Monthly Archives: April 2012

Resources to help foreign nurses get a USA RN license.

भारत में अपने सभी पाठकों के लिए बधाई.अपने दोस्तों के साथ इस साझा करने और उन्हें सदस्यता के लिए आमंत्रित करें.चलो सब एक साथ काम करने के लिए दुनिया एक स्वस्थ जगह बना.

mangyaring ibahagi ito sa bawat mag-aaral ng nars at nursing at hinihikayat ang mga ito upang mag-subscribe sa blog na ito.


Note: this blog uses hyperlinks. each hyperlink is underlined. click on it and it will take you where you need to go, as if by magic!

WordPress statistics

WordPress provides detailed analysis of “hits” – how many, which page, etc. Recently WordPress made it easier to look at the country of origin of the readers as well. Last week I posted a page that summarized the locations of my readers. They come from about sixty countries. Yesterday, for example, there were 55 page views (not counting email subscribers) and the breakdown was:



United States FlagUnited States


Egypt FlagEgypt


Canada FlagCanada


Jordan FlagJordan


Saudi Arabia FlagSaudi Arabia


Germany FlagGermany


Indonesia FlagIndonesia


Libyan Arab Jamahiriya FlagLibyan Arab Jamahiriya


Australia FlagAustralia


Malawi FlagMalawi


So it does not surprise me that today I got an email from a nurse asking “I want to move to America and go to graduate school in midwifery there. What is needed to be an RN in USA?”

Should you?

I will leave aside the issue of whether you should do it or not. The people in your home country probably need you more than we do here, but USA has its allure. International nurse migration has been studied extensively by people who are more intelligent than I am. Their conclusion? it’s complicated.

Think carefully

You do need to know up front, that right at this moment, the USA  job market is not as wide-open as it was four or five years ago.

Three resources

Any international nurse needs to find three specific resources on the internet.

1) NCSBN document

The National Council of State Boards of Nursing (NCSBN) publishes a document titled: “Resource Manual for International Nurses”  which describes the American system, state by state. You will need to become familiar with the legal terms for licensure.  Download it.  NCSBN also has an online course you can take, (which costs $30 USD) that describes the typical work setting of a nurse in USA.

2) CGFNS  application handbook

The Commission on Graduates of Foreign Nursing Schools (CGFNS) administers the VisaScreen process for nurses.

from the CGFNS website:

What does this service do?

Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act (the IIRIRA) of 1996 requires specific health care professionals complete a screening program before they can receive either a permanent or temporary occupational visa, including Trade NAFTA status. This screening includes:

  • an assessment of an applicant’s education to ensure that it is comparable to that of a U.S. graduate in the same profession
  • a verification that all professional health care licenses that an applicant ever held are valid and without restrictions
  • an English language proficiency examination
  • for registered nurses, a verification that the nurse has passed either the CGFNS Qualifying Exam®, NCLEX-RN® or its predecessor, the State Board Test Pool Examination (SBTPE)

When you visit CGFNS, you can start the process online, but I would also advise that you be sure to download the application handbook. It is a 40-page document on that very same page (lower right in the blue box).  It is free.

3) Official Guide

and finally, there is a 435-page book titled The Official Guide for Foreign-Educated Allied Health Professionals: What you need to Know about Health Care and the Allied Health Professions in the United States. You can get a used copy on Amazon for $15 USD, or buy it new for $#7 USD.  Much of the information in it duplicates the free documents above.

For me, I know that the USA health care system can be very different from those of the Low Income Countries of the world. You are embarked on a journey of learning and adaptation that will be challenging at times. Please share this blog widely with your friends, and consider subscribing – click on the little button on the right.

Also, if you are considering a move to USA, please feel free to comment on this blog. I would enjoy reading a sample of how you made the decision and what you think.



Filed under foreign nurses in USA, nursing education

#4 – for teachers – ask yourself about your own role in the “Inner Game”

Latest in a series about classroom management.  please share with nursing faculty members. why not subscribe?

مرحبا بكم في بلادي القراء من الناطقين بالعربية الأراضي. الرجاء المشاركة ويرجى النظر في الاشتراك. السلام!

not too long ago I worked with a new faculty member who was – shall we say? – a diamond in the rough.  When the class was assembling, she would get their attention by saying “sit down and shut up!” or “start paying attention!”

Ooooh Nooooooooooooo

And the odd part was, she seemed to think it was normal to treat students this way. I had this idea that  she grew up in a family where people were ordered around, or maybe she had spent too much time in a work setting where the boss told everyone what to do next. There has got to be a better way to get people to be a part of the team……

The Inner Game

The idea for the day is, The Inner Game. Recognize your own role in becoming the “little voice inside the student’s head” that tells them how they are doing and what to think about themselves. What message was that faculty person delivering?

The Inner Game applies to any profession in which a person needs to learn a highly complex skill set that has to be coached in person. It is unquestionably true in Advanced Cardiac Life Support (ACLS) training, but applies anywhere that a person needs to perform a skill while people are watching. Just like tennis.

Did this get your attention? keep reading…….

Let’s back up a bit. The Inner Game of Tennis was a best-selling book in 1974. The idea was simple: when you play a competitive individual sport, you have two opponents. The first is the person on the other side of the net. You need to respond to them and score more points than they do. The second opponent is not so obvious. The second opponent is the little voice in your head that tells you how you are doing. If the little voice in your head is fearful, full of doubt, and negative, you must beat that opponent first before you can beat the person on the other side of the net. The book was a pioneer in the genre of sports psychology, but also in the study of peak performance – the search for “flow” and “playing in the zone” – which has also been studied by such nursing luminaries as Patricia Benner and Marlene Kramer.  The author started a sort of franchise – the Inner Game of Skiing, the Inner Game of Investing, etc – but the original metaphor still remains strong. The book is about how to eliminate self-defeating thoughts from your quest for excellence in what you do.

I won’t recap the whole book for you here. You can get an updated copy via Amazon, inexpensively. Or go to the Inner Game website.


The bottom line is: We as faculty need to be especially careful not to supply self-defeating thoughts. Nursing students rely heavily on cues from faculty to guide them (a sort of variation on WWJD) and the voice of the faculty becomes the little voice in the student’s head. If you as the faculty use language that is negative, or if you supply negative imagery, you (the coach) will create the conditions for that person to limit their own potential.

Be a model of positive inner dialog about challenging situations.

The Inner Game is the basis for successful problemsolving. if the person says “I’m a student and I will never figure this out” they create a self-fulfilling prophecy. If the student says ” there must be a better way to address this problem, I will come up with it if I work at it” – they reframe the issue in a way to succeed.

I think i will also write a companion blog on The Inner Child as it relates to nursing……

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Filed under classroom management, nursing education, nursing faculty jobs in Hawaii

#3 – “Dear Abby” in the nursing classroom

note: to my international readers – please do subscribe to the blog – that way you won’t miss anything! share with every one in your country, widely – I hope to do a future blog on international nurse migration……stay tuned!

I try to keep these blog entries short. how am I doing?

Dear Abby

From a previous blog, I shared the mantra “it’s not about what the faculty knows; it’s about what the students learn”  and an effective teacher will always take the opportunity to check in with the students to determine how they are doing, through every means possible. exams are only one avenue to evaluate effective teaching.

what if you ask the class a question and nobody answers?

I will write a future blog on the subject of querying the class as a part of lecture style. In some cultures, such as Asian cultures, it is not polite to ask a question of the teacher, and also impolite to blurt something out without a period of silence first. There are ways to engage the class that will overcome this, and here is one.

Also known as a variant of  Nominal Group Process

here is a little exercise I do when there are ten minutes of unfilled time. for example, we once hosted a guest speaker who was ten minutes late due to parking issues, or the time we needed to call to IT to send tech support who would address some computer issue. (hate it when that happens.. I always check out the tech stuff as far in advance as possible)

from Wikipedia;

The nominal group technique is particularly useful:

  • When some group members are much more vocal than others.
  • When some group members think better in silence.
  • When there is concern about some members not participating.
  • When the group does not easily generate quantities of ideas.
  • When all or some group members are new to the team.
  • When the issue is controversial or there is heated conflict.
  • When there is a power-imbalance between facilitator and participants or participants: the structure of the NGT session can balance these out.

hand out 3 x 5 index cards, or scrap pieces of paper.

students writeDear Abby……..” in upper left hand corner.

then “…..what I want to know is___________________”  and pass the cards forward. they are told to write whatever they like – maybe something bothering them, some question about the class schedule or calendar, or any random thing. (one time the prompt was “name a person in the class who you wish to publicly thank for something they did that was nice” but not everyone took that seriously).

a really good one is “the question I was afraid to ask was _________________”

you can also use this to ask a survey question to see if everyone “got it” – such as “….. what is my comfort level with using this skill in clinical?” – the trick is to supply an open-ended prompt.

when they are collected, each statement is read out loud and an off-the-cuff response in given.  As the reader, if somebody writes something inappropriate, you can skip it. You can make the responses as factual, or humorous as you wish.

One variation of this is to ask everyone to get out their cell phone and to text their question directly to the faculty cellphone.  not quite as anonymous.

Nowadays there is technology such as i-clickers that serves to poll the class, and some teachers use it to guide such activities as learning how to read an NCLEX exam question.

hope this gives you a tool you can use.


Filed under classroom management, nursing education

2 of “10 tips.” – – – Mantra for New faculty. need to repeat this over and over until they “get it”

We are all in search of the eternal truths of life, and nursing education is no different.

hint: be sure to click on the hyperlinks. These show up as underlined text or sometimes as text of a different color.

If I had just one magic incantation for new  nursing faculty, it would be this one:

It’s not about what you know, it’s about what the students learn

Medically-oriented knowledge

Do you know a lot about physiology? This is the answer to a common pitfall for new faculty who are trying to decide what to focus on when choosing material for a lecture. You have just come from graduate school in nursing and you make up your mind that you will be a better teacher than your undergraduate faculty were; the students will learn more advanced concepts from you than they ever learned from somebody else.

result: you spend time lecturing on some physiological problem that doesn’t happen that much. students are left confused. they don’t know whether it was important, or not. they scratch their heads.

hint: if you are discussing some physiologic problem that you personally have not dealt with, or for which you can not give an example from your practice, it’s probably waaaay over the student’s head.

working with beginning generalists

Or else maybe you are feeling imposter syndrome and you need to reassure yourself how smart you are and that you really do belong here.  You can tell if this is happening to you because you have the uncontrollable urge to share your qualifications or to talk about the finer points of some unusual medical illness that maybe the other faculty haven’t even heard of.

hint: this is nursing school, not medical school. what does the nurse need to know about the topic at hand?

Exams by a new faculty – what do they measure?

Or maybe you are looking at the item analysis report for an exam the team just gave, for the very first time and you see that the students scored a “0.0%” on the correct answers for all your questions; you find yourself arguing that they really ought to know that answer.

hint: when nobody chooses the correct answer for a question, you really do need to consider the possibility that there was something wrong with the question, or perhaps that your teaching was not effective. This is humbling.

Truth: if the entire class scores poorly on any given exam,  it is a reflection on you, not on them. How could you have presented the material better? in the meantime, drop the question overboard without ceremony. you will do better next time.

ability to test reality

I only recently heard about a phenomenon known as the Dunning-Kruger effect.

The Dunning–Kruger effect is a cognitive bias in which unskilled individuals suffer from illusory superiority, mistakenly rating their ability much higher than average. This bias is attributed to a metacognitive inability of the unskilled to recognize their mistakes

Even though you may not heard of this by name, surely you seen it at work – I know I sure have.  As clinical faculty, one of our main jobs is to give students a dose of reality-testing strong enough so that they can develop a sense of their own limits and abilities.

The Dunning-Kruger Effect applies to you as a new faculty member. You will be evaluating not just what they students learn, but how. The same applies to evaluating your own skill in a new dimension.

Pearl of Wisdom

I guess the executive summary of this blog entry would be: when you start a teaching career, leave you r ego at the door. be humble. trust yourslef that you do belong there, but in the meantime, start thinkiing about the goal, which is to enhancestudent  learning – not to show how much you know. I will end this blog entry with The First Rule of Knowledge (according to Buddha) which is:

admit what you do not know

PS please pass this along to as many faculty and nursing students as you know and encourage them to subscribe to this blog. hey – why not subscribe yourself?????

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Filed under classroom management, Honolulu, nursing education, nursing faculty jobs in Hawaii

#1 ten tips for new nursing faculty – name tags at school

new series

Announcing a series of blog entries for nurse educators. For the next few blogs I am going to share some hands-on ways to make the class hum. Surely you know what I mean. Sometimes every one gets to a class with enthusiasm, ready to share and participate; other times the group trudges in, head down and dispirited. Forced to be there against their will. Which class room experience would you rather have?

today’s tip – name tags

Something I do at the beginning of each semester is to get a box of name tags, the pin-on kind. on the first day, there is a table at the door to the class with lots of marker pens. Instructions: “write your first name on this tag, using the whole tag; write it in letters so big that an old man can read it from across the room”  then I explain the system for collecting them at the end of the class.

was this worth writing about?

Yes, this is so simple it sounds stupid, perhaps not worth writing about. but for those who dismiss it: do you know the name of every student in your class? especially at the beginning of nursing school, the students have come from prerequisite science classes where maybe there were 300 people in a lecture hall ( happens in a lot of Universities). They become accustomed to the idea of anonymity.  There is a lot of sociological work about what happens to people when they feel they are totally anonymous….. In a work setting in health care, anonymity is never an option. start now to get people used to this.

an alternative

The University used to photograph every nursing student and keep the photos on a shared database with their names. for cost reasons we don’t do that anymore. But, with the advent of smart phones, one thing I did recently was to take each student’s picture using my own smartphone, along with the email and number. I indexed the photos in such a way that if I forgot the students name during class, I could scroll through the photos and remind myself. At the end of the semester I delete each class, but then I find I can still remember them next semester even though I have to learn sixtyfive new names and faces.


the students will learn each other’s name. In a big classroom, don’t assume that they know each other. sometimes they only stick with a subgroup such as from their clinical site.

you grab their attention when you call each student by name in class. The students know that they can’t be anonymous during a class discussion.

if every one picks up their name tag at the beginning of each class, you can easily tell who is absent simply by looking at the leftover name tags.

If the students are wearing a name tag with LARGE LETTERS, you don’t need to  be close by to remind yourself who they are. For a male faculty in this age of political correctness, this is a good thing,  since there is a taboo about glancing down at a woman’s thorax to read their name in small letters.  the awkwardness of this can be avoided.


people lose the name tags.

people may protest that it isn’t “cool” – and frankly, sometimes the faculty can’t be bothered….. that is a problem. You do need to get the faculty to buy in and enforce it if the course is team taught. A box of name tags costs $20 and you can’t afford to buy a new box each week.

invariably, as the semester proceeds, people sometimes try to fool you by trading name tags with somebody else or perhaps deciding that everyone will be “Barbara” on a particular day. Actually, when that happens, I interpret it to indicate that the students are having fun.

ways to use this system

we once had a cohort in our lab class where the students seemed to form cliques that did not mix. In that lab session, there were three clinical groups and they stayed amongst themselves. nursing students need to learn to work well with others and to keep themselves fresh. We decided to put a small fish sticker (like you buy at the Drugstore for kids) and add a sticker to each name tag. When the time came to break up into groups of three, we told them to arrange themselves so each group of three was composed of one person from each of the three groups, using the fish stickers as a guide.  problem solved.

Philosophy of cliques

I have referred to this a bunch of times without clarifying why it is so important to break up cliques when they form. Generally, when the students clump together, the subgroup will include all the top students in one clump. When that happens, the lesser achieving students are deprived from working alongside them and learning from their peers. I will write a longer blog on this later – I believe that forming cliques is something that contributes to ” Nurses Eating Their Young”

We used variations of this all semester long. Whenever the class breaks into smaller groups, you can choose to direct the class as to how to compose each group.

Thes tips all come under the header of “Classroom Management” techniques – if you were teaching in third grade, you would probably take a three-credit course in this. Not so much of a priority in nursing education.


Filed under classroom management, nursing education

The Ultimate Multicultural icebreaker for nursing

Update August 17, 2015. This blog entry has had 1985 views. If you used this after finding it here, please post a comment to let us know how it went. inquiring minds want to know!

also: I have worked in many settings where I was the only outsider and there was a distinct cultural identity of the group, including trips to Nepal to teach nursing to batches of Nepali nursing students. To read about that experience go to Amazon and buy The Hospital at the End of the World, (my first book), or else buy one of my books. Browse my blogroll.

Honolulu Hawaii is the most minority-majority city in the US. Our classrooms in Honolulu reflect this.  You would think that inclusiveness and respect for multiculturalism is ingrained, but it is not… Even here, there is no guarantee that the subgroups within a class or cohort will mix unless we actively promote the idea. Frankly, we always have a subgroup of European descended students from Da Mainland, who start off by sticking to themselves. They need to get hip in a hurry. My goal has always been to prevent any group from forming cliques that don’t mix with the other subgroups. I’m pleased to report that by the end of the time here, these students have become culturally sophisticated. That’s what you want for a nurse!

And of course in nursing, you need to be comfortable with care delivery across a wide variety of ethnic and cultural backgrounds. It is not unusual for me to have a clinical group in which there are no “Howlies” or be caring for a patient group in which everybody is from one Asian culture or another. It’ s something I love about Hawaii.

What is an icebreaker?

It’s an exercise used when a group is forming their identity, designed to get them members to mingle and learn about people in the group they might otherwise not interact with. We do this particular icebreaker on Day One of nursing school.

Disclaimer: this one is best when there is a high number of English-as-Second-Language students in the group.

How I came up with this: it is probably not new to me. The first time I ever used it was in Maine. At a nursing school there, the population of faculty and students was mostly Mainers; but we also had a dozen or so RN-to-BSN students who were Korean nationals with limited English skills. They  did not mix and it was painful to watch. So we organized a “tea.” At the tea, the Americans sat on one side and the Koreans on the other, each uncomfortable as to how to get started.

It was like a Junior High Dance, all over again…..then…. I did this icebreaker. Magic happens.


everyone  stands up and stretches.

then, those who only speak English are told to sit down.

Announce: “one of the great things about nursing is the opportunity to meet people from different cultures and to learn from each other. I love the idea of feeling at home no matter where you may be in the world”

“if you only speak English, you are at a cultural disadvantage, and we need to address that. Those who speak more than one language are waaaaay ahead of you.” ( usually people are surprised by this)

The multilingual persons are then dispersed around the room. The English-only students grab a pen and scrap paper, and divide up in to small groups, each led by one of the multi-lingual students. In Hawaii we usually have students that speak: Hawaiian, Ilokano, Tagalog, Mandarin, Cantonese, Japanese, Korean, Vietnamese, Samoan, and Thai. We also get a smattering of European languages as well. The more languages, the better this one works. One of the memorable ones was from South Africa who taught us something in Zulu. wicked cool!

Next, each group has five minutes in which the leader teaches a phrase in their language, to the English-only students. chosen by the multilingual person. doesn’t need to be long.

then the large group reconvenes and each group recites. we go around the room.

During the recitation, I am usually pretty theatrical, seeking ways to get the larger group engaged. I use all the skills I perfected back along when I was the front man for a polka band that played a lot of wedding receptions.

serendipity happens:

one time a German-speaker taught a beer-drinking song. I got the entire group to stand and wave their arm to-and-fro as if hoisting a mug.

a male  Ilokano-speaking student recited a love poem in Ilokano – the class was in stitches

we teach people the proper way to bow when with a Japanese person.

We teach about eye contact in Asian Cultures, using a specific game. students pair off, holding hands. if one of the pair looks away, smiles, or laughs, they must sit down. I once did this with Japanese students and they all sat down within five seconds; an American pair can last for two minutes.

If somebody writes using a foreign alphabet ( such as Japanese or Chinese) we ask them to write it on the board and everyone copies it.

We had a student who was fluent in signing for the deaf and taught the gestures to accompany the chosen phrase.

we did once get an Aussie student who taught some Aussie slang ( sort of cheating but it was funny).

There are an infinite number of variations. there are a million ways to use this; With an Italian speaker, for example, you can include hand gestures.

Success depends on the verbal quickness and eclecticism of the moderator. You can convey a sense of inclusion and fun.

Evaluations for this have been overwhelmingly positive, esp from among our English-as-a-Second-Language students. often, these persons get socially isolated due to language insecurity. Weeks or months later, some of these persons will take me aside and thank me for helping them by doing this.

in Maine? back to the original group in Maine – the Koreans and the Mainers.

All the Americans learned a phrase in Korean and found a way to remember the Koreans as people, not simply “Koreans.” I was instantly famous.

Here is a video of an icebreaker that was a dismal failure.

On the evaluations, I did have a person write “I have always disliked forced socialization exercises” – I think it was from a European-descended individual from a very reserved culture. There is always somebody at the back of the classroom who displays the haughty ennui of having done this too many times. Cut them some slack. You can’t please everybody, and obviously, the exercise was not designed for her.

This is my gift to you

Nowadays nursing schools everywhere are more likely to have students from diverse backgrounds that are breathtakingly representative of the whole world. If you teach in a multicultural classroom, you are invited to use this icebreaker. let me know how it works for you!


Filed under nursing education

Part 4 – the Nurse’s Brain – joining the borg!

Nurse Brain

Florence once said that to own a pen was more iimportant than to know how a stethoscope worked.There were three parts to the discussion about the Nurse’s Brain so far, and buried in the discussion after one of the entries was a question from an experienced nurse:

Joe,  I do like your brain and it looks like a good way to teach students. However, we have a ten minute overview report followed by bedside report, then it is go go go. Do you have a preprinted template your new nurses can just fill in? I’m not sure when a floor nurse would have time to make a detailed outline for the day.

That was  a great question which deserves to be addressed in a separate blog altogether. As I have said, a brain is a way to organize data, and if your happen to be at a hospital which has a good informatics system, there must be a way to set this up so that much of the stuff gets a nurse-friendly printout. Any number of templates will do…. in my blogroll is a site where you can find a collection of such things.

Answer – join the “borg!”

In the meantime, here is my answer:

One option is for the nurses to get there a bit early and scout these things out.

But here is another way to use it: In the 1980s I was nurse-manager of an ICU/CCU in a community hospital in rural Maine. At that place, all the nurses used a brain, it was a four bed unit with a lot of CCU ( this was in the olden days,  prior to TPA and the modern era of thrombolysis, that tells you how old I am….). The team there had adopted a twist to the system (prior to the time I ever got there) which was very helpful.

One of the duties of the off going nurse was to construct a nurse’s brain for the upcoming shift of next nurse, one for each patient. Obviously it would be subject to change, but it was a good way to start. It consisted of a handwritten summary of assessments, labs, IVs, treatments, etc  and it was used along with the Kardex and chart, during report.

When the system worked (most of the time) it was terrific. (of course, there were times when the plan changed dramatically the next time somebody went into the room, but that is another story…)

You might consider adopting some system such as this. It’s way to get the staff involved into the subject of what we nowadays refer to as “handoffs” and accountability.

Oh, and by the way….

Some people will be scratching their head, asking “What is the borg?”

Any fan of Star Trek will tell you. There was a planet in Star Trek where every person was hooked directly into the main computer so that they completely lost the ability to have an individual thought, but on the other hand, each person shared the collective wisdom of a billion humanoids…..

The end result of using a Nurses Brain is effective teamwork and preparation. Here on planet earth there are different models of achievement. If you can adopt a Nurse’s Brain, you will be just like the person in this video. trust me!

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Filed under Nurses Brain, nursing education

My Date in New York May 30th


Hosack Hall

Hosack Hall is the auditorium of the New York Academy of Medicine, and the Phillips Beth Israel School of Nursing in Manhattan will  conduct their 2012 commencement there. May 30th. 1 PM.

I was honored to receive the request to be their speaker. Fired up, if you really need to know. I learn more about the school, and it’s a gem of New York City. The affiliated hospital, Beth Israel Medical Center, has an inspiring history, associated with the social activism of Lillian Wald and others working on the legendary Lower East Side. This year the PBISN marks it’s 100th anniversary.  I was privileged to meet the senior class last week while in Manhattan.

the day i stopped by, the school posted this announcement for everyone, by the elevator.I had a limited time there but we had fun playing “Dear Abby” which is an icebreaker I always use. It’s simple – everyone gets a small piece of scrap paper, write “Dear Abby in the upper left hand corner, then writes a question or statement on anything, such as, “what I want to know is_____________”  Then we collect the slips of paper and I answer each one. For those teachers among my readership, try it when you have five free minutes. It’s a good way  to guage the mood of the class. I did it in twenty minutes.

The Big Question

question to my readers: what would you say if you were giving a commencement speech these days? I have got some ideas, but I am always interested to poll “the cloud”…..


Filed under nursing education, Uncategorized