping people think through. So yeah, bicollis, what do you think? Yay or nay, is it going to be on the test?

Whitney:
Oh, that’s sneaky. Okay, the only thing I wasn’t allowed to talk about are test questions.

Jen:
Yeah, that’s fine.

Whitney:
I would say the different malformations and such of the uterus could be mentioned. And if you go to that section in the RNC PDF that they break it down, it’s a very small percentage. So have some awareness. That’s where I think it’s really important that you go through some way of studying and prepare-

Jen:
Print that guide out.

Whitney:
Yes. And NCC does not endorse anything specific, but they want you to prepare and study and provide a list of resources. So however that looks for you, certainly educate yourself on uterine malformations and different things like that. And keep in mind where you put your energy. Because the labor and delivery section is this big percentage and then they get smaller and smaller. So have some awareness. Do we need to get into the weeds with some of those things? Probably not.

Jen:
Yeah. If you miss one question because you don’t know that bicollis means two cervix. Just take that one.

Whitney:
Yeah, for sure.

Sarah:
Whitney, thank you so much for being here. I will link, like I said, everything down in the show notes down below. Do you have any final tips for our audience of people that are anticipating taking this test? It is a stressful time. I remember just like it was all I thought about. I don’t know that I have test taking anxiety, but I’m a perfectionist and I want to do well. And I fully obsessed. I read the AWHON Perinatal nursing book twice before going in. That’s way a little much. So for those going into their tests, what are your final tips for our nurses?

Whitney:
Yeah, thank you. And thanks for having me, this has been super fun. It is just like we’re hanging out.
I think my biggest tips that I would give, and I was just talking about this earlier this week, is you need to do all of this in a short timeframe. So don’t draw out the process. So when you get on there and you apply to test, get it scheduled, maybe even before you’ve started preparing. Short window, maybe six weeks. I would schedule it out, plan your test, go for it, and test. If you draw it out and out, that’s when we start to overthink and over prepare and start to question and just gets really muddy. So if you can be very laser focused for a shorter amount of time. And I am not a great test taker, like I said. But I think giving yourself an adequate amount of time of about six weeks to really prepare and be focused, and then just go for it. Because if you’re at that point in your career where you’re able to test, then you’ve got a really good strong foundation. You just need to bulk it up. And that’s best done, I think, in a short window so you don’t overthink it, just like you said.

Sarah:
Thanks for spending your time with us during this episode of Happy Hour with Bundle Birth Nurses. If you like what you heard, it helps us both if you subscribe, rate, leave a raving review and share this episode with a friend. If you want more from us, head to BundleBirthNurses.com or follow us on Instagram.

Heidi:
Now it’s your turn to take what you learned here today and apply it to your life. And stop dragging your feet, go and get certified, add those letters. You deserve it, you’re worth it.

Jen:
Join the club.

Sarah:
We’ll see you next time.