Student nurse attrition from pre-registration courses: investigating methodological issues

Improving mental health of student and novice nurses to prevent dropout: A systematic review

Aims

To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout‐related outcomes.

Design

Systematic review.

Data sources

Research papers published between January 1971–February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar.

Review methods

We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer‐reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout‐related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta‐analysis of studies was performed.

Results

We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies showed a statistically significant effect on dropout‐related outcomes. The overall risk of bias was high.

Conclusion

A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high‐quality studies in this field, preferably with a randomized controlled design.

Low interest in clinical practicum placement is associated with increased stress in nursing students in Taiwan: A cross-sectional survey study

BACKGROUND

Nursing students often find themselves in a highly competitive environment, and stress is a commonly acknowledged experience in nursing students.

OBJECTIVES

The aim of this study was to explore factors, particularly an interest in nursing and in clinical practicum placement, associated with stress in Taiwanese nursing students.

DESIGN

Cross-sectional survey study.

SETTINGS

A nursing college in central Taiwan and a university in eastern Taiwan.

PARTICIPANTS

814 nursing students.

METHODS

Level of stress of the participants was measured using the 43-items Stressors in Nursing Students (SINS) scale, which was translated into a traditional Chinese version (TC-SINS). Simple and multiple linear regression analyses were used to evaluate factors significantly associated with stress.

RESULTS

A total of 814 nursing students completed the questionnaire with a return rate of 83.6%. The mean age of the participants was 18.9 years and 94.8% was female. Regarding the students' interest in nursing, 2.6% expressed that they strongly or somewhat disagree. In addition, regarding the students' interest in clinical practicum placement, 7.2% indicated that they strongly or somewhat disagree. Results from multiple regression analysis showed that students who expressed somewhat or strong disagreement to interest in clinical practicum placement were significantly associated with a higher level of stress. Of the various strategies for stress relief, listen to music (75.2%) was the most popular choice, followed by talk to a friend (72.3%), and catch up on sleep (61.3%). A third of the participants used three strategies for stress relief.

CONCLUSIONS

Low interest in clinical practicum placement was associated with increased stress levels in nursing students in Taiwan. Future studies should explore the underlying reasons for stress induced by clinical practicum placement, and possible solutions for stress reduction in nursing students.

Causes of ATtrition in CHIldren's NursinG (CATCHING): An exploratory mixed method study

Professional, financial and ethical reasons necessitate nursing improves its understanding of student attrition. Previous studies identify causes of attrition as multifactorial. However, few studies focus on children's nursing. This study aimed to explore causes of pre-registration children's nursing attrition. Exploring the causes of attrition was achieved through quantitative and qualitative approaches. Three years of quantitative data relating to attrition rates and causes was obtained. These data informed semi-structured interviews of children's nursing students, from four London universities. These students had faced challenges and either 'left' (n = 5) or 'stayed on' (n = 13) their pre-registration programme. Most attrition occurred in the first year of programmes and was primarily due to academic failure or personal circumstances; clinical placements also played a role. Emergent themes were 'expectations of pre-registration children's nursing'; 'realities of a pre-registration children's nursing course', and 'factors that influence students leaving or staying on the course'. Many participants reported a reluctance to disclose issues while on their course. Support to continue on the programme was frequently obtained away from university and students described relying on self-determination to complete programmes. Findings indicated several areas of potential improvement for student support including targeted interventions focusing on a student's first year and reducing variation in support services provided.

Nursing Students' Perceived Faculty Support, Stress, and Substance Misuse

BACKGROUND

Nursing school can be an extremely stressful experience. Many nurses with substance misuse issues developed the problem when they were students. The authors, guided by Peplau's interpersonal theory in nursing, examined whether stress and perceived faculty support were related to substance misuse.

METHOD

A quantitative, cross-sectional, correlational design was used. Data were collected from members of the National Student Nurses Association using an Internet questionnaire.

RESULTS

Students with higher stress scores had a higher incidence of substance use. Most students who had higher perceptions of faculty support tended to use fewer nonprescribed stimulants for academic enhancement.

CONCLUSION

Nursing students reported a moderate level of stress and used non-prescribed prescription drugs more frequently as the stress scores increased. Perceived faculty support was inversely related to the use of nonprescribed stimulants and does not appear to moderate the effects of stress on substance misuse. [J Nurs Educ. 2017;56(7):404-411.].

Early predictors of study success in a Dutch advanced nurse practitioner education program: A retrospective cohort study

BACKGROUND

Study delay and attrition are major concerns in higher education. They cost time and effort, and threaten the availability of higher qualified professionals. Knowing early what factors contribute to delay and attrition may help prevent this.

OBJECTIVE

The aim of this study was to examine whether student characteristics, including a literature study report grade as a proxy of cognitive abilities, predicted study success in a dual advanced nurse practitioner education program.

METHODS

Retrospective cohort study, including all 214 students who between September 2009 and September 2015 started the two-year program at the HAN University of Applied Sciences in Nijmegen, the Netherlands. Study success was defined as having completed the program within the envisaged period. Variables examined included: age, gender, previous education (bachelor's degree or in-service training in nursing), work setting (general health, mental health, public health, or nursing home care), and literature study report grade (from 1 to 10). A hierarchical logistic regression analysis was performed.

RESULTS

Most students were female (80%), had a bachelor's degree in nursing (67%), and were employed in a general healthcare setting (58%). Mean age was 40.5years (SD 9.4). One hundred thirty-seven students (64%) had study success. Being employed in a general healthcare setting (p≤0.004) and a higher literature study report grade (p=0.001) were associated with a higher study success rate.

CONCLUSION

In advanced nurse practitioner education, study success rate seems associated with the student's cognitive abilities and work field. It might be worthwhile to identify students 'at risk of failure' before the start of the program and offer them extra support.

Dreams and disappointments regarding nursing: Student nurses' reasons for attrition and retention. A qualitative study design

BACKGROUND

In the Netherlands, hundreds of students register annually for a nursing programme, but not all of these students manage to complete their training.

OBJECTIVE

The main aim of this study was to examine which factors affect student nurses' decision to leave or complete their programme.

THEORETICAL FRAMEWORK

The study used an exploratory descriptive design, employing a qualitative phenomenological approach.

SAMPLE

Student nurses (n=17) at the beginning of their third year of the four-year Bachelor's programme.

DATA COLLECTION

Data were collected at four Universities of Applied Sciences in the Netherlands, from December 2013 to January 2014. Semi-structured interviews were used to collect the data, using an interview guide.

RESULTS

The main reasons for students to become nurses were the caring aspect, personal experiences with healthcare, role models in their immediate environment, and job opportunities. They had both altruistic and professional perceptions of their profession. Reasons for attrition were strongly related to the training programme and to their clinical placements, in particular the perceived lack of support from mentors and team. Feelings of being welcomed and working in a nice team proved to be more important reasons for completing the programme than the specific clinical field.

CONCLUSIONS

Student nurses started their studies with many dreams, such as caring for people and having the opportunity to deliver excellent nursing care. When their expectations were not met, their dreams became disappointments which caused them to consider stopping and even to leave (attrition). The role of lecturers and mentors seems invaluable in protecting and guiding students through their programme and placements. Optimal cooperation between lecturers and mentors is of paramount importance to retain student nurses in their training programmes.

Stress, resilience and psychological well-being in Chinese undergraduate nursing students

BACKGROUND

Globally, stress is a well-recognized feature of the life of undergraduate nursing students. However, there currently is little evidence to suggest what role resilience plays in this issue.

OBJECTIVES

To examine the relationship between stress and resilience on psychological well-being in a cohort of Chinese undergraduate student nurses.

DESIGN/PARTICIPANTS

A cross-sectional study was conducted using multivariate logistic regression and descriptive statistical analysis in three Chinese nursing schools. A total of 1538 nursing students participated in the study, completing three validated self-administered questionnaires.

RESULTS

Nursing students in their final year reported the highest mean General Health Questionnaire 12 (GHQ-12) scores (Mean 4.50 SD 2.89) and Stress in Nursing Student (SINS CN) scores (Mean 105.11 SD 25.37), Moderate levels of resilience were noted across all four years of nursing training programmes (Mean 121.59 SD 21.49). Resilience scale (RS) scores were negatively correlated with mean total score for stress (r=-0.236, P<0.01) and negatively correlated with psychological well-being (r=-0.411, P<0.01).

CONCLUSION

Psychological well-being appears impaired in Chinese nursing students, particularly final year students, prior to registration. Globally, more attention could be given to the potential role of resilience training and other forms effective coping strategies to deal with the inevitable sources of stress in student nurse training.

Don't go with the 'FLO' - a student mobile texting service to enhance nursing student retention

BACKGROUND

The review undertaken revealed that there is an abundance of literature concerning retention and the high levels of attrition among undergraduate students and of relevance here, nurse education. The study undertaken evaluated the use of mobile phone automated texts designed to provide information, support and reassurance to help alleviate the stress and anxieties that some undergraduate nursing students experience during the early phase of their studies and which can lead to some students leaving their programme.

OBJECTIVE

The objective of the study was to evaluate how use of automated mobile phone texts, using a system known as FLO, could usefully supplement pastoral support, as an intervention to reduce attrition among undergraduate nursing students.

DESIGN

A qualitative and quantitative evaluation was conducted using an open-ended questionnaire designed specifically for the study.

PARTICIPANTS

The sample were two cohorts of undergraduate first year student nurses (n=178). Of these 123 (69%) signed up to FLO and 77 (63%) completed the evaluation form.

METHODS

The evaluation form that was administered in a classroom situation one week after use of FLO had ceased. Data were analysed through use of a descriptive statistics and thematic analysis approaches.

RESULTS

A range of key themes emerged from the analysis including that text messages were helpful and supportive, increased a sense of belonging to the University and encouraged retention. There were some unresolved issues concerning the costs incurred by participants when sending reply text messages.

CONCLUSIONS

It is concluded that FLO or use of similar mobile phone protocols can be a useful addition to approaches to improve undergraduate nursing student retention rates.

Seconding healthcare assistants to a pre-registration nursing course

Attrition from traditional pre-registration nursing programmes in the United Kingdom continues to be substantial and, once qualified, new staff nurses experience a number of challenges in adapting to their new role. A possible solution, strongly favoured by the current government, is to second existing healthcare assistants onto pre-registration programmes. The premise is that, because of their previous caring experience and exposure to work in the National Health Service, secondees will be more committed to complete training and will undergo role transition more effectively.

This paper presents an in-depth, qualitative study concerning the role transition of newly qualified staff nurses who had previously been employed as healthcare assistants. Uptake of the scheme had been substantially lower than anticipated, with only a small number of secondees eventually returning to their original wards. Secondees, their ward managers, percerptors and clinical practice facilitators were interviewed and the data were analysed employing the sequence for qualitative data analysis described by Miles and Huberman (1994). Findings suggest that healthcare-assistant secondment may not offer a ready solution to increasing the qualified nursing workforce. Contributory factors include: the length of time required for each newly qualified practitioner to qualify via the secondment route; the degree of commitment required on the part of secondees and university staff; the apparently limited benefits of previous healthcare-assistant experience; and personal costs to the secondees. Secondees described how they had been afraid of not completing the course successfully because of the public nature of failure if they were obliged to return to their original workplaces in the same role as before. This additional pressure has not been anticipated by proponents of secondment schemes and may help to explain why so few eligible candidates applied for secondment.

Seconding health care assistants to a pre-registration nursing course: Evaluation of a novel scheme

Traditionally in the United Kingdom, reliance has been placed on unqualified support workers, such as student nurses, to deliver a high proportion of patient care. However, the move of nurse education into higher education and the accompanying supernumerary status of student nurses in the 1980s resulted in a shortfall of staff to deliver that care. The government has made a number of suggestions for increasing recruitment. One possible solution regarded as very promising is to encourage health care assistants (HCAs) with at least 12 months' experience in the National Health Service to enrol on existing pre-registration programmes, providing them with financial incentives to do so. Very little literature directly concerned with training opportunities for HCAs could be traced, but it was evident that financial constraints and family commitments had, in the past, operated as disincentives to training, although some HCAs would otherwise be keen to register.

In 1999 one of the workforce development confederations in London responded to government policy by seconding HCAs onto a pre-registration programme operated by the local university. Plans for evaluation were made at the outset. Interviews were conducted with two consecutive intakes of secondees at three time intervals: after three months; after 12 months and during the final placement of the 36-month course. Interviews with other stakeholders were conducted just before the course ended. A qualitative approach was taken and the data were analysed employing the sequence recommended by Miles and Huberman (1994).

Evaluation highlighted important features of the secondment process contributing to its success and indicated pitfalls attached to introducing such schemes. It is recommended that evaluation should be extended to explore how the new staff nurses prepared by this novel scheme continue to develop their career trajectories. Given the emphasis now being placed on the 'skills escalator' model of staff development in the NHS, such approaches will assume even greater importance in future, and more extensive evaluations will be needed.

The effectiveness of peer mentoring in promoting a positive transition to higher education for first-year undergraduate students: a mixed methods systematic review protocol

BACKGROUND

The global transfer of nursing and midwifery education to higher education institutes has led to student nurses and midwives experiencing challenges previously faced by traditional third-level students, including isolation, loneliness, financial difficulties and academic pressure. These challenges can contribute to increased stress and anxiety levels which may be detrimental to the successful transition to higher education, thus leading to an increase in attrition rates. Peer mentoring as an intervention has been suggested to be effective in supporting students in the transition to third-level education through enhancing a sense of belongingness and improving student satisfaction, engagement and retention rates. This proposed systematic review aims to determine the effectiveness of peer mentoring in enhancing levels of student engagement, sense of belonging and overall satisfaction of first-year undergraduate students following transition into higher education.

METHODS

MEDLINE, Web of Knowledge, ProQuest, Embase, CINAHL, ERIC, PsycINFO and CENTRAL databases will be searched for qualitative, quantitative and mixed methods studies on the implementation of peer assessment strategies in higher education institutes (HEIs) or universities for full-time, first-year adult students (>17 years). Included studies will be limited to the English language. The quality of included studies will be assessed using a validated Mixed Methods Appraisal Tool (MMAT). The findings will be presented as a narrative synthesis or meta-analysis as appropriate following sequential explanatory synthesis.

DISCUSSION

The review will provide clear, non-biased evidence-based guidance to all third-level educators on the effectiveness of peer-mentoring programmes for first-year undergraduates. The review is necessary to help establish which type of peer mentoring is most effective. The evidence from qualitative and quantitative studies drawn from the international literature will be utilised to illustrate the best way to implement and evaluate peer mentoring as an effective intervention and will be useful in guiding future research and practice in this area. These findings may be applied internationally across all disciplines.

Development and evaluation of an online, interactive information and advice tool for pre-registration nursing students

Attrition rates for student nurses on academic programmes is a challenge for UK Higher Education Institutions. Reasons for leaving a programme of study include personal, financial issues or practice placement experiences. Research has shown systematic and integrated support mechanisms may improve attrition rates and student experience. This project explored the sources of, and support needs of nursing and allied health students, develop and evaluate and interactive online tool: 'SignpOSt'. Enabling students to access 'the right support, at the right time, from the right place'. Focus groups were carried out with 14, 3rd year students and 8 academic staff including personal tutors, programme/module leaders. Thematic analysis of transcribed data under four key themes for support and advice: 1. Financial 2. Programme 3. Personal 4. Study/academic, found poor student knowledge and little clarity of responsibilities of academic staff and services leads to students sourcing support from the wrong place at the wrong time. Students valued the speed and accessibility of information from informal, programme specific Facebook groups. Conversely, there were also concerns about the accuracy of these. Further research into the use of informal Facebook groups may be useful along with additional evaluation of the SOS tool.

Exploring commitment, professional identity, and support for student nurses

Problems with the recruitment and retention of nurses globally mean that insight into the factors that might increase retention in qualified staff and students is crucial. Despite clear links between work commitment and retention, there is little research exploring commitment in student nurses and midwives. This paper reports the findings of a qualitative study designed to provide insight into commitment using semi-structured interviews conducted with nine pre-registration students and a qualitative survey completed by 171 pre-registration students. Thematic analysis of the data emphasised the impact of placement experiences on commitment via interpersonal relationships. Students typically emphasised their professional identity as the basis for commitment, although many participants also highlighted a lack of acceptance by qualified practitioners, which reduced it. There was evidence that suggested that practitioner workload may impact the student experience due to challenges in making sufficient time to provide support. Implications for retention strategies are discussed.

Issues concerning recruitment, retention and attrition of student nurses in the 1950/60s: a comparative study

AIM

To investigate student nurse recruitment and attrition in the 1950' and 1960s and undertake comparisons to modern day concerns. The study was set in one hospital in the U.K.

BACKGROUND

In the period studied nursing was unpopular as a profession and there were difficulties surrounding recruitment. Attrition rates were high.

METHOD

Documentary analysis of 641 training records dating 1955 to 1968 was undertaken. Attrition rates, reasons for non-completion and employment following successful completion were determined.

RESULTS

Most recruits were young, unmarried, females and had overseas addresses. The majority (n = 88) had prior nursing experience. Over 69% (n = 443) successfully completed their training. Attrition rates were over 30% (n = 198), the main reason being academic failure. Following completion over 40% (n = 183) undertook midwifery training (n = 183) or secured a staff nurse post (n = 153).

CONCLUSIONS

Issues relating to recruitment, retention and attrition in the 1950s and 1960s put into context present day issues. Recent attrition rates from pre-registration nurse education have fallen, nevertheless some of the issues of yesteryear remain problematic. In the present study significant numbers of entrants left due to domestic and ill-health problems resonates with many modern day studies. Also failure to complete due to academic shortcomings continues to be a concern.

Recruitment, selection and retention of nursing and midwifery students in Scottish Universities

BACKGROUND

High attrition rates from pre-registration nursing and midwifery programmes have been reported in both the UK and in other countries.

OBJECTIVES

A study was conducted to identify best practice in recruitment, selection and retention across Scottish Universities providing pre-registration programmes.

DESIGN

A survey of all universities providing pre-registration programmes in Scotland was conducted. Semi-structured interviews were conducted with key personnel in each university. Documentary evidence was collected to supplement interview data and evidence recruitment, selection and retention practices.

SETTINGS

All universities in Scotland providing pre-registration nursing and/or midwifery programmes.

PARTICIPANTS

All 10 identified universities agreed to take part and a total of 18 interviews were conducted.

METHODS

Semi-structured face to face and telephone interviews were conducted. Relevant documentary evidence was collected. All data were subject to thematic analysis.

FINDINGS

Universities are predominantly concerned with recruiting to the institution and not to the professions. Interviews are widely used, and are a requirement in the United Kingdom. However, there is no evidence base within the literature that they have predictive validity despite creating scales and scoring systems which are largely unvalidated. The study identified initiatives aimed at addressing attrition/retention, however most had not been evaluated often due to the multi-factorial nature of attrition/retention and difficulties with measurement.

CONCLUSIONS

Recruitment selection and retention initiatives were rarely evaluated, and if so, adopted a relatively superficial approach. Evidence from existing studies to support practices was mostly weakly supportive or absent. The study highlights the need for a coordinated approach, supporting the development of a robust evidence base through the evaluation of local initiatives, and evaluation of new strategies. Evaluation strategies must take account of the local context to facilitate transferability of findings across different settings.

Factors that enhance rates of completion: what makes students stay?

BACKGROUND

This study was one of four projects commissioned by NHS London to examine the readiness for work of nurses upon completion of their pre-registration programmes. The study examined the factors that contribute to students completing their nursing programmes.

OBJECTIVES

The objectives of the study were to explore understanding the factors that influence the attrition and completion rates of year 2 students on the adult field of a pre-registration nursing programme.

DESIGN

An ethnographic case study methodology was employed in two large London NHS Acute trust hospitals, both partnered with the same Higher Education Institution. Data was collected between 2010 and 2011 through a combination of document review, non-participant observation in practice settings, focus groups and interviews

PARTICIPANTS

A self-selected group of 50 year 2 student nurses from a total population of 200 participated in this study. All students were from the same cohort group at one London-based university who undertook practice learning experiences at two NHS Acute Trust hospitals.

RESULTS

The study found a number of factors that impacted on retention which included student identify and the organisation, fostering resilience and clinical support. In addition the Higher Education Institute does not appear to be the most significant factor in a student's decision to continue on the programme, but that practice placement mentors and clinical placements have the greatest impact on student retention.

CONCLUSIONS

The study is important in that its findings contradict much of the literature on student nurse attrition and retention in that the clinical placement experiences emerges as the most important factor in whether a student chooses to stay or leave the course.

Vocation, friendship and resilience: a study exploring nursing student and staff views on retention and attrition

Introduction:

There is international concern about retention of student nurses on undergraduate programmes. United Kingdom Higher Education Institutions are monitored on their attrition statistics and can be penalised financially, so they have an incentive to help students remain on their programmes beyond their moral duty to ensure students receive the best possible educational experience.

Aims:

to understand students’ and staff concerns about programmes and placements as part of developing our retention strategies.

Design:

This study reports qualitative data on retention and attrition collected as part of an action research study.

Setting:

One University School of Nursing and Midwifery in the South West of England.

Participants:

Staff, current third year and ex-student nurses from the adult field.

Methods:

Data were collected in focus groups, both face-to face and virtual, and individual telephone interviews. These were transcribed and subjected to qualitative content analysis.

Results:

Four themes emerged: Academic support, Placements and mentors, Stresses and the reality of nursing life, and Dreams for a better programme.

Conclusions:

The themes Academic support, Placements and mentors and Stresses and the reality of nursing life, resonate with international literature. Dreams for a better programme included smaller group learning. Vocation, friendship and resilience seem instrumental in retaining students, and Higher Education Institutions should work to facilitate these. ‘Vocation’ has been overlooked in the retention discussions, and working more actively to foster vocation and belongingness could be important.

Should I stay or should I go? A study exploring why healthcare students consider leaving their programme

BACKGROUND

Attrition in healthcare programmes is a growing concern internationally. Students leave for a variety of reasons but it is difficult to understand the complex interactions that eventually lead to attrition.

OBJECTIVES

The objectives of this study were to identify the factors that prompted students to consider leaving their programme, and to make recommendations regarding strategies to reduce attrition.

DESIGN

One aspect of a larger survey, which itself was part of a larger sequential mixed methods study.

SETTINGS

Nine universities in the North West of England.

METHODS

An online survey developed as part of a mixed methods sequential exploratory study was completed by students on nursing and allied-health programmes. The detailed responses obtained for a question relating to if the students have ever considered leaving their current programme were analysed both quantitatively (content analysis) and qualitatively (framework analysis).

RESULTS

1080 students completed the survey (an estimated 11% response rate); of this group 999 students answered the question 'have you ever considered leaving your current programme?' 465 students (47%) indicated that they had considered leaving and provided detailed comments explaining the circumstances that induced them to deliberate whether or not to stay. A thematic analysis of the data found three distinct themes: dissatisfaction with academic workload and support; difficulties associated with clinical placements, and personal concerns and challenges. A significant number of student comments combined two or more of these themes. A number of students also detailed why they decided to stay.

CONCLUSIONS

Those students that had considered leaving frequently described how a combination of diverse factors accumulated to lead to them contemplating leaving their programme. Strategies to reduce attrition in healthcare students need to consider the student lifecycle from recruitment to graduation, to set reasonable student expectations and ensure that a career within healthcare is both desired and valued.

Predictive validity of the Macleod Clark Professional Identity Scale for undergraduate nursing students

BACKGROUND

The self-identification of nursing students with the profession has been linked with a successful transition, from being a student to being a professional nurse. Although there is no empirical evidence, there are suggestions that students with high professional identity are more likely to persist and complete their studies in their chosen profession.

OBJECTIVES

The purpose of this study was to evaluate the psychometric properties of a professional identity scale and to determine the relationship between professional identity and student retention in a large group of first year nursing students.

DESIGN AND METHODS

A survey design was used to examine the professional identity of first year nursing students, as measured by the Macleod Clark Professional Identity Scale (MCPIS-9). Baseline data obtained from the initial surveys were then compared with student drop-out rates 12 months later.

RESULTS

Exploratory factor analysis of the MCPIS-9 yielded a one-component solution, accounting for 43.3% of the variance. All 9 items loaded highly on one component, ranging from 0.50 to 0.79. Cronbach's alpha coefficient of the MCPIS-9 was 0.83 and corrected item-total correlation values all scored well above the 0.3 cut-off. Students who: were females, had previous nursing-related vocational training, reported nursing as their first choice, or engaged in nursing-related paid work, had statistically significant higher professional identity scores. Using logistic regression analysis, students with high professional identity scores at baseline were more likely to be still enrolled in the nursing program at 12 months, controlling for gender, language spoken at home and engagement in nursing-related employment. These results support the psychometric properties of the MCPIS-9.

CONCLUSIONS

Professional identity has a direct relationship with student retention in the nursing program. It is important to adequately measure professional identity in nursing students for the purpose of monitoring and identifying students who are at risk of leaving nursing programs.

European nursing students' academic success or failure: a post-Bologna Declaration systematic review

OBJECTIVES

The aim of this systematic review is to synthesise the available evidence in the European scientific literature produced after the Bologna Declaration and to evaluate studies that quantify and examine the factors associated with the academic success or failure of nursing students.

DESIGN

A systematic review of the literature was conducted.

DATA SOURCES

Major health literature databases were searched for studies published from 2000 to 2011.

REVIEW METHODS

This review includes only European observational studies that were submitted to a quality assessment by two researchers before inclusion.

RESULTS

Only five studies were included in this review. There are discordant results regarding the predictors of success or failure, which were common objects of study (gender, age, qualification on entry, ethnic group). other factors were studied individually (student personality, gendered view of nursing careers, intention to leave, family commitments, working while on course, student performance, clinical learning environment) need to be confirmed in additional studies. Although the predictors may be relevant at the local level, given their low external validity and the conflicting results, it is not possible to state with certainty that these factors are effectively predictive of success or failure in the context of post-Bologna Declaration Europe.

CONCLUSIONS

This review showed that over the last ten years, in the European context, only a few high-quality observational studies have been performed. In this regard, given the small number and heterogeneity of the available studies, there is little useful evidence available for Higher Education Institutions (HEIs) to effectively address the problem. In the future, European researchers should focus not only on the documentation of the predictors but also on the documentation of the outcomes produced by the HEI strategies that have been implemented to prevent avoidable academic failure and contain physiological academic failure.

A study identifying the difficulties healthcare students have in their role as a healthcare student when they are also an informal carer

There is a growing body of literature concerning the needs of informal carers, however, there is little relating to the needs of carers who are also university students. There are a number of publications concerning the difficulties university studies may cause and in particular the stress that some healthcare students endures when they undertake clinical placements. Being an informal carer has the potential to aggravate any difficulties students may have in the normal course of their studies. The purpose of the study was to explore the experiences and needs of healthcare students who are also informal carers. An electronic survey (February 2010) of 3567 students identified 36 students who are also informal carers. Most were female, pre-registration nursing students, studying full-time and who cared for their physically disabled children, chronically ill parents or terminally ill grandparents. Most respondents spent over 6h a day on informal caring responsibilities. The majority said informal caring had a negative impact on their studies. An in-depth interview study was undertaken (April 2010) with ten students. Data themes identified in the analysis were; descriptions of being an informal carer, impact of caring on studying, sources of support and hidden lives. In the theme 'hidden lives' students highlighted that they did not want university staff to know that they were informal carers as they did not want 'special' treatment. It was theorised that this could be due to the stigmatisation sometimes attached to being a carer. The value of the study was that it was found that more targeted information about student support services is needed, to help students successfully complete their studies. This would be beneficial for universities too as students who leave early without successfully completing their programme have financial implications.

Support for nursing and midwifery students: a special case?

In order to address attrition amongst nursing and midwifery students, three Scottish universities were funded to employ Pastoral Care Support Advisers (PSA). This paper presents the findings of an evaluation which explored nursing and midwifery students' support needs and their experience of the PSA service. Telephone and focus group interviews were carried out with staff (n=14) and students (n=25). Based on the findings of these interviews two on-line surveys were developed and completed by 88 members of staff and 525 nursing and midwifery students. A majority of staff indicated that students had more complex problems than in the past, and would benefit from access to a dedicated source of support. Levels of anxiety and depression amongst students were found to be above a desirable level, and three quarters of students who completed the survey reported having experienced problems. Some members of staff believed that the PSA had had an impact on attrition, and students that participated reported that they would have left had they not received this support. The PSA service not only benefitted the students it also reduced staff time spent with students on non-academic issues. A source of independent support would benefit students, university staff, and the National Health Service.

Should nursing-related work experience be a prerequisite for acceptance into a nursing programme? A study of students' reasons for withdrawing from undergraduate nursing at an Australian university

AIM

This paper reports on two studies that examined why students withdrew from a Bachelor of Nursing degree.

BACKGROUND

With the aim of recruiting undergraduate candidates who are the most likely to complete the degree and pursue a nursing career, the University of Adelaide requires high matriculation scores and satisfactory performance in a structured oral assessment as part of the process of selection.

METHOD

In the first study, two questionnaires were used to collect data from all applicants before and after an oral assessment. The degree of personal desire and motivation to become a Registered Nurse, including knowledge about nursing and the profession were among qualities rated. For the second study, semi-structured telephone interviews were conducted with students who had withdrawn.

RESULTS

Statistical comparison showed there were significant differences between continuing and withdrawing applicants in whether or not they had previous nursing-related experience and in knowing someone who was a nurse. The qualitative data reinforced the importance of these factors for attrition. Participants identified emotional issues surrounding an aversion to illness, sickness, pain, suffering and blood.

CONCLUSION

The results of both studies suggest that a primary factor in attrition is a lack of realistic expectation regarding nursing as a profession.

Health, sustainability and student travel

A survey of 246 pre-registration nursing students in a University in the South West of England was carried out to explore the impact of course related travel on the student experience. Results from the survey indicated that students' main mode of transport to practice placements was by car which reflects the rural nature of the South West and the relative paucity of public transport. Long distances that many students travel to their study centre and to placements, and the concurrent financial strain that this creates, impacted negatively on the student experience. Students recognised the need to travel to a place of study and clinical placements and suggestions of minimising the negative impact of travel were offered. These included the increased use of electronic delivery of lectures, attendance at local university premises, the provision of shared transport to placements and placements closer to the student's home. Few students, however, considered the environmental impact of travel. Higher Education Institutions need to address issues of sustainability through promoting student wellbeing and taking steps to reduce greenhouse gas emissions. It is therefore important that student awareness of sustainability related issues is increased as well as focusing on reducing the environmental impact through organisational change.

Can we predict successful completion of the common foundation programme at interview?

AIM

To gain an understanding of patterns of retention and attrition for student nurses on the diploma of higher education (DipHE)/bachelor of science (B.Sc.) (adult) on completion of the common foundation programme (CFP=year 1 of the programme).

METHOD

A questionnaire called the "interview score sheet" (ISS) collected data on six cohorts from a Higher Education Institution in Scotland. At the initial recruitment interview each candidate was scored independently by two interviewers on the ISS. Successful/unsuccessful attempts of theory-based and practice-based modules, and any reasons for attrition were recorded throughout the CFP. For the purposes of this study success was defined as achieving a pass grade in all modules associated with year 1 of the programme.

MAIN OUTCOME MEASURES

The study investigated the potential of the ISS in providing a reliable guide for student selection onto the DipHE/B.Sc. in nursing (adult) and providing information about the characteristics of a typical successful/unsuccessful student from the CFP.

ANALYSIS

Statistical analysis was conducted to examine the correlation between the total score on the ISS, any characteristics on the ISS and the students' successful completion of the CFP.

RESULTS

Six-hundred and thirty-eight students entered the CFP: 118 (18%) were unsuccessful and 520 (82%) were successful completers of the CFP. From the characteristics noted at interview on the ISS, the most reliable predictor of success was age. The total score achieved on the ISS was shown not to be a reliable predictor of success. Although not statistically significant, testing of numeracy and standard and content of written work may be of some value in predicting success and may warrant further study.

Understanding student nurse attrition: learning from the literature

Student attrition in nursing causes concern, but is not a new phenomenon. Challenges in defining and understanding attrition, changes in the commissioning of nurse education and developments within the United Kingdom National Health Service (UKNHS) and the profession contribute more generally to making this a complex topic for managers and for research. In this paper we discuss findings from an integrative review of the UK literature and discuss three levels of possible contributory factors identified from the literature (micro/individual; meso/institutional; and macro/political and professional). In conclusion, we argue that a concern with attrition is legitimate and that strategies should be put in place to respond to each level of contributory factors. Factors contributing to attrition are complex and interact. We argue that some degree of attrition is inevitable if we are to maintain standards within the profession. There is, therefore, an ethical and professional imperative for attrition in some circumstances. We suggest that Tinto's model relating to social integration might inform further research.

Developing a valid and reliable Self-Efficacy in Clinical Performance scale

AIM

This paper describes the development and testing of the Self-Efficacy in Clinical Performance (SECP) instrument for nursing students.

BACKGROUND

Accurate measurement of self-efficacy can be used to predict nursing students' clinical performance. The literature review indicated there is no existing self-efficacy in clinical performance instrument for Iranian nursing students.

METHODS

To clarify the concept of self-efficacy in clinical performance, 28 semi-structured interviews and three focus groups were conducted. A self-efficacy framework with well-developed theoretical constructs was formed. A review of literature and content analysis of the interview transcripts identified subscales and items to be included in the instrument. Then, a methodological design was used. The SECP was developed into 69 Likert-format items, which were evaluated by 20 nursing experts in the form of content validity index. The scale's validity and reliability were tested in a randomized sample of 207 final year nursing students.

FINDINGS

The final scale consists of four dimensions with 37 items. The overall scale internal reliability had alpha = 0.96; the dimensions Cronbach's alpha ranged from 0.90 to 0.92. Test-retest reliability with a 2-week time interval was: r = 0.94. In addition, concurrent validity was obtained (r = 0.73, P = 0.01).

CONCLUSIONS

The SECP has demonstrated evidence of content validity, construct validity, concurrent validity, internal consistency reliability and stability. Statistical analysis provided an objective tool for assessing nursing students' self-efficacy in clinical performance. It may have been fruitful to further test the instrument with students from other years of their education.

Reporting behaviours of nursing students who have experienced verbal abuse

AIM

This paper is a report of a study exploring the reporting behaviours of nursing students who had experienced verbal abuse while gaining clinical experience.

BACKGROUND

Under-reporting of incidents of verbal abuse has been identified internationally as a limitation leading to incomplete data collection when researching aggression in healthcare facilities. This can call into question conclusions, recommendations and policy initiatives based on the research.

METHOD

Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one preregistration nursing programme in England. A total of 114 questionnaires were returned, giving a response rate of 73.0%. Fifty-one students (44.7%) reported verbal abuse and all of these gave details of the behaviours concerned.

RESULTS

Thirty-two students (62.7%) of those reporting verbal abuse) stated that they had reported the incident and 19 (37.3%) of respondents stated that they had not. Only four incidents resulted in formal documentation. The most frequent feelings reported by respondents were embarrassment and feeling sorry for the abuser.

CONCLUSION

Failure to document experiences of verbal abuse formally was prevalent and reporting practices were variable. Both higher education institutions and healthcare providers should consider establishing process for formal reporting and documenting of incidents of verbal abuse during nurse education, and students should have access to formal support services.

Nurse education: factors associated with attrition

AIM

This paper is a report of a study to identify the factors having an impact on student completion rates in a preregistration programme.

BACKGROUND

Nursing student attrition is an international issue causing concern in many parts of the developed world including Australia, the United States and Europe. In the United Kingdom, nursing student attrition has become a major issue, despite having one of the lowest general university dropout rates in the developed world.

METHOD

A retrospective cohort study was conducted in 2007 using routinely-collected demographic and completion data on four cohorts of nursing students (1259 in total) studying at a large English university.

FINDINGS

Students who were older on entry were more likely to complete the programme than younger students, and those who had only the minimum educational qualifications on entry were less likely to complete than those with higher-level qualifications. There was some evidence of increased risk of resigning from the course in students taking the child branch, and increased risk of discontinuation (involuntary removal) from the course in both male and black/minority ethnic students. There was also some evidence that the healthcare organization responsible for a student's placement could influence completion rates.

CONCLUSION

To improve attrition rates on preregistration nursing programmes, higher education institutions should actively target recruitment at mature candidates; increase the level of qualification required to gain entry; examine course structures for flexibility and provide multi-level student support.

Hate the course or hate to go: semester differences in first year nursing attrition

Most of the attrition from nursing courses occurs in the first year of study. Devising university strategies to reduce attrition requires an understanding of why students leave. The aim of this study was to explore whether students who leave a nursing course in the first semester leave for the same or different reasons than students who leave in the second semester of study. Seventeen students who had left the course were interviewed by telephone: seven in the first semester and ten in the second. In the first semester, students who leave consider themselves unprepared for university, have competing roles outside university and develop a strong dislike of the nursing course. They decide quickly that the course is unsuitable and leave. Those who leave in second semester would prefer to stay but events in their life create a crisis where they can no longer cope with university studies. These students hope to return to nursing whereas students who leave in the first semester are unlikely to consider returning. Attempts to retain students in the first semester may be futile as these students may be unsuited or uncommitted whereas there is greater scope to retain those who leave in the second semester.

Predicting who will drop out of nursing courses: a machine learning exercise

INTRODUCTION

The concepts of causation and prediction are different, and have different implications for practice. This distinction is applied here to studies of the problem of student attrition (although it is more widely applicable).

BACKGROUND

Studies of attrition from nursing courses have tended to concentrate on causation, trying, largely unsuccessfully, to elicit what causes drop out. However, the problem may more fruitfully be cast in terms of predicting who is likely to drop out.

METHODS

One powerful method for attempting to make predictions is rule induction. This paper reports the use of the Answer Tree package from SPSS for that purpose.

DATA

The main data set consisted of 3978 records on 528 nursing students, split into a training set and a test set. The source was standard university student records.

RESULTS

The method obtained 84% sensitivity, 70% specificity, and 94% accuracy on previously unseen cases.

DISCUSSION

The method requires large amounts of high quality data. When such data are available, rule induction offers a way to reduce attrition. It would be desirable to compare its results with those of predictions made by tutors using more informal conventional methods.