Recent Blog Posts
Nursing Schools by State
Nursing Career Info
Demand for Nurses
Nurses may be the most in-demand health care position in the country.
January 26th, 2011
Fayetteville State University (FSU) in North Carolina has announced it will resume the admissions process for its nursing program, nineteen months after the institution’s chancellor suspended them, reports The Fayetteville Observer. This was one of three developments to come from school officials this week.
University trustees voted unanimously to apply with the state Board of Nursing to re-establish the institution’s four-year degree program. They will submit the application in February and expect to hear back by May.
In addition to the university’s willingness to accept new nursing degree applicants, school officials announced that they would like to establish a master’s program.
According to Afua Arhin, head of FSU’s nursing department, the university’s RN-to-BSN has become a feeder for graduate programs provided by other schools. This has led Arhin to believe the institution must establish their own master’s degree.
These announcements coincided with the opening of FSU’s new, $10 million Southeastern North Carolina Nursing Education and Research Center.
The American Association of Colleges of Nursing states that graduates of master’s nursing programs can expect to make annual salaries that range between $60,000 and $90,000. These wages depend on an individual’s experience and geographic location.
January 26th, 2011
A group of 10 students will each receive a $10,000 scholarship that they may use to help pay for a nursing degree program, reports the Tri-State Defender.
The scholarships will be awarded to underrepresented minorities and males enrolled at the University of Tennessee who hold bachelor degrees in other fields. According to the news source, the Robert Wood Johnson Foundation New Careers in Nursing program was launched in 2008 to address the national shortage of healthcare workers and add more diversity to the profession.
Through the program, students have the ability to pursue an accelerated bachelor’s or master’s nursing program. Individuals who choose the graduate-level option are allowed to have undergraduate experience in a different field.
Donna Hathaway, professor and dean of the university’s College of Nursing, says that the program helps make students’ dream of becoming a nurse a reality in about two years.
“They begin their nursing careers at the master’s level instead of having to start by earning another bachelor’s degree in the nursing field,” she adds.
Job prospects for registered nurses are expected to be excellent due to a high turnover rate in hospitals, the Bureau of Labor Statistics reports.
January 26th, 2011
A national summit was held earlier this month in Washington, D.C. on the future of the healthcare industry. Issues discussed at this meeting may have an impact on state nursing programs, reports California Healthline.
The summit was held to officially launch the Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health. Officials behind the study said that the purpose was not to reform healthcare, but transform how it is delivered.
According to Donna Dolinar, who is on the board of the California chapter of the American Nursing Association, her state is ahead of the curve in implementing healthcare reform.
In fact, California is the only state that has staffing ratios. According to Dolinar, senator Barbara Boxer may be interested in making this a national law.
In 1999, California passed a state law that established nurse-staffing levels and led to improved safety and higher retention.
“If you know that you will be going to work with decent ratios, when you know how many patients you’re going to be taking care of, that makes a big difference to coming into work,” said Dolinar.
California was expected to have a shortage of 12,000 registered nurses by 2014, according to a 2007 report that was released by Elizabeth G. Hill, the state’s key legislative analyst.
January 26th, 2011
By Kitty Holman
There are so many nursing specialties out there, it can be hard to keep track of just what opportunities are available for students in nursing school to pursue as a career. There may even be jobs that suit your needs and interests perfectly, but you had no idea they even existed as an option. Here are some of the coolest, most cutting edge, fulfilling and interesting ways to use your nursing degree, many of which you might not have ever even considered as a career path for yourself.
- Holistic Nursing. If you want to follow in the footsteps of Florence Nightingale, you might want to consider a career in holistic nursing. Holistic nursing focuses on healing the whole person, not just what ails them. Nurses in this profession work with patients to improve the health of their bodies, minds, emotions, relationships – even their environment. Additionally, many holistic practitioners blend traditional Western treatments with alternative medicine. It can be the perfect career choice for nurses who want to practice medicine, but also want a more spiritual, interconnected experience with their patients. Holistic nurses may find work in many different kinds of facilities, but are most often found working in private practices.
- Nursing Informatics. Love nursing but can't get enough of technology? This exciting and relatively new field is the perfect way to combine both interests into one challenging and rewarding career. Nurses who take this path will combine their knowledge of efficient and conscientious patient care with the latest technologies, enabling them to more effectively care for those in a medical facility, manage records and even reduce some of the most common errors. Jobs in this career field are often found in large medical facilities as well as in private consulting firms; this profession is an excellent choice for any student looking to bring cutting-edge technology into standard health care practice.
- Forensic Nursing. When you first hear the term forensic nurse, you might think of shows like CSI or Bones, where medical professionals put their expertise to use in solving crimes. While forensic nurses do play a role in the criminal justice system, it's not quite as romanticized as these television shows make it out to be — though it's still a very interesting and cool career. Forensic nurses must not only access patients and help treat injuries, but must also look for any signs that a crime has been committed and collect any evidence that may be found on the body of the perpetrator or victims. Sometimes forensic nurses are also involved in much more macabre tasks such as identifying bodies from remains. Often employed in large hospitals, these nursing professionals combine law, health care and criminal justice into one cutting-edge, challenging career.
- Parish Nursing. If you're an especially spiritual person and want to bring that enthusiasm and belief into your nursing career, parish nursing may be the right choice for you. Parish nurses generally choose to work in a community of faith, such as a church, temple or other religious institution. Within this group, they work with members to not only improve their physical health, but their spiritual well-being as well; they believe that comfortable faith is an essential part of health as a whole. Parish nursing programs are most popular in the US and Canada, but are spreading to other areas of the world as well. While most parish nurses belong to Christian denominations, the principles of this spiritual branch of nursing can be applied to almost any belief system out there.
- Cruise Ship Nurse. Love the thought of traveling through beautiful Caribbean waters for work? You may be able to do just that as a cruise ship nurse. These health care professionals work to help ensure the safety and well-being of passengers aboard a cruise ship. This can mean treating non-serious issues like bumps and scrapes, or most serious conditions like heart problems or dehydration, until a patient can be moved to a hospital on land. Because of limited supplies and distance from shore, this kind of nursing career can be surprisingly challenging, but the rewards of spending your days off cruising warm, scenic waters may be worth it.
- Hyperbaric Nursing. Also called baromedical nurses, this branch of nursing focuses on treating patients within a hyperbaric or decompression chamber. This is one of the most challenging and sometimes intimidating fields of nursing, but it can be pretty darn exciting too. Hyperbaric chambers are used to relieve the symptoms of a number of different conditions from anemia to decompression sickness from diving. This field is in high demand, despite the limited number of medical hyperbaric chambers around the world. Nurses in this field will get to work with cutting-edge treatments and a wide range of patients, but should recognize that there can be serious health risks to this career as well, as decompression sickness can occur from repeated exposure to the decompression chamber.
- Oil Rig Nurse. Oil rigs are often located several miles offshore, and are worked by professionals who may spend months at a time out on them. The work can be dangerous, and it's essential that medical professionals such as doctors and nurses are on hand should an injury occur. Nurses who want to pursue this kind of career will be entering a highly competitive and sometimes stressful career, but one that can be rewarding personally and financially. Nurses may find jobs in far-flung destinations around the world, and more opportunities will be open to those who are bilingual or who have extensive emergency medicine training.
- Flight Nurse. Want to make your career as a nurse a little more exciting? Why not become a flight nurse? These nurses get additional training to work with patients who are in transport aboard a medical helicopter or aircraft. Nurses in this field must be able to work under a stressful situation, helping maintain patient stability and life with limited supplies and while in-flight. These nursing personnel must also work well with doctors and paramedics to help patients get the best care they can. Jobs in this field are available through hospitals and medical facilities as well as in the military, providing a wide range of options for nursing students to choose from.
- Medical Esthetics Nurse. Want to work in the medical side of the beauty industry? This field could be for you. Nurses who work in medical esthetics will work with clients to perform procedures like chemical peels, botox, collegen injections, laser therapy and spider vein treatments. In today's youth-obsessed culture, these types of nursing jobs are hot and in very high demand. Nurses may find work with a spa or within the office of a plastic surgeon or other medical professional.
- Insurance Nursing. There are a wide variety of jobs available to nurses who choose to work in the insurance industry. From evaluating patient claims to teaching classes to insurance salespeople, you're bound to find something that meets your personal needs and talents. For nurses who enjoy working directly with patients, this may not be the best career choice but for those who also have a passion for business, insurance nursing can be an amazing way to use their expertise.
January 25th, 2011
A number of students are choosing to pursue nursing degrees while they wait for the recession to pass, reports the Daily Titan.
For example, many students enrolled in California State University, Fullerton’s (CSUF) nursing program say that they see their time at the institution as an investment while they wait for the economy to improve.
Atossa Araghian, a CSUF nursing student, is hopeful that the economy is moving in the right direction and told the news source that she believes there will be more job opportunities by the time she graduates.
Mary Wickman, coordinator of pre-licensure programs at CSUF, says that the state of the economy is bringing a number of nurses out of retirement and back into the workforce. Individuals who were working part-time positions are now going full-time.
“Right now what we’re seeing is that there are a lot of hospitals not employing new grads, and they will have many applicants and only a few that are offered jobs because if the available space,” Wickman says.
The hospitals are also suffering. A number of facilities have had to downsize, put a freeze on hiring or shut down due to the economy.
Despite the uncertain uncertain economy, the Bureau of Labor Statistics projects employment of registered nurses to increase by 22 percent over the next eight years.
January 25th, 2011
More students are pursuing careers in the healthcare industry by enrolling in nursing degree programs and other related fields, reports The Daily Times.
According to the news source, interest in New Mexico’s San Juan College’s health science school’s offerings are booming. Originally, a nursing program was the only healthcare-related degree offered. The institution now offers six other tracks, including those that focus on dental hygiene, physical therapist assistant and clinical laboratory technology.
Currently, there are 385 students enrolled in the college’s health sciences school, and more than 700 others are on a waiting list. San Juan officials say graduates of the programs have some of the highest paying and secure jobs.
In addition, the college is halfway done with the construction of a $10 million health sciences building.
Mandy Linker, a student in San Juan’s respiratory program, had already obtained a bachelor’s degree in accounting and management, but had trouble finding a job that paid in her field. Linker hopes that by switching to a healthcare concentration, she will earn a high wage and have job security following graduation.
In 2008, median annual wages of registered nurses were $62,450, reports the Bureau of Labor Statistics.
January 24th, 2011
By Kitty Holman
Pop psychology and the real science it shamelessly parodies have almost nothing in common. Thanks to the self-help vomit spewed forth from the capped teeth of overpolished, dead-eyed social mercenaries, the tenets of actual psychology and actual disorders needing actual medical attention go obscured — if not outright inverted. Unfortunately, far more than only 12 myths perpetuated by pop culture frauds backstroking through the pools of money afforded them by the cult of personality exist out there. It's going to take decades to undo the serious damage they've caused millions of disordered individuals, assuming it can even be reversed in the first place. Education, above all else, makes for the only effective method for dismantling their intense stranglehold on society. Read up on research for a look into how psychology and mental illness actually operate, and the critical danger inherent in believing unfounded rumors and misconceptions.
Just thinking positive thoughts will make the depression all go away: Bobby McFerrin's "Don't Worry, Be Happy" is certainly a memorable, popular song, but many pseudo-psychologists most unfortunately take it so far the put lives at risk. For the tens (if not hundreds) of millions of depression-afflicted individuals worldwide, "simply" thinking positive isn't exactly going to completely reset their brain chemistry, emotional and/or physical trauma or other trigger. Depending on the origin and severity of the illness (and depression is an illness, not the product of listening to too much Dashboard Confessional), treatment options include cognitive and behavior therapy and/or a strict regimen of medications. Perpetuating such a dangerous myth accomplishes absolutely nothing, and serves only to further marginalize the mentally ill in society and trivialize their suffering. It discourages them from seeking the advice of medical professionals, who actually possess the training and skill sets needed to genuinely help the depressed. Patients nursing suicidal thoughts or behaviors especially need the intervention of a counselor, psychologist or psychiatrist. Smiling more isn't exactly going to prevent them from blending up a cerebral daiquiri using a 12-gauge.
Trying to cure clinical depression with happy thoughts is like trying to cure cancer with pony rides.
Opposites attract: In fiction, juxtaposing opposite individuals establishes compelling conflict that moves characters and plots forward with relative ease. In real life, it can result in interpersonal disasters of Hindenburgian proportions. As this Scientific American podcast points out, when it comes to sexual attraction, people feel much more passionate with partners who agree with them on at least 6 out of 10 issues. Long-term relationships stem from being able to share hobbies and ideas, not verbally kicking one another down metaphorical flights of stairs over whether or not the weekend should be spent synchronized swimming or tandem biking. Men and women alike prefer forging close bonds with partners on similar (if not the same) wavelengths regarding religion, education, politics, financial habits and plenty more, with physical attraction only playing a role in the (very) short term. Situations such as speed dating typically lead to future exes rather than future spouses, as emphasis lay more in hooking up with the particularly toothsome — not those with whom one can necessarily strike up an engaging conversation about the collapse of the American hegemony or how mainstream readers typically miss the satirical elements of Jane Austen novels.
The full moon leads to erratic behavior in humans: The moon effects the Earth's tides, gives NASA another reason to exist and fuels creativity in horror and science-fiction writers, but that's pretty much the extent of its non-religious uses. Plenty of scientific studies have entirely negated the myth that lunar phases directly impacts human behavior patterns. Some professionals, especially those in law enforcement and the medical sector, continue to believe that the full moon leads to an upswing in criminal behavior and traumas. While their work may prove particularly busy during one of the twelve full moons of the year, there is a rather easy psychological explanation. Humanity, after all, tends to follow a little pattern known as the "self-fulfilling prophecy." So the next time Babysitter catches Junior trying to shove Baby in the toaster as Luna hangs outside in all her silvery glory, he doesn't exactly have an acceptable explanation to give anymore.
Schizophrenia and Dissociative Identity Disorder are the same thing: The mass media, paragon of flawless research that it is, continues to use diagnoses of schizophrenia and dissociative identity disorder (formerly known as multiple personality disorder) as interchangeable. As with many psychiatric disorders, the two do share some overlap in symptoms. Individuals with DID can harbor personalities that display psychotic tendencies or experience the same auditory and visual hallucinations as schizophrenics, but that does not inherently mean they qualify for a diagnosis. Schizophrenics, on the other hand, may display delusional behaviors — but they rarely (if ever) involve more than one "persons" sharing the same body. As with the earlier depression example, the fact that such a myth continues to permeate popular culture places patients in even more danger. Their families, employers and peers may not understand exactly what's going on, impeding treatment and causing emotional rifts by acting as if the disorders are one in the same.
Humanity only uses 10% of its potential brain power: Self-help opportunists absolutely adore spouting off the idea that people only use 10% of their brain meats, wringing money out of suckers who want to learn the secret of becoming special and beautiful snowflakes with intellects rivaling Nikola Tesla. Meanwhile, in the world of real science, no compelling research exists to prove this statement's veracity. Experts disagree about the specific origins of the myth, though they do largely agree that a mis-attributed quote or concept by Albert Einstein, William James, Pierre Flourens, Karl Lashley or a similar scholar is probably to blame. Dr. Eric H. Chudler at University of Washington points out that damage to every part of the organ still leads to cognitive, neurological or behavioral issue. If humans only used 10% of their brains, then the number of devastating cranial traumas would be far, far lower than reality reveals. Regardless of what those pop psychology, feel-good hacks like to say, humans actually use around 100% of their brains. Yes, even those who throw good money at so-called "motivational" speakers.
A direct correlation exists between personality and handwriting: Just about the only thing psychologists concede to graphologists — the fancy, science-y sounding term for handwriting analysts — is that one can occasionally glean gender just by looking at a few written words. Things like personality tics, appropriate marital or long-term partner or professional future, not so much. Graphology only boasts between a 60% and 70% success rate when it comes to guessing gender, and everything from there on out is around 50% or less. In most respects, handwriting analysis isn't any different from the techniques used in palm reading or pretty much everything John Edward does. It's broad guesswork, with customers filling in their own details. Absolutely no scientific research supports graphology as a valid means of understanding the nuances of one's personality. Anyone really wanting to know about what goes on upstairs is better off working with a legitimate mental health professional.
Anorexics and bulimics only care about being pretty: The myriad myths surrounding the eating disorders, including the oft-overlooked binge-eating disorder (currently classified under "eating disorder not otherwise specified, though this could very well change with the 2012 release of the DSM-V), fill numerous debunking articles alone. One of the most tragic and pervasive, however, frequently stereotype victims as only caring about their looks. By painting them as superficial, pathetic creatures obsessed with their bodies, society marginalizes their very real suffering and precludes many people from feeling any real empathy or sympathy. It also discourages the disordered to come forward with friends and family and seek out the psychological help they truly need to heal. The realities of eating disorders are as varied as the peoples (not only women!) suffering from them. Depression and obsessive-compulsive disorder frequently exist as co-morbid with anorexia, bulimia and EDNOS, and the latter three sometimes crop up as coping mechanisms for the former. Certainly a far different origin than simply wanting to look like a supermodel. Even then, those who cite such a motivation (it happens, it just isn't the only reason) have plenty of other severe psychological issues lurking beneath the surface, but there's still no legitimate excuse for dismissing them or slapping an insulting "shallow" label on the very deep pain.
Expressing anger is healthy: Pop psychologists want their victims to get all the anger out. Go all Oscar de la Hoya on big, soft pillows, they say. Scream like a godforsaken banshee, they say. VENT, VENT, VENT, they say. "Ha!" says real science. Many people fear that suppressing their anger or frustration will eventually turn them into fleshy little Vesuviuses, but legitimate psychological research assures them that reality is the exact opposite. Aggressive solutions to anger only lead to heightened aggressive behavior. Such things program the mind to react even more violently in times of stress and frustration than it otherwise would. Instead, the healthiest route towards assuaging volatile emotions is engaging in more gentle, calming stimuli. Watching light, funny movies or reading their literary equivalents both make for a great start, and are probably the most common anger-mitigating methods. Getting a massage, talking it out, taking a walk and soaking in a lovely hot bath all work marvelously as well. Experiment with a more personalized regime and witness firsthand the huge difference a bit of softness makes.
Therapists only help you because you pay them good money: Every industry has its greedy, selfish and disinterested workers. Nobody demonizes the entire accounting industry because of the legal missteps by Arthur Andersen, yet the whole psychological profession suffers setbacks when controversies such as the Stanford Prison Experiment crop up. As Dr. John M. Grohol points out, the mental health profession doesn't pay nearly as much as most people think. The vast majority of counselors, social workers, psychologists, psychiatrists and psychiatric nurses go into caring for the mentally ill for the exact same reasons anyone else goes into any other medical field. They want to help others live out the happiest, healthiest existence possible. Some even volunteer at suicide hotlines and schools, or offer completely free, confidential services for students and others who may not be able to afford them. If one therapist doesn't work out, every major city and most suburbs host a slew of other options that very well might — though patients must always keep in mind that they themselves will have to put forth the majority of the effort. Counselors, social workers, psychologists and psychiatrists only act as guides rather than definitive cure-alls. They're basically Yoda, and the patients are Luke Skywalker. Any professionals touting their ability to make it all go away with a few bits of advice are best avoided.
Slick self-help "gurus" absolutely adore trashing the mental health industry for reasons one can probably very easily assume.
Psychiatry and psychology are fully interchangeable disciplines: Like schizophrenia and dissociative identity disorder, psychiatry and psychology are often considered pretty much the same thing. Though overlap exists, there are some notable differences in how both fields approach and treat mental illnesses. Probably the easiest way to tell the two disciplines apart is the knowledge that psychologists cannot prescribe medications, while psychiatrists can. Psychiatrists are medical doctors who attended medical school, psychologists are not. In spite of dealing with the same diagnoses, psychologists are more likely to approach patients with tests and cognitive or behavioral therapy. Their MD counterparts, obviously, tend to prescribe pills and medical procedures when appropriate. As one can probably assume, debates do rage over which approach is superior. In reality, though, different therapies heal different patients in different ways. Medication may work for one instance of depression, but inspire suicidal thoughts in another. Behavioral therapy may quell panic attacks in one case, but inflate them in another. Individuals serious about seeking help may have to shop around a few times before deciding whether or not psychology or psychiatry meets their needs best. Before embarking on a treatment regimen, however, they should note that many psychologists and psychiatrists work together. The former sometimes refers patients to the latter when they personally feel as if medication is the only valid solution, though this won't always be the case.
Healthy self-esteem means healthy productivity: Clinical depression is not an extended bout with "the blues" any more than bolstered self-esteem leads inexorably to an improved existence. Again, real psychological studies hack away at the carefully-constructed veneer of toothy, toupéed suits. Studies prove that absolutely no correlation exists between productivity in school or the workplace and heightened levels of self-regard. Any connection they noted was tenuous at best. Individuals with a largely poor self-image were still entirely capable of earning good grades and succeeding in the business world, and their confident counterparts were just as likely to falter or fail. While more severe cases of mental illnesses such as depression and anxiety can sometimes (not always!) cause disruptions in productivity, the whole "self-esteem" thing holds little impact over most people. In fact, some studies showed that artificially-inflated self-image frequently led to individuals considering themselves more entitled than others — many of them went so far as to think themselves above such common courtesies as not manipulating or marginalizing their peers!
Classical music doesn't make babies any smarter: Music and music education both boast a few academic benefits, but queuing up Bach while breastfeeding isn't going to add a few points to Junior's intelligence quotient. Even the woman whose research led to the myth, Dr. Frances Rauscher, doesn't believe such things. What pop psychology dubs the "Mozart Effect" is, in reality, little more than a misinterpretation of her initial findings while with the University of California, Irvine. The study in question discovered a link between piano lessons and reasoning skills. Absolutely none of the research involved had anything to do with prenatal or postnatal babies or the simple act of listening to classical music. All it took was one reader misinterpreting the research to launch one incredibly pervasive myth. On the positive side, though, it at least got more people to start listening to and hopefully appreciating classical music.
January 23rd, 2011
Educational opportunities exist for individuals who have an interest in careers in healthcare, but hold a bachelor’s degree in another field. For instance, Montana State University (MSU) plans to offer an accelerated nursing program.
Students who pursue the university’s College of Nursing’s accelerated bachelor’s degree will be able to complete the program in 16 months, rather than the usual 29.
Interested individuals must have completed the same prerequisite courses as those in the non-accelerated nursing track.
Helen Melland, dean of the College of Nursing, views the program as a “wonderful and efficient” way for students from other disciplines to begin a second career. She adds that the university has already received a number of applications for the 16 available slots.
The first class of accelerated nursing degree students will begin taking classes in the summer of 2011, and be on track to graduate the following summer. They will be eligible to take the national licensing examination upon completion of the program.
Melland believes this offering will help ease the shortage of healthcare workers in Montana and other states.
The accelerated degree option will be available at MSU’s College of Nursing’s Bozeman campus. School officials say the program may expand to the institution’s other locations in the coming years.
January 23rd, 2011
Several New Jersey community colleges have announced plans to offer a nursing degree completion program on their campuses through a partnership with Kean University.
The plan’s framework will allow students who hold an associate degree in nursing from a community college to transition to Kean where they can complete a bachelor’s.
Community colleges involved include Bergen, Ocean County and Raritan Valley. Each of these institutions are in varying stages of partnering with Kean.
In the spring of 2011, associate degree holders who graduated from one of the three participating institutions will be able to enroll in the Kean partnership at their community college. To be eligible, students must have a grade point average of at least 2.0 in addition to a New Jersey nursing license. They will also be required to complete 125 credits.
“This is another example of New Jersey’s community colleges coming together in a statewide way to solve a statewide challenge,” said Dr. Lawrence Nespoli, president of the New Jersey Council of County Colleges.
Essex County and Middlesex County Colleges, which helped design the plan, are currently reviewing the nursing degree completion program on their campuses.
January 23rd, 2011
In the fall of 2011, the use of simulation methods in multiple prelicensure nursing programs will be studied across the country.
The National Council of State Boards of Nursing (NCSBN) will conduct the study to evaluate and highlight the best practices in simulation use. Students from five associate and five baccalaureate degree programs will be monitored from their first day of school, through graduation and into their first year of practice.
Among the 10 study sites are Florida International University, Johns Hopkins University and Washington State University.
Nursing degree students from the 10 institutions will be randomly assigned to one of three groups. If a school’s particular program typically devotes 10, 25 or 50 percent of its time to training at clinical sites, for the sake of the study, that time will now be spent in simulation.
A study team comprised of faculty and staff will be located at each of the participating institutions. It is the responsibility of these groups to monitor students several times over the course of the study.
“Information that will be gained from this research is desperately needed by nursing regulators and educators, and will impact the future of nursing education,” says Jennifer Hayden, the simulation study project director.
Following the completion of the study, researchers from NCSBN will compare the effectiveness of clinical and simulation exercises.