6 Hardest Classes in Nursing School and Ways to Survive Them

Written By: Kasee Wiesen DNP, APRN, FNP-C

Becoming a nurse is incredibly rewarding and satisfying and can lead to numerous job opportunities and career advancement. As a nurse, the settings you can work in is endless—you can work with inpatients on a medical-surgical floor, an intensive care unit, the operating room, or pre-and post-op. You can also work as a school nurse, in a clinic, as a hospice or palliative care nurse, and as a home health nurse. The opportunities for career advancement are a plus—and while some require additional education, others require experience. But, the first step to achieving all of this is completing nursing school—which can be intimidating. Nursing school is challenging and requires hard work and dedication. One question you may have is, what is the hardest class in nursing school? This is a tricky question to answer as it may differ for everyone. Below, I have provided information on the 6 hardest classes in nursing school and effective ways to survive them.

Are All Nursing Classes Hard?

Nursing school is hard—and everyone wants to know what is the hardest nursing class or hardest course in nursing school. But, there is no one simple answer to that question because every student will have their challenging moments and courses throughout nursing school. What you may find difficult, another student excels in. But again, nursing school, in general, is hard. This is because nursing school prepares you to practice independently—to deliver direct patient care, answer patient and family questions and work directly alongside the healthcare team to provide high quality and appropriate care to patients. Therefore, the courses you take are designed to teach you this knowledge and skillset.

So, to come back to the question, are all nursing classes hard and what are the hardest classes in nursing school? It is very individualized. Some students find every course challenging, while others find the pre-requisites challenging but have no issues once in nursing school. Let me give you an example—when I was in nursing school, I found OB to be incredibly hard. I can still remember studying for those exams and not having the information make any sense. I was the minority when it came to not comprehending OB in nursing school—most of my class found it incredibly easy. However, I took a critical care course that focuses on cardiac disorders and EKG interpretation—that class I excelled. I loved it! And when I reflect on this—it makes sense. I still do not fully understand OB, but I loved working in critical care environments such as the ER during my bedside nursing career.

10 Ways to Prepare and Succeed in The Hardest Classes in Nursing School

Now that you are in nursing school, you may be wondering how you prepare for the hardest nursing classes. Below, you will find ten ways to prepare and succeed in the hardest classes in nursing school--—please note these are in no specific order.

1. Get organized before the start of the semester.

Before the semester starts and throughout the first week of the course, get organized! In other words, get the folders, notebooks, notecards, and binders you may need. Ensure you have the required textbooks. Print off any vital information, including the syllabus, course calendar, and rubrics--and highlight important dates such as assignments due or tests on your calendar. During this time, also ask any scheduling questions you may have.

2. Go to class and ask questions.

This may seem obvious, but you must go to class to succeed. You must attend class either in person or virtually, depending on your program offers. This also includes attending all clinical dates as well. And, it is not uncommon for the simple act of attending class not to be enough—you also need to ask questions or seek clarification on anything you do not fully understand.

3. Learn and know your learning style

It is crucial to figure out and know which learning style is best for you. This may take a couple of weeks to determine as it may be different for you than when in high school. From personal experience, how I learned in high school compared to nursing school was completely different. I just read the assigned readings in high school and completed the assignments, and I would do fine on the tests. Nursing school was different, and I learned that very early on. I am a visual and hands-on learner and use notecards, typing up my study guides, answering the objectives, and joining a study group to study and succeed in nursing school.

4. Form a study group

This flows nicely with the point above—join a study group. There are no rules to how many people can join a study group; you want to make sure the study group you join is a good fit for you regarding study techniques and personalities. Study groups allow you to also learn from other students whose explanation on a specific topic may make more sense than how your instructor explained it. Also, for many people, the act of discussing the topic with others can lead to better retention of the information.

5. Study a little every day

Study a little every day. I cannot stress this enough. This may mean 15 minutes of practice questions or 3 hours of serious and intense studying. As I have stated numerous times, nursing school is hard, and you are taking multiple courses at once. Therefore, studying a little bit every day will help prevent falling behind—because if you fall behind, it can be challenging to catch back up.

6. Get to know your teachers and ask for help when needed.

Your nursing instructors are there to help you. Do not be afraid to ask for help or seek clarification from them. They can provide direct responses to your questions, but may also be able to provide information about other resources that may help the student—ie. a tutor.

7. Complete the readings or other prep work before each

Your class instructors methodically plan out what information you should focus on in your textbook or other class resources before class. It is essential to read or, at the very minimum, skim the info before each class. This will allow you to be prepared for class, have a greater understanding of the content covered in class, and will allow you to ask more thoughtful and specific questions. Doing the pre-class work means the information being taught isn’t brand new—or in other words, when the instructor covers it in class, it is more a review of the information and not first-time exposure.

8. Focus on the course and unit objectives when studying. And if you are lucky to get a study guide—focus on that information when studying

It is not uncommon for your course readings to focus on a lot of information. All of this information is important, and you should complete the required readings, but when studying for tests, I recommend you focus on the course objectives, and any study guides your teacher provides you. This is typically the content they want you to know for their tests.

9. Find hobbies or activities outside of nursing school and studying.

Studying for nursing school is important—but you must take breaks! Be sure to find outlets for stress and develop a good school-life balance.

10. Review your tests

Review your test, even if you did well or have no significant questions. It is another tool to help solidify information you have learned and clarify questions you missed—which may help you on future exams or in your practice as a nurse.

What is the Hardest Class in Nursing School?

I am unable to tell you with 100% which class is the hardest class in nursing school, but I am able to provide you with a short list of the hardest classes in nursing school. Below, I will discuss the 6 hardest classes in nursing school and effective ways to survive each one of them. Please note, these hardest nursing classes are in no specific order.

1. Human Anatomy

What is the Class About:

Anatomy discusses the structure and components of the human body. This course teaches about the bones, tendons, muscles, ligaments, nerves, and organs—and the location within your body. This course is often taught alongside a pathophysiology course as the information goes hand-in-hand.

What Makes it Hard:

This course is challenging because there is a lot to learn—and the majority of the information is new. Learning the bones, nerves, tendons, muscles, etc., and their location within your body requires much focus and study.

How to Survive this Class:

To survive human anatomy in nursing school, I recommend you do each of the 10 things I list above to prepare and succeed. Some items specific to succeed in anatomy class include:
1. Use mnemonics:
Mnemonics are great at helping you remember important information—and when studying human anatomy, you will come across numerous mnemonics to help you remember the cranial nerves, bones in hand, cranial bones, etc.
2. Use practice anatomy quizzes and flashcards:
There are a lot of practice anatomy quizzes and flashcards you can purchase or find online. These are great because they allow you to apply the information but do not affect your grade.
3. Re-draw diagrams:
Lastly, re-draw the diagrams you are provided throughout your class. Personally, this helped me a lot. I would use this technique along with #4 when studying anatomy. Even though I am a horrible artist, drawing re-drawing the diagrams solidified the information in my brain and helped me excel throughout the course.

2. Pathophysiology

What is the Class About:

Pathophysiology is the study of illnesses and diseases in the body—including the impact these diseases can have and how to manage these diseases processes.

What Makes it Hard:

This class is challenging because you learn about numerous disease processes within the body, including treating various illnesses or disorders. That leads to a lot of information that needs to be understood. This information is also critical to retain as it lays the foundation for the remainder of your nursing courses.

How to Survive this Class:

To survive pathophysiology in nursing school, I recommend you do each of the 10 things I list above to prepare and succeed. Some items specific to surviving pathophysiology class include:
1. Use mnemonics:
As I mentioned for anatomy, some mnemonics can be helpful to remember specific information learned in pathophysiology—for example, the 3Cs for common causes of hepatomegaly.
2. Create flashcards or study guides:
Do not just memorize the information—you need to comprehend the information to be successful. Creating flashcards and study guides are very helpful when studying pathophysiology. You can build your study guide off of your course objectives, or you can even find study guides online or through other references (i.e., Books) to further assist your studying. I would use my objectives to create a study guide to help me succeed in pathophysiology.
3. Use online resources to supplement the information learned in class:
Using other resources to increase the information you learn in class is very helpful. There are numerous videos out there to help you further understand the content. For example, specific youtube videos will break down hypertension, EKG abnormalities, diabetes, etc.

3. Medical-Surgical Course 1

What is the Class About:

Adult Medical-Surgical 1 nursing course teaches the students about the various disease processes they may encounter in the adult patient and how to deliver nursing care to them. It starts to put together all of the student’s information in previous courses and how it will translate to care for the patient.

What Makes it Hard:

This course is challenging because it is one of most BSN students’ first nursing-specific courses. It is often their first opportunity to apply the information they have learned from their foundation courses—anatomy, pathophysiology, pharmacology, and health assessment—making it feel overwhelming at times.

How to Survive this Class:

To survive Adult Medical-Surgical Course 1 in nursing school, I recommend you do each of the 10 things I list above to prepare and succeed. Some items specific to this course include:
1. Find opportunities in clinical to apply the information:
A clinical course is often attached to this nursing course, and this is your chance to use the information you learn in class—not just discuss it theoretically. While you cannot control your experiences during clinical—you can seek out learning opportunities. You are often assigned one patient, but if your nurse doesn’t have any other students, ask if you can follow them around with their other patients. Also, if you do not know something you see in clinical, write it down and look it up yourself—or ask your instructor for clarification. Clinical is your chance to do the “hands-on” portion of nursing but with support from your nurse or instructor.

4. Pharmacology

What is the Class About:

Pharmacology is about the medications or drugs you may encounter as a nurse. Whether you are administering the medication, see it on a patient's medication record or their list of home medications. This includes why the drug is prescribed, how it works within the body, the desired outcome of the medicine, and possible side effects.

What Makes it Hard:

This class is challenging because you have to learn a lot of information. Learning and memorizing the drug class, what the drugs are used for, and possible side effects are challenging and time-consuming.

How to Survive this Class:

To survive pharmacology in nursing school, I recommend you do each of the 10 things I list above to prepare and succeed. Some items specific to pharmacology include:
1. Make note cards.
Notecards are easy to carry around with you—providing the opportunity to study anywhere. You can use them to learn which drugs are in a specific class, why the class of drugs is used, or even the side effects of the drugs.
2. Take practice quizzes:
Practice quizzes are a great tool to practice comprehension of the information before sitting for the test. With so much information in pharmacology, practice quizzes help you identify the content you know from the content you may struggle with. This allows you to identify your weaker areas--indicating what areas you need to emphasize in your studying.
3. Use the assigned readings and supplemental online information:
This depends a lot on your learning style and how the information is taught in class. When I taught students completing their BSN degree, I often referred them to other online resources such as Youtube videos to provide further clarification or even clever ways to help remember drug endings and other things.

5. Microbiology

What is the Class About:

Microbiology is the study of organisms, specifically microorganisms, that are too small to be seen with the naked eye. This includes bacteria, viruses, fungi, protozoa, algae, and archaea.

What Makes it Hard:

Microbiology is complex for several reasons. First, there is a lot of content covered throughout the course--including the names of microorganisms, characteristics of the microorganisms, and the diseases they cause. This is important to know because it will help guide the treatment of these diseases. Lastly, this class also has a clinical, which may be challenging for some students. Your “experiments” or assignments in clinical may not go as planned, leading to some frustration.

How to Survive this Class:

To survive Microbiology in nursing school, I recommend you do each of the 10 things I list above to prepare and succeed. Some items specific to Microbiology include:
1. Read the chapter before class and clinical—I have provided this suggestion for other courses.
You must complete the assigned readings and assignments that are part of the pre-class prep work before class. This will allow you to start already learning the information, so the terminology and concepts aren’t new when you are in class. By already having a foundation of the content being covered, you will more actively participate in class and ask meaningful questions.
2. Make notecards:
Notecards are easy to transport—allowing you to study wherever you are. You can use notecards for terminology, names of the microorganisms, and how to identify and treat the organisms.
3. Read over your class and clinical notes within one day of taking.
This will lead to greater retention of the information and allow you to identify areas you are not understanding, leading you to seek out help from the instructor or tutor earlier on.

6. Health Assessment

What is the Class About:

Health assessment is a fundamental course that you will take early on in the nursing program. The purpose of this course is how to perform a thorough head-to-toe assessment and review of systems (subjective and objective assessments).

What Makes it Hard:

This course is challenging because many students in nursing school have never had to complete a thorough review of systems with a patient or complete a physical assessment on the patient. There is a lot of information to learn—for example, you must learn how to listen to heart and lung sounds, identify what is abnormal, and the possible causes of this abnormal finding in your assessment. You will also learn how to chart your results—both normal and abnormal correctly.

How to Survive this Class:

To survive Health Assessment in nursing school, I recommend you do each of the 10 things I list above to prepare and succeed. Some items specific to survive this course include:
1. Find a study partner:
Find a study partner who will allow you to practice your assessment skills. This is beneficial because you will get to practice your assessment skills, but when you are the “patient” for your partner, you can point out areas that need improvement, further aiding your learning.
2. Use clinical time wisely:
Health Assessment will have a clinical component. This is your opportunity to practice on mannequins or participate in the SIM lab to practice your assessment skills. Many students do not take advantage of this time, leading to poor scores or assessment skills. If the lab is open for 2 hours, use the whole 2 hours to practice your assessment skills. These skills are the foundation of your nursing career, and you must be able to perform them correctly to deliver high-quality care to your patients.
3. Watch videos:
Videos are beneficial when learning health assessment skills. It is helpful to watch other people perform the assessment, and the videos often include assessments for abnormal findings and what the next step should be. Lastly, videos will be able to play recordings of what you may find on an abnormal assessment, including abnormal heart or lung sounds and neurological changes.

My Final Thoughts

Do you feel better about applying for nursing school and tackling the challenging courses? I know I did not answer the question, what is the hardest class in nursing school? Again, I believe this question can be somewhat individualized. But, I hope the information I provided you regarding the 6 hardest classes in nursing school and effective ways to survive them gives you tips and tricks you can use to succeed in these 6 nursing courses—and truthfully, all of your nursing courses.

Frequently Asked Questions Answered by Our Expert

1. Out Of All The Classes, What Is The Hardest Nursing Class?

As I stated above, no one course is considered the hardest class in nursing school. This is typically an individual experience and opinion, but it is often one of the six courses I discuss above.

2. What Hardest Nursing Class Is The Most Important?

All nursing classes are important. Nursing schools have similar curriculum outlines designed to prepare you for success as you progress through the program, and each course typically builds on the information you learned previously. For example, your nursing-specific courses such as medical-surgical nursing, pediatrics, and OB build on the information you learn in anatomy, pathophysiology, pharmacology, and health assessment. Therefore, all information you learn in each nursing class will be vital to your nursing career and directly impact the care you deliver.

3. On An Average, How Much Do Nursing Students Score In The Hardest Nursing Classes?

Most nursing schools require you to achieve a C or C+ test grade average to pass the class—regardless if this is one of the hardest nursing classes or not. This is a great question to ask when completing nursing school interviews.

4. Can I Choose To Skip Taking A Nursing Class Because It Is Hard?

No. There are specific courses that you must complete before graduating from nursing school and sitting for the NCLEX. And to practice as a nurse, you must pass the NCLEX board certification exam.

5. What To Do If I Fail A Hard Nursing Class?

If you fail a challenging nursing class, do not give up. Identify what you could have done differently and try again. This is done through self-reflection, meeting with your teacher and dean, and meeting with a tutor. Be mindful, though, that most programs will only allow you to fail two courses before you are asked to leave the program.

Kasee Wiesen DNP, APRN, FNP-C
Kasee Wiesen is a practicing family nurse practitioner. Her nursing background includes emergency medicine, pediatrics and peri-op. Education is a passion of Kasee’s, and she has taught BSN, RN-BSN and DNP students, and has enjoyed every moment of it!