The problem, as far as we've worked it out, is threefold:
1. Nursing school, and its methods of evaluating knowledge, bears no resemblance to anything else on the planet. Even if you've done well in school before, you're unlikely to do well on the first one or three or six quizzes or tests you take, simply because the testing format is so strange. By "strange" I mean "all the questions come in an NCLEX format and that's freaky as hell."
Query one for Faithful Minions: How do you work out the correct answer when faced with NCLEX-style questions? How is this process different than it was in, say, English class or Biology 101?
2. Screwing up tests and quizzes makes one fearful and anxious of doing it again. This leads to test anxiety, which is a true black, shaggy bitch on your shoulder.
Query two for Faithful Minions: How do you get rid of test anxiety?
3. Screwing up tests and quizzes makes one feel idiotic and unmotivated. Never mind that nursing school is like unto nothing else on the planet except maybe a bad Surrealist novel; it's still happening.
Query three for Faithful Minions: How do you get your mojo back and stay motivated in the face of fuckups?
I have to confess: as my memories of nursing school get foggier, my ability to say anything sensible on this subject dwindles. I'm putting it out there for you guys with the certainty that somebody else will be able to deliver in the brilliance department.
Git to it.
31 comments:
I'm actually rather good at answering many NCLEX-type questions...the trick is to think "what have they given you over the semester as the ABSOLUTE STEREOTYPICALLY PERFECT NURSE? What would SHE do?"
Aka- she would NEVER leave a pt. to call the doctor, she would ALWAYS think safety first, and she would never say ANYTHING that would upset someone.
On top of that, you can usually knock out any answer that involves letting anybody else 1. assess 2. teach or 3. do ANYTHING with your pt. for the FIRST time.
As for the anxiety piece: Just find your local CBT therapist and put a few weeks in. Hell, if there's a university nearby, the Psychology Department may run a community clinic staffed by grad students. If they do good CBT anxiety work based on research evidence, there's a good chance they'll help your FM knock out that anxiety in a matter of 15-20 sessions.
I'm in my Junior semester. It doesn't get easier but you do start to find a rhythm to the tests. The questions seem to have a hidden question inside a question. You have to stop and think what are they really trying to ask me? Eliminate two as usual and then usually the other two are your choices.. I stay stressed out :) OMG I can't another year of this either !!! I'm losing my hair literally.
Practicing Nclex questions while I study helps me to find that rhythm... As for anxiety ... I haven't a clue !!
The key to success is a strong study group. It can be one or as many as needed. Practice questions on each other and from books until your head wraps around the style of questions. Review what you missed and stive to do better. Over time you get practiced at how future questions may be worded and you slowly adjust.
You are going to flub up in the start, but how you adjust and learn what is expected of you will lead to the promiss land. School is rewiring how you think - so all yourself to be re-wired. And eat lots of fatty food, drink loads of coffee and bitch to anyone who will listen.
1. Get NCLEX books and start reading and studying how they ask questions, they even have practice tests you can do on the computer. Look at the questions in the area you are studying in school, like cardiovascular or GI. I started doing this after the first year of nursing school, should ahve done it sooner.
2. Anxiety happens in life, and it happens daily in nursing. Time to learn how you deal with it, we all have our own ways.
3. I stayed motivated by the goal of finishing and being able to get a job just about anywhere. I wanted out of frozen MN and to warmer weather. Keep posters of goals and people you know it will benefit in the long run by you becoming a nurse.
I TOTALLY second David on the NCLEX book thing. It also helps to take those questions and use them to figure out what you DONT know
NCLEX answers: First of all there will be 3 right answers, and you have to choose the best of the 3. If one of them says never or always, odds are that it is wrong. If it is not a nursing intervention, e.g. call the doctor, it is probably wrong. How do you pick the best of the 3. It might be the most detailed. For example, for teaching a patient, it will give the most information that is also accurate. Although all may be true, one may be more specific the circumstances, or the question asked. Another way to pick among the three is to choose the one that is highest priority. Which one would you do first? This depends on how the questions is phrased. You have to be able to tell whether they are asking which one to do first, or which one is most important for overall treatment. Things that you usually do first: Put on oxygen, get a set of vitals, stop an IV, even if what they really need in the next 20 minutes is a medication, or a medical intervention, or . When things are going south, you usually still need a good focal assessment in order for you and medical staff to decide on a treatment plan. Odds are the right answer is NURSING intervention, done by a nurse. If you are choosing between common sense, what you saw in clinical vs what is in the book or what you know the professor said, choose the book or the professor.
Sometimes, if a question is really horribly worded, it is because the professor took it from the teachers version of the book. Look at the sample questions in the book, and the CD that came with it. Some professors will pick questions straight from there. Sometimes, you have to ignore what you think, and try to think like the professor. Try to think about how his or her mind works. If their mind is really alien to you, try to study with someone else who gets them.
Do go back and check your answers. Check that if you circled A, you filled in the bubble for A. Check that you didn’t get off by one. Go back and read the questions carefully. Look for the words NOT, Worst, best , First, except, and all those other little words that change what the question is asking. Check that you didn’t misread the question. DO NOT OVERTHINK OR SECOND GUESS YOURSELF. DO NOT change an answer unless you REALLY read the question wrong. If it can be interpreted a different way, you interpreted it correctly the first time.
How do you get your mojo back. C = degree. Your grades don’t matter, passing does. How you do in clinical matters more than the tests. What matters is that you learn what you need to take care of patients by the end of the program. Not by the end of the first semester. Your grades don’t matter, what matters is that you can get a professor recommendation from someone before you graduate. When you were taking biology, you were taking it with a mix of students. In nursing school, you are probably in a class full of students who had to get straight A’s to get in. If you need A’s for a scholarship, then that is a different matter. Also, I promise it does get easier to know what you need to do. The workload doesn’t get easier but how to handle it does. Also, most of the professors know that they assigned more reading than is physically possible. For most of my classes I don’t even try to do the reading. If the professor says this is really important during lecture, I read it. If I didn’t understand what they were saying I read it. If they say it is important but didn’t have time to cover it, I read it. I also look at all the pictures, tables, and diagrams, and the chapter summary.
I read all the material and shunned study groups; in my experience study groups spend more time trying to figure out what will be on the test and less time learning the material. If you know the answer, you can argue your point even if you miss a question (unlike the real NCLEX). As for the rest of it, I just had to accept that nursing school was going to be a horrible experience that would end at some point. I never did find a way to thrive in the environment. I'm really, really, really glad it's over. And it WILL end.
I agree with what has been posted above, but had to add my $0.02.
English is far too subjective compared to NCLEX, don't even use it as a comparison. So too is BIO as it has "absolutes". Not so with the NCLEX. 90% of the time you can rule out absolutes like, "always", "never" and the like. If you can't figure out the "most right" of the answers, go with your gut. But keep in mind that the test is grounded in the reality of schoolwork - not actual bedside practice!
Test anxiety? I had a ritual that I applied for every test my last year. I listened to the same song right before every test (even the NCLEX!) It was my cue to put on my game face. If you can find a similar ritual, going through the repetition will ease the mind and put you into a good frame of mind.
Getting the mojo back? Not dwelling on the past and keeping the goal in mind. Have goal and keep it in your mind that "this" is why you're putting yourself through this.
It will end, I promise!
Dude, seriously? This one simple rule will earn you the correct answer on 75% of NCLEX/nursing school questions: ABCs! Airway, Breathing, Circulation. Once you drill this into your brain, those questions just pop out at you!
Rule #2: Always answer the question with "do as the (text)book says, not as you would do in clinical reality". For example, if the textbook says tip the chin forward then back when inserting an NGT, then answer it that way, even if you've found a different technique that works for you, your clinical preceptor, and all of your friends.
Rule #3: Never go back and change an answer on a test. Never.
Re: how to handle anxiety: I didn't have any anxiety because I followed the above rules! And I went to the gym EVERY DAY after lecture to lift weights and decompress.
having JUST finished nursing skool, I can second what Not Nurse Ratched said, studying was totally up to me. some people do well with others, some not. i can't really help as far as the test anxiety goes because i never have any. i'm pretty good about not letting things that are out of my control bother me. how hard or how well i study are in my control, how well that translates to testing is not up to me, so, no worries.
which brings us to C's gets degrees. totally agree. your GPA is not going to be on your badge, just your name and the letters 'RN.' the thing about nursing skool is that they are trying to give you a basic knowledge, yes, but more importantly they are trying to teach you or make sure you can critically think. so, you can either critically think or you can't, and the NCLEX-hell type questions are trying to figure out if you can figure out. so, yes, what would the ABSOLUTE STEREOTYPICALLY PERFECT NURSE do is a good way to answer those, but just remember that there is NCLEX world, and the real world. you have to keep both straight in your mind as you learn things. those two worlds DO NOT reconcile, you should't try.
and the NCLEX? its a hoop you have to jump through, as is nursing skool. as for motivation? light at the end of the tunnel, baby, its there, its good light, warm and sunny like the first day of spring after a hard winter. i went thru an 18 month program, lots of drama, lots of hoops, BUT. SO. WORTH. IT. and lets face it, anything that is that much trouble must be worth it, right? it is.
fuckups are a learning moments, and they're gonna happen no matter if you are a student or in the biz for years upon years. i worked with a 20 years nurse the other day, and she was hanging some dopamine. she thought she had cleared the pump and set the dopa to run at 30, but turns out the pump was still programed to run some antibiotics at 300. doapmine at 300ml/hr = no bueno.
did the pt die? no. think i learned something? yes. so, basically, if nobody dies, its a learning moment. everybody has them. EVERYBODY. had a dr tell the other day, 'yeah thats a p-wave.' uh, no, its afib. whoopsie....
anyways, keep your head up and good luck. we could always use another good nurse.
Absolutely the number one rule for NCLEX-style questions: DO NOT over-analyze. DO NOT put something in the question that was not there to begin with. When you think TOO much, you will get it wrong. Have faith in yourself and your abilities (hey, you got into school in the first place, right?).
Here's my two cents:
1. After studying Kaplan's methodology for the NCLEX, I performed so much better on practice exams and as a result passed my boards. I highly recommend it.
2. a) Test anxiety is CONTAGIOUS. Stay away from your classmates right before your exam. I would put my headphones on, listen to some kickass music and do some deep breathing and a little stretching to loosen myself up. I know that sounds weird, but if you up your O2, you can think CLEARLY. Pretend you're warming up for a marathon, 'cause really that's what nursing school is. b) Don't do any last minute cramming. As long as you put your all into studying for the test, cramming minutes before the test will just send you into more anxiety. Basically you're telling yourself you're not ready - which is not the case if you've been doing your work all along!
3. Ah, yes, failure. Been there - many many times. What worked for me was taking the time to remind myself that I have been through worse and survived worse. Count on your inner voice to kick in and say, "OK, are you done feeling sorry for yourself? Now quit your crying and let's get on with this." If that doesn't work for you, then make a list of all the difficult situations you've been through and have survived - and even thrived. Review this list PRN. And when you're feeling really low and vulnerable, remember there is a whole community of nurse bloggers who have been there and know your pain. I can't say enough about the support I received not so long ago. They were my angels!!!
1. Agree with the above. Also, RTFQ!! (read the f'ing question). What are they REALLY asking?
Always go with your first instinct. Your brain remembers more than you think it does.
Practice, practice, practice! Get those NCLEX 'training' books.
2. BREATHE! Don't over-study! Read your stuff thru ONCE the night before any test (even the for-real boards), then do something fun/relaxing. If you don't know it the afternoon before, trying to cram it into your head in a few short hours will only muddle things up in your head.
3. Be gentle with yourself. You are human, you WILL make mistakes. It's a fact of life.
And when you DO make a mistake, learn from it.
All best wishes!!!
1.I try not to think about the CRNEs (Canadians RN exams). They're far enough away and any questions we get in that format are taken with a grain of salt, because you learn from them, and can apply them later.
2.Don't cram. Stay away from others who are anxious. It's catchy!
3.I stay motivated in nursing school by reading some feel-good nursing lit. Tilda Shalof's books are really inspiring. Also try Chicken Soup for the Nurse's Soul 1 & 2.
Also, don't look too far ahead. Sure, it's nice to plan for when you're a nurse, but take it one semester at a time.
1.I don't actually start nursing school for another month yet, but I just had orientation yesterday, and we got to talk to some of the current students. One of the suggestions they all agreed on is that we should get the NCLEX prep guide now-- don't wait until it's actually time to study for boards.
Before every exam, especially the first one, read the appropriate section of the prep guide and go over the sample questions. Even if you miss some because of details you haven't learned yet, this will show you the question format and explain their rationale for finding the answer.
2/3. For handling anxiety, test-related or not, I'm a big fan of meditation. My daily practice involves twenty minutes of sitting every morning. Just sitting in a quiet place-- no music, no TV, no talking, just eyes closed and sit. There doesn't have to be any religious or spiritual component. Learning to sit still helps you remember what it feels like to be calm, so it's much easier to find that place again later in the day when you are feeling anxious or rattled.
I always show up late to the party.
1. Nclex-style questions -
Pretty much what everyone else said. I would add that these seem to get A LOT easier as time goes on. Some of that is purely a function of becoming more familiar with the question format, but a lot of it also comes from the pool of your background knowledge becoming broader and deeper.
If you started a new job unloading trucks, it would take some time for your muscles to fill out. In nursing school, those "muscles" are not your native intelligence - everyone's sharp - they're your background knowledge. That takes time to fill in.
These questions are just squirrelly. Nothing to do but be mentally prepared for a measure of squishiness that you just can't do anything about.
2. Getting rid of test anxiety -
Study and prepare. Trust yourself to know more than you think you do.
3. Getting your mojo back -
I find it's helpful to use the other students in my class as a benchmark. When I look at a grade and my eyes bug, I'll check myself against some of the really smart, really hard working students. If I'm reasonably near where they are, I don't beat myself up too much. Usually I am not doing as badly as it feels like I am.
If I do mess up, oh well. I try to be generous and gracious when someone else messes up. I am willing to extend myself the same courtesy.
My other tricks: lots of clinicals, and keeping my computer desktop set to something that will remind me why I'm doing this.
Regards.
(Oh, and I'm only second-semester, so you might wanna take my bloviating and oh-so-sage pseudowisdom with a pinch of salt.)
I *really* struggled my first two years of nursing school as well so I feel like I can definitely relate.
I agree with a lot of what was said here already, especially with Nurse J and Marjorie. (B's and C's get degrees and stay away from classmates before exams).
I used to get nosebleeds or start vomiting from test anxiety and have had to work really hard at ameliorating that problem.
-For me I found (light) exercising like a short run, walk, or yoga really helped (get the endogenous opiates flowing and neurotransmitters firing).
-I never studied the morning of or late the night before--sleep has been shown time and time again in studies on memory to be KEY in retaining/regurgitating.
-I always take 30 seconds at the beginning of an exam where I close my eyes, breathe, and remind myself that "in a lifetime this exam is nothing but a blip in terms of importance". Because really, even if you fail an exam, course, semester, year, etc. if you want something bad enough you will achieve it--no matter what obstacles stand in your way.
-I also have a 'get pumped' song that I listen to before exams which strangely oscillates between "Lose Yourself" by Eminem and the "Prayer of St. Francis" version by Sarah McLauchlan.
My advice--nursing school is really really tough but it is totally worth it--so keep your eye on the prize and stick it out! Good Luck!
I'm graduating in two months and it does get easier. The first year and a half was a complete overload, and much of the way we were treated was often illogical. It was completely frustrating. The second year has been much better, you start to have a knowledge base, and the professors and hospital staff begin to treat you reasonably and sometimes, even as an equal with a voice.
1) As for tests: Use only knowledge from the book. Your real world experience will hurt you. I think of it not so much as the perfect nurse, but the perfect hospital. In nclex style questions, there is always adequate staffing, always enough supplies. Also, some professors who write their own questions in 'nclex' style suck at it. So after the first test, always go to office hours and look at the test and the answers so that you can learn that teacher's style. Do not expect consistency between semesters.
2) Thing that works for me for test anxiety is to finish my studying the night before. Take all the practice questions you can find, so that you can learn what you don't know the night before and address those learning needs then. Do not cram before class.
The second part of that, is that I don't talk to anybody before the test starts. I've noticed that people like to talk about how nervous they are, or how much they don't know. Do not get sucked in. Just smile and nod and know that you studied and that you are going to kick ass.
3) As for motivation, maintain your non-nursing life. A night out or dinner even once a month with non nurses can keep you from getting sucked completely into the bubble of nursing school. It helps keep things in perspective.
Good luck.
Agree very strongly with marjorie and not nurse ratched... First of all, study groups have always been counterproductive for me. You need to figure out what YOU do and don't know. If you have a specific question, ask a friend... But avoid the groupthink! And so true about test anxiety being contagious!!! I was a big fan of headphones right until the teacher passed out the test. At that point, you know what you know- time to do your best. Anxiety and last minute fact checking will only hurt you at that point. So listen to a song, get in your happy place, and ignore the negative energy.
One question I liked to ask myself if I was feeling uneasy about an answer... If I could only do ONE thing for the patient, and then I had to leave... Which action would create the best outcome for the patient?
Our kaplan instructor was always telling us- don't make up stories!! The information you have is there and that's it. It doesn't matter what you saw in clinical last week or read about- use the information you have!!
Good luck!! It does get easier and it is worth it... I've been a nurse for 6 months now, and even with the bad days couldn't imagine doing anything else :-)
ugh. I am glad I am been gone rid of that test!
1. Practice practice practice nclex style questions from the CD that comes with your text and others. I have pretty much given up studying from my actual textbook and rely heavily on Saunders Review. (last semester here, not first)
When in doubt, always go with safety or airway. If neither of those are available, I'd go with an assessment.
Failing that, if you have no clue, pick the answer that is most unlike the other three. Also, if you have NEVER heard/read about a particular treatment or medication it is probably not the correct answer (unless you never go to class or study). Finally - DO NOT change your answer - remove the eraser from your pencil if you have to. DO NOT change your answer. DO NOT.
2. I have not gotten rid of any anxiety related to nursing school. I have managed to internalize it almost completely, though, so the only clue that I am freaked out is the fresh rash of hives on my hands.
3. Know that it will end, and sooner than you think, you will be facing graduation and the last big test. When things are bad, go to the bathroom and cry, then shake it off and get back to it =)
a)As a nurse, you have to work in frustrating systems and deal with a lot of bullshit. I always thought that 50% of nursing school was actual clinical knowledge, and 50% of nursing school was toughening up to be able to deal with the byzantine, complex and frustrating job of being a nurse in an imperfect system. If you can get through the challenges of nursing school, you can get through (and enjoy!) the challenges of nursing. Seriously, the best thing i ever learned in nursing school was how to cope.
b)That said, i tended to cope with food, and gained 25 lbs in 18 months. That's generally not the best idea, and i wish i'd worked out instead. Still, do what you need to do (while recognizing that it's not always the healthiest thing).
c)Study groups weren't about studying, for me. They were about getting together with my classmates for good food (again, 25 lbs ;) and stress relief. Often i left feeling like i still didn't know anything that was on the next day's test... but i no longer felt like i was going to cry or freak out anymore. When i did need to study, i had a study partner who was good at staying on track and who would let me explain the material to him (because i found i learned the material better if i tried to teach it to someone). Find someone who works well with you, and stick with them.
d)the beginning is the worst, because you're constantly reminded of how little you know. It gets better, SO MUCH better, and then you start having those a-ha! moments when you start to get it. And those are AMAZING. It takes time--years--to really feel like you've arrived as a nurse. And while that's frustrating, just remember--keep calm and keep your head about you. It's the best thing you can do at a nurse, no matter what the situation.
And good luck!
Read all the NCLEX questions you can. Your nursing instructors use those because they are licensed by the state you're in based on the number of students who pass NCLEX on the first try...really!
I ran through every NCLEX question I could get a hold of...some are better than others. Silvestri, IMNSHO is one of the best books.
ABCs are always paramount, look at what's alike and what's similar about all your answers (if all are the same and only one is different, in many cases the different one is right).
Do not buy into the "psych out strategies" some of your classmates use before tests to mess with people. Bring headphones before the test to drown them out if you have to do it!
Finally, it really is true...take care of yourself. Give yourself a little reward after every test. It will keep you sane!
Nursing school is hard period. One may have been a straight-A, 4.0 student in all other subjects and the prereqs but flunk horribly in the nursing courses. The questions on the test are all application based, meaning they are testing not only your knowledge of the subject but if you know to do the right thing at the right time.
1. She needs to get a current NCLEX book and practice the questions that correlate to the area she is studying. There is a book that I used that was highly recommended by my school called Test Success by Patricia M. Nugent. It was very helpful.
When looking to answer questions, prioritize according to the ABCs, then Maslow. I used to ask myself "if there is only one thing that I have time to do, what is that one thing that if I don't do or check on that would tell me that the pt is deteriorating or crashing?"
2. To avoid test anxiety I used to take the hour before the test to go for a relaxing walk, drink green tea, or blow bubbles. She needs to do something that she finds relaxing for her whether it be reading poetry, singing in a shower, doodling, or yoga. It is no good cramming the night before, you have to study the material well before the test and get a good night's sleep before.
3. My school had a retention specialists and tutors available.
Don't be afraid to asks your instructors for help and join study groups. If there is a particular are that she is struggling with (such as ABGs) use other resources such as the Nursing Made Easy series of books, current nursing journals, etc. She should be able to find many of these resources in public libraries.
Lots of good advice above, but I'll add this:
study about 20-30 minutes each day, too much more and your brain starts to File Under Junk. do this even on your days off. and don't wait until the 20-30 minutes before the test.
learn how to effectively skim your readings. read the bold stuff, the boxes, the stuff that tripped you up in lecture. aim for the big picture.
eat breakfast.
I'm a recent grad and I worked as a peer tutor during school. Over and over and ooooovvvveeeeer, I saw students who knew the info, or could make good guesses, but told themselves they were under-prepared, or stupid, or listened to 3rd semester SNs who told them it was an impossible test/give up now/etc. stick your fingers in your ears, scrunch your face up tight and repeat: I'm not listening, I can't hear you.
the first semester of school does kind of suck: nursing theory, therapeutic communication, nrsg process. It's all kind of boring until you start using it more.
It gets better, especially with more clinical experience.
so hang in there, champ!
Ditto to practicing the NCLEX style questions but I recommend the Kaplan as the best. There is always MORE THAN ONE RIGHT ANSWER but the questions are looking for the trick -- what's the hinge between this disease and the trivia they want you to know about it. Also, PAIN IS CONSIDERED PSYCHOSOCIAL on the NCLEX and therefore, secondary to anything physiological. Weird, huh? Funny. Most of my cancer patients come in for pain control.
Getting your mojo back: find some good buds to study with who will lift you up no matter what. We all suffer together and there are just times when someone can pull you out of the misery like you can't. I HATED the way they teach in nursing school.
..just a word from the other side of the red pen of doom~I second completely the RTFQ tidbit. I use a test bank but add in more "wrongness" to the incorrect answers, and still students miss vital stuff.
For example.....signs of Hogwarts Fever are turning green, peeling eyeballs, and temporary loss of vision. Which of the following patients likely has a case of HF?
a. Pt. A, who has peeling eyeballs and has turned crimson
b. Pt B, who reports he can't see at all today, but thinks his left eyeball is peeling. His roomate told him he looked a little green.
c. Pt C., who has been reading Wikipedia this morning and is sure his purple thumb indicates HF.
d. Pt D, whose eyes itch.
AND SOMEONE will alway pick "a" and argue that "He has peeling eyeballs and that is a sign!" Yes, dear, but RED skin is not, and that invalidates the entire answer!
OK, off my soapbox, just remember that if PART of an answer is wrong the whole ANSWER is incorrect!
Pattie, RN
As someone about to start school in June, I just want to say thank you for making this post and thanks to all the commenters! I swear I might have to make a cross stitch sampler of some of these comments. Especially staying away from negative nellys before a test - in my prereqs that was the worst part of exams, waiting to go in the doors before an A&P lab practical with people bemoaning how awful it was going to be. (Full disclosure: sometimes I was one of them.)
How to get thru nursing school (I graduate May 8!!!)
Please please, if you have anything that feels like it could be depression or psychosis, please get some real help. Go to a real psychiatrist and get some meds. If you are driving home and think, hmm, if I veer in front of that truck, I won't have to take that exam, that is a sign you may need help. (I got the meds, by the way)
I am serious, please get help sooner rather than later.
Kiss of peace, Biscuitx
Just be resourceful in preparation for the exam. There are many materials which are available! If you can manage to attend a review class go ahead, but me I'm only doing self-study method. I am using NCLEX mobile app , ebooks and other books I found helpful.
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