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Refresher Course - RN

Refresh your knowledge

Are you an inactive registered nurse looking to review and update your nursing knowledge and skills? This self-study refresher course was developed to help the inactive registered nurse review and update their nursing knowledge and skills, thus allowing them to move with confidence into a nurse orientation program and return to practice.

This course is offered as distance education through online learning and may be completed in one’s home community at a pace and time which best meets individual needs. The Refresher Course is not a college credit-granting program. This course is taken to pursue professional re/certification of a nursing license.

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number of theory hours (completed online)

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maximum time for course completion

12 months
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minimum Number of clinical hours

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program fee


"This was a fantastic course and I feel like I learned a ton! Great preceptor and I learned so much from my clinical rotation."
-Former RN refresher course participant, Alaska

Course Structure

    Course Objectives

    The objectives of the course are to provide an opportunity for the participant to:

    • Gain an understanding of current philosophy, objectives, and social and cultural implications of nursing.
    • Review and enhance previously acquired nursing skills.
    • Demonstrate the role of the registered nurse in assessing clients' needs and in planning individualized care.
    • Review and increase knowledge of selected medical and surgical conditions, therapies and procedures, current diagnostic and treatment measures and patient care needs.
    Course Start Date

    The program is ongoing. Participants may enroll at any time.

    Course Delivery and Required Technology

    Course Components

    This course is split into two components: 145 hours of theory and a minimum of 80 hours of supervised clinical (or hours as required by your state board of nursing). The theory portion of the course can be completed entirely online, and the clinical component can be completed in your home community.


    All course materials and theory module exams are delivered online through Desire2Learn (D2L) and Assessment Technologies Institute (ATI) supported modules, followed with a medication calculation test. All required exams in D2L and ATI must be successfully completed before proceeding to the clinical component of the course.

    The participant will complete course review and exams at a time and location of their choosing. A computer with built in or add-on webcam is required for taking exams. A desktop or laptop computer is required when taking exams. iPads, iPhones, Tablets, etc. are not permissible. Video proctoring and browser lockdown applications are enabled through D2L for this time to provide participant verification and testing security measures. A webcam is not provided by SDSU and will be an additional cost to the participant.

    Participants need to make sure their browser is properly configured to use the D2L system. The following checks ensure that the browser is properly configured:

    • JavaScript Cookies enabled,
    • Adobe Flash plug-in,
    • Screen resolution recommendation -- 1024 by 768 pixels and
    • Rich content editing.

    Theory Component

    Theory Component

    The theory component is based on a textbook to help direct and reinforce learning. The theory portion has been organized into ten major instructional modules with an examination after each module. ATI products are integrated in the theory modules and include Skills, Pharmacology Made Easy and Dosage Calculation – Dimensional Analysis, with a final medication calculation test. After successful completion, the RN Refresher participant is awarded 145 theory hours. Completion of theory involves successful completion of all module tests, ATI skills, ATI pharmacology, ATI dimensional analysis modules and the final medication calculation test. 


    There are ten (10) multiple choice examinations, one for each theory module. Each examination contains twenty-five (25) questions in varying formats such as true/false, multiple choice, multiple select. Two opportunities are allowed to successfully complete each module post-test with a score of76% or greater. If a score of less than 76% is attained on post-test A, the participant will review the module material again and complete post-test B. If a score of 76% or greater is not obtained on either post-test A or B, the participant will be dismissed from the program.

    ATI Skills

    The twenty-six (26) required and four (4) optional ATI Skills modules are integrated throughout the course material to provide learning opportunities related to the requirements of a registered nurse in various clinical settings.

    The ATI Skills are used in conjunction with the textbook to provide in-depth information and visual cues for each learning experience. ATI Skills modules are designed with a pre-test, completion of learning modules, then followed by a post-test. The modules are self-paced and interactive, contain audio and video clips as well as step-by-step procedures. Case studies in the form of practice challenges are included in each module. The modules support the participant’s skill-building, apply the theoretical and evidence-based information and instill confidence in understanding of skills. The participant should expect to spend an hour to complete the pre-test, review of the tutorial including the overview, step-by-step viewing, accepted practice components and post-test.

    Participants must receive a post-test score of 76% or greater on each of the twenty-six (26) mandatory ATI Skills. If a 76% is not attained on the first attempt, participants will re-take the post-test until the passing score of 76% or greater is achieved. Participants will document their test activities on the SDSU provided form and submit to the CNE office upon completion. This data is verified by the CNE office before approval is granted to proceed to the clinical experience.

    ATI Pharmacology Made Easy

    The thirteen (13) modules are integrated throughout the theory modules to provide learning opportunities and application of skills. Video case studies that simulate providers interacting with clients focus on the clinical application of drug information. 10-item drills at the conclusion of each module reinforce content and enhance learning. Recommended time for completion of modules range from one (1) hour (Introduction) to four (4) hours (cardiovascular system). Each module includes a post-test that contains twenty-five (25) NCLEX-style questions to assess knowledge acquisition. Participants will receive immediate feedback with rationales provided for both correct and incorrect answer choices to reinforce learning. 

    Participants must receive a post-test score of 76% or greater on each of the thirteen (13) ATI Skills. If a 76% is not attained on the first attempt, participants will re-take the post-test until the passing score of 76% or greater is achieved. Participants will document their test activities on the SDSU provided form and submit to the CNE office upon completion. This data is verified by the CNE office before approval is granted to proceed to the clinical experience.

    ATI Dosage Calculation 2.0 – Dimensional Analysis

    This module is an interactive, media-rich, online tutorial that is designed to help participants learn the basics of safe medication administration. The Dosage Calculation series improves comprehension and critical-thinking skills in relation to safely calculating medication dosages. The nine (9) modules provide approximately six (6) hours of interactive instruction in which participants practice clinical reasoning and problem-solving skills while working through in-depth tutorials and real-life case scenarios. Questions are interspersed throughout each module to provide practice problems. A twenty (20) question post-test will be completed after each module with participants receiving immediate feedback with rationales provided for both correct and incorrect answer choices to reinforce learning.

    Participants will complete the nine (9) ATI modules and receive a 76% or greater score on each of the module tests. If a 76% is not attained on the first attempt, participants will re-take the post-test until the passing score of 76% or greater is achieved. The participant will then proceed to the ATI final by completing the nine (9) case studies and take the four (4) post-tests. Participants must receive a score of 76% or greater on each of the four final tests. If a 76% is not attained on the first attempt, participants will re-take the four (4) final tests until the passing score of 76% or greater is achieved. Participants will document their test activities on the SDSU provided form and submit to the CNE office upon completion. This data is verified by the CNE office before approval is granted to proceed to the clinical experience.

    Final Medication Calculation

    Participants will take a medication calculation test at the end of theory and before proceeding to clinical. The test includes ten (10) questions that require the participant to calculate and document their answer. Up to three (3) opportunities are allowed to successfully complete the medication calculation test with a score of 100%. Participants that do not obtain a 100% on the medication calculation exam A, B or C will be dismissed from the program.

    Theory Overview

    Module I             

    Conceptual Foundations of Nursing (Part 1)

    • Unit 1: The Profession of Nursing
    • Unit II: Health, Wellness and Integrative Healthcare
    • Unit III: Healthcare in the Community and Home
    • Unit IV: The Nurse’s Role in Healthcare Quality and Patient Safety
    • Unit V: Culture and Diversity Unit VI:  Focus Studies – Delegation, Informatics, Leadership & Management
    Module II           

    Conceptual Foundations of Nursing (Part 2)

    • Unit I: Communication in the Nurse-Patient Relationship
    • Unit II: Values, Ethics, and Legal Issues
    • Unit III: Nursing Research and Evidence-Based Care
    • Unit IV: Patient Education and Health Promotion    
    Module III          

    Nursing Process

    • Unit I: Critical Thinking and the Nursing Process: Foundations for Practice
    • Unit II: Nursing Assessment Unit III:  Nursing Diagnosis
    • Unit IV: Outcome Identification and Planning  
    • Unit V: Implementation and Evaluation
    • Unit VI: Documentation and Communication in the Healthcare Team   
    Module IV          

    Clinical Nursing Therapies

    • Unit I: Health Assessment
    • Unit II: Vital Signs
    • Unit III: Asepsis and Infection Control
    Module V           

    Clinical Nursing Care – Part 1

    • Unit I: Safety Unit II:  Sensory
    • Unit III: Cognitive
    • Unit IV: Self-Concept
    • Unit V: Stress, coping and adaptation
    • Unit IV: Medication Administration
    • Unit V: Intravenous Therapy
    Module VI          

    Clinical Nursing Care – Part 2

    • Unit I: Hygiene and Self Care
    • Unit II: Urinary Elimination
    • Unit III: Bowel Elimination

    Module VIII       

    Clinical Nursing Care – Part 4

    • Unit I: Nutrition
    • Unit II: Skin Integrity and Wound Healing
    • Unit III: Infection Prevention and Management
    Module IX          

    Clinical Nursing Care – Part 5

    • Unit I: Mobility
    • Unit II: Sleep and Rest Unit III:  Pain Management    
    Module X

    Clinical Nursing Care – Part 6

    • Unit I: Families and their Relationships
    • Unit II: Loss and Grieving
    • Unit III: Human Sexuality Unit
    • IV: Spiritual Health Unit
    • V: Caring for the Older Adult

    Medication Calculation Exam

    Skills via ATI

    • HIPAA
    • Physical Assessment (Adult)
    • Vital Signs
    • Blood Administration
    • Central Venous Access Devices
    • Intravenous Therapy
    • Medication Administration 1-4
    • Enemas
    • Personal Hygiene
    • Urinary Catheter Care
    • Air-way Management
    • Closed-Chest Drainage
    • Oxygen Therapy
    • Diabetes Management
    • Enteral Tube Feedings
    • NG Intubation
    • Nutrition, Feeding and Eating
    • Infection Control
    • Surgical Asepsis
    • Ambulation, Transferring and ROM
    • Pain Management

     Pharmacology via ATI

    • The Hematologic System
    • The Neurologic System – Part 1 & 2
    • The Gastrointestinal System
    • The Reproductive and Genitourinary Systems
    • The Respiratory System
    • The Cardiovascular System
    • The Endocrine System
    • The Immune System
    • Infection
    • The Musculoskeletal System
    • Pain and Inflammation

    Dosage Calculation - Dimensional Analysis via ATI

    • Safe Dosage
    • Medication Administration
    • Oral Medications
    • Injectable Medications
    • Powdered Medications
    • Parenteral (IV) Medications
    • Dosage by Weight
    • Pediatric Medications
    • Critical Care Medications
    • Case Studies (9)
    Clinical Component

    Clinical Component

    Arranging for the clinical experience is the responsibility of each prospective participant. Clinical sites must be within the United States, or on a US Military base in a health care setting operated by medical staff licensed within the US. Examples of accepted clinical settings include but are not limited to hospitals, nursing homes, surgery centers, urgent care centers, rehabilitation centers, home health or hospice agencies. The prospective participant must check with the appropriate Board of Nursing to learn specific health care settings for clinical are required.

    COVID-19 Waiver

    Due to the current COVID-19 Outbreak, SDSU is temporarily waiving the requirement to obtain a verbal commitment for the clinical experience prior to enrollment. Because of current restrictions in healthcare facilities, SDSU will allow participants to enroll and begin the theory component of the course before a clinical site is secured.

    Arranging Clinical

    Clinical hours must be arranged with an approved health care provider before or at the completion of the theory component. Arranging the clinical experience is still the responsibility of the participant. Participants will make the initial contact to request and secure that the facility can provide a clinical experience. After a verbal commitment is achieved, SDSU Continuing Nursing Education (CNE) staff will contact the clinical site to establish the required affiliation agreement.

    Hours Required

    A minimum of 80 clinical hours is required for course completion. However, each state Board of Nursing determines the number of clinical hours necessary for license reactivation. If the state requirement is more than 80 hours the participant will be notified of this with enrollment, and this requirement will be adhered to during the clinical experience.


    Where required, a limited license must be obtained from the State Board of Nursing during the clinical component of the refresher course that allows nursing practice only under the direct personal supervision of a licensed registered nurse identified as the clinical preceptor. The limited license is only valid for a specific time period and may not be used for gainful employment.

    Clinical Plan and Pre-Clinical Requirements

    When preparing for clinical, the participant will submit a completed Clinical Plan to SDSU. This one-page form is reviewed and may be approved after the following pre-clinical requirements are uploaded and approved in the participant’s CastleBranch account. When all pre-clinical requirements are met, the Clinical Plan is approved and a date range for clinical hours will be set. The start date for clinical will be a minimum of ten (10) business days after approval, or longer if work to complete a required affiliation agreement with the site is still underway.

    Pre-Clinical Requirements

    1. Copy of Government issued photo identification card (submitted with enrollment)
    2. FBI Background Check with Fingerprinting (completed with enrollment application)
    3. Online Background Check (completed with enrollment application)
    4. Multi-Waiver Release Form
    5. Measles (Rubeola) Immunity
    6. Mumps Immunity
    7. Rubella (German Measles) Immunity
    8. Varicella Immunity
    9. Hepatitis B Immunity or Waiver
    10. TB skin test
    11. Tetanus, Diphtheria, Pertussis Immunity
    12. Influenza Vaccination – required during flu season October - March
    13. CPR Certification for the Professional Rescuer / Health Care Provider
    14. Proof of Personal Health Insurance Coverage
    15. Professional Liability Insurance
    16. Drug Screening (10 panel – current within 3 months of beginning clinical)
    17. Temporary Permit or Limited License (where required)

    Participants that elect to complete only the theory portion of the course will not open a CastleBranch account to obtain the above pre-admission background checks or pre-clinical requirements. A copy of a government issued identification card may be submitted with the enrollment application.

    Clinical Evaluation Procedure

    The clinical experience is evaluated by:

    1. The setting and attainment of personal learning objectives,
    2. The evaluation of the clinical preceptor during the clinical experience, using the evaluation tool included in the course materials,
    3. Clinical hours log and
    4. The participants typed summary of 400 words or more, of what was learned during the course.

    The clinical experience requires a satisfactory performance evaluation by the clinical preceptor. If the participant’s performance is unsatisfactory on any given clinical day, it is at the discretion of the clinical preceptor whether to count that clinical day toward the total hours required for the clinical component.

    If the participant’s overall clinical performance is unsatisfactory, the preceptor, in collaboration with the College of Nursing faculty, will determine if further experience beyond the required clinical hours is needed or if dismissal from the program is in order. Additional information pertaining to the clinical experience is available in the Clinical Syllabus and the CNE Program Handbook.

    Course Completion

    Successful Course Completion

    The participant must successfully pass both the theory and clinical components to complete the refresher course. Upon successful completion, a certificate will be mailed to the participant. A copy of the certificate will be sent to the participant’s Board of Nursing to document successful completion of the course.

    If a participant is unable to successfully complete either the theory or the clinical portion, this will result in failure of the refresher course. Appeals for the opportunity to retake course exams or the clinical experience are not guaranteed and will be handled on a case-by-case basis. No participant will be allowed more than two opportunities to successfully complete clinical. Any dismissal from the course for academic reasons is appealable pursuant to University Policy 2:4.

    Completion Time Frame

    The refresher course is self-paced. Once enrolled, the participant has one (1) year to complete the course. If the course is not completed within the one-year deadline, the participant may purchase a one-time extension for $500.00. The extension adds three months for course completion. A request to extend must be received within thirty (30) days of the course end date. After this period, re-enrollment with payment of the full program fee and background checks is required.  

      Course Enrollment and Cost

      Admission Criteria

      Admission Criteria

      The refresher course considers enrollment from prospective participants in the following circumstances:

      • Formerly licensed RNs who wish to reactivate their nursing licensure.
      • Currently licensed RNs who desire to refresh their knowledge or skills in the profession, due to time away from practice.
      • Unlicensed RNs that have successfully completed an RN education program however have not yet successfully completed the NCLEX-RN exam. Admission for this participant is accompanied by the requirement that s/he must successfully complete the NCLEX-RN exam prior to receiving approval to begin the clinical component of the course.

      Conditional Admission

      Admission to the clinical portion of the refresher course is conditioned on the results of the background checks completed through CastleBranch and acceptance into clinical placement determined by a health care agency.

      If a prospective participant has been convicted, pled guilty or no contest to, or received a suspended imposition of sentence for a felony or other criminal offence, or is under disciplinary action with their current or former Board of Nursing, the participant is advised it may not be possible to be accepted into the refresher course at SDSU. Participants may be denied reinstatement from their state Board of Nursing, from taking the required licensure exam, and/or may be prevented from gaining employment in the field of nursing.

      Participants that elect to complete only the theory portion of the refresher course are not required to open a CastleBranch account to complete the background checks.

      Technical Standards

      CNE program participants must be able to independently, with or without reasonable accommodation, meet identified technical standards for enrollment in and successful progression through the refresher course program. These requirements pertain to participant conduct regardless of the setting (ie didactic, clinical, email communication, etc). Please review the identified technical standards.

      Enrollment Process
      See the enrollment page for details.
      Cost of Course
      Program fee$1750
      CastleBranch pre-enrollment$139.75
      CastleBranch post-enrollment$77.75
      TextbookPurchase locally or online.
      • Full payment of the program fee is due when the participant is accepted for enrollment. Payment plans are not available. Payment may be made via check, money order or credit card. The accepted credit cards are MasterCard, VISA, American Express and Discover.
      • All refresher course participants must establish an account with CastleBranch, the chosen vendor for document management. CastleBranch is endorsed by the AACN – American Association of Colleges of Nursing, and is the source to submit program pre-admission and the aforementioned clinical requirements. The pre-enrollment package price for CastleBranch covers the two background checks. The post-enrollment package is required for clinical preparation. These are additional costs to the participant and will be paid directly to CastleBranch. The participant will experience variable expenses as they prepare for clinical. Participants that elect to complete only the theory portion of the course are not required to open a CastleBranch account to submit the background checks or pre-clinical requirements.
      • The participant will purchase the textbook "Fundamentals of Nursing" Human Health and Function, 8th edition, by Craven, Hirnle, and Henshaw, ISBN-13:  978-1469898605. The textbook may be purchased locally or online.
      • If the participant receives the course materials and decides against continuing, s/he is allowed 30 days from the date of enrollment to notify the CNE office of their intent to withdraw and receive a refund of 70%. After 30 days, no refund will be granted. No refund will be extended to the participant if s/he is dismissed from the refresher course.
      • Participants in this course will not be issued a 1098T from SDSU for qualified educational expenses.

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