Test anxiety can happen to anyone at any time. Even if you never had test anxiety during your pre-requisite courses, it does not mean you are immune to it in nursing school. In fact, a study conducted in 2009 showed that nursing students experience test anxiety at higher rates than other majors. Why is that? Aren’t we all super high-performing individuals with brains for days? Absolutely…but nursing school test anxiety has nothing to do with being smart. Here’s why.

The nursing school grading scale is brutal

Remember the good old days when a score of 90-100 was an A, and 80-100 was a B? Nursing schools often use a seven-point scale instead of this traditional ten-point scale, which is a key contributor to test anxiety. Using this scale, a 93-100 is an A, 85-92 is a B, and a C is 77-84. And don’t even think about getting below a 77%, because anything below a C in most nursing programs is FAILING. Can you imagine walking into an exam knowing you MUST score above a 77% no matter what? Yep, huge potential for test anxiety for this reason alone. 

Exit exams can be really scary (if you let them!)

Maybe you’ve heard nursing students talking about exit exams such as the ATI or HESI. These exams are often required at the end of each semester before the student can progress. Schools will require a certain score on these exams and students must reach this score within a pre-determined number of attempts (usually three), or be failed from the program. 

What makes these exams so special is that they are used to predict whether or not a student will pass the NCLEX. Schools rely heavily on these exams to weed out students who aren’t likely to pass the licensing exam while at the same time giving students a lot of practice with NCLEX-style examinations. Why do they care so much if you pass your NCLEX if you’ve already graduated from the program at the time you take it? Because each school’s reputation depends on their NCLEX pass rate, as does their accreditation status. These exams are a VERY big deal and a monumental source of stress for many students.

Information overload contributes to nursing school test anxiety, too!

Nursing students must learn massive amounts of information in order to care for patients safely and in order to pass a multitude of tests, which include skills check-offs, course exams AND the aforementioned exit exams. The amount of material presented each week is enormous. I often look back at my nursing school binders and am shocked I ever held that much knowledge in my head. When you must know SO MUCH information and more is added on each week, it can be easy to believe that you’ll never know enough to do well on exams. 

You associate grades with your personal worth

Many nursing students are fiercely competitive and identify as high-performing individuals. To not do well on an exam would challenge that core belief. As such, every test becomes a high-stakes event that does more than define how well the student knows the subject…it defines the student’s sense of identity and sense of personal worth. That’s your mind playing games with you!

Fear of disappointing others

Every nursing student I’ve ever met has worked incredibly hard to get admitted to their program and expectations are high. Maybe it’s a student who has two kids and another on the way…now there’s an entire FAMILY depending on you to graduate. Or, perhaps it’s your parents, friends or extended family…all the people who have been your cheerleaders over the past few years. They’ve done so much to help you get where you are today and you’d hate to disappoint them. Talk about stress! 

Fear of the unknown can cause nursing school test anxiety

Many students enter the exam room without fully understanding what types of questions will be on the test of if they studied the correct content in the most efficient way. Should they have done practice questions or flashcards? Would it have been better to do case studies or watch YouTube videos? Is the lecture on the treatment of burns going to require calculations? What medications will be included? It can be incredibly stressful to walk into an exam with so many questions running through your mind. 

Timed exams

The NCLEX is a timed exam, so guess what? So are your exams in nursing school. Hearing “you have two hours to complete the exam” sends you straight into math mode…if the exam has 60 questions and you only have 2 hours to complete it, that’s two minutes per question. Is that enough time? What if you get stuck on a question? Should you skip it and come back later? Are you even allowed to go back to revisit questions? Is it better to guess and move on, or spend more time on the more difficult questions? And on and on it goes. Many students are so worried they won’t finish the exam on time that they waste a ton of time doing this “exam math” rather than buckling down and working through the questions. 

What are you going to DO about nursing school test anxiety? 

In addition to studying efficiently, organizing your time, prioritizing your activities and maximizing your understanding of material (versus just memorizing it), there are several techniques you can use to help lessen your nursing school test anxiety. 

  • Identify and replace negative self talk. When you catch yourself saying, “I don’t know this” or “I am guessing” or “I am going to fail” replace it with a more positive, self-affirming phrase such as “I prepared well and I’m doing my best.” 
  • Deep breathing. Inhale through your nose for a count of ten, filling up every part of your lungs. Feel the air press your lungs out in all directions as you fill from the bases to the upper lobes. Exhale through your nose for a count of ten, deflating your lungs from the top down and pulling your belly in at the bottom of the exhale. Do this five to ten times before you begin your exam and imagine the stress leaving your body with every exhale. 
  • Tense and release. With your feet flat on the floor, grab the underside of your chair with your hands. Push down with your feet and pull up on the chair simultaneously for a count of five. Release and relax for a count of ten. Repeat two to three times. 
  • If your exam shows a timer indicating how much time remains, see if there is an option to hide this from your view. Seeing tick tick tick as the time slips away from you can cause a heightened sense of anxiety. Instead, use a regular clock to monitor how much time you have left.

Get this on audio in Episode 67.

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References

Brodersen, L. D. (2017). Interventions for Test Anxiety in Undergraduate Nursing Students: An Integrative Review. Nursing Education Perspectives38(3), 131. https://doi.org/10.1097/01.NEP.0000000000000142

Driscoll, R., Evans, G., Ramsey, G., & Wheeler, S. (2009). High Test Anxiety among Nursing Students. Retrieved from https://eric.ed.gov/?id=ED506526

Nolting, P. D. (2000). Math Study Skills Workbook, Your Guide to Reducing Test Anxiety and Improving Study Strategies. Retrieved from http://www.unm.edu/~adurakie/unm_template/common/docs/TEST%20ANXIETY.pdf

Shapiro, A. L. (2014). Test anxiety among nursing students: A systematic review. Teaching and Learning in Nursing9(4), 193–202. https://doi.org/10.1016/j.teln.2014.06.001

The Princeton Review. (n.d.). 10 Ways to Overcome Test Anxiety. Retrieved from https://www.princetonreview.com/college-advice/test-anxiety