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If you’re in your first semester of nursing school and struggling on exams despite putting in serious study time, I want you to hear this first: the problem is almost certainly not your effort, your intelligence, or how much you care. It’s most likely how you’re engaging with your studying, which is actually great news, because it’s fixable.

Over the years I’ve seen students struggle and students thrive, and what becomes clear pretty quickly is that the students who struggle tend to repeat the same handful of mistakes. It’s NOT because they’re lazy or unmotivated but because they don’t know the approach necessary to doing well in nursing school is different from what they’ve done to succeed up to this point.

Here are six of the most common first semester mistakes I see, and of course, what to do differently.

Mistake #1: Studying Only Before Exams Instead of Building a Weekly Rhythm

For most of us, exam-driven studying is the default. You have a test coming up, you study for it, you take it, you move on. That system worked fine for microbiology and A&P so of course it feels like the natural approach in nursing school too.

Here’s the problem: in nursing school, there is no such thing as a “regular week” versus an “exam prep week.” Every single week, you are learning new material that builds directly on something you learned last week, or last month. If you only engage with content right before an exam, you’re trying to process weeks of layered, progressively complex information in a matter of days.

Your brain simply doesn’t work effectively that way. Memory consolidation — the process of moving something from short-term memory to long-term memory — takes time and repeated exposure. A six-hour cram session the night before an exam cannot shortcut that process.

What does work is building a consistent weekly rhythm where you engage with the material regularly in smaller, more focused sessions. Students who do this walk into exams feeling like they actually know the material. They didn’t log more total hours, the gave the material more time to stick. I call it letting it percolate. You learn something, you let it sit, you come back to it, and every time you do, it gets a little more solid.

Exam-driven studying keeps you in permanent reactive mode: high cortisol, high stress, always behind. Consistent studying puts you in control. And knowing when to stop studying for the day? That’s one of the most underrated skills you can build as a first semester nursing student.

Mistake #2: Taking Passive Notes and Calling It Studying

This one is sneaky because it looks a lot like studying from the outside. You’re in lecture, you’re following along, you’re highlighting slides and scribbling in the margins. Your notes are covered in color and annotations. It feels thorough and productive.

But here’s the thing: annotating someone else’s words is not the same as learning them.

When you scribble a note on a slide in the moment, your brain does the minimum amount of work. It can recognize that information, but it doesn’t have to retrieve it, reorganize it, or explain it, and those are the actions that actually build real, lasting memory.

The shift is to do what I call “active rewriting”. This doesn’t mean copying every single thing. It means taking what you just learned and putting it into your own words in a format that actually makes sense to you. Write it out as though you’re explaining the concept to your best friend. Use a mix of paragraphs and bullet points and don’t make it sound like a transcript – it should feel coherent.

When you do this, your brain has to reconstruct and organize the information. It has to organize it. As you do this, you’ll quickly notice exactly where you’re fuzzy because you won’t be able to explain what you don’t actually understand.

I hear it all the time: “I didn’t have time to rewrite my notes.” But what students often don’t realize is that the rewriting is the studying. It’s not a bonus step. It’s one of the highest-value things you can do with your study time.

Mistake #3: Waiting Until You “Feel Ready” to Do Practice Questions

The instinct here makes total sense. When you’re still learning respiratory disorders, jumping into practice questions before you feel solid on the material can feel like showing up to an exam without studying. Because of this, students are more likely to learn the content, review the notes, and only start those practice questions on the night before the exam.

The problem with that approach is two-fold. First, that feeling of readiness often doesn’t actually come. Second, waiting means you’ve spent your entire study period in one mode: reading and reviewing. You’ve never practiced the other thing nursing school is testing, which is thinking mode.

Nursing school exams are not testing whether you’ve memorized something. They’re testing whether you can use what you’ve learned. Can you apply it in a patient scenario? Can you prioritize correctly when there are distractors? Can you perform under pressure?

That is a skill, and like any skill, it requires practice.

Think of NCLEX-style questions not as a self-test to see if you’re ready, but as a learning tool. Getting a question right is great. Getting one wrong is actually better because then you can read the rationale, understand why the wrong answers were wrong, and learn something you wouldn’t have learned from your notes alone. This process is clinical reasoning. Start doing practice questions early, do them consistently, and always review the rationales.

Mistake #4: Memorizing Nursing Interventions Without Understanding the Why

This one is closely related to the last, but it shows up in such a specific and common way that it deserves its own spotlight.

When students are learning nursing interventions (all the things a nurse does for a patient), there is a very strong pull to memorize the list. Totally understandable. Memorization is familiar – we all did a lot of it in A&P. Interventions can feel mysterious when you’re new, so defaulting to “I’ll just memorize what to do” feels safe.

Unfortunately, if you only know the what without understanding the why, you’re going to run into problems on your exams and eventually at the bedside.

Here’s a quick example. If you’re learning about left-sided heart failure and you know you need to monitor respiratory status, that’s good. But why? Because when the left side of the heart isn’t pumping effectively, fluid backs up into the pulmonary vasculature and causes pulmonary congestion. So oxygen levels, work of breathing, lung sounds, and respiratory rate all need to be watched closely, because respiratory compromise is the most immediate threat to this patient’s safety.

When you understand it that way, “monitor respiratory status” isn’t a memorized line on a list. It’s a logical response to what’s happening in the body. Logic transfers to scenarios you’ve never seen before while memorized lists do not.

As you work through nursing interventions, get in the habit of asking yourself: Why does this make sense? What’s happening in the body that makes this the right thing to do? Once you start thinking that way, you can’t undo it. That’s thinking like a nurse, and it makes everything easier.

Mistake #5: Treating a Poor Exam Score as a Verdict

First semester is often the first time nursing students study hard for something and still don’t get the grade they expected. It can be genuinely devastating walking out of a test knowing you prepared and not getting a score that reflects it. Some students start questioning whether they’re cut out for nursing school, while others spiral into a place that’s really hard to come back from.

That feeling of defeat is real and it’s incredibly common. But it doesn’t have to be your reality.

A poor exam score is not a verdict, it’s data. It tells you that there’s a gap between how you prepared and what the exam was actually testing. That score is not telling you that you lack intelligence or potential.

The students who improve fastest in nursing school are the ones who treat every exam as feedback. They go back through the material they missed and ask two questions: Was this a content gap (I didn’t actually know this material) or a thinking gap (I knew the facts but struggled to apply them in a clinical scenario)? Those are two different problems with two different solutions.

A content gap means go back and review the material. A thinking gap means what you need isn’t more memorization, it’s more NCLEX-style practice and clinical reasoning.

There’s also a third type of gap worth knowing about: the test mechanics gap. This is when you go back and realize you changed right answers to wrong ones, or missed qualifying words like “priority” or “first” that completely changed the meaning of a question. If that’s the pattern, the fix is slowing down and managing test anxiety – not studying more.

A bad exam score isn’t a failure. It’s an opportunity to recalibrate.

Mistake #6: Letting Anxiety Drive Your Study Decisions Instead of Having a System

This last mistake underlies all the others. It’s letting anxiety run in the background of everything in nursing school, allowing it to make decisions for you.

Anxiety-driven studying looks like this: You feel behind, so you study everything. You feel uncertain, so you stay up later. An exam is coming up, so you abandon your schedule and go into panic mode. You get a question wrong and spiral. You see what someone else is doing and suddenly feel like you need to do what they’re doing or you’ll fall behind.

Anxiety is not a study strategy. It’s loud and convincing, and it can have you spinning your wheels for hours while making very little actual progress. Our brains simply don’t work well in a highly anxious state.

You can combat anxiety with a system; a set of decisions you make in advance, when you’re calm and thinking clearly. That way, when anxiety shows up, you don’t have to negotiate with it. You just follow the plan.

Think about BLS. The reason you can respond to an unresponsive patient without completely panicking is because you have a system to follow. You know what to do. Nursing school works the same way. A system might look like: every Sunday evening I map out what I’m going to study, when I’m going to study it, and what my goals are for each session. When I miss a question, I have a specific process for figuring out why. I know which resources I’m using and what I’m doing next.

Anxiety doesn’t just disappear once you have a system in place, but it loses it’s power over your decisions. There’s a lot in nursing school that is genuinely stressful, but with a system, you’re not studying because you’re scared. You’re studying because it’s Tuesday at 4 p.m. and that’s what Tuesday at 4 p.m. looks like in your system.

That shift from reactive to intentional, from anxiety-driven to systems-driven, is entirely learnable.

Here’s What All Six of These Have in Common

Look at this list as a whole: studying only before exams, passive note-taking, avoiding practice questions, skipping the why behind interventions, treating a bad grade as a verdict, letting anxiety run the show.

Notice what’s not on the list? Not working hard enough, not caring enough, not being smart enough.

Every single one of these is about how you’re engaging with nursing school, not whether you have what it takes. They’re default habits, familiar responses to an unfamiliar environment. And when nobody hands you a different approach, it makes complete sense that you’d fall back on what’s always worked before.

Now that you know the reality of the nursing school environment, and the level of intentionality required, you can do something about it.

Ready to Build That System?

If any of this hit home, that’s a good thing. Awareness is always the first step.

The next step is actually doing something with it. If you want a solid place to start, grab my free Nursing School Survival Blueprint. It walks you through how to build the kind of intentional weekly approach I talked about in this post: studying with purpose, reducing the chaos, and actually feeling in control of your nursing school experience. It’s free and it’s practical, and I made it specifically for students who are ready to stop surviving and start building something solid.

And if you want to go deeper on the clinical thinking piece, learning the foundational concepts that make everything else in nursing school click, that’s exactly what Crucial Concepts Bootcamp is all about. Whether you’re heading into your first semester or trying to turn things around after a rough start, Bootcamp will give you the tools to think like a nurse from day one.

Get the nursing school survival blueprint

The information, including but not limited to, audio, video, text, and graphics contained on this website are for educational purposes only. No content on this website is intended to guide nursing practice and does not supersede any individual healthcare provider’s scope of practice or any nursing school curriculum. Additionally, no content on this website is intended to be a substitute for professional medical advice, diagnosis or treatment.

References:

Cepeda, N. J., Pashler, H., Vul, E., Wixted, J. T., & Rohrer, D. (2006). Distributed practice in verbal recall tasks: A review and quantitative synthesis. Psychological Bulletin, 132(3), 354–380.

Slamecka, N. J., & Graf, P. (1978). The generation effect: Delineation of a phenomenon. Journal of Experimental Psychology: Human Learning and Memory, 4(6), 592–604.