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Success Strategies for Nursing Students 1

Nursing Students
Success Strategies for Nursing Students 2

Prepared By: N. Gail Yearick, RN, BSN

November, 2006

Dear Nursing Student,

This collection of information has been assembled to assist you

through your nursing education journey. These topics were selected
after researching the experiences and needs of associate degree
nursing students. It is my wish that this will be the start of a wonderful
and exciting career for you in the nursing profession as well as the
beginning of unending educational exploration!

Best Wishes!

N. Gail Yearick, RN, BSN

Success Strategies for Nursing Students 3

Table of Contents
I. Nursing School
A. What to expect
B. Care planning process
C. Student Nursing Associations

II. Personal Management

A. Time management
B. Prioritization
C. Stress management
D. Motivation
E. Confidence
F. Personal health management

III. Strategic Learning Tools

A. Concentration
B. Reading strategies
C. Note-taking
D. Study Skills
E. Study groups

IV. Testing Strategies

A. Test anxiety
B. Test preparation
C. Test-taking

V. Students with Special Needs

A. English-as-a-Second-Language
1. English Language and Culture
2. Minority student nursing associations
B. Students with Concentration Problems
1. Compensatory strategies
2. Accommodations for Special Needs

VI. References
Success Strategies for Nursing Students 4

Nursing School
What to expect …

Everyone who starts nursing school knows what they hope to accomplish by the end of the
program – graduation from the nursing program along with the opportunity to take the state
nursing licensure exam and to enter the practice of nursing. What many students do not know is
exactly what to anticipate in the journey toward achieving these goals. Being aware of the
expectations and having the tools to assist you in meeting these requirements will help you in
being successful in this process.

Nursing school encompasses different types of learning opportunities. These include lectures and
activities in the classroom as well as laboratory and clinical experiences. Clinical experiences will be
added to your experiences each week. They will take you to different healthcare settings, including
long-term care facilities, acute care hospitals and community health settings.

Care Planning

Care planning is like the skeleton upon which nursing care for individual patients is built. The care
planning process includes five (5) steps: assessment, establishing a nursing diagnosis, planning
outcomes and interventions, implementing those interventions, and evaluating the success of the
process. Learning how to carry out this process will enhance your clinical practice.

Let’s review this process now.


Assessment refers to the activities of assessing your patients. This includes looking, listening and
feeling for clues about their condition. You will assess their physical, mental and psychosocial
status through assessment techniques that you learn in nursing school. You will consider the
information that you discover from your assessment to formulate a nursing diagnosis. The nursing
diagnosis is one of the keys to successful nursing practice.

Nursing Diagnoses

A nursing diagnosis is defined as “a clinical judgement about individual, family, or community

responses to actual or potential health problems/life processes” (NANDA, 1990). Nursing diagnoses
“provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is
accountable” (NANDA).

For your reference, here are the formats for nursing diagnoses with some sample diagnoses:

Actual Diagnosis: Problem related to Etiology as evidenced by Symptoms.

Example: Ineffective airway clearance related to decreased energy as manifested by ineffective

Risk Diagnosis: Risk for (or Potential for) Problem related to Etiology.
Example: Risk for injury related to altered mobility and mental disorientation.

Wellness Diagnosis: Condition related Contributing Factors as evidenced by Indications.

Success Strategies for Nursing Students 5

Example: Effective individual coping related to adequate support systems as evidenced by client’s
active participation in medical treatment regimen.

Factors to consider when formulating nursing diagnoses include the following:

 Client’s medical diagnoses
 Your assessment findings: subjective (what the client says to you) and objective (what you
see, hear and feel)
 Medications (especially side effects)
 Diagnostic test results


The planning phase of the care planning process includes identification of outcomes or goals that
address the nursing diagnoses and interventions or actions that will assist the client in achieving
those outcomes. In developing these steps of the care plan, you should refer to the nursing
diagnosis for clues.


The outcomes should be aimed at resolving the problem, preventing the risk, or sustaining the
wellness condition. Relevant outcomes will address the symptoms, etiology or indications in a way
that leads to achieving the ideal situation for the client - given their personal circumstances.
Outcomes are client-centered and state what client behavior is expected. These behaviors may be
passive or active on the part of the client. The client’s maintaining lab values within normal limits
is passive, while the client’s performing deep breathing exercises every two hours is an active

Outcomes need to be both realistic and measurable. To be realistic, consideration needs to be

given to the client’s condition to determine what is actually feasible. To be measurable, an
observable behavior must be specified along with a time frame for that behavior to be achieved.
For example, lab values may be specified to be within normal limits throughout the pateint’s
hospital stay. The example cited above of deep breathing exercises every two hours included the
time parameter of every two hours.


Nursing interventions will include strategies to assist the client in achieving the outcome(s). Unlike
the outcomes, the intervention is healthcare provider-centered and will state what members of the
healthcare team, including the nurse, will do to address the condition identified in the nursing


Implementation refers to the actual application of the care plan. This will be where the
interventions are carried out to facilitate the client’s achievement of the outcomes that have been


Evaluation includes two (2) steps:

 The determination of whether the client has met the outcomes
 Decisions about whether or not changes need to be made to the care plan
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If the client is not meeting the outcome(s), consideration needs to be given as to whether the
outcomes were realistic and measurable and/or whether the interventions were appropriate and
adequate in helping the client to achieve the outcomes. If problems are found with the outcomes or
interventions, the care plan should be revised for the client.

Professional Nursing Associations

Nurses do not practice in isolation but rather are part of group of professionals who are larger than
themselves individually. Professional nursing organizations have been established to inspire
professional camaraderie. Membership and participation in these organizations allows nurses to put
their voices together to speak out on issues in a powerful way. Many nursing organizations address
clinical specialties while some others draw ethnic groups together. Others address the interests of
the profession at large. You can obtain listings of and information about professional nursing
associations by researching the internet.

The nursing organization most relevant to you as a nursing student will probably be the National
Student Nurses Association (NSNA). Most states have their own student nurses’ associations that
are constituents of the NSNA. Additionally, some colleges have their own ethnic or multi-cultural
nursing associations. These efforts offer additional support to minority students. The nursing
department administration at your college should be able to provide information to you about these
associations and how to become members.
Success Strategies for Nursing Students 7

Personal Management
Time Management

Efficient time management is essential to your success in nursing school. With only so many hours
in a day and the volumes of information that you must learn to become prepared to enter the
nursing profession, you must carefully consider how to accomplish everything. Here are some
strategies for effectively managing your time.

1. At the beginning of each semester, prepare a calendar that includes all the activities in your
life. This calendar should be updated as changes occur. Activities to be included on this
calendar include:

 Scheduled classes
 Class assignments, including reading and required submissions
 Scheduled tests
 Planned school activities, such as clinical rotations and extracurricular activities
 Work
 Family activities

2. Every Sunday, the upcoming week’s schedule should be reviewed. This will help you avoid
surprises and assure that all necessary activities are included. This review should include:

 Daily classes
 Review of class notes to see if any additions are needed
 Allotment of time for working on assignments and projects
 Test preparation

3. Each evening, you should review the schedule for that day and for the following day. This
review should include:

 Checking to see that all scheduled tasks for the day have been accomplished and checked
 Moving unaccomplished tasks to future dates as needed
 Reviewing the day’s class notes and making additions

The following suggestions are offered by the Academic Skills Center at Dartmouth College (2001).

1. Count all your time as time to be used and make every attempt to get
satisfaction out of every moment.
2. Find something to enjoy in whatever you do.
3. Try to be an optimist and seek out the good in your life.
4. Find ways to build on your successes.
5. Stop regretting your failures and start learning from your mistakes.
6. Remind yourself, "There is always enough time for the important
things." If it is important, you should be able to make time to do it.
7. Continually look at ways of freeing up your time.
8. Examine your old habits and search for ways to change or eliminate
9. Try to use waiting time-review notes or do practice problems.
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10. Keep paper or a calendar with you to jot down the things you have to
do or notes to yourself.
11. Examine and revise your lifetime goals on a monthly basis and be sure
to include progress towards those goals on a daily basis.
12. Put up reminders in your home or office about your goals.
13. Always keep those long term goals in mind.
14. Plan your day each morning or the night before and set priorities for
15. Maintain and develop a list of specific things to be done each day, set
your priorities and the get the most important ones done as soon in
the day as you can. Evaluate your progress at the end of the day
16. Look ahead in your month and try and anticipate what is going to
happen so you can better schedule your time.
17. Try rewarding yourself when you get things done as you had planned,
especially the important ones.
18. Do first things first.
19. Have confidence in yourself and in your judgment of priorities and
stick to them no matter what.
20. When you catch yourself procrastinating-ask yourself, "What am I
21. Start with the most difficult parts of projects, then either the worst is
done or you may find you don't have to do all the other small tasks.
22. Catch yourself when you are involved in unproductive projects and
stop as soon as you can.
23. Find time to concentrate on high priority items or activities.
24. Concentrate on one thing at a time.
25. Put your efforts in areas that provide long term benefits.
26. Push yourself and be persistent, especially when you know you are
doing well.
27. Think on paper when possible-it makes it easier to review and revise.
28. Be sure and set deadlines for yourself whenever possible.
29. Delegate responsibilities whenever possible.
30. Ask for advice when needed.

Stress Management

Nursing school imposes a separate and distinct level of stress on students. Students are expected
to acquire a great deal of knowledge and demonstrate the ability to apply that knowledge in a
relatively short period of time. Training programs for registered nurses, whether in pursuit of an
Associates Degree in Nursing (ADN) or Baccalaureate Degree in Nursing (BSN), typically include
four semesters of learning. During these four semesters, many students enter the nursing program
with no experience in the healthcare environment. They are expected to quickly progress and be
able to demonstrate an adequate clinical skill level to be deemed competent to enter the nursing
profession. This can impose high levels of stress on an individual.

While a certain level of stress is useful for maintaining optimal motivational levels for learning, it is
well known that being overly stressed may result in impeding learning. Studies of nursing students’
experiences have revealed that excessive stress is commonly felt while participating in nursing
education programs. High levels of stress actually have been found to prevent students from
performing at their best level.
Success Strategies for Nursing Students 9

The stressors that students encounter in nursing school have been identified by students of nursing
for many years and are not likely to change. In fact, as technological advances are made, nurses
must be prepared to function in these highly technological settings - while remembering to focus
on the patient. Additionally, when nursing students graduate and enter practice settings; they are
likely to encounter continued stress due to inadequate resources and budgetary restrictions. For
these reasons, it is important that nursing students develop methods for managing their stress
levels. This strategy enables the student to have both a positive learning experience while in
school as well as to be prepared to effectively cope upon entering the profession.

The Academic Skills Center at Dartmouth College (2001) offers the following methods for managing
stress effectively:

 Add balance to life; don't overdo studies or play.

 Know and accept what kind of person you are: strengths and
 Get a thorough physical exam.
 Take "time outs", especially during study.
 Expand your support network, reinforce friendships.
 Exercise regularly.
 Watch your breathing.
 Walk loosely and walk more.
 Learn and practice relaxation skills.
 Study each subject regularly for moderate periods of time.
 Discuss problems with friends, family, dean or counselor.

The Academic Skills Center at Dartmouth College (2001) offers the following excerpt to students at
their website. It is from an article by Geoffrey Cowley in Newsweek, June 14, 1999,:

As Stanford psychiatrist David Spiegel puts it, "Living a stress-free life

is not a reasonable goal. The goal is to deal with it actively and

One approach is to emulate people who are naturally resistant to

stress. Some people weather devastating experiences with uncanny
serenity. By studying them, researchers have discovered that they
share distinctive habits of mind.

 They tend to focus on immediate issues rather than global ones.

 Stress-resistant people also tend to share an optimistic "explanatory
 They assume their troubles are temporary ("I'm tired today") rather
than permanent ("I'm washed up") and specific ("I have a bad habit")
rather than universal ("I'm a bad person")
 They credit themselves when things go right, while externalizing their
failures ("That was a tough audience," not "I gave a wretched
Success Strategies for Nursing Students 10

Aside from dealing directly with stressors and the stressful responses they elicit, you should also
consider using relaxation techniques to lower your personal threshold for becoming “stressed out”.
These techniques include doing any activity that leads you to relax. They may be either active or

Active and passive approaches may include the following either alone or in combination:

 Physical exercise
 Counseling
 Socializing with family and friends
 Meditation
 Yoga
 Massage
 Music
 Cinematherapy
 Aromatherapy
 Naps
 Bubble bath and a glass of wine

Selecting activities to reduce stress and to promote relaxation is highly individualized. You should
experiment and find what you most enjoy and find helpful. You need to strike a balance to prevent
excessive levels of stress and to perform your best.


Motivation is necessary for achieving any goal. Some people are more motivated than others.
Additionally, some people are motivated to excel while others have just enough “push” to get the
job done. Many factors influence the levels of motivation that we have to set goals and then to
pursue them.

If you have entered nursing school, you have set the goals of passing your nursing courses,
graduating from the program, passing the NCLEX-RN exam, and working as a nurse. It is critical
that you keep these goals uppermost during your journey through nursing school. This will help to
keep you focused on why you are working so hard to master the nursing curriculum.

While in nursing school, this must be considered your primary job. You must carefully block out
time to allow for studying and participation in the classes, lab sessions, and clinical shifts. You need
to solicit as much support as possible from family and friends. They should provide encouragement
and assist in meeting other needs, such as child care or household maintenance.

Motivation includes the drive to accomplish goals in combination with the ability to avoid
procrastination. Maintaining adequate motivation will assist in avoiding procrastination. The Center
for Advancement of Learning at Muskingum College (n.d.) suggests the following actions to support
a non-procrastination plan:

A Non-Procrastination Plan

Make a Schedule

Allocate specific times to complete tasks using semester, monthly,

weekly, or daily planners.
Success Strategies for Nursing Students 11

Get Motivated

It does no good to make a schedule unless it will be followed. Work

with a friend to motivate each other. Consider how long-term and
short-term goals will be fulfilled by getting things done on time.
Visualize how it felt to get tasks done on time in the past, and
remember how stressful it was to put off work.

Reevaluate Your Priorities

How do you prioritize success in school, social life, work, and other
activities in your life? If school is your first priority, that work must
come before any other activities. If you decide success in school is not
your first priority, then don't expect high grades.

Take Responsibility

Don't make excuses to yourself for procrastinating, and don't blame

others when distracted. Saying "I'm so busy I never get to..." is just
an excuse and form of procrastination. Staying on track is a personal
responsibility. It's in your hands.

Cause and Effect Relationships

Step back and critically examine cause and effect relationships in your
life. How do you explain failures? To what factors do you attribute
them? Be honest. Did you receive a poor grade on a project because
you started it late or didn't put in enough time? Avoid rationalizations
like "The prof hates me" or "I didn't understand the assignment."
Thoughtfully examine the consequences of your behavior.

Working "Under Pressure"

Some people describe themselves as "working better under pressure."

If you feel this way, honestly and critically the validity of this
statement. When you work under pressure, are you really turning in
your best work? If not, procrastination is having a negative impact on
you. If you really think you are doing your best, make sure the
pressure comes from you and not someone else.

Variety is the Spice of Life

Make two activity lists: "Things I like to do" and "Things I have to do."
Mix up activities from both lists and work on each activity for a short
period of time. Alternating between fun and distasteful tasks helps to
maintain motivation and interest.

Think Small
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Because it is easier to put off overwhelming tasks than small ones,

divide major assignments into smaller parts and work on one part at a

Be Realistic

Some people procrastinate because they have too much to do. They
have every intention of doing things in a timely manner, but they run
out of time. There are only 24 hours in a day. Thoughtfully examine
your obligations and responsibilities. Is your schedule realistic? Are
you involved in too many activities? Don't "spread yourself too thinnly"
because none of your projects will get the full attention they deserve.

Focus on Assets

Some people are good at summarizing major ideas. Others write

exceptionally well. Some people work well with others. Find out what
your assets are. Then work them into everything you do. This will
improve your confidence and motivation for tackling a distasteful job.


Reward yourself lavishly when tasks are completed on time. Make the
reward appropriate for the difficulty and boredom of the task.


Life as a nursing student is laden with opportunities for feeling unsure of yourself. You will be
presented with many new and unfamiliar circumstances in an environment with high expectations.
You must be kind to yourself and remember that you are a student and that learning takes time. In
fact, as a nurse, you will never stop needing to learn and to be open to changing to practice in the
most current evidence-based manner so that you can offer the best standard of care to your
patients. Achieving a sufficient level of self-confidence is essential as you progress in nursing
school and in life in general. Having a high level of self-esteem is important as you proceed in the
nursing program working to build self-confidence in your new role as a nurse.

The UT Learning Center at the University of Texas at Austin (2006) offers the following suggestions
for building self-esteem:


Crises of self-esteem are a part of the human experience. When you

feel troubled by low self-esteem, review the suggestions below and
choose those that are relevant to your situation and work on them. Be
patient with yourself: change takes time and steadfast work.

1. Free yourself from "shoulds". Live your life on the basis of what is
possible for you and what feels right to you instead of what you or
others think you "should" do. "Shoulds" distract us from identifying
and fulfilling our own needs, abilities, interests and personal goals.
Success Strategies for Nursing Students 13

Find out what you want and what you are good at, value those, and
take actions designed to fulfill your potential.
2. Respect your own needs. Recognize and take care of your own needs
and wants first. Identify what really fulfills you — not just immediate
gratifications. Respecting your deeper needs will increase your sense
of worth and well-being.
3. Set achievable goals. Establish goals on the basis of what you can
realistically achieve, and then work step-by-step to develop your
potential. To strive always for perfectionist, absolute goals — for
example, "Anything less than an A in school is always unacceptable" —
invites stress and failure.
4. Talk to yourself positively. Stop listening to your "cruel inner critic."
When you notice that you are doubting or judging yourself, replace
such thoughts with self-accepting thoughts, balanced self-assessment
and self-supportive direction.
5. Test your reality. Separate your emotional reactions — your fears and
bad feelings — from the reality of your current situation. For example,
you may feel stupid, anxious and hopeless about a project, but if you
think about it, you may still have the ability and opportunity to
accomplish something in it.
6. Experience success. Seek out and put yourself in situations in which
the probability of success is high. Look for projects which stretch —
but don't overwhelm — your abilities. "Image" yourself succeeding.
Whatever you accomplish, let yourself acknowledge and experience
success and good feelings about it.
7. Take chances. New experiences are learning experiences which can
build self-confidence. Expect to make mistakes as part of the process;
don't be disappointed if you don't do it perfectly. Feel good about
trying something new, making progress and increasing your
8. Solve problems. Don't avoid problems, and don't moil about them.
Face them, and identify ways to solve them or cope with them. If you
run away from problems you can solve, you threaten your self-
9. Make decisions. Practice making and implementing positive decisions
flexibly but firmly, and trust yourself to deal with the consequences.
When you assert yourself, you enhance your sense of yourself, learn
more, and increase your self-confidence.
10. Develop your skills. Know what you can and can't do. Assess the skills
you need; learn and practice those.
11. Emphasize your strengths. Focus on what you can do rather than what
you cannot. Accept current limitations and live comfortably within
them, even as you consider what strengths you might want or need to
develop next.
12. Rely on your own opinion of yourself. Entertain feedback from others,
but don't rely on their opinions. Depend on your own values in making
decisions and deciding how you feel about yourself and what is right
for you to do.

Personal Health Management

Maintenance of personal health is critical to academic success in nursing school. Being alert and
paying attention in learning sitautions may not occur with compromised health. Proper sleep,
Success Strategies for Nursing Students 14

nutrition, exercise and relaxation is necessary for good health. Adequate rest is essential to optimal
performance. Having a healthy balance of these elements may assist with your ability to
concentrate as teaching occurs. Health concerns should be addressed with a healthcare practitioner
so that proper diagnoses and treatment may be obtained. As noted with good stress management,
ideal personal health management needs to be carried out in an ongoing manner.

Improper sleep can cause many problems for students. These range from inability to learn to
inability to recall what you have learned. Additionally, for nursing students, adequate sleep is
essential prior to attending clinical shifts where you are responsible to provide care for patients.

The Academic Skills Center at Dartmouth College (2001) cites Peter Hauri from the Upjohn
Company who offers the following guidelines for getting adequate sleep.


1. Sleep as much as needed to feel refreshed and healthy during the

following day, but not more. Curtailing time in bed a bit seems to
solidify sleep: excessively long times in bed seem related to
fragmented and shallow sleep.

2. A regular arousal time in the morning seems to strengthen circadian

cycling and to finally lead to regular times of sleep onset.

3. A steady daily amount of exercise probably deepens sleep over the

long run, but occasional one-shot exercise does not directly influence
sleep during the following night.

4. Occasional loud noises (e.g., aircraft fly-overs) disturb sleep even in

people who do not awaken because of the noises and cannot
remember them in the morning. Sound-proofing the bedroom might
be advisable for people who have to sleep close to excessive noise.

5. Although an excessively warm room disturbs sleep, there is no

evidence that an excessively cold room solidifies sleep, as has been

6. Hunger may disturb sleep. A light bedtime snack (especially warm milk
or similar drink) seems to help many individuals sleep.

7. An occasional sleeping pill may be of some benefit, but the chronic use
of hypnotics is ineffective at most and detrimental in some insomniacs.

8. Caffeine in the evening disturbs sleep, even in persons who do not feel
it does.

9. Alcohol helps tense people to fall asleep fast, but the ensuing sleep is
then fragmented.

10. Rather than trying harder and harder to fall asleep during a poor night,
switching on the light and doing something else may help the
individual who feels angry, frustrated, or tense about being unable to
Success Strategies for Nursing Students 15

Strategic Learning Tools


When confronted with large volumes of information to learn, often including information that may
seem complex, the need to set yourself up for effective concentration is paramount to your
success. This includes identification of an appropriate area and time schedule to enhance your
efforts. The following suggestions are offered by the Cook Counseling Center at Virginia Tech
(2006) regarding concentration:

Concentration: Some Basic Guidelines

1. Set aside a place for study and study only!

A. Find a specific place (or places) that you can use for studying (for
example, the campus libraries, vacant classrooms, quiet areas in the
student center, bedroom at home, etc.)

B. Make a place specific to studying. You are trying to build a habit of

studying when you are in this place. So, don't use your study space for
social conversations, writing letters, daydreaming, etc.

C. Insure that your study area has the following:

 good lighting
 ventilation
 a comfortable chair, but not too comfortable
 a desk large enough to spread out your materials

D. Insure that your study area does not have the following:

 a distracting view of other activities that you want to be

involved in
 a telephone
 a loud stereo
 a 27-inch color TV
 a roommate or friend who wants to talk a lot
 a refrigerator stocked with scrumptious goodies

2. Divide your work into small, short-range goals.

A. Don't set a goal as vague and large as ... "I am going to spend all
day Saturday studying!" You will only set yourself up for failure and

B. Take the time block that you have scheduled for study and set a
reachable study goal. (for example: finish reading 3 sections of
chapter seven in my Psych. text, or complete one math problem, or
write the rough draft of the introduction to my English paper, etc.)
Success Strategies for Nursing Students 16

C. Set your goal when you sit down to study but before you begin to

Set a goal that you can reach. You may, in fact, do more than
your goal but set a reasonable goal even if it seems too easy.

Reading Strategies

Everyone has to identify an approach to reading that is effective for them. This is especially
important in nursing school where there is so much to read. A couple examples of specific
strategies are discussed at a website, A Study Skills Resource Site (n.d.).
These strategies include the SQRW and the REDW. The SQRW reading strategy is summarized as

A Strategy for Reading Textbooks

SQRW is a four-step strategy for reading and taking notes from

chapters in a textbook. Each letter stands for one step in the strategy.
Using SQRW will help you to understand what you read and to prepare
a written record of what you learned. The written record will be
valuable when you have to participate in a class discussion and again
when you study for a test. Read to learn what to do for each step in

Surveying brings to mind what you already know about the topic of a
chapter and prepares you for learning more. To survey a chapter, read
the title, introduction, headings, and the summary or conclusion. Also,
examine all visuals such as pictures, tables, maps, and/or graphs and
read the caption that goes with each. By surveying a chapter, you will
quickly learn what the chapter is about.

You need to have questions in your mind as you read. Questions give
you a purpose for reading and help you stay focused on the reading
assignment. Form questions by changing each chapter heading into a
question. Use the words who, what, when, where, why, or how to form
questions. For example, for the heading "Uses of Electricity" in a
chapter about how science improves lives, you might form the
question "What are some uses of electricity?" If a heading is stated as
a question, use that question. When a heading contains more than one
idea, form a question for each idea. Do not form questions for the
Introduction, Summary, or Conclusion.

Read the information that follows each heading to find the answer to
each question you formed. As you do this, you may decide you need to
change a question or turn it into several questions to be answered.
Stay focused and flexible so you can gather as much information as
you need to answer each question.
Success Strategies for Nursing Students 17

Write each question and its answer in your notebook. Reread each of
your written answers to be sure each answer is legible and contains all
the important information needed to answer the question.

As you practice using SQRW, you will find you learn more and have
good study notes to use to prepare for class participation and tests.

HINT: Once you complete the Survey step for the entire chapter,
complete the Question, Read, and Write steps for the first heading.
Then complete the Question, Read, and Write steps for the second
heading, and so on for the remaining headings in the chapter. (n.d.) summarizes the REDW strategy as follows:

Reading Comprehension: The REDW Strategy for Finding Main


REDW is a good strategy to use to find the main idea in each

paragraph of a reading assignment. Using this strategy will help you
comprehend the information contained in your assignment. Each of the
letters in REDW stands for a step in the strategy.

Read the entire paragraph to get an idea of what the paragraph is
about. You may find it helpful to whisper the words as you read or to
form a picture in your mind of what you are reading. Once you have a
general idea of what the paragraph is about, go on to the next step.

Examine each sentence in the paragraph to identify the important
words that tell what the sentence is about. Ignore the words that are
not needed to tell what the sentence is about. If you are allowed to,
draw a line through the words to be ignored. For each sentence, write
on a sheet of paper the words that tell what the sentence is about.

Reread the words you wrote for each sentence in the paragraph.
Decide which sentence contains the words you wrote that best
describe the main idea of the paragraph. These words are the main
idea of the paragraph. The sentence that contains these words is the
topic sentence. The other words you wrote are the supporting details
for the main idea.

Write the main idea for each paragraph in your notebook. This will
provide you with a written record of the most important ideas you
learned. This written record will be helpful if you have to take a test
that covers the reading assignment.
Success Strategies for Nursing Students 18

Use REDW to help you understand the information in your reading


A great deal of the reading that you will be expected to complete in nursing school is about
complex topics. The Center for Advancement of Learning at Muskingum College (n.d.) offers the
following suggestions for reading difficult material.


Reading assignments may be challenging if the information is highly

specialized or technical, or if the material is beyond the student's level
of preparation. In these situations it is common for students to lose
interest and motivation. The following tips may help students get
through difficult reading assignments.

 Repetition.
o Read over the assignment once. Switch to another task for a
period of time or sleep on it. Re-read the material later or on
the following day. Review the assignment periodically.
 Remediation.
o Consult supplemental resources for learning fundamental
information needed to understand the reading assignment.
Possibilities include introductory textbooks, student workbooks
or study guides to textbooks, lab manuals, and survey books.
 Consult with Professionals.
o Additional help in understanding difficult readings may be
obtained from the instructor during office hours, from graduate
assistants, and from professional tutors. Peer tutors or upper-
class majors may also provide valuable assistance.
 Essential Words.
o Focus on key words in the text. Emphasize verbs and nouns
only; ignore or cross out unnecessary adjectives and adverbs.
Look for terms in bold print or italics.
 Review and Summarize.
o Review after reading each paragraph of text. Identify the main
idea of each paragraph. Be sure to understand each paragraph
before moving on to the next. Review at the end of each
section as well as at the end of the chapter. Develop your own
summary of the chapter and compare it to the summary
presented in the book.
 Make Reading More Active.
o Comprehension may be improved if one uses senses other than
vision while reading. Stimulate the auditory sense by reading
aloud or listening to tape recordings of the text. Take notes
during or after reading difficult material.
 Make Reading Interactive.
o Work with another student. Read to each other, and take turns
summarizing sections or chapters of text. "Teach" each other
the more difficult concepts, making liberal use of visual aids.
Relate the material to personal experiences.
 Review Questions.
Success Strategies for Nursing Students 19

o Evaluate your understanding of the material by answering the

review questions at the end of the chapter or in student study
guides and workbooks. If questions are not available, make up
your own by converting the section headings into questions.
 Words and Definitions.
o Look up the definitions of all unfamiliar words, even if they are
not in bold print or italics. Compile a written list of unfamiliar
words (and definitions) that appear repeatedly, or record the
words and definitions on audio tapes and listen to them for
review. Use a dictionary to look up non-technical words, and
consult the glossary in the book for technical word definitions.
Place a colored paper clip on the glossary pages for quick


The Cornell Method of note-taking is recommended by multiple learning institutions. This system
requires that the student identify key words and list relevant points or pertinence. This method of
note-taking forces the student to categorize information and provides a good outline for later

The Center for Advancement of Learning at Muskingum College (n.d.) provides the following
directions for using the Cornell method:

Directions for using the Cornell method are as follows.

 Divide the paper

 Use loose leaf notebook paper and write on one side of the page only.
 Divide the paper vertically by drawing a line from top to bottom about
2" from the left side of the page.

 Documentation
o Write the following information at the top of each page: student
name, course, date, and page number.
 Record Notes
o During lecture, record the main ideas and concepts on the right
side of the page. This is the notes column.
Success Strategies for Nursing Students 20

o Rephrase the information in your own words before writing it

o Skip one line between ideas and several lines between topics.
o Avoid writing in complete sentences; use symbols and
abbreviations instead.
o The format or style of the notes can vary, but avoid using a
formal outline. Suggestions for organizing the notes are:
 Paragraph Style: For unstructured information,
record notes in paragraph style with short,
telegraphic sentences and phrases.
 Topic and Ideas Style: For expanded topic
information, record topics and ideas.
 Sentence Style: For ideas and concepts, record
notes in short sentences.
 Definition Style: For main topics and features,
record definitions and explanations of words in
short phrases.
 Review and Clarify
 As soon after class as possible, review the notes in the
right column and clarify any ambiguous information.
 Compare the information with the book and/or other
students' notes.
 Then pull the main ideas, concepts, terms, places,
dates, and people from the right column and record
them in the left-hand recall column.
 Summarize
 Prepare a summary of the lecture material and record it at the end of
the notes.
o The summary may be in sentences or short phrases. It should
include only the main ideas from the lecture.
 Study

o Use both sections of the notes to prepare for quizzes and exams.

Study Skills

Study skills are essential for nursing students. Here are some general principles about the use of
study skills.

 Schedule study time into sessions of 20 to 30 minutes, which is the average attention span
of most people. Breaks should be scheduled between these sessions.
 Develop a plan that schedules study time for all necessary topics as this will increase your
chances of covering all necessary material.
 Squeeze studying into small periods of spare time, such as time between classes.


To be successful in nursing school students need to be able to memorize information as well as to

apply that information to perform critical thinking. Memorized facts provide the base of knowledge
that is needed to perform as a nurse, making the clinical decisions that are best for the clients.
People remember approximately 10% of what they read, 20% of what they hear, 30% of what
they see, 50% of what they see and hear together, 70% of what they say if they are thinking
Success Strategies for Nursing Students 21

about what they are saying, and 90% of what they do (Muskingum College, n.d.). Given this
information the wisest strategy for study success would be to use a combination of methods that
offer opportunities to engage the material to be learned in a variety of ways. A variety of study
strategies will be discussed in this section. You may want to experiment with them to find the most
effective ones for you.

The Academic Skills Center at Dartmouth College (2001) offers the following strategies for assisting
your memory.


It is more natural to forget something than to remember it. If you

intend to remember something, apply as many of the following
techniques as possible.

 Be flexible. Experiment with many learning procedures. Be willing to

abandon outmoded and faulty learning procedures so you will be free
to acquire new and more efficient methods.

 Overlearn. In order to retain anything learned, you must practice

and reorganize it into your current ongoing activity. One way to do
this is to incorporate the learned material as part of your present habit
system. Use it in speaking and writing. Act out the material as a
rehearsal of a part in a play-a process known as role-playing. This is
especially helpful in learning a foreign language.

 Schedule. Schedule your study time so that the time at which

something is learned or relearned is close to the time at which it will
be used.

 Rephrase and explain. Try a little role-playing. Take the point of

view of the teacher, for a change. Rephrase and explain the material,
in your own words, to a classmate. Allow your classmate to criticize
your presentation. Then let the classmate be the teacher, while you
criticize. If you can't explain something, you don't really know it.

Many students adopt the so-called warm-body attitude toward

learning. A "warm" feeling toward one particular answer becomes the
basis for its selection, regardless of whether one really knows why the
answer is correct. This attitude is the result of classroom examining
procedures in which true-false and multiple-choice items are used
exclusively for testing. Testing in this manner encourages the attitude
that mere recognition of the most probable answer constitutes

Even though a particular course may not require adequate recall by

using more penetrating recall-type questions, don't allow yourself to
fall into this warm-body learning trap. Insist on testing yourself! If
you can explain the material, most certainly you can pass any
"objective" test calling for superficial recognition. However, the
reverse is most certainly not true. Learning only to a point of
recognition, and depending on your ability to ferret out the correct
Success Strategies for Nursing Students 22

response, is insufficient for total-recall kinds of tests. Sooner or later

this habit will result in total failure in a demanding test situation.

 Eliminate accidental and unrelated associations. A study

situation in which a phone is constantly jangling produces breaks in
the mental association process. Remove the receiver. The only
suggestion that can be made for the elimination of television during
the study period is to donate the set to a family that is not involved in
higher education.

 Eliminate previous mistakes. Take note of all previous mistakes

and make every effort to eliminate them from future practice. It has
been shown experimentally that consciously reviewing mistakes,
making note of exactly why they were incorrect, helps to reinforce the
correct response. This process is sometimes referred to as negative

 Decide on an order of importance. Some things are more important

than others. In a particular study unit, decide what these are and
organize the important material into an outline or framework. "Over-
learn" this particular framework.

 Become emotionally involved. Assume the attitude that you fully

believe the viewpoint of the author. Strive for perfection. You may
never achieve it, but you will most certainly improve your
performance. Learn to discuss your current beliefs calmly with people
holding different attitudes. Cite authorities to back up your position.

 Use mechanical memory aids. When material is complicated, it may

be necessary to use mechanical memory aids. For example, suppose
you had reason to believe that a certain table showing all of the
endocrine glands of the body with their secretions and functions would
be called for in an examination. In order to be sure that you would be
able to recall all of the glands, you memorized the first letter or
syllable of each gland, and organized them into three very strange
words: Anpothy Paramed Adcorpan, the novelty of which aided
recall. This could be deciphered as follows: An=anterior pituitary,
po=posterior pituitary, thy=thyroid, par=parathyroid, amed=adrenal
medulla, adcor=adrenal cortex, pan=pancreas, etc.

Specific study methods have been identified by different learning institutions to aid with
memorization. Some of these methods are described below.


Mnemonics refers to organizing material by arranging key words in an order where the first letter
of each is arranged into an order that forms a word or acronym that is more easily memorized.
Each letter is then used as a cue to recall a word or phrase.

What are the qualities of a scientist? (mnemonic answer: PIPOC)
P erserverance
I ntelligence
Success Strategies for Nursing Students 23

P atience
O riginality
C uriosity


Grouping is a strategy that can be helpful when trying to recall a long list of items. Rather than
attempting to remember the entire list, where items in the middle tend to be forgotten, the long
list is broken down into several smaller lists making it easier to commit to memory.


Alphabetizing offers an easy and quick method for list memorization. Note that this strategy may
be used in combination with other strategies, such as grouping or mnemonics.

Rhymes, Songs, and Poems

Rhymes, songs, and poems may offer an easier strategy for remembering information than rote

The Center for Advancement of Learning at Muskingum College (n.d.) offers these guidelines for
the use of rhymes, songs and poems in studying:

To remember information using rhymes, songs and poems, follow

these steps.

 Identify the new information to be remembered.

 Try to link the new information with a song or tune already known.
Familiar tunes like "Old MacDonald" or "Bingo" are often effective.
 If no song works, try to work the information into a simple poem.
 If a poem cannot be formed, repeat the information in a rhythmic
manner to aid remembering.

Study Cards

The use of study cards is helpful in memorization as they engage the learner in both kinesthetic
and visual manners. The more ways that a student engages in learning information the more likely
the student will recall that information. If the student also verbalizes the writings on the cards they
will be also engaging their sense of hearing.


Outlining material to be remembered can be effective when there is a large volume of information
to be recalled. This is done by identifying key points from the body of information and then
arranging it in a logical order that can be more easily remembered.

RCRC Strategy

The RCRC strategy (Read, Cover, Recite, Check) is useful for memorizing information. It may be
helpful in learning definitions and facts. This would be a good way for nursing students to study
Success Strategies for Nursing Students 24

medication dosing and laboratory values. Muskingum College (n.d.) provides the following steps for
this strategy.

 Read: Read and reread a portion of the information.

 Cover: Cover the material with a piece of paper.
 Recite: Recite what you have read in your own words.
 Check: Check the accuracy of recitation against the written

Rehearsal Strategies

Rehearsal strategies are intended to be repeated a number of times to commit new information to
memory. These methods allow for active participation in learning, which improves learning.
Muskingum College (n.d.) offers the following information about rehearsal strategies.

Practice Makes Perfect ?!

Students should be taught to thoroughly check the accuracy of

information to be rehearsed prior to beginning the process. Practice
may indeed make perfect, but students may be practicing perfectly
information that is inaccurate or incomplete.

Recitation and Review Strategies

The following strategies of recitation and review make rehearsal a

more active process. Students should be encouraged to use more than
the visual sense (reading) when reviewing information.

 Self-monitoring, or reading aloud to oneself or another person

 Read or speak into a tape recorder and listen to the tape while
 Provide rehearsal in a realistic context (e.g. study in the testing room,
reduce interference)
 Daily distributed review, or spread sessions throughout the day

For more information on recitation and review, see the Reciting and
Spacing Reviews section of this page.

Task Checklists

To maintain focus, keep an ongoing checklist of studying: the types of

problems to be solved, the skills to be mastered, and the major ideas,
terms, theories, formulas, and equations to be memorized. Make the
task descriptions as brief as possible.

Study Actively

Effective rehearsal involves doing something with new information.

Several of the suggestions listed below may be used both for rehearsal
(implanting information in short-term memory) as well as for encoding
(implanting information in long-term memory).
Success Strategies for Nursing Students 25

 Develop flash cards

 Transfer notes into alternative note-taking formats
 Rewrite notes or enter them into a computer
 Develop questions on the material
 Use new terms in sentences or in a journal
 Work example problems
 Tutor or lecture another student
 Develop summaries or outlines of the material

According to Herrman, Raybeck and Gutman (1993, p. 91-92),

"rehearsal is particularly useful for two kinds of situations: when you
want to keep information in consciousness, but are not concerned
about establishing a long-term memory; or when you are not
motivated to use a more challenging or elaborate manipulation to
establish a long-term memory." They suggest several rehearsal
strategies for improving memory performance:

 Act out the information to be remembered. For example, when

studying by yourself pretend to be a historical figure, or when studying
with a group pretend to be atoms diffusing from an area of high
concentration to an area of lower concentration.
 Articulary rehearsal involves repeating information syllable by syllable,
noting the placement of the tongue at each stage.
 Rhythmic rehearsal entails repeating an item in a rhythmic manner, by
syllables or with a beat.
 Spaced rehearsal involves repeating information aloud or mentally with
increasing intervals of time between each repetition. For example, say
"property depreciation," wait 1 second, repeat "property depreciation,"
wait 2 seconds, repeat "property depreciation," wait 4 seconds, repeat
"property depreciation," wait 8 seconds, etc.

Cumulative rehearsal involves repeating items in a list in successively larger groups,

starting with the first item each time. For example, say "cell," then say "cell, tissue,"
then say "cell, tissue, organ," then say "cell, tissue, organ, system."

Visual Aids

Visual aids can be powerful tools to assist with learning. Combining the use of these tools with
other learning tools that engage the other senses actively will enhance the learning. Some
examples of visual aids include:

 Tables
 Flow charts
 Outlines
 Concept maps (fishbone diagram, spider maps)

The ability to visualize these items when in situations calling for recall of information is often used
unconsciously. Students may intensify the effectiveness of this strategy by calling upon formalizing
their use of visualization and by calling upon other senses to cement the new information into their
memory. Muskingum College (n.d.) provides the following directions for visual association.

 Identify the new information to be remembered.

Success Strategies for Nursing Students 26

 Identify an image from existing knowledge that reminds you of the

new information.
o Make the image large, exaggerating features and enlarging it to
unusual or unnatural proportions.
o Make the image as bizarre or unusual as possible.
o Produce associations that are different from what might be
o Images may be still or, better yet, animated. When motion is
added to a mental picture, it helps the mind to retain it.
o Add sounds or smells to the image if you can.


Chaining is a study strategy where the student links concepts to each other, two at a time. This
strategy seems especially to some of the material that nursing students must learn, such as
pathophysiology where one physiological response leads to the next which leads to the next and so
on. Muskingum College offers the following directions for using the chaining strategy.

 Identify the list of information to be remembered.

 Arrange the list of items in order, if they need to be remembered
as such.
 Look at the first pair of items. Develop a vivid mental picture that
links the two items.
 Look at the next pair of items, numbers two and three in the list.
Develop a vivid mental picture that links the two items.
 Repeat the process until all items in the list have been chained.

Color Coding

Color coding is a highly versatile study strategy as it may be used during many different study
activities, such as reading, note-taking and test preparation. Color coding may be used as a way of
organizing information, such as highlighting main ideas in a particular color, pertinent details in a
different color, and subtopics in yet a third color. Color coding may be done by writing or
highlighting in different colors. Muskingum College (n.d.) offers these suggestions for using color

 Try writing flash cards about different topics in different colors of inks
or on different colors of index cards.
 Use different colors of ink to arrange information in outline form. To
distinguish main points from supporting details, write the former in
one color and the latter in another. To distinguish information related
to different topics, write the main points and supporting details for
each topic in a unique color of ink.
 Identify important information in the notes or textbook by using
colored highlighters.

Study Groups

Study groups offer a wonderful opportunity for sparking motivation as accountability to group
members may help to keep you enthusiastic about accomplishing the learning tasks. The idea
behind study groups is to divide learning into smaller tasks that are accomplished by individual
Success Strategies for Nursing Students 27

members and then collectively shared with the group to enhance everyone’s learning. Muskingum
College (n.d.) discusses examples of how study groups can be used.
 Exam Preparation Study Group
o For a management class, the instructor is going to test students
over lecture notes and required readings.
o Members of the study group divide the material into the
following topics: product strategies, process strategies, location
strategies, and human resources strategies.
o Each member writes a summary of his/her topic, combining
both lecture and reading material.
o Each member also makes up three essay questions for his/her
o The study group meets to exchange information.
 Homework Completion Study Groups
o A geology lab assignment involves walking around campus and
identifying different types of rocks.
o Members of the study group divide the area into four parts:
residence hall area, quad area, recreation area, and south
o Each member tours one of the areas and records the rocks in it.
o Then the study group tours all the areas together and each
member explains his/her results for his/her area.
 Notetaking Study Group
o Three students who are auditory learners are having trouble
keeping up with notetaking in Arts and Humanities.
o Each member of the group takes notes for about 18 minutes
during class.
o When not taking notes, the other members of the group listen
closely to the lecture and just write down the major points.
o Then the group meets after class to put the notes together in
an organized manner, to check for discrepencies, and to review
main points.
 Learning Strategies Study Group
o A group of biology students form a study group for an
introductory course.
o They discuss strategies for learning the material for the exams.
o They decide to use flash cards, tables, and sample questions.
o Each member of the group is responsible for applying one of
these strategies to the exam material.
o They meet to exchange their results.
 Reading Study Group
o A marketing reading assignment is divided into parts and
assigned to members of a study group.
o Each member intensively reads his/her section and prepares a
o Then each member skims the other sections.
o The study group meets to exchange notes and discuss the
Success Strategies for Nursing Students 28

When deciding to form a study group it is important to proceed in an organized manner to facilitate
learning and to avoid problems that can occur. (n.d.) offers the concrete advice
regarding the formation of study groups.

Getting a Study Group Started

Study groups don’t just happen. Here is what you should do to

get a study group started:

Get to know your classmates by talking with them before class, during
breaks, and after class. When selecting a classmate to join your study
group, you should be able to answer YES for each of the following
o Is this classmate motivated to do well?
o Does this classmate understand the subject matter?
o Is this classmate dependable?
o Would this classmate be tolerant of the ideas of others?
o Would you like to work with this classmate?

Invite enough of these classmates to work with you in a study group until
you have formed a group of three to five. A larger group may allow some
members to avoid responsibility, may lead to cliques, and may make
group management more of an issue than learning.

Decide how often and for how long you will meet. Meeting two or three
times a week is probably best. If you plan a long study session, make sure
you include time for breaks. A study session of about 60 to 90 minutes is
usually best.

Decide where you will meet. Select a meeting place that is available and is
free from distractions. An empty classroom or a group study room in the
library is a possibility.

Decide on the goals of the study group. Goals can include comparing and
updating notes, discussing readings, and preparing for exams.

Decide who the leader will be for the first study session. Also decide
whether it will be the same person each session or whether there will be a
rotating leader. The leader of a study session should be responsible for
meeting the goals of that study session.

Clearly decide the agenda for the first study session and the
responsibilities of each group member for that session.

Develop a list of all group members that includes their names, telephone
numbers, and email addresses. Make sure each group member has this
list and update the list as needed.
Success Strategies for Nursing Students 29

Characteristics of a Successful Study Group

Once started, a study group should possess the following

characteristics to be successful:

1. Each group member contributes to discussions.

2. Group members actively listen to each other without interrupting.

Only one group member speaks at a time.

3. The other group members work collaboratively to resolve any concern

raised by a group member.

4. Group members are prompt and come prepared to work.

5. The group stays on task with respect to its agenda.

6. Group members show respect for each other.

7. Group members feel free to criticize each other but keep their
criticisms constructive and objective. This can encourage group
members to reveal their weaknesses so that the group can help to
strengthen them.

8. Group members feel free to ask questions of each other.

9. At the end of each study session, an agenda including specific group

member responsibilities, is prepared for the next session.

10. Above all, the positive attitude that “we can do this together” is

Possible Pitfalls of a Study Group

A study group can be a very positive learning experience.

However, there are pitfalls to be avoided. Here are some

1. Do not let the study group get distracted from its agenda and goals.

2. Do not let the study group become a social group. You can socialize at
other times.

3. Do not allow group members to attend unprepared. To stay in the

group, members should be required to do their fair share.

4. Do not the let the session become a negative forum for complaining
about teachers and courses.

5. Do not allow one or two group members to dominate the group. It is

important that all members have equal opportunities to participate.
Success Strategies for Nursing Students 30

Testing Strategies
Test anxiety

The meaning of text anxiety is just what it says – too much anxiety about a test. Most people
experience some level of anxiety prior to and/or at the time of testing. In fact a certain level of
anxiety inspires us to perform at our peak level. However, when a student is overly anxious,
effective test preparation and test-taking can be elusive.

Graduation from nursing school and entry into the profession is dependent upon testing
successfully. Nursing students must become savvy in coping with test anxiety to accomplish their

To determine how to best deal with test anxiety, it is helpful to determine whether this is a
challenge for you. The following questions are offered by to assess if you are
affected by test anxiety.

You probably have test anxiety if you answer YES to four or

more of the following:

1. I have a hard time getting started studying for a test.

2. When studying for a test, I find many things that distract me.

3. I expect to do poorly on a test no matter how much or how

hard I study.

4. When taking a test, I experience physical discomfort such as

sweaty palms, an upset stomach, a headache, difficulty
breathing, and tension in my muscles.

5. When taking a test, I find it difficult to understand the

directions and questions.

6. When taking a test, I have difficulty organizing my thoughts.

7. When taking a test, I often “draw a blank.”

8. When taking a test, I find my mind wandering to other things.

9. I usually score lower on a test than I do on assignments and


10. After a test, I remember information I couldn’t recall during the


Strategies for minimizing test anxiety are offered at

Success Strategies for Nursing Students 31

Here are some things you can do before, during, and after a
test to reduce your test anxiety.

1. Use good study techniques to gain cognitive mastery of the

material that will be covered on the test. This mastery will help you to
approach the test with confidence rather than have excessive anxiety.
Employ the tips we provide at Preparing to Study.

2. Maintain a positive attitude as you study. Think about doing

well, not failing. Think of the test as an opportunity to show how
much you have learned.

3. Go into the test well rested and well fed. Get enough sleep the
night before the test. Eat a light and nutritious meal before the test.
Stay away from junk foods.

4. Stay relaxed during the test. Taking slow, deep breaths can
help. Focus on positive self-statements such as “I can do this.”

5. Follow a plan for taking the test. Don’t panic even if you find
the test difficult. Stay with your plan!

6. Don’t worry about other students finishing the test before you
do. Take the time that you need to do your best.

7. Once you finish the test and hand it in, forget about it
temporarily. There is nothing more you can do until the graded test is
returned to you. Turn your attention and effort to new assignments
and tests.

8. When the graded test is returned to you, analyze it to see how

you could have done better. Learn from your mistakes and from what
you did well. Apply this knowledge when you take the next test.

You have to know the material to do well on a test. You have

to control test anxiety to show what you know.

The Academic Skills Center at Dartmouth College (2001) offers the following guidelines, adapted
from the Harvard Law School Health Service, to combat test anxiety.

1) Try to stay on a reasonably regular schedule of reviewing, eating,

sleeping, and relaxing. Start at least a week, or preferably two, before
exams begin.

2) Don't attempt to study 24 hours a day; your efficiency and capacity

to retain material will rapidly decrease.

3) Don't force yourself to study beyond your normal limits of

concentration. If you find yourself able to concentrate for only ten or
twenty minutes, study for only that period of time and then take a
short break. Your concentration should return. In fact, short and
Success Strategies for Nursing Students 32

regular study periods are more productive than lengthy single


4) Eat a well-balanced diet and drink lots of fluids. Excessive amounts

of coffee may produce confusion and even disorganization of thought

5) Don't use drugs or alcohol -- they can decrease your ability to think
clearly. Take medication only under the supervision of a physician.

6) Be conservative and reasonable about the demands you place on


--adapted from: Harvard Law School Health Service

--this handout prepared by Alison Burrell '95

Test Preparation

Test preparation begins when the course begins and should be ongoing each day during the course
through the use of study skills, such as the ones described in the Study Skills section of this
resource. However some strategies specific to test preparation will be discussed in this section. The
University of Texas at Austin offers excellent advice regarding self-management during exam

How to Survive Exam Weeks

Do you find yourself panicking when you have several exams to take in
a short period? Do you feel a lot more stress during mid-terms and

If so, then the following suggestions should prove useful.

DEALING WITH TENSION. Expect a certain amount of tension. It is

normal during an exam period. Actually a little anxiety helps to
heighten your awareness and can enhance your performance.

1. TAKE TIME TO RELAX. Cope with your excess tension before and
between exams through rest, exercise and deep muscle relaxation. For
example, long walks and bike rides are excellent ways to release
nervous energy and maintain your stamina for the duration of your
exam period.

2. ADOPT A POSITIVE APPROACH. To avoid becoming too anxious, look

at the exam as the application step of your study efforts, instead of a
threatening new experience.
3. ANXIETY IS CONTAGIOUS. Keep away from people who are highly
anxious before exams, because their nervousness may tend to
increase your own.
4. PLAN REWARDS. Schedule a meal, a movie, a handball game, a visit
with a friend periodically throughout finals. Plan a treat when they're
all done. These help keep your spirits up.
Success Strategies for Nursing Students 33

SCHEDULE FOR EXAMS. Prepare a general schedule. Write down the

time of each exam and plan how much time you can allot to studying
for each course; remember that your hardest course will require more

1. START EARLY. Schedule your study periods to avoid last-minute


for getting down concepts and basic relationships.
3. ALLOW SHORT PERIODS FOR REVIEW. Use the odd moments, in the
shower or walking across campus, for recall and review. Run through
the information frequently; this will ensure that you remember it and it
will broaden your understanding.
4. VARY WHAT YOU STUDY. Don't study for two similar courses
consecutively. It is better to break the pattern with a completely
different study approach. For example, study chemistry and then
French instead of chemistry and then physics.
5. SCHEDULE BREAKS. Respect your concentration span. Especially if you
haven't studied much all semester, it may be difficult to study for
several hours at a time. Starting your exam period with impossibly
long study periods is likely to leave you exhausted before it is all over.
6. STAY WITH YOUR ROUTINE. Stick to your normal daily routine as
much as possible. If you do get off your routine and need extra time,
avoid staying up all night; go to bed at your regular time and get up a
couple of hours earlier than you normally would, to continue studying.
You will be able to understand and remember more when you are
rested than you would if you postpone rest.

THE NIGHT BEFORE. As you approach the first exam, and the time
between exams,


LEARNED. Try not to tackle new material then.

2. AVOID STAYING UP ALL NIGHT. The shorter you are on sleep the less
clearly you will be able to think and write what you know on the exam.
3. CRAM SELECTIVELY. The night before an exam when you are more
anxious than usual is one of the least effective times for study. Your
ability to deal with concepts and synthesize material is greatly
reduced, and even your ability to memorize is impaired by marked
anxiety. Cramming only serves to make you more frantic about the
exam and, hence, less prepared to do your best. If you do come up to
exam time unprepared, use your last minute studying as a review of
key concepts, instead of trying to learn it all. Be realistic about what
you can accomplish: set priorities based on what you expect to be
emphasized on the test. Stay calm.
4. DON'T GO TO THE MOVIES. Don't get involved in any activities that
might either interfere with what you have been learning or make you
feel so guilty that you come home to study far into the night to make
up for lost time. Review and relax.
Success Strategies for Nursing Students 34

TAKE CARE OF YOURSELF. In addition to taking an organized and

calm approach to studying, you need to make common sense and
moderation a general life style during this and other times of stress.

Some strategies related to anticipation of the exam content and format are suggested by
Muskingum College (n.d.) and are worth considering.

Expectations about Exam Content and Organization

One reason some students experience test anxiety is uncertainties

about the content and organization of the exam. They do not know
what to expect on the exam. Some of the most common concerns are
listed below (D. Applegate, CAL).

 When and where will the test be administered?

 Which topics, chapters, and readings will be covered on the test?
 What proportion of the questions is from lecture? From readings? From
 What are the most important ideas?
 What kinds of questions - essay, identification, multiple choice, etc. -
will be asked?
 Is the exam open-book or closed-book?
 Do students have to memorize formulas, or is a "cheat sheet" allowed?
 What ancillary materials - blue book, calculator, ruler, etc. - are
required or permitted?
 What level of detail does the instructor expect in the answers?
 Does the instructor look for accurate regurgitation of memorized facts
or for interpretation of information?
 Who will administer the exam - the instructor or a teaching assistant?
 Who grades the exams - the instructor or a teaching assistant?
 How will the questions be graded - full or partial credit, by hand or by
 Does the instructor deduct points for spelling or grammar mistakes?

There are a number of ways to answer these questions. The following

tips are based, in part, on Lunenfeld and Lunenfeld (1992) and
Kesselman-Turkel and Peterson (1981).

Examine the syllabus.

 Many of the aforementioned questions can be answered simply by

checking the syllabus. Most instructors describe testing procedures,
including the types of questions and the ancillary materials permitted,
in the syllabus. Look at the course schedule; topics listed here will
probably appear on the test. Check the syllabus before meeting with
the instructor; he/she may be put off if you ask questions whose
answers are clearly indicated in the syllabus.

Ask the instructor.

Success Strategies for Nursing Students 35

 One of the best ways to clarify expectations is to consult with the

instructor well in advance of the test. It is better to get information
"from the horse's mouth" than from a secondary source. Ask for
clarification during or after class, or better yet, make an appointment
to visit the instructor during his/her office hours. Have a list of
questions ready to ask when you meet with the instructor.
 In some cases, the instructor will reward you with information just for
coming to see him/her. But if the instructor seems hesitant to answer
questions related to the topics or ideas on which the exam focuses,
don't press him/her. Similarly, if he/she says "you should know
everything" and when pressed doesn't offer more clarification, check
the syllabus, old exams, the book, or talk with other students for
insights. Instructors are sometimes unwilling to divulge too much.

Analyze the instructor's behavior.

 If the instructor offers few hints and you've never had a test from
him/her before, try analyzing his/her behavior for clues. Consider the
types of information emphasized in lecture, the nature of assignments,
and the manner of lecture presentation. Ask yourself: Does the
instructor focus on details? Does he/she emphasize facts or ideas?
Would he/she ask "trick" questions? What's his/her goal in teaching
and attitude toward testing? Has he/she encouraged students to
evaluate and interpret concepts?

Look at old tests.

 Old exams are a valuable source of information concerning the topics

or ideas emphasized, the types of questions asked, the way questions
are worded, the level of detail the instructor expects in answers, and
grading procedures. If copies of old tests are not available, say on
reserve at the library, ask the instructor if this accommodation is
possible. Some instructors will do this, but only if asked.

Consult with other students.

 Talk with students who have taken the class before. Not only may they
have old tests, but they may provide insights into instructor
expectations, main ideas, and grading procedures. Current classmates
may have ideas about the major topics to study.

Use the textbook.

 Most texts provide review questions at the end of each chapter or unit.
These should give you ideas of what may be asked on the test. Or try
turning the chapter headings into questions. Check the index listing of
people and concepts; the more page references, the more important
the idea.

Use text workbooks.

Success Strategies for Nursing Students 36

 Student workbooks that accompany the text are an excellent source of

review questions for the reading material. They can give you an idea
of what topics might be covered on the exam and what the questions
may look like.

Practice Test Questions

Doing practice test questions is a wonderful way to prepare for an exam. Study groups could work
together to prepare test questions for group members to use. Muskingum College (n.d.) offers the
following guidelines for using this approach for test preparation.

 Consider the types of questions.

 Find out what types of questions will be asked on the test:
essay, multiple choice, true-false, etc.
 Look on the syllabus, ask the instructor, examine old tests, or
talk with former students in the class.
 Write practice questions.
 There are several approaches to writing practice questions.
Turn the section headings in the book into questions. Take sets
of related pieces of information and write questions focusing on
that relationship. Look for the main ideas presented in each
lecture and form them into questions. Change the numbers
given in math problems and rework them. Ask the instructor for
a few sample questions to get an idea of the how he/she writes
 Until you become accustomed to the strategy, you may want to
use prewritten questions instead of making up questions. There
are several sources of practice questions: old exams, review
questions at the end of each chapter in the textbook, and
student workbooks accompanying the text.
 Because writing one's own questions requires thorough
examination of the test material, students should attempt to
move in this direction as they become more proficient.
 Record the questions.
 Depending on personal learning strengths and preferences,
students may choose to record the practice questions as a list
on paper, individually on flash cards, or as a list on audio
 Answer the questions.
 There are three options at this stage. Students may answer the
questions as they write them. Or, students may answer the
questions later, using the notes and readings as references. In
either case, students may want to record the page numbers on
which the answers are found in the notes or book.
 The third option is to use the questions to as a practice test
after reviewing for the exam. This is done without the use of
notes or other study materials.
 Record the answers.
 Again, students may record the answers on paper, flash cards,
or audio tapes.
 Review the answers periodically.
Success Strategies for Nursing Students 37

 To be really effective, practice questions should be reviewed

periodically to test recall and to improve understanding.
 Look at the flash cards during "down" time between classes or
while standing in line. Listen to the tapes while commuting to
school or to work.
 Change the order.
 Shuffle the questions so the information is not learned in a
particular order.
 This insures that one is actually learning the information itself,
rather than order of questions and answers.
 This also helps one to prepare for tests in which the questions
are arranged oddly; instructors don't always arrange questions
topically or in the order in which the information was covered in
 Practice.
 It takes time to gain proficiency in this strategy.
 Both writing the questions and predicting what might be asked
on the test require practice.
 These skills should improve as students are exposed to a
variety of tests and as they learn more about their instructors'
test-writing habits.
 Don't lose heart when your questions don't appear on the test.
If you've used the strategy effectively, chances are you know
the material well enough to answer different questions.


Students should do whatever they can to enhance their confidence in their exam preparation and
test-taking skills prior to taking an exam. A good level of self-confidence will help to diminish test
anxiety and to prompt optimal performance. If a student believes they will do well on an exam,
they are more likely to do so.

Being over prepared is a good strategy for making oneself more confident and minimizing test
anxiety. Study until you are certain that you know the material. Test yourself on the material either
independently or with a study group to assure your knowledge of the material.


Effective test-taking requires that you approach the exam with strategies to aid you in responding
correctly to test items. In this section discussion will include suggestions for responding to multiple
choice questions, which are the most popular types of questions on exams in nursing school, as
well as being the format used on the NCLEX-RN state licensure exams.

DETER Strategy for Test-Taking

The DETER strategy offers an overall approach to test-taking that is relevant to all test types. How- (n.d.) offers the following explanation of this approach.

D = Directions
Success Strategies for Nursing Students 38

 Read the test directions very carefully.

 Ask your teacher to explain anything about the test directions you do
not understand.
 Only by following the directions can you achieve a good score on the
 If you do not follow the directions, you will not be able to demonstrate
what you know.

E = Examine

 Examine the entire test to see how much you have to do.
 Only by knowing the entire task can you break it down into parts that
become manageable for you.

T = Time

 Once you have examined the entire test, decide how much time you
will spend on each item.
 If there are different points for items, plan to spend the most time on
the items that count for the most points.
 Planning your time is especially important for essay tests where you
must avoid spending so much time on one item that you have little
time left for other test items.

E = Easiest

 The second E in DETER reminds you to answer the items you find
easiest first.
 If you get stuck on a difficult item that comes up early in the test, you
may not get to answer items that test things you know.

R = Review

 If you have planned your time correctly, you will have time to review
your answers and make them as complete and accurate as possible.
 Also make sure to review the test directions to be certain you have
answered all items required.

Information Dumping

Information dumping is a test-taking strategy that may help you in recalling information that you
are afraid that you will forget or confuse. With this strategy you quickly write down information
that you want to remember when beginning the test either on the test booklet or scrap paper, as
allowed by the instructor. Examples of information that you may want to include may be names,
dates, formulas, mnemonics or visuals that helped you memorize test material. Be sure that this is
allowed by the instructor to avoid allegations of cheating.

Multiple Choice Tests (n.d.) offers the following suggestions regarding responding to multiple choice
test items.
Success Strategies for Nursing Students 39

1. Circle or underline important words in the item. This will help you
focus on the information most needed to identify the correct answer
2. Read all the answer choices before selecting one. It is just as likely for
the last answer choice to be correct as the first.
3. Cross out answer choices you are certain are not correct. This will
help you narrow down the correct answer choice.
4. Look for two answer choices that are opposites. One of these two
answer choices is likely to be correct.
5. Look for hints about the correct answer choice in other items on the
test. The correct answer choice may be part of another item on the
6. Look for answer choices that contain language used by your teacher or
found in your textbooks. An answer choice that contains such
language is usually correct.
7. Do not change your initial answer unless you are sure another answer
choice is correct. More often than not, your first choice is correct.
8. Choose “all of the above” if you are certain all other answer choices in
the item are correct. Do not choose “all of the above” if even just one
of the other answer choices is not correct.
9. Choose “none of the above” if you are certain all other answer choices
in the item are incorrect. Do not choose “none of the above” if even
just one of the other answer choices is correct.

The Cook Counseling Center at Virginia Tech (n.d.) offers some strategies to
use with difficult exam questions. Here are their recommendations.

Strategies to use with difficult exam questions

A. Translate the questions into your own words.

B. Read each option carefully.

C. Use a strategy.

Attack unfamiliar words by sounding them out, by breaking them into

familiar parts with meanings you know, by looking at the surrounding
words and sentences for clues to the meaning of the word.

Use your general knowledge. Ask yourself, "What do I already know

about ____________"?

Anticipate the answer and look for the one most like what you expect.
Be flexible. You may not always find exactly the choice you are looking
for. Then, you must choose the best of the options available.

Use logical reasoning. For each possible answer, ask yourself, "What
would happen if . . . "?

Use process of elimination with multiple choice questions for which

more than one option is correct.
Success Strategies for Nursing Students 40

← Pick out the options you are sure are correct.

← Pick out the options you are sure are incorrect.
← Rule out all answers which contain wrong options.
← Rule out all answers which omit options you are sure of.
← Select the best remaining answer.

If you guess at an answer, check your guess against what you already
know and against what your logical reasoning tells you.

Adapted from Kentucky State University Reading Lab

Post-Test Review

Once the test has been completed often a test review will be offered to students.
This may be done once the test is graded or prior to the grading. In either case it is
wise for students to attend this review as it offers the opportunity to gain insight
into how the instructors who prepared the test were thinking and what to expect in
future exams. Hopper (2006) offers a dozen reasons to review a returned test,
which are well worth sharing.

A Dozen Reasons to Review a Returned Test

 Check the point total to make sure it is right. Look for mistakes
in grading.
 Know what questions you missed and why you missed them.
The reason you missed the question is often as important in
taking your next test as the answer.
 Study the instructor's comments especially for essay questions
so that you will know what is expected next time.
 Look for kinds of questions and tricky questions that the
instructor likes to use.
 See if the questions came from the text or the lecture.
Concentrate more on that source for the next exam.
 Correct and understand what you missed. This is information
you need to know. It may appear on a later test or the final.
 Analyze the type of problems you missed so you can review
strategies for that type of question.
 Review to get an idea what kind of test the instructor might
give next time.
 Review to put information back into long term memory.
 You want to ask questions while the test is "fresh."
 Review how you studied for the exam. Look for better ways.

Maintaining Self-Image

Despite how you do on a test it is important to maintain a healthy self-image. The experience of
each exam should be used to identify methods for doing better on future tests. Although adequate
grades for passing the course are the ultimate goal, much can be learned from an exam that you
fail, specifically how to do things differently on the next test.
Success Strategies for Nursing Students 41

You need to focus on what you did right and identify what could have been done better or
differently. Evaluate your test preparation strategies and your approach to test-taking and
determine how you what changes you will make as you approach the next exam.

Additionally, acknowledge the positive aspects of your performance in the nursing program. These
successes can be viewed as examples of your personal success and remind you that you can be
successful in test-taking. You need to focus on the positive and ignore any negative self-talk or
comments from others that distract you from being positive. You can succeed in this nursing
program if you set your mind to it!
Success Strategies for Nursing Students 42

Students with Special Needs


Students with English-as-a-Second-Language (ESL) often face unique challenges, including the
adaptation to American culture, language barriers and social isolation. There are some strategies
that can be undertaken to assist with minimizing these challenges and enhancing educational
success with students with ESL.

English Language and Culture

The University of Texas at Austin offers specific advice regarding English acquisition to students
with ESL. These strategies would also assist the non-native American student with becoming more
comfortable with the American culture. Some of these suggestions are specific to the University of
Texas at Austin but can be adapted to other learning institutions.



Many hours of speaking and listening are needed to produce fluent

speech in your second language. These hours do not need to be in the
classroom alone — natural conversation with minimal correction is
better for fluency than drills. So stop worrying about mistakes you
might make in using English and go out and talk! Making an effort to
have conversations regularly is very important to improving your
speaking and listening skills, especially if you do not speak English at
home. Here is a list of suggestions for getting into conversations in

1. Sign up for informal classes. You'll learn something and there will be
lots of chances to discuss class matters with other students and
2. Visit the academic department that teaches your native language (or
the Department of Linguistics if there is not such a department). Ask
to post a notice that you would like to exchange conversation practice
with an American who is learning your language. Include your name,
phone number and when you can be reached on the notice.
3. Volunteer your time to help handicapped students, old people, children
or others. You will learn more about American life and feel useful as
4. After class, ask another student to explain a point you didn't
understand or disagreed with. Continue this conversation over a cup of
coffee or glass of beer at the Texas Union! Form a study group with
other students to discuss the course and prepare for exams. Talk to
your professors during their office hours about course concerns.
5. Ask Reference Librarians for research assistance at the libraries. Their
job is to help students with such questions, and they can give you
excellent suggestions for your work. If you're not familiar with the
resources of the libraries, take the self-guided tour which is on
Success Strategies for Nursing Students 43

cassette tape. Ask for this at the information desk in the main lobby of
the PCL.
6. Join a club or recreational sports activity on campus. These are often
advertised in the Daily Texan and new people are welcome in most of
the groups.
7. In the grocery story, ask the vegetable or meat counter clerk how to
cook some item of food.
8. In a restaurant, ask the waiter or waitress what a dish is made of and
how it is prepared.
9. Get an American roommate. There are lists of prospective roommates
at the UT Housing and Food Office in Kinsolving Dorm or you can add
your name to the list. Also, pay attention to the Texan for
announcements of a "Roommate Fair" and look around the Union
bulletin boards for "Roommate Wanted" signs.
10. If you belong to a church, join the local one, or at least visit there and
get to know a few members. Some churches have special activities for
international students.
11. Watch the news on television or listen to it on the radio. Try to
understand what is being said. Make a list of words, phrases or news
stories you don't understand and ask an American friend about them.
Pay special attention to idioms.
12. Read the comics in the newspaper. Clip any that confuse you and ask
a friend to explain them. You'll find many idiomatic and slang
expressions and also learn more about the American sense of humor!
13. If you live with your family or other people from your country, set
aside a period of time every day, for example during dinner, to speak
nothing but English. This provides excellent practice for you and them

Minority student nursing associations

Often minority nursing students have difficulties meeting nurses who are of their ethnic or cultural
background. Getting in touch with nurses from similar cultural and ethnic backgrounds should help
to minimize social isolation. Included here is a list of nursing associations addressing cultural
and/or ethnic minorities within nursing practice in the United States. This listing was provided at (2006):

Minority Nursing Associations

Aboriginal Nurses Association of Canada

56 Sparks Street, Suite 502
Ottawa, ON K1P 5A9, Canada
(613) 724-4677

Asian American/Pacific Islander Nurses Association

400 N. Ingalls, Suite 3160
Ann Arbor, MI 48109-0482
(734) 998-1030
Success Strategies for Nursing Students 44


American Assembly for Men in Nursing

P.O. Box 130220
Birmingham, AL 35213
Contact: Byron McCain, (205) 802-7551

National Alaska Native American Indian Nurses Association

Contact: Beverly Patchell, President,

National American Arab Nurses Association

P.O. Box 43
Dearborn Heights, MI 48127
(313) 982-4070

National Association of Hispanic Nurses

1501 16th St., NW
Washington, DC 20036
Tel: (202) 387-2477
Fax: (202) 483-7183

National Black Nurses Association, Inc.

8630 Fenton St., Suite 330
Silver Spring, MD 20910
Tel: (800) 575-6298
Fax: (301) 589-3223

National Coalition of Ethnic Minority Nurse Associations

6101 West Centinela Ave., Suite 378
Culver City, CA 90230
(310) 258-9515
Fax (323) 292-5001

Philippine Nurses Association of America

Contact: Rosario May Mayor, President
Success Strategies for Nursing Students 45

Students with Concentration Problems

Students who have difficulty with concentration will be challenged by nursing curriculums as they
need to be able to focus to learn large amounts of information. Muskingum College (n.d.) offers
several suggestions to assist these students in their college education experience. These
suggestions are as follows.

Task Orientation, Organization & Preparation, Time

Management, Study Skills and Compensatory Considerations

Task Orientation

Staying on target when completing a task may be difficult for attention

deficit students. The following suggestions may help students remain
task oriented. Students may apply the strategies themselves or enlist
the assistance of a facilitator.

Make the task definite

 Determine what must be done to complete the task.

 Make sure the directions and expectations for the task are fully
 Seek clarification of instructions from the instructor rather than from
other students.

Divide and Conquer

 Break the task into smaller, more manageable parts.

 Develop some sort of structure that makes sense to the student.
 Develop a time schedule for completing each part.
 Work on one part at a time, switching to another part when boredom
rears its ugly head.
 Organize each part of the task into separate folders.
 Reward yourself after completing each part of the task.

Feel strongly the urge to do the task

 Relate completion of the task to one's academic goals.

 Relate completion of the task to one's short-term goals, long-term
goals, and ambitions.

Get started at all costs

 Try to ignore difficulties you anticipate.

 Don't think of things you would rather be doing, or just budget time to
do them and get them out of the way.
 If other commitments are fogging your concentration, make a list of
things to do later; this will get them off your mind temporarily.
Success Strategies for Nursing Students 46

 See the Concentration section of this page for more information.

Prepare an effective study area

 For tips, see the Eliminating External Distractions and Organization

and Preparation Considerations sections of this page.


 Work on concentration strategies to help you stay focused.

 See the Concentration section of this page for specific suggestions.

Reduce stress

 Face personal problems and sources of stress directly.

 See the Eliminating External Distractions section this page for more


 Constantly, objectively and realistically evaluate progress toward

completing the task.
 If necessary, enlist the assistance of an outside party (instructor,
advisor, tutor, counselor, parent, trusted friend) for evaluating

Organization and Preparation Considerations

Being organized and prepared to learn eliminates one strong

distraction that may inhibit attending and listening. If you are
organized and prepared, it is one less thing to worry about! Being
organized and prepared for class and study sessions can enhance
attending and listening. Additional strategies are described in the
Organization page of the General-Purpose Learning Strategies main

Organization and Preparation for Class

 Think about the subject matter before class; those five minutes spent
walking to class are the perfect time for this.
 Arrive early to class so you can select a seat in the least distracting
part of the room (see the section on Eliminating External Distractions
of this page).
 While waiting for class to begin, review previous day's notes to get in
the frame of mind of the subject.
 Take the appropriate materials to class: note books, books, pens,
pencils, calculator, etc.
 Complete assignments in a timely manner.
 Do assigned readings before they are to be covered in class (even for
math courses). You have to read them some time, so best to do it
Success Strategies for Nursing Students 47

before class. If you don't have time to read the assignments

thoroughly, at least skim over them to get the main points.
 Take an outline of the readings or a summary of the main points with
you to class.
 Prepare a list of questions over readings and previous notes; you will
be ready to ask intelligent questions when you feel your attention
 Organize course papers into three-ring notebooks or folders.

Organization and Preparation for Study Sessions

 Have a specific place to study, or a place that can come to be

associated with studying.
 Organize your workspace (desk, books, notes, school supplies) and
have everything you will need close at hand. Tips are given in the
Spatial Organization section of the Organization page in the General-
Purpose Learning Strategies main stack.
 Work in a distraction-free area (see the Eliminating External
Distractions section of this page).
 Develop a regular routine of eating, studying, relaxing, and exercising.
 Develop daily activity schedules and weekly planners, and stick to
them. Specific strategies are given in the Time Management page of
the General-Purpose Learning Strategies main stack.
 Make reminders to yourself about assignments and display them in
prominent places in your room.
 Break down large projects into more manageable tasks, then set
deadlines for completing the smaller tasks. See the Time Management
page of the General-Purpose Learning Strategies main stack for
 Buy your own books and supplies rather than borrowing them.

Time Management Considerations

While time management is covered in more detail in the Time

Management page of the General-Purpose Learning Strategies main
stack, some basic points are relevant to a discussion of attention and

Course Schedules

 The number of classes as well as their content should be carefully

considered when scheduling courses.
 A student who has difficulty paying attention might choose not to
enroll in classes longer than 50 minutes if possible, especially lecture
courses in which little student action occurs.
 A student who has difficulty paying attention might choose not to
enroll in back-to-back courses without a break.

Personal Time
Success Strategies for Nursing Students 48

 Daily, weekly, monthly and semester schedules should be organized to

assist in time management.
 Time should be allocated in the schedules for adequate study time as
well as leisure time.
 It is very important for students to periodically evaluate how they
planned to spend time and how it was actually spent. This helps to
develop an awareness of time management practices.
 Students should make class preparation part of their everyday
 Different subjects and activities should always be interspersed during
short study periods to avoid boredom.

Tutoring Sessions

The following strategies can make tutoring (and other intensive

academic) sessions more productive for attention deficit students.

 Divide each session into different tasks, spending 15-20 minutes on

 Provide a review at the beginning and end of each session and/or each
new activity.
 Consider rescheduling sessions to find the optimal time that is
appropriate for the student's interest or activity level.
 Divide assignments into realistic time frames in consultation with daily,
weekly, monthly or semester planners.

Group Learning

The following strategies can make group sessions more productive for
attention deficit students.

 The goals and expectations of the study group should be clearly

 The group should meet for short periods of time, or should divide the
session into smaller tasks, spending 15-20 minutes on each task.
 The group should meet in a distraction-free area (see the Eliminating
External Distractions section of this page).
 If the attention deficit student has poor social skills or impulse control,
he/she should be introduced gradually to group learning situations; in
addition, supervision by a mediator may be helpful until the student
becomes accustomed to the situation.

Study Skills Considerations

Study skills, as discussed in other pages of the General-Purpose

Learning Strategies main stack, may aid in sustaining student

Strategies such as SQ3R help students attend while reading.

Success Strategies for Nursing Students 49

Color coding and highlighters help the student pay attention to more
important information.

Visual aids such as charts, graphs, flashcards, and timelines may help
students to focus.

Time management strategies, such as spacing reviews and time

planners, help students to maintain their attention on the task at

Compensatory Considerations

Compensatory equipment is often useful to the attention deficit


Textbooks and reading assignments on tape help the student to focus

while reading.

Taping lectures provides a fairly complete, permanent, auditory record

of lectures. Students may use tapes to improve the quality of notes if
they trouble paying attention for the entire class.

Accommodations for Special Needs

Legislature requires that learning institutions offer accommodations for students with certain
conditions that might prevent them from being successful in educational endeavors. If you have a
learning, health, emotional, or physical condition that interferes with your ability to perform in
school you need to consult with the nursing department at your school to see how you may
proceed to be considered for accommodations.

The following table, offering examples of student characteristics and possible accommodations was
developed by the University of the State of New York, the State Education Department, and the
Office of Vocational and Education Services for Individuals with Disabilities (2006).

Examples of Student Characteristics and Possible Accommodations

Student Characteristics Possible Effect Possible Accommodations
on Test-taking
Poor attention/distractibility. May have difficulty  Separate setting free from
Has difficulty remaining on concentrating on test items distractions
task. for extended length of time  On-task focusing prompts
and completing exam in  Provide breaks during
allotted time. May be exam period
distracted by other students.  Extended time
 Study carrel
Success Strategies for Nursing Students 50

May have difficulty  Directions read more

following or remembering than standard number of
directions. times
 Directions provided for
each page of questions
 Directions simplified
May have difficulty  Record answers directly
dividing attention between in test booklet
the test booklet and
recording answers on a
separate answer sheet.
Processes written May not be able to complete  Extended time
information at a slow rate. exam within standard
May become  Separate setting
fatigued/distracted.  Directions read
 Tests read orally*
 Multiple day
Poor physical /motor Unable to or has difficulty  Use of computer/word
coordination /writing recording responses using processor or other writing
difficulties. paper and pencil in standard aids.
manner.  Respond orally to scribe
 Separate setting when
using scribe
 Use of adaptive writing
Difficulty recording  Record answers directly
answers on a separate in test booklet
answer sheet.  Allow additional space
for writing

Writing tasks completed at a  Extended time

slow rate.
Unable to or has difficulty  Use of calculator/math
using paper and pencil to tables*
solve computations.  Use of graph paper to
align numbers when
doing computations
Success Strategies for Nursing Students 51

Difficulty May not understand what  Directions read orally

following/understanding the test requires them to do.  Directions simplified
directions.  Additional examples of
directions provided
 Key words or phrases of
directions highlighted

May have difficulty  Directions reread for

remembering directions. each page of questions

Visual Impairments Unable to or has difficulty  Braille

accessing test in standard  Tests read orally*
print format and requires  Tape recorder
tactile or oral means to
obtain information.
May have low or limited  Large type
vision and has difficulty  Magnifier
with standard print.  Tests read when fatigue
sets in due to eye strain*
 Special desk or book
stand to hold materials
for easier reading
 Extended time
 Increase spacing between
test items
 Fewer items per page

Unable to use paper and  Use of calculator/talking

pencil to solve calculator*
computations  Use of graph paper to
align numbers

Difficulty tracking from test  Record answers on test

to answer sheet. booklet
 Templates to reduce
visible print
May have low or limited  Highlighting entire
vision and has difficulty graphs to increase
with detailed visual tasks contrast from color of
such as printed material, page
graphs, charts, diagrams,  Special lighting
etc.  Oral description of
graphs, charts, etc.
presented in a neutral
Success Strategies for Nursing Students 52

Difficulty maintaining place  Use of templates to

in a standard test booklet. reduce visible print
Visual-perceptual Difficulty focusing on  Large type
difficulties individual items if too many  Increase spacing between
items are presented. test items
 Fewer items per page
 Use of templates to
reduce visible print

Emotional/ Mental Health Displays test anxiety.  Extended time

Impairments  Breaks during test
Exhibits inappropriate  Separate location
behavior.  On-task focusing prompts

Administered medication  Test administered during

which may affect the optimal times when
student’s physical stamina. student is most alert
Health Impairments/ Poor Unable to sit for extended  Extended time
stamina lengths of time without  Breaks provided for rest
changing position. periods
 Adaptive furniture
Unable to complete test  Multiple day testing
within standard time  Separate setting
allotted due to fatigue.
Increased fatigue as  Use of scribe when
duration of taking test fatigue affects ability to
increases. write
 Tests read when fatigue
affects ability to read*
Difficulty with reading Reading skills below grade  Oral reading of tests or
level of test. sections of tests that do
not measure reading
Slow reading pace.  Test read orally to student
individually in a separate
location to accommodate
individual student pace*
 Extended time
Success Strategies for Nursing Students 53

Hearing Impairments Unable to or has difficulty  Use of sign language

accessing oral directions or interpreter for oral
listening sections of test in directions and listening
standard manner. passages
 Listening passages may
be signed more than once
 Written directions
 Extended time
 Separate setting
 Amplification devices
 Preferential seating in
front of interpreter
Difficulty with auditory Difficulty remembering  Repeat directions more
processing and/or understanding oral than standard number of
directions. times
 Directions simplified
 Provide written directions
 Preferential seating
 Repeat listening section
more than standard
number of times
Success Strategies for Nursing Students 54


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