Nursing · Professional practice, leadership and research
Almost every teaching failure is the same failure — assuming that because something was said, it was learned
Every nurse teaches — patients managing a condition, students learning a procedure, relatives learning to care at home, colleagues at handover — so teaching is not a separate role but most of the job. It also decides whether treatment works: a person with diabetes, asthma or a wound spends a few hours a year with clinicians and every remaining hour managing it themselves, so what they learned determines the outcome rather than what was prescribed. There is a very large global shortfall of nurses concentrated in the poorest countries, which makes education a workforce intervention. And bad teaching drives people out: students and new nurses leave because of humiliation, abandonment and being used as unsupervised labour. Yet nurses are expected to teach with almost no preparation in how to do it, when the skills are specific and learnable.
Teaching patients how to manage a condition, showing a student a procedure, explaining a medicine, handing over to a colleague, and helping a relative learn to care at home. Teaching is not a separate role; it is most of the job.
There is a very large global shortfall of nurses, concentrated in the poorest countries, and closing it depends on educating and retaining people. Education is therefore a workforce intervention as much as an academic one.
A person with diabetes, asthma, heart failure or a wound spends a few hours a year with clinicians and every remaining hour managing it themselves. What they learned decides the outcome, not what was prescribed.
Students and new nurses leave the profession because of how they were treated while learning — humiliation, abandonment, being used as unsupervised labour. That attrition is a direct consequence of teaching practice.
Nurses are expected to teach patients, students and colleagues with little or no preparation in how to do it. The skills are learnable, specific, and almost never taught.
Adults engage with learning when its purpose is clear and connects to something they need to do. Information delivered without that connection is heard and not retained.
New learning attaches to existing knowledge and experience, which is why finding out what somebody already understands, or wrongly believes, is the first teaching act rather than a preliminary.
People retain far more of what they practise than of what they hear, which is why demonstration and supervised practice outperform explanation for any skill. Explaining a procedure is not teaching it.
Learning spread over time with repetition is retained far better than a single long session, and the long single session is what most healthcare teaching consists of. Planning repetition is realistic rather than inefficient.
Somebody frightened, in pain, exhausted, humiliated or newly diagnosed cannot learn, and teaching delivered in that state is wasted. Recognising the moment is part of the skill.
Nursing is studied in English, French or another second language by an enormous number of students, who are simultaneously learning the content, the terminology and the language. That doubles the cognitive load.
A sentence that must be decoded before it can be understood consumes the capacity needed to understand the idea. Plain, short sentences are not a simplification of teaching; they are a condition of it.
Clinical vocabulary is necessary and must be taught explicitly, defined when introduced, and not assumed. A student who nods at an unfamiliar term will not ask twice.
Speaking quickly, using idiom, and colloquial abbreviation excludes people who read the language well. Slowing down and avoiding idiom costs the speaker nothing.
Where listening is harder, written material, diagrams and the chance to read afterwards carry much of the learning. Verbal-only teaching disadvantages exactly the students who are already working hardest.
Asking what somebody currently does, rather than telling them what they should, finds the actual problem in a minute and reveals unsafe practice that would otherwise persist for months.
A newly diagnosed person cannot learn everything, so identifying the two or three things that must be understood now — and leaving the rest for later — is what makes any of it stick.
Teaching in the patient's own vocabulary, including their name for their condition and their body, is what allows them to remember and repeat it. Correcting their terminology is rarely the priority.
Inhalers, injections, dressings, blood glucose meters and wound care are taught by demonstration and then by watching the person do it. Nothing else establishes whether they can.
In most households one person cooks, one manages the medicines, and one does the caring. Teaching only the patient is frequently teaching the wrong person.
Consultations conducted through a relative, a child or nobody at all produce useless histories and unsafe teaching, and a professional interpreter is a clinical necessity rather than a courtesy. Speak to the patient rather than to the interpreter, in short complete sentences, and allow twice the time — and check understanding by teach-back through the interpreter, because the usual signals of comprehension do not survive translation.
Almost everybody says yes, out of politeness, embarrassment, or believing they did. The question produces no information and it is the commonest way teaching failure goes undetected.
Asking somebody to explain in their own words what they are going to do, framed as checking your own explanation rather than testing them, reveals misunderstandings reliably. It is the single most useful technique in this manual.
For any skill, observing performance is the only assessment. A person who has been shown an inhaler three times and never watched using one is frequently using it wrongly.
Most teach-back reveals at least one error, which is the point rather than a failure. Framing it as your explanation needing improvement keeps the person willing to try again.
Verbal instructions given at a busy discharge are largely gone within a day. Written information, in their language, with pictures where possible, is what survives the journey home.
A substantial proportion of adults in every country struggle to read, understand and act on health information, and they include people who read fluently in other contexts. It is not confined to people with little schooling.
People conceal difficulty reading out of shame, saying they forgot their glasses or will read it later, and they nod through instructions they cannot follow. Assuming literacy is a routine source of harm.
Doses, times, percentages, risks and measurements are misunderstood by many people who read text adequately. Twice a day is understood; every twelve hours frequently is not.
Short sentences, common words, one idea per line, pictures, and the most important information first. Material written this way is better for everybody, not only for those who struggle.
Asking somebody to read aloud, or asking whether they can read, humiliates them. Offering to go through it together, as standard practice for everybody, achieves the same result with no cost.
Show it at normal speed, show it again slowly with explanation, have the learner talk you through it while you do it, then have them do it while talking through it. That sequence is far more effective than demonstration alone.
Complex procedures are learned in components and then assembled, because attempting the whole thing at once overloads a beginner. Deciding where the joints are is the teacher's work.
Taking over the moment somebody hesitates prevents learning, and tolerating a slow, imperfect but safe attempt is what produces competence. Knowing when to intervene is the skill.
A skill demonstrated once and not practised for three weeks is gone. Arranging early repetition is more valuable than perfecting the first demonstration.
A learner who understands the reason for each step can adapt when circumstances differ, while one who memorised the sequence cannot. Rationale is what converts a procedure into judgement.
Most clinical learning happens during ordinary work, in fragments, under time pressure. Accepting that and using short deliberate moments works better than waiting for a quiet period that never comes.
A brief targeted question, one piece of feedback, and one thing to look up afterwards constitutes effective clinical teaching. Long explanations are neither possible nor necessary.
Explaining your own reasoning aloud while making a decision teaches clinical judgement in a way no lecture can. Students consistently name this as the most valuable thing a nurse did for them.
Students learn by doing with supervision, and being used only as an observer or as a pair of hands for basic tasks teaches nothing. Graduated responsibility is the mechanism.
Correcting a student publicly damages the student, alarms the patient and teaches everybody watching to hide uncertainty. Corrections that concern safety are made immediately and quietly; everything else waits.
How a student or newly qualified nurse is received — whether they are expected, named, welcomed and oriented — shapes their confidence, their competence and whether they stay. It costs almost nothing.
A named person, present, who the learner knows they can approach, is the single most valued feature of a placement. Being allocated to somebody who is never available is the commonest complaint.
Beginning with what the learner has done before, what they are anxious about and what they want to achieve makes a placement purposeful instead of accidental. It takes one conversation.
Supervising directly at first, then at a distance, then remotely, is how safe independence is built. Assuming competence because somebody is in their final year is how errors happen.
Precepting on top of a full clinical load, with no allowance, is why it is done badly, and saying that is legitimate rather than complaining. Good precepting requires time that must be defended.
Specific, timely feedback changes performance more than almost anything else, and most learners report receiving almost none, or only criticism. That gap is the largest single failure in clinical education.
Telling somebody they did well teaches nothing. Telling them that explaining each step before touching the patient visibly reduced the patient's anxiety teaches them exactly what to repeat.
Feedback given weeks later about a forgotten event is useless, and feedback given in front of others is heard as humiliation. Same day, somewhere private, briefly.
Asking a learner how they thought it went, and what they would change, produces most of the content and makes them a participant. Most learners identify their own main problem when asked.
Praise with no substance is not believed and criticism without recognition is demoralising. Saying what worked and what needs changing, both specifically, is what learners describe as useful.
Assessors pass students they know are not competent, because of sympathy, workload, fear of appeal, or reluctance to end somebody's career. That documented tendency passes unsafe practitioners into the profession.
A student told in week two that their practice is unsafe has time to improve; one told at the final assessment does not, and will reasonably ask why nobody said anything. Early honesty is the fair action.
Saying that a medicine was given without checking the identity band is actionable; saying somebody is careless is not, and it invites defence rather than change. Specific behaviour is always the subject.
Concerns recorded contemporaneously, with dates and examples, are what make a fair judgement possible and what withstand challenge. Concerns reconstructed at the end are neither fair nor defensible.
A learner told their practice is inadequate needs a clear plan, specific objectives, a timeframe and somebody to help. Honesty without support is abandonment, and support without honesty is negligence.
Assessment either supports learning by showing somebody where they are, or certifies competence for patients' protection. Confusing the two produces assessment that neither teaches nor protects.
Assessment drives what learners study, so assessing recall of facts produces people who memorise facts. Assessing reasoning, communication and practical competence produces people who can nurse.
Somebody competent in one setting with one type of patient may not be in another, which is why a single sign-off does not establish general capability. Breadth of assessment matters.
Clear criteria known in advance, consistent application, multiple assessors and the possibility of challenge. Assessment that depends on who happened to supervise you is not assessment.
An assessment in which nobody ever fails certifies nothing and protects nobody. Its credibility rests on the possibility of a negative result.
Multiple choice questions test recognition and can test reasoning if well written, and they cannot test whether somebody can do anything. Knowing their limits prevents over-interpreting a result.
Ambiguous stems, implausible distractors, and questions testing trivia rather than judgement produce meaningless scores. A good question describes a real situation and asks what you would do.
Watching somebody perform a task against clear criteria, in a standardised situation, is how practical competence is assessed. It is resource-intensive and there is no substitute.
Different assessors mark differently, which is why criteria, training and more than one assessor matter. An assessment system that ignores assessor variation is measuring the assessor.
Somebody who can perform a skill competently may fail under observation, and distinguishing genuine incompetence from examination anxiety requires more than one occasion. That distinction matters enormously to a career.
Simulation allows procedures, emergencies and communication to be practised repeatedly, including rare events nobody would otherwise encounter until it was real. Its value is proportional to how it is debriefed.
The scenario generates experience and the structured discussion afterwards converts it into learning. Simulation without a proper debrief is expensive theatre.
Learners perform badly and learn nothing if they fear humiliation, so establishing explicitly that mistakes are the purpose is the precondition. A simulation used to expose people teaches concealment.
Expensive manikins are not necessary for most learning, and low-cost simulation with good facilitation outperforms sophisticated equipment used badly. That is important where budgets are small.
Running a scenario with the real team in the real place reveals missing equipment, unclear roles and communication failures that no individual training finds. It is an audit as well as teaching.
Reflection means examining an experience to understand it and change future practice, and done well it is how experience becomes expertise. Done as a form-filling exercise it is resented and worthless.
What happened, how you felt, what was good and bad, what you make of it, and what you will do differently. Any consistent structure works; the discipline is what matters.
Reflection that ends in insight without a change in practice is incomplete. The final question — what will I actually do differently — is the one most often skipped.
Examining what went well, and why, is as instructive as examining failure and considerably better for morale. Reflection used only after mistakes becomes associated with blame.
Reflective writing can be read in investigations, so learners are taught to be honest about their learning without recording admissions about patients in identifiable or careless detail. That is a real tension and it is rarely explained.
A portfolio collects evidence of competence, learning and development, and is used for registration, revalidation and progression. Its value depends on it being evidence rather than assertion.
Portfolios assembled retrospectively are inaccurate, stressful and thin. A short entry made the same week, repeatedly, produces something real with less total effort.
A small number of well-chosen examples with genuine reflection demonstrates more than a large collection of certificates. Assessors read for depth.
Patient-identifiable information must not appear in a portfolio, and anonymising properly means more than removing a name. This is a common and serious error.
A portfolio that records what you have learned and what you want next is genuinely useful for planning a career, and treating it purely as a compliance burden wastes it.
Teaching is planned backwards from the intended capability, then the assessment, then the content. Starting from the content produces sessions that cover material and change nothing.
Two or three specific things the learner will be able to do afterwards, said at the start. Vague aims produce vague sessions.
A session in which learners do something — practise, discuss, solve, teach each other — produces far more learning than one covering twice the content by lecture. Less material, better learned.
Almost every teaching plan contains too much, and running out of time means the most important part, which is usually at the end, is lost. Planning for two thirds of what you intend is realistic.
Asking whether learners enjoyed it measures satisfaction rather than learning. Asking what they can now do, or checking it later in practice, measures teaching.
A lecture efficiently conveys structure, enthusiasm and a framework, and it is a poor way to teach a skill, change behaviour or check understanding. Knowing what it is for prevents misuse.
Attention falls sharply after a short period, so anything long needs activity, questions, discussion or a break every few minutes. This is the single most effective improvement to most teaching.
Discussion works when the task is clear, the time is bounded, everybody has a role, and the quiet members are brought in deliberately. Unstructured discussion is dominated by the confident.
Open questions directed at the group produce silence, while a specific question about a specific situation produces answers. Naming somebody kindly, having given the group thinking time, works better.
Learners teaching each other learn more than those being taught, because preparing to explain something forces understanding. Building it in is cheap and effective.
Online teaching reaches nurses who cannot leave their post, travel or afford residential study, and in many countries it is the only realistic route to further qualification. That access is its main justification.
Long uninterrupted online sessions fail badly, and effective online teaching uses short segments, activity, interaction and things to do between sessions. The format has to change, not just the medium.
Learners on unreliable connections, on a phone, paying by the megabyte, or sharing a device cannot participate as designed. Materials that work offline, and recordings, are equity measures.
Clinical skills cannot be learned entirely online, and programmes claiming otherwise produce practitioners who have never done the thing. Blending is the honest approach.
Online learners drop out largely from isolation and lack of contact, and regular human contact — a call, a group, a named tutor — is the strongest predictor of completion.
In an environment where questions are met with impatience or ridicule, learners stop asking, conceal gaps and guess, and patients are harmed by that concealment. This is a patient safety matter.
A question answered willingly teaches that asking is safe; a sigh teaches the opposite and is remembered for years. Every response is teaching something about the culture.
A senior nurse saying they do not know and will find out gives permission that no policy can. It is the most efficient way to build a culture where people check.
A team that can discuss its own mistakes without punishment learns from them, and one that cannot repeats them privately. Learning from error is impossible without safety to report it.
A quiet group is frequently a confused or intimidated group. Assuming silence means understanding is how teaching failures pass unnoticed.
Illness, caring responsibilities, money, bereavement, language, undiagnosed dyslexia, bullying on the placement, and lack of confidence all present identically as poor performance. Assuming lack of ability skips the diagnosis.
A learner who does not know there is a concern cannot address it, and vague hints are not a warning. Specific, documented, kindly said, with a plan.
What must improve, how it will be demonstrated, what support is available, and when it will be reviewed. Without those four elements, an action plan is a gesture.
Shift patterns incompatible with childcare, travel costs, no money for food, working nights to fund study. Addressing those changes performance more than academic support does.
Occasionally the right outcome is that nursing is not for this person, and saying so honestly and early is kinder than allowing years of failure. That conversation is handled with care and with support.
A learner whose practice endangers patients is removed from that activity immediately and supervised directly, whatever the consequences for their progression. Nothing outranks this.
Record what was done or omitted, when, and what the consequence or risk was. Documented specifics are what allow a fair process and what protect patients.
Concerns about a learner's safety or conduct go to the named educational lead and through the institution's process rather than being managed informally. Informal management is how unsafe practice persists.
Dishonesty, not reporting an error, failing to seek help, disrespect toward patients, and boundary violations are more serious than clinical inexperience. Skills can be taught; these must be addressed.
Assessing and acting on serious concerns about a learner is difficult and should involve the education provider, a senior colleague and the institution's process. Isolation leads to either paralysis or unfairness.
Bullying, humiliation, exclusion and incivility toward students and junior nurses are widely reported, and the phrase about nurses eating their young exists for a reason. It is not an unfortunate minority phenomenon.
Rudeness measurably degrades the performance of the person receiving it and of those witnessing it, in simulated and real clinical tasks. Incivility is therefore a clinical risk rather than a matter of manners.
Fear of failing a placement, of being labelled, and of having nowhere else to go silences students almost completely. A system relying on them to complain will hear nothing.
People treated badly as learners frequently repeat it, believing it made them resilient. Naming that explicitly is how it is interrupted.
Greeting a student by name, including them, defending them, and not tolerating it in front of you. Students consistently remember the one person who did that.
Students from ethnic minority backgrounds, international students, disabled students and mature students are more likely to fail, be referred, and leave, and the differences are not explained by prior attainment. That pattern is measured and consistent.
Minority ethnic and international students report more hostile placements, less support, more scrutiny and more informal complaints, which then appear as performance problems. The environment is part of the outcome.
Reasonable adjustments allow disabled students to practise safely and competently, and assumptions about what is impossible exclude capable people. Adjustments are an entitlement in many jurisdictions rather than a favour.
Unpaid placements, travel costs, childcare, and the impossibility of paid work alongside full-time study exclude poorer students, who are disproportionately from minority and mature groups. It is structural rather than individual.
Institutions that count who fails, who leaves and who reports problems, broken down properly, can act. Those that do not, cannot, and generally assume there is no problem.
A substantial proportion of nursing students do not complete, and the reasons are consistent: money, placement experience, workload, health, caring responsibilities and feeling unwanted. Very little of it is academic failure.
A poor first clinical placement predicts leaving more than almost anything else, and the features are being unexpected, unsupervised, used as spare hands, and made to feel a burden.
The gap between what students expect nursing to be and what the work is like causes disillusionment at a predictable point, and preparing people honestly for it reduces the damage.
The first year after qualifying carries high attrition, driven by responsibility without support, staffing, and fear of making mistakes. A structured first year with a named supervisor substantially reduces it.
People leaving say clearly why, and that information is collected and not acted upon in most institutions. Using it is cheaper than recruitment.
Regular protected time to discuss practice, difficult cases and one's own responses, with somebody skilled, is supportive and developmental rather than a performance review. Conflating the two destroys it.
Good supervision is associated with lower burnout, better retention and better practice, which makes protecting the time an organisational interest rather than a staff perk.
A mentor is somebody further on who helps you think about your career and your development over years. Most nurses never have one and most who do describe it as decisive.
Colleagues talking to each other after difficult shifts is the commonest and most used form of support, and it depends on time, space and staffing to exist at all. Removing breaks removes it.
Seeking supervision, support or help is a marker of competent practice rather than of weakness, and saying so out loud to juniors gives them permission they otherwise lack.
Evidence, guidelines, technology and drugs change throughout a career, and a nurse practising as they were taught twenty years ago is practising badly. Continuing learning is an obligation rather than an option.
Most regulators require evidence of continuing learning and reflection to remain registered, and the requirements are specific. Knowing what yours requires, and collecting it as you go, avoids a crisis.
Discussing cases, reading about a patient's condition, teaching somebody else, and reviewing an incident are all legitimate learning and are frequently more useful than a course. Recording them is the only extra step.
Study leave, course fees and cover are unavailable to very many nurses, particularly in poorer settings and in private employment. Free resources, journal access and peer teaching are what remain.
A habit of reading a small amount consistently outperforms occasional intensive study, and it is what keeps practice current over decades. Ten minutes is a real intervention.
Teaching colleagues what the evidence says changes practice far less than expected, because habit, workload, equipment and culture determine behaviour. Education alone is a weak change tool.
The existing practice usually has a reason — it is faster, the equipment is missing, somebody was told to, or a bad experience happened once. Addressing that reason is the intervention.
Changing where equipment is kept, what a form asks, or what happens by default changes behaviour more reliably than persuasion. Design beats exhortation.
Practice changes when respected colleagues adopt it, not when a poster appears. Identifying and involving those people is how a change spreads.
Showing a team its own data, non-punitively, changes practice measurably. Telling them what they should do without showing where they are does not.
Whether a study asked a question relevant to your patient, in a comparable population, with a comparable comparison, determines whether the answer applies. Much apparently contradictory evidence is answering different questions.
A small study, an uncontrolled one, or one funded by a party with an interest in the result warrants more caution. None of those invalidates it and all of them affect confidence.
A halved risk sounds enormous and may mean a change from two in a thousand to one in a thousand. Reporting risk in relative terms is the commonest way findings are made to sound larger.
A guideline summarises evidence and adds judgement, cost and local circumstance, and guidelines differ between countries for those reasons. Following one is sensible and understanding what it is remains necessary.
Many things nurses do have never been formally studied, particularly in poorer settings, and that is not the same as being ineffective. Knowing what is unknown is part of literacy.
No simulation centre, no library access, no internet, few staff, large classes and shared textbooks. Teaching described as requiring those things is unavailable to a large share of the world's nursing students.
Demonstration, supervised practice on real patients, peer teaching, oral questioning, locally made low-cost models, and a teacher who explains their reasoning aloud. All of it is effective and free.
Fruit for injection practice, cloth and bottles for anatomy, role play for communication, and household items for equipment. Well-facilitated low-cost simulation outperforms expensive equipment used badly.
Where connection is unreliable or unaffordable, printed and offline material is what actually reaches learners. Designing for offline use is an equity decision.
Teaching only practice that requires unavailable equipment leaves learners unable to act, and teaching what is achievable while naming the gap prepares them honestly. Both halves are necessary.
Learners copy how you speak to patients, how you respond to interruption, whether you cut corners, and how you treat colleagues, far more than they absorb what you tell them. Behaviour is the curriculum.
A teacher who says they do not know, who corrects themselves, and who asks a question is more trusted than one who appears certain about everything. Certainty is not authority.
Structuring a session, giving feedback, checking understanding, facilitating a debrief and assessing fairly are specific skills with evidence behind them, and nurses are expected to do them untrained.
Teaching well requires time that clinical work does not contain, and doing it badly because there is no allowance is a system problem rather than a personal failing. Asking for the time is legitimate.
A nurse who taught well affects the practice of people who will practise for forty years and teach others. It is the most durable thing available in this profession.
A learner or patient corrected repeatedly stops volunteering anything, which removes the information the teacher needs. Framing a correction as a gap in your own explanation, and asking what made them do it that way, keeps them talking and finds the actual misunderstanding rather than just replacing the wrong action with a memorised right one.
Most long-term and end-of-life care in the world is given by relatives who are unpaid, exhausted, frightened and untrained, and what they are taught determines whether somebody stays at home, avoids readmission, or develops a pressure injury. Teaching a family member is therefore a clinical intervention with measurable outcomes rather than a courtesy performed at discharge.
Tube feeding, injections, catheter care, turning, wound dressing, oxygen and recognising deterioration cannot be taught in the hour before somebody leaves. Teaching across several days, with the relative doing the task under supervision while the patient is still in hospital, is what makes home care survivable.
A relative who has been shown a procedure and who nodded will frequently be doing it wrongly within a week. Observing them perform it independently, then again on a later day, finds the errors while somebody is still there to correct them.
A short written list of the specific signs that warrant a call, in their language, with a number that is actually answered, prevents a large share of emergency admissions. Given verbally at a busy discharge, none of it survives the journey home.
Relatives describe terror of giving the wrong dose, of moving somebody and hurting them, and of being blamed if something goes wrong. Saying explicitly that they will not be blamed, and that asking is expected, is what allows them to ask rather than guess.
More is learned and transferred at handover than in any classroom, and a handover that lists tasks without the reasoning, the risk and the plan has passed on the work without the understanding. Saying why a patient matters is teaching the next nurse how to think.
A consistent format — who they are, what is wrong, what has happened, what to watch for, what to do — prevents the gaps that occur when people improvise under time pressure. Structure is a safety device rather than bureaucracy.
A handover delivered as a monologue that nobody may interrupt transmits less than one where the receiver is expected to ask. Pausing and asking whether anything is unclear takes seconds and catches misunderstandings before they reach a patient.
Preparing and delivering a handover forces a learner to organise what they know, identify what they do not, and prioritise, which is exactly the reasoning being taught. Watching them do it reveals gaps that no written test finds.
The most valuable sentence in any handover is the one naming what might go wrong and what to do about it. Learners copy that habit, and it is the single most transferable thing a senior nurse demonstrates.
Checking understanding by teach-back rather than asking whether they understood; the four stages of teaching a skill; specific timely feedback; failing to fail; and adjusting teaching for health literacy and language.
Asking a patient whether they understand; explaining a device instead of watching them use it; teaching the patient when somebody else manages the medicines; giving feedback publicly or weeks later; passing a learner known to be unsafe; assuming silence means understanding.
Find out what they already do. Show, then watch. Ask them to say it back. Give it in writing. Feedback specific, soon and private. Raise concerns early, in writing, with a plan and support.
Ask them to explain it back as a check on your explanation. Watch the inhaler. Teach whoever cooks. Say your reasoning out loud. Greet the student by name. Say when you do not know.
Almost every teaching failure in this manual is the same failure: assuming that because something was said, it was learned. Checking is the entire difference.
Written in plain sentences on purpose. Nursing is studied in a second language by a large share of the students who will read this, and a sentence that has to be decoded twice is a sentence that teaches less. This manual has a chapter on exactly that.
These are the twelve questions written with this SUNYRA nursing manual, to check what it teaches. They are not past papers and were not written to any one examination's pattern; an examination tag means only that the examination's published blueprint covers this subject. Difficulty was not graded in the source, so every question is marked medium.
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