by Gannon Tagher, EdD, MSN, RN, APRN
Nursing students experience a high level of stress and anxiety throughout their education. In fact, nursing students experience more anxiety, especially test anxiety, than students from any of the healthcare disciplines (Turner & McCarthy, 2016). Many factors contribute to stress and anxiety in nursing students. Students in nursing programs often have other competing priorities, which can lead to higher stress levels. Because of decreased financial aid, many students struggle to pay for classes; therefore, they have to work while attending nursing school to make ends meet (Turner & McCarthy, 2016). Having to balance didactic and clinical courses while simultaneously balancing financial, family, and other life issues has the potential to exacerbate any stress or anxiety caused by the nursing program alone. The high rigor of nursing curricula also leads to stress and anxiety, because failure in either a course or a program results in lost time and investment in the student’s education, which in turn causes a delay in future earning potential (Tagher & Robinson, 2016).
Unfortunately stress and anxiety can have a myriad of negative effects on a student, which faculty see daily. Stress can affect health, memory, problem-solving, and the ability to cope, all of which can lead to decreased academic performance (Goff, 2011). Subsequently, decreased academic performance can lead to higher stress levels, catching the student in an unhealthy cycle of distress. Fortunately, faculty and administrators can implement many strategies in nursing programs to help decrease stress in students.
Learning how to take a nursing examination appears to be one of the biggest obstacles to success for new nursing students. Nursing questions are rarely straightforward and require students to think critically rather than pull from memorized content. How many times have you heard from a student “I can get it down to two answers, but I always choose the wrong one?” Helping students understand how to read questions, pick out pertinent material in the stem, and truly understand what the question is asking can help to mitigate some of the stress associated with course examinations, especially in the first year of the program. Group practice questions in class, along with discussion of the questions and answers, can give faculty insight as to where the students are veering off course. Test review for students can also be critical to fostering their understanding of how to read questions and why they may be drawn to incorrect answers. While this process can be time-consuming for nurse educators, especially in the Fundamentals course, it can make a difference in student success, potentially if it helps to reduce their stress during later courses.
Along with learning how to take nursing examinations, acquiring study skills for deep learning seems to be another challenge that causes stress for nursing students. Students enter nursing programs used to learning for memorization, taking the test and moving on, often forgetting the material they learned. I have seen students making flashcards for unit exams, simply trying to memorize information and hoping to pass the test. Studying in this manner, students can often squeak through the program until the final semester or two in which they are required to synthesize information they have learned throughout the program.
To help decrease the stress and anxiety students experience and to promote study skills, faculty should encourage students to form study groups before the first nursing examination. For participants, study groups often become support systems that last throughout the nursing program. Encouraging senior students to mentor first-year nursing students can also have many benefits. Such mentoring can help first-year nursing students acquire the study skills needed to be successful in the program. Peer mentors can encourage students to look up unknown information when reading question rationales, rather than simply reading them and moving on. This type of study can promote deeper learning than memorization. Additionally, peer mentoring has other benefits by providing an outlet for support and promoting connectedness, which can decrease stress and foster academic success (Lombardo, Wong, & Sanzone, 2017).
Clinical experiences are another stressor for nursing students. Remember what it was like to walk into a patient’s hospital room for the first time? Students are terrified of doing something wrong. Today, simulation can help ease the stress associated with the clinical experience. Faculty can use simulated scenarios with either high-fidelity simulators or standardized patients to help familiarize students with clinical situations prior to their first clinical experience (Turner & McCarthy, 2016).
In addition to stress related to courses, examinations, and clinical experiences, perceptions of faculty attitudes can cause anxiety for students. When students perceive that their faculty care about student success, stress levels are decreased. Conversely, students become more stressed when they perceive that a faculty member is not being objective or fair. Additionally, students are more stressed when they perceive that a faculty member is disorganized or not knowledgeable about the content (Torregosa, Ynalvez, & Morin, 2015). Nursing faculty should be aware of how they communicate with students, striving to convey a positive and caring attitude.
Nursing curricula are stressful and tend to cause anxiety for many students. It often seems as if nursing students are just stressed in general. However, there are a variety of ways to promote stress reduction, both formally and informally, throughout nursing programs. Nursing faculty should be cognizant of the stress experienced by their students and encourage activities to mitigate stress and foster success.
Goff, A.M. (2011). Stressors, academic performance, and learned resourcefulness in baccalaureate nursing students. International Journal of Nursing Scholarship, 8(1), 1–20.
Lombardo, C., Wong, C., Sanzone, L., Filion, F., & Tsimicalis. (2017). Exploring mentees’ perceptions of an undergraduate nurse peer mentorship program. Journal of Nursing Education, 56(4), 227–230.
Tagher, C.G., & Robison, E. (2016). Critical aspects of stress in a high stakes testing environment: A phenomenographical approach. Journal of Nursing Education, 55(3), 160–163.
Torregosa, M.B., Ynalvez, M.A., Morin, K.H. (2016). Perceptions matter: Faculty caring, campus racial climate, and academic performance. Journal of Advanced Nursing, 72(4), 864–877.
Turner, K. & McCarthy, V.L. (2017). Stress and anxiety among nursing students: A review of intervention strategies in literature between 2009 and 2015. Nurse Education in Practice, 22, 21–29.