Conquer 6 Types of Nursing School Anxiety

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Nursing school is an intense environment with high-stakes events and assessments happening almost every day. What this usually means is that students have multiple sources of anxiety, which can lead to feelings of stress, overwhelm, depression, and burnout. The good news is, that once you recognize these sources and have a plan to meet them head-on, you can lower your anxiety and maybe even start to enjoy nursing school!

The key sources of anxiety for nursing students are:

• Math anxiety
• Test anxiety
• Anxiety about clinical
• Anxiety in skills lab and with skills check-offs
• Sim lab anxiety
• Workload anxiety

Math anxiety in nursing school

Math anxiety is defined as a feeling of tension, fear, or apprehension that interferes with the ability to perform math calculations. Unfortunately, this feeling of anxiety uses up your working memory, making it very difficult to think through problems. The reason math anxiety is of genuine concern in nursing school is because you will need to pass a nursing math exam with a very high grade in order to stay in the program. This exam is typically administered early on in the first semester, and then again at the beginning of each semester. In most cases, the cutoff is 90%, but I’ve seen instances where schools require 95 or even 100% scores on this crucial exam. 

So, what is this math exam all about? Dosage calculations, my friend. For example, you are faced with a situation where you have an order to administer 0.2 mg per kg of medication for your patient who weighs 98 pounds. The medication comes in a 10 ml vial containing 20 mg of medication. You need to be able to figure out how many ml you will administer.

You’re not the only one with math anxiety

Now, before you start thinking you’re the only student with math anxiety, I want to assure you that you are not alone. In fact, studies show that 93% of adults experience some level of math anxiety, and 1 in 5 adults in the United States report experiencing severe math anxiety. And, to make you feel even better, emerging research shows that students with math anxiety are actually average to high math performers. In other words, having math anxiety does not mean you are bad at math or incapable of learning how to solve dosage calculations with total and complete accuracy.

How to combat math anxiety for nursing school

The first thing to do when combating math anxiety is to reframe how you talk to yourself. Instead of saying “I am bad at math” or “I am going to fail this exam,” think of how you can shift that to say something that’s more positive but also true. For example, “I am practicing math and feeling more confident every day” or “I am open to learning how to do math without fear.” 

Next, it’s vital that you break the math cycle of failure, which I talk about in more detail here. This involves practicing regularly, which leads to a more positive math experience (in other words, doing well on an exam). And just like that, the math cycle of failure is broken, and your math anxiety is drastically reduced! If you’re not sure where to find dosage calculations questions, I include ten practice questions in my free Dosage Calculations Guide.

Test anxiety in nursing school

Another closely related type of anxiety in nursing school is test anxiety. Even the most prepared student can start to panic during an exam. It’s what you do next that determines if test anxiety is going to take over or if you’re going to get past it and calmly continue with the exam.

The key is to recognize test anxiety as soon as those feelings start to creep in. This can include a rapid heart rate, sweaty hands, a feeling of dread, constantly checking the clock, a rush of adrenaline, tremors, and reduced comprehension (which often manifests as reading the question over and over again without understanding what it’s asking).

I dive into what you can do to put the brakes on test anxiety in this article, but here are the highlights: 

• Pause and take a few breaths
• Reframe your negative self talk
• Release pent up energy by tensing and releasing  your muscles (especially the shoulders!)
• Resume the test with clarity and intention
• Slow down and read each and every word of the questions
• Make sure you read all the answers before choosing one

Nursing school anxiety about clinicals

As a clinical instructor, I’ve seen firsthand how this environment causes anxiety in students – especially first semester students. The first thing I want you to know is that this is completely expected! You are in an entirely new environment, interacting with real patients, and it’s actually a good thing that you’re a bit nervous here. It means you understand the importance of what you are learning and this can help make you a careful and conscientious nurse. But, when anxiety becomes too intense, it can actually hinder your performance. So let’s talk about tactics you can use to lessen your clinical anxiety. 

Prepare in advance – Some clinical sites allow students to come in the day before to select patients, which means you have plenty of time to look up your patient’s specific conditions and medications. But more and more clinical sites are stopping this practice so students must show up and choose their patients at the start of their day. This can be especially nerve-wracking for new students who have limited knowledge and aren’t used to caring for patients. 

Even if students aren’t able to select patients in advance, students usually do know which units they are assigned to each week. Take some time to brush up on key medical conditions you might see on that type of unit as well as some common medications utilized. 

For example, if you’re assigned to a neuro unit, review the care of stroke patients and common drugs such as antiseizure and antiplatelet medications. If you’re assigned to an ortho unit, review the post-surgical care of a patient who has undergone hip arthroplasty and common drugs such as antibiotics, pain medications, and anticoagulants. 

Chances are you don’t have time to read extra chapters in nursing school, but you can still review disease conditions you haven’t learned in class yet. A great way to do that is to listen to episodes on the Straight A Nursing podcast, or get quick video tutorials and downloadable study guides with my program, Med Surg Solution. Both are great ways to prepare before clinical so you can walk into your patient’s room with confidence!

Plan your day – Take a moment at the start of the shift to get familiar with your patient. A great place to start is with the most recent physician progress note and end-of-shift nursing summary. It’s also important to look at their active orders. This information will give you a good overview of the patient’s problems and the things that are being done to address them. Use this data to plan your day. 

For example, if you see that your patient has orders to be out-of-bed for meals, you can plan to spend some time helping them to the chair before the meal trays arrive. If they need blood glucose checks, you can write those down on your shift schedule, too. Other things to plan in advance include routine tasks such as repositioning, oral care, and dressing changes. 

One quick note about plans is that even the best plans usually fly out the window when unexpected things come up. Know that this is likely to happen and that you’ll need to continually be reassessing your patient and your plan as you go. 

Share your concerns – If you’re particularly anxious or nervous about something, share this with the nurse you’re working with or your clinical instructor. We’ve all been there and can help you see through your fear to approach new situations with more confidence. Remember we all want you to succeed!

Skills lab anxiety

Skills lab is actually a really fun and engaging environment where you learn how to do hands-on skills such as nasogastric tube insertion, medication administration, dressing changes, and bathing. A few key skills require what’s called a “skills checkoff” and these can be anxiety producing simply because they are considered high-stakes assessments. In other words, you only get two or three attempts before you receive a failure for the entire course. In the program I attended, skills checkoffs were conducted for taking vital signs, conducting a head-to-toe assessment, inserting a Foley catheter, and administering medications. 

The key to handling skills lab anxiety is to prepare, prepare, prepare! This means practicing the skill you are being evaluated on over and over again. Print out the checkoff list and have a classmate or friend observe you performing the skill to ensure you hit all the required elements. You can even record a video of yourself practicing the skill and then reviewing it to ensure you’re ready for your checkoff evaluation.

For more tips on surviving skills lab, check out this post here.

Nursing school anxiety about sim lab

Sim lab is another source of potential anxiety in nursing school. The fear of looking like you don’t know what you’re doing in front of your peers and professors, combined with the fear of doing the wrong thing and accidentally killing your simulated patient, are definitely valid. But, with the right preparation and attitude, you can turn this anxiety-producing experience into a fabulous learning opportunity. 

The key to doing well and feeling confident in sim lab is, of course, to prepare. You should know in advance what the overall theme of the lab will be, But if you don’t, here’s a hint. It will likely be related to the content you are currently learning in your Med Surg class. Take some time to review your notes before you attend the simulation, and you’ll definitely feel a lot more confident. 

The other factor in feeling less anxious in sim lab is knowing what to do. And that, my friend, is as easy as following the nursing process, which always starts with assessment. For a deep dive into using the nursing process in sim lab, check out this post here.

Workload anxiety in nursing school

Another big factor in nursing school anxiety is the workload, which can definitely be intense. Your best defenses against workload anxiety are to get supremely organized and use some kind of planning system to manage your time. I go into this in great detail inside my nursing school prep course, Crucial Concepts Bootcamp, and I’ll share a few highlights with you here: 

• Take time before the semester begins to organize your digital filing system, and all your nursing school paperwork. I cannot stress enough how beneficial this will be and how much time it saves overall.
• Take some time to learn how to navigate your school’s learning management system (such as Canvas). 
• Use some kind of planning system that allows you to make lists and block out time. I’m a huge fan of paper planning systems, but you can also achieve this with a digital planning system if you utilize it correctly. What I find most useful about a paper system is it gives me the ability to easily see what tasks or exams I have coming up so I can plan accordingly. If your digital system makes this easy, then by all means, keep using it! 
• Be very protective of your time. This means identifying and removing time wasters and minimizing distractions. In many cases, this means avoiding large study groups, removing apps from your phone, and setting up a designated study space that helps you maximize your focus.
• Avoiding overstudying, which not only wastes time but also ramps up your anxiety. If you find that you are reviewing material you already know, it’s time to stop and move on to something else.

I hope these tips on recognizing and managing nursing school anxiety help you feel less stress and more confidence in your program!

Last Updated on January 6, 2025 by Maureen Osuna, MSN, RN