“Nurses eat their young” is a common phrase that is engrained into the minds of nurses everywhere. What I learned the hard way – it can start as early as nursing school.

It is so, so real.

This summer I started a job at a new long-term care facility and had my first shift on my own. However, I had done CNA work for 5 years, I know how to do cares like the back of my hand.

I was originally supposed to have an internship in the ED-Trauma department at a major hospital that I was extremely excited for. Due to COVID-19, it was unfortunately cancelled. I decided to take a position as a summer CNA at a facility that was desperate for CNA help due to the rising COVID-19 cases.

I was pulled to a floor I had never been on before, and of course I was slow as I have never been one to half-do my cares in order to get all the residents done faster.

I was told to take my lunch break, which I did, and had no clue what I was coming back to.

Long story short, I was completely belittled by a nurse manager on my floor in front of all of the other nurses and CNAs. I was accused of taking my break when I was not supposed to, not following the daily schedule correctly, and yelled at over our walkie talkie system which everyone, including the residents, can hear. Take into consideration this was my first day on my own in a separate facility and new floor I had never stepped foot on. I stood there, in tears, innocently and hopeless explaining I was brand new and had never been trained on this floor, but the nurse wasn’t taking it. I had never met this woman before.

I’d like to thank the angel of a LPN who noticed I was struggling and pulled me into a closet and let me break down into tears, personally went with me to the floor to help with cares, and gave me time to collect myself before I went back out on to the floor with tears still running down my face shield for the remainder of my shift.

All I could think of was, “I should be at my internship in the ED-Trauma department right now. I chose to move here. I chose to come help this facility because I knew they desperately needed the help due to COVID-19. I’m even running on five hours of sleep because I stayed late the previous night to finish all the cares and to help out on the other campus.” I wanted to defend myself, but I stood there paralyzed and struggled to return to work the rest of the summer.

According to the Joint Commission, 44% of nursing staff members have been bullied.

Never, will I ever belittle my CNAs, patient care techs, or anyone considered “lower” than me. I know how it feels to be a newbie, overworked, and underappreciated.

I highly encourage anyone who experiences workplace bullying to report it immediately. You aren’t “tattling,” you are saving yourself, and probably many others, from mental distress and abuse. No one deserves to go to work scared or dreading it.

Nursing doesn’t have room for bullying. Stop eating your young.

Hi everyone, my name is Sam, and I am currently in my last semester as an Associate Degree Nursing Student at Lake Region State College in Devils Lake, ND.  

A question I’ve been asked from quite a few students, whether they are in high school, college, or looking at switching their career is this: “How did you know nursing was what you wanted to do?” or “How do I go about getting into nursing school?” 

I’ve known I wanted to be a nurse since I was 5 years old. I loved taking care of people and making them feel better, but as I got older, I thought that I couldn’t do it. I struggled with math all through high school and had such a negative mindset of “I have to be perfect or at least good at math to even get in.” I became very discouraged and eventually I gave up on that dream of being a nurse and I went to college to be a teacher. After that, I went to cosmetology school for a brief time, and while I loved both I soon began to realize that those two careers allowed me to educate and make people feel good or better about themselves…something nurses do every day! 

I realized that I could do anything I put my mind to, I simply had to believe in myself, and you should too!  

How do I know if becoming a nurse/nursing school is right for me? 

I think the best way to gauge if nursing school or nursing in general is a good fit, is to get some experience. Getting your Certified Nurse Assistant (CNA) License, working as an Unlicensed Assistive Personnel (UAP), volunteering at a medical facility like a nursing home, or even shadowing in a provider’s office can shed some light on what to expect as a nurse.  

For me, I started this process by working as an optician and eventually moved over to a bigger medical facility where I worked as a medical secretary and worked with scheduling, insurance, and had contact with patients, nurses, and doctors every day. By getting my foot in the door and gaining experience, not only did it look good on my application, but I got to get a feel for how the medical world was and I liked it!  

So how do you go about getting into nursing school? 

1. Know why you want to be a nurse 
   Maybe you care about helping people and want to make a difference in the lives of others, or maybe you’ve been impacted first-hand by healthcare. Either way, you should have a good understanding of why you want to do this. You will be asked many times and how your answer can increase or decrease your chances of getting into the school you want.
   
2. Start looking at schools that offer programs and look into their requirements for applying.
   Every school is a little bit different with how their program is run, who they’re accredited by, their requirements for entry, and their NCLEX pass rates. These are all attributes that can determine how long you go to school, where you will have clinicals, and how your overall experience might look.
   
   Personally, I chose an accelerated 18-month program with a high NCLEX pass rate because I wanted to start working as soon as possible and I wanted to be highly prepared, but I know others have chosen a four-year BSN program because they wanted that higher degree and wanted summers off from school. It all depends on what you want and what works for you! 
   
3. Take your required pre-requisites, entrance exam, and gain experience. 
   Pre-requisites, sometimes called pre-reqs, are the classes you need before you can be considered a nursing student. In some cases, programs want these done before you apply to the specialized program, but other times schools may let you take these while you’re considered a nursing student.
   
   Some schools also require an entrance exam. These are similar to the standardized tests you take while in high school, but also assess your decision-making skills, learning style, and critical thinking skills.
   
   I chose a school that allowed the latter because I didn’t want to waste a year completing a few pre-reqs. They also did not require medical experience, but since I had some, they counted it as a bonus for me to be considered for entry.
   
4. Apply! 
   Now is the time to apply! Make sure you apply early enough so you don’t miss out on the deadlines! Oftentimes these deadlines are in place so you can also get scholarships and other opportunities set up before starting school. Remember why you started and why you wanted to be a nurse! Nursing school can be overwhelming, but I promise it goes by quickly and is SO worth it!  

Elsevier Adaptive Quizzing (EAQ)™ really reflects what nursing questions are like. Most of my peers find EAQs challenging, and in fact they are. I believe the harder the questions, the better the student will become. I have seen a great improvement in my own course grades because I spent so much time practicing questions and reading the rationales.

Customize Quizzes

Custom quizzes are the greatest invention ever and honestly a great tool for all nursing students. You can specify EAQ target areas to focus on or simply the areas that will be tested during the course exam. The quiz is customizable to even the number of questions you want to do, so you can answer as few as five or as many as thirty questions while using study mode or exam mode. I prefer and would recommend using study mode because it gives you the answers with the rational after each question.

Practicing these quizzes changed my approach to studying for course exams. Normally, I would re-read slides, re-read chapters, and re-watch lectures, but now I practice questions. My exam score went from a 68% to an 82%, and I completed the semester with an 82% average. I credit these successes to practicing specific questions using EAQ.

Reading Rationales

I used to be someone who would answer a question, get it wrong or right, then move on. I never read the question rationale until one day I happened to glance at it and notice that they offer motivational advice, excerpts from specific textbooks, graphs, diagrams, processes, etc. From then on, even if I get a question correct, I would read the rationale provided. Sometimes it helped me realize that my rationale for picking the correct answer was not completely correct, and ultimately, it came down to me guessing.

I also use the answer rationale to guide my reading. It informs me of what information I need to focus on from the chapter, what assessment data I missed, if I listed the appropriate medications, and what common side effects I may have omitted. This is what the rationale does, it guides you.

Practicing Multiple Questions

Don’t give up just because you couldn’t answer the questions. Yes, the EAQs are hard, but it is for a reason. Practice the same concept at least five times. You’ll start to notice a pattern on how questions are asked for particular concepts. Do 30 questions at a time and repeat the process. Take notes while you go through.

Calendar View

I love this tool. I don’t need a planner because the EAQ already has a calendar available with all my due dates for assigned work. Use this to mark off study days before and after a concept is taught. This is a time gauge and requires dedication. After all, your grades depend on it. Use your calendar option to plan ahead. For example, if a coping EAQ is due 3 weeks from today, start gathering your coping materials and start customizing practice questions focused on coping. There is a trend in how questions are asked. Practice a lot so you can recognize different question formats and focus your studying on how to answer these questions.

Timing

I appreciate that EAQ times how long you spend on a question. This is very important since most nursing school exams (or at least mine) are 75-90 minutes long ranging from 50-60 questions per exam. Because practice questions with EAQs are timed, you get to see how long it took you to answer a specific question.

I am not encouraging anyone to speed through an exam, but I have mentored and seen far too many students not completing an exam because time ran out. Create a journal and log how much time it took you to answer 30 questions in EAQ. Aim to reduce your time. One piece of advice is to use the Forest app, something I used myself. I plant a tree for 1 hour and document how many questions I can answer within that hour before the tree is fully grown. This puts some fun into your studies as well.

Success from using EAQ is not a one-time deal. You must be consistent in practicing questions, which means you have to log in daily. Remember that calendar view I mentioned? Well, if you don’t check your calendar daily you might miss an assignment. That has happened to me countless times and now I make it a priority to log in and check my EAQ daily.

Look at your Analytics

Most programs will require that you master a specific concept, which means you can spend anywhere from 10 minutes to hours mastering a concept, which is dependent on you doing practice questions.

What I’ve noticed is that whenever you practice questions on EAQ, let’s say Maternity, those practice questions count towards you mastering the concept. EAQ has three levels, level three being mastery. If you never looked at your EAQ, or even practiced a few questions, this is where this mastery exam can take hours because now you have to go through all the levels (1, 2, 3).

This is where the analytics come in. Use this as a guide to identify what concept/content area needs leveling up. Your EAQ will often have a quick suggestion of some content on the top of the banner the moment you log in. Practice a few of these questions. It will save you some time on the mastery exam. See the image below for an example. Notice that in leadership I am currently at Level 1 mastery; I will need to practice more leadership questions to full master this content area. Log in and check it out.

Lastly, you got this. Stay the course and practice with EAQs, and trust me, you will see a difference. P.S. — do not expect instant results, this takes time and a great understanding of oneself and one’s strengths and weaknesses.

You’ve completed your prerequisites, and now it’s time to focus on the entrance exam. Here are a few tips and a break down of what the HESI A2 entrance exam consist of: 

• Grammar: Students are expected to display their knowledge of basic grammar concepts. Each student must show their comprehension of parts of speech, typical grammar errors, and important grammatical concepts. The HESI grammar test is 50 questions and students are given 50 minutes to complete. I failed the entrance exam twice! English is not my first language and I struggled with grammar. I am sharing this because nursing school is very diverse. Applicants are from all over the world, or newly immigrated to the U.S. Don’t be discouraged. I used the SATs, language portion, to prepare for the Hesi grammar section along with the evolve HESI A2 entrance exam book. (image below). 
• Math: The HESI math questions are evaluating a candidate’s knowledge of basic mathematical concepts. The math skills tested normally have some relation to health related scenarios. Don’t be scared, breath and extrapolate the needed information. Each student is expected to have a strong grasp of the following math skills: addition, subtraction, multiplication, division, fractions, proportions, ratios, and decimals. Questions will also be presented on roman numbers, calculating dosages, household measures, and conversions. The section is 50 minutes long and consists of 50 questions. If you’re a math lover like me, you got this!  
• Physics: This section is dependent on your program. For my program physics is not required, which means I did not have this section on my test. But, for those who have to, here’s what included. The physics test will cover general physics concepts such as: rotation, friction, gravitation, energy, average speed, Newton’s Laws of Motion, projectile motion, light, optics and acceleration. Test takers are given 50 minutes to answer 25 questions. The physics test is usually only required for Nursing programs that require Physics as a prerequisite course. You got this physics lover! 
• Biology: This is by far my favorite section. The biology questions, I’ve noticed, are focused on general biology topics including: biology basics, cellular respiration, photosynthesis, metabolism, biological molecules, and cells. The HESI biology exam contains 25 questions. The biology test is not required by all Nursing programs. 
• Anatomy & Physiology: This section was not required for my program, so I have no insider tips on how to be successful. What I do know is this: The A&P exam evaluates a student’s understanding of fundamental Anatomy and Physiology concepts such as: anatomical systems, structures and general terminology. This section also has 25 questions.
• Chemistry: This seems to be the most difficult for most students I’ve talked with or tutor. The chemistry section is designed to quiz students on the periodic table, chemical equations, atomic structure, chemical bonding, nuclear chemistry and chemical reactions. This section is also 25 questions  

Knowing that these are the areas being tested on, I would advise that students should take a post-test on all these areas to identify gaps in knowledge. I have mentored students who did this, and realize they need a quick “Intersession course,” generally two weeks long, to brush up on the foundations. Most universities offer these courses like this.  

Finally, invest in some resources! You are accountable and responsible for your education.  

Preparation is just one of many test-taking strategies for students. Walsh (2015) reveals that preparation is key to passing tests. Preparing for tests can be time-consuming because students generally don’t know what will be tested. Therefore, students should create enough time for preparation. They need time to study key concepts, commit to refresher courses and read through publications and manuals. Moreover, students need time to practice problems, work, and time for family and friends. Time is crucial in preparing for tests. Hence, Walsh (2015) suggests that students should begin preparing for tests as soon as possible. Early preparation builds students’ confidence for test-taking.

Self-assessment is also essential for test-taking. Students should begin performing a self-assessment once the exam date is confirmed. Walsh (2015) states that self-assessment can be done using tests related to the course and rating knowledge of the subject matter. This way, students evaluate their strengths and weaknesses and adjust accordingly before the actual test-taking date. Once students perform self-assessment, they should register for refresher courses, which are a valuable resource for test preparation (Walsh, 2015). In addition to refresher courses, students should read, review, solve practice problems, and take practice exams. Walsh (2015) suggests that students should also consider tutoring as a strategy for exam preparation. In essence, Walsh (2015) observed that tutoring allows students to cover challenging areas and gain more confidence for taking the test.

Students who prepare for tests early are more likely to excel than others. Academic success requires preparation and resource utilization, which enhances students’ confidence. Walsh (2015) says that confidence eliminates text anxiety that is caused by uncertainty and fear regarding the subject material. Thus, more preparation builds more confidence for test-taking.  

Most importantly, students should understand instructions before taking tests. Sullivan et al. (2020) observed that students are often overwhelmed when reading test instructions for the first time. However, thorough reading helps them understand the instruction and reduce anxiety. Students are often anxious about tests because they don’t know what exactly is on the test (Sullivan et al., 2020). Reading through the test more than twice helps students understand the test. Hence, Sullivan et al. (2020) encourages students to read the directions carefully to avoid mistakes that would lead to failure.

Before answering the questions, students should ensure that they understand all the requirements. Sullivan et al. (2020) found that some students rush to answer the questions and later realize that they haven’t met the requirements. For example, a test may require students to choose specific questions, but the person ends up answering all the questions because they didn’t identify the requirement. Sullivan et al. (2020) encourage students to go through the questions slowly to grasp all the requirements. This way, students avoid skipping important instructions and assuming that they know what the question asks.

References

Sullivan, B., Dunn, K., & Berry, V. (2020). Test preparation: An international comparison of test takers’ preferences. Assessment in Education: Principles, Policy & Practice, 28(1), 13-36.

Walsh, K. (2015). How to pass exams: evidence-based advice?. Journal of the Royal Society of Medicine, 98(6), 294-294.