What Is the Hardest Class in Nursing School? 10 Tough Courses

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Written by Marie Hasty, BSN, RN Content Writer, IntelyCare
Students in library studying for the hardest class in nursing school.

Whether you’re considering nursing school or are starting classes soon, you’ve probably heard how challenging nursing curriculums are. Being a nurse is a huge responsibility, and nursing classes must prepare you for situations where you’re holding lives in your hands. Is there a hardest class in nursing school? Let’s go over typical curriculums and their difficulty.

Nursing Program Structure

First, it’s important to understand the different nursing programs. Here’s a breakdown of the most common paths to licensure:

Licensed Practical Nurse (LPN) programs prepare students for practical nursing roles, where they provide basic care under the supervision of RNs and physicians. Programs typically last 12 to 18 months and include classroom learning and clinical practicum. Courses include anatomy, pharmacology, and basic nursing skills. After completing the program, students must pass the NCLEX-PN exam to become licensed.

Registered Nurse (RN) programs are longer and prepare nurses for a broader scope of practice. These college programs have more general education requirements than LPN training, and you’ll graduate with a degree rather than a certification. There are two main paths to choose from if you’re pursuing an RN license, and both paths qualify you to take the NCLEX-RN exam:

  • Associate degree in nursing (ADN) programs typically take 2 to 3 years to complete, focusing on essential skills and knowledge needed for nursing practice.
  • Bachelor’s degree in nursing (BSN) programs generally take 4 years and provide a more comprehensive education. BSN programs have a broader focus on nursing theory and leadership.

Each of the three educational paths above share some courses, but the depth of information may differ. For example, every program has a pharmacology component, but an LPN program’s pharm course will likely cover less information than an ADN or BSN pharm course.

10 of the Hardest Classes in Nursing School

If you’re anticipating nursing school soon, what are the classes you should look out for? Within ADN and BSN programs, you’ll generally take courses in this order:

  1. Prerequisite classes, such as microbiology, anatomy and physiology, and psychology
  2. Early core classes, such as fundamentals, advanced anatomy and physiology, and adult nursing
  3. Later core classes, such as obstetrics, pediatrics, psychiatric nursing, and capstone

Let’s break down 10 of the hardest class in nursing school, in the order you may encounter them during your education:

1. Anatomy and Physiology

This foundational course is often one of the first hurdles nursing students face. It covers the intricate details of the human body, from cellular structure to organ systems. The volume of information, and the need to memorize and understand how everything interconnects, can make this course a challenge.

2. Microbiology

Microbiology introduces you to the world of microorganisms — bacteria, viruses, and fungi. You’ll learn about their roles in health and disease, as well as infection control practices. The subject matter can be overwhelming, especially with the detailed lab work that often accompanies it.

3. Pathophysiology

Pathophysiology builds on your anatomy and physiology knowledge but takes it a step further by exploring how diseases affect the body. The complexity of understanding disease processes and how they alter normal physiological functions makes this course tough but essential for nurses. The good news is that while taking this course, you’ll typically also be seeing patients in the clinical setting, which can make learning concepts easier.

4. Pharmacology

Some students believe pharmacology takes the cake for being the hardest class in nursing school. In this course, you’ll dive into drug classifications, mechanisms of action, side effects, and interactions. The content is both dense and expansive — you’ll need to learn hundreds of different medications, and their implications for nursing care.

5. Adult Health Nursing (Medical-Surgical Nursing)

Sometimes referred to as med-surg, this course is a cornerstone of nursing education. It covers topics related to the care of adult patients with various medical conditions. This course is typically paired with one of your first clinical rotations, where you’ll begin putting your skills into practice. The breadth of content and the need to apply knowledge in clinical settings can make this especially challenging.

6. Pediatric Nursing

In pediatric nursing, you’ll focus on the care of infants, children, and adolescents. The challenge lies in understanding the unique physiological and psychological needs of this population. For example, a normal heart rate for an infant could mean acute distress in an eight-year-old. In the clinical setting, you’ll also need to implement communication skills for interacting with both young patients and their families.

7. Obstetrics and Gynecology (OB/GYN) Nursing

This OB-GYN nursing course covers the nursing care of women during pregnancy, childbirth, and the postpartum period, as well as reproductive health. The material is complex, and the clinical rotations can be intense, making it a challenging yet rewarding course.

8. Psychiatric Nursing

In psychiatric nursing, you’ll care for patients with mental health disorders. You’ll learn about various diagnoses, symptoms, and pharmacological management. The course is challenging because it requires not only a strong understanding of psychiatric conditions but also the development of therapeutic communication skills. This course typically also has a clinical component so you can practice these skills with patients.

9. Advanced Medical-Surgical Nursing

This course is an extension of your initial med-surg class, but it delves into more complex and acute health issues. The advanced nature of the content, combined with high expectations in clinical settings, makes this the hardest class in nursing school for some students. The silver lining is that this is typically one of your last nursing school courses, so if you’ve made it this far, you’ve probably developed good study habits.

10. Capstone Course

The capstone course typically comes at the end of your nursing program and is designed to integrate everything you’ve learned. It often involves a major project, research, and working one-on-one with a preceptor.

Capstone is challenging because it tests your ability to apply all your knowledge in a comprehensive and practical way, often with high-stakes evaluations. By the end of your capstone clinical rotation, you may even be caring for patients independently under the supervision of your preceptor.

Graph showing 10 possible answers to question "What is the hardest class in nursing school?"

Why Are Nursing Classes So Hard?

Class difficulty is subjective — the hardest class in nursing school for one student might be easy for another. Still, nursing school courses have a reputation for being notoriously challenging, for reasons that are practical, academic, and cultural. Here are four reasons why nursing school can be demanding:

1. Job Responsibility

Being a new grad nurse is challenging. Graduates of other degree types — like English, Philosophy, or Math — aren’t likely to carry as much responsibility in their first job out of college. Nurses are on the front lines of patient care, making critical decisions, managing complex health situations, and ensuring patient safety.

Intense coursework reflects the gravity of these responsibilities and is meant to prepare students for real-life situations where the stakes are high. For this reason, rigorous nursing programs don’t just keep up NCLEX pass rates, they help keep the public safe.

2. Practical Challenges

Nursing programs typically have a more demanding schedules than other degrees, including clinical rotations, frequent exams, and lectures. You’ll likely need to arrive at clinicals before dawn at 0645, and you may not leave until 1930 in the evening. As a nursing student, you may have less time to go to social events and travel, and your time for studying may be at a premium.

3. Academic Rigor

Nursing school exam prep includes some basic memorization, but instructors will also be testing your critical thinking skills. Subjects like pharmacology, anatomy, and pathophysiology require a deep understanding of the human body and how it responds to illness and treatment. To do well in your later-stage nursing courses, you’ll need to remember content from previous ones and apply it.

Additionally, some programs use a more stringent grading scale. For example, in many schools, an exam score under 80% is a failing grade. Dosage tests may have an even smaller margin of error, with the lowest passing grade at 90%.

4. Cultural and Interpersonal Challenges

Nursing school, like the nursing profession, has a unique culture that may require some adjusting to. Part of the job of nursing instructors is to introduce students to this culture, and this introduction can be abrupt. For example, don’t be surprised if instructors lock the doors to their lecture halls at the start of class to prevent students from coming in late.

While these enforcement practices may help students adjust to the requirements of being a nurse, this behavior may also be described as bullying. Nurse bullying doesn’t just happen on nursing units — it can also begin in nursing schools.

One study revealed that in 6 months, 78% of nursing students experience bullying in school. Intimidation and incivility from instructors, who hold more institutional power than students, is a significant challenge within nursing education. The hardest class in nursing school can have more to do with the instructors than the course content.

Nursing Classes: FAQs

What’s the hardest class in nursing during the first year?

Of the first several courses you take, Anatomy and Physiology is sometimes seen as the hardest class in nursing school prerequisites. Typically broken up into AP I and AP II, this course lays the foundation for all future nursing studies, covering everything from cellular biology to the functions of major organ systems. The amount of detail and memorization, combined with the pressure to grasp how the body functions as a whole, can make this a tough course for many students.

What is the most failed class in nursing school?

This will depend on the program you choose, but some students feel that the class with the highest failure rate is Pharmacology. This course is challenging due to the amount of information you need to memorize, including drug classifications, mechanisms of action, dosages, and side effects.

Many drugs sound similar; Celebrex and Celexa, for example, are completely different medications. You’ll need to know and apply the information you learned in Anatomy and Physiology, as well as Pathophysiology, to do well in this class.

Is Pharmacology the hardest nursing class?

It depends on who you ask, but Pharmacology does require more technical knowledge than other courses. Other challenging nursing classes include Pathophysiology, Adult Nursing, and Obstetrics.

What are the easiest classes in nursing school?

Students typically find that the easiest nursing school classes cover topics like theory, community health, and leadership. These are some of the courses that differentiate an ADN degree from a BSN. Many ADN-prepared nurses graduate from their programs, pass the NCLEX, and take these courses part-time while working.

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