The Student Nurse Guide to Coping with Testing Anxiety

Natalie Jane, NP

Exams are tough-but anxiety? Anxiety is tougher. Even the prospect of situational anxiety seems to mess up the underlying exam mental game. And to make things better, it seems that the difficulty level or the self-regarded importance of any exam may be directly associated with the level of anxiety experienced!

When it comes to test anxiety and performance anxiety in general, I used to be the absolute worst. I would get so anxious and nervous that I would walk out of exams in high school. In nursing school, I would finish first-and not because I was disgustingly arrogant or knew the material better than anyone else-only because I wanted to get out of the room!

My doctor tried prescribing me propranolol-the drug they give to surgeons with a tremor and nervous public speakers. However, after almost fainting in the shower because of a drop in my blood pressure, I knew I would have to approach the issue more holistically. Here are some of my best tips for student nurses for beating testing anxiety during nursing school exams and, of course, the big board exams!

1. Know the Science Behind Testing and Performance Anxiety.

One of my favorite elective classes in undergrad was Sports Psychology. The content is really fascinating. I played competitive tennis in high school and college which involves so much mental stability in the moment-which I lacked! It's really not that much different from taking an exam. One concept I was particularly interested in was Yerkes-Dodson Law.

I perceive sports performance anxiety and academic testing anxiety as analogous. Knowing the science behind my testing, or performance anxiety, was truly the first step in overcoming the obstacle. It really made me look critically at myself. When am I successful? When am I overly-anxious-and how do I best calm myself down? When do I become fatigued, and if I do, how do I address that? Yerkes-Dodson Law states that optimal performance is attributed to optimal arousal. My job was to find "my flow" state.
Tennis CourtNatalie Jane

2. Slow Down on The Caffeine Intake

I started drinking coffee when I was 14 and I may have went a little bit too far with it. I realized quickly it was a great tool for my ADHD-in MODERATION. Suddenly I was more focused and I really did start to do better in school. However, anything over two cups and I felt like I was going to have a heart attack. In that high anxiety state, it's difficult to focus.

However, an adequatly titrated amount of caffeine can at least push you into the moderate or optimal arousal stage and out of fatigue mode-without the panic state. I encourage people to slow down on the caffeine intake on the day of the test to stay out of a high anxiety mode. If you normally have two cups, one will likely be sufficient on test day.
Drinking CoffeeNatalie Jane

3. Strategy, Tempo, and Momentum

I use these words a lot when I am board-prepping students. You have to attack the question with the same approach (strategy) in a timely manner (tempo). This is what facilitates forward momentum. This helps prevent over-thinking during the exam, and getting stuck on a question.

I expect all of my students to come up with some sort of answer for each question, even if it's a guess! It's important to approach the test questions the same EVERY TIME. Then-if you're in an anxious state-at least you're still moving forward. It's that brain "muscle memory," if you will. I think of it as an assembly line. If you create something the same every single time, even if your morale is low or you're feeling under the weather, you can still perform. For a lot of these exams you must perform "well enough," but it's impossible to predict every piece of content and critical thinking skill evaluated. I want my students to be comfortable answering any level question to the best of their ability. A consistent approach lessens anxiety.

4. Translate

Unfamiliar words can be anxiety-inducing, especially latin terms and drug names. However, patterns do exist! If you see a bunch of unfamiliar terms, try to translate the words or phrases into your own. Let's say you get a question on Diverticulitis-but you can't exactly remember exactly what it is. But you remember it's a GI condition and that "itis" can translate to inflammation or infection. That may give you enough information to get to the correct answer. When you see a bunch of words you don't know-pause and calm yourself before you get anxious, start to panic, and then blank. You might know more than you think you do, it may just be a matter of translation!

5. Simulate the Environment to Desensitize

While I tutor, I try to make the platform look as similar to the testing environment as I can. The test is virtual, so I stay virtual. If you have a history of testing anxiety, it is very important to simulate your studying environment with your testing environment. You want to be as comfortable as you are studying while you test. This can also help with memory. If the computer-based test increases your anxiety-that's exactly where you need to be when you're studying. If you feel more comfortable talking things out in a group, your goal needs to be thinking it out on your own. If you don't do well under pressure, start timing yourself and give yourself rewards for certain milestones.

6. Yoga Deep Breathing

When I feel like my heart is racing during an exam, deep breathing can be extremely helpful. I actually recommend taking a Yoga class in order to learn this, because the instructors are typically deep breathing masters. I read somewhere that it (deep breathing) has an almost sedative, anxiety-reducing effect, and science backs this up. When you get riled up and anxious during an exam, this can be extremely helpful.
YogaNatalie Jane

7. Work Out First

This can help relieve some of the anxious tension prior to an exam. I wouldn't recommend running a marathon prior, but maybe something similar to walking briskly for thirty minutes.

8. Food as Fuel

A high-protein diet is important for me. I feel almost too many highs and lows with a high carbohydrate or sugar diet. If I eat a high protein breakfast before studying as well as before studying for an exam, I feel much more focused. I have read that the longer burn of a high protein diet can be helpful for ADHDers in terms of focus.
HamburgerNatalie Jane

9. Practice Stoicism and Take Off the Pressure Off Passing

It sounds strange, but I encourage students to take the pressure off of themselves when it comes to passing. Obviously passing should be the goal, and I want to help get them there! However, sometimes that extra pressure can hurt them rather than help them. I don't recommend students place themselves in situations where a job is contingent upon them passing if they don't think they can handle that added stress. If you don't pass the first time, it's not the end of the world, even if it seems like it. It's important to re-evaluate and modify your study plan at this time. Taking the emotion out of it, or remaining stoic, can help significantly.
ReadingNatalie Jane

10. "Don't Feed in to Viral Emotion"-(Robert Greene)

A lot of my students talk about friends who have already taken the exam and what they have said about it. They even discuss message boards where they have received a lot of miscellaneous information concerning the exam that may or may not be true. I highly encourage them not to listen and just to focus on their own study path. It's easy to get caught up in the drama of nursing school and nursing peers, but it's not worth it. Before the test, focus on yourself. You don't want to unintentionally absorb the emotions and insecurities of others and begin questioning yourself. Emotions can be quite contagious. Robert Greene say this in one of his many books.

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Nurse Practitioner turned Board Exam Preparation Coach and Mom.

St. Louis, MO

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