Exclusive: Student drop-out rates put profession at further risk

Attrition data obtained by Nursing Standard shows one in four nursing students are not completing their degree courses.

Competition is fierce for a place on an undergraduate nursing course, yet a Nursing Standard investigation reveals one in four students who do make the grade end up dropping out.

Nursing Standard asked 70 universities to supply start and completion data for three-year pre-registration nursing courses ending in 2016.

Out of 17,055 students starting courses in 2013 in the UK, 4,284 quit their studies early, revealing an average UK nursing student attrition rate of 25.1%.

Not new

The issue is not new. Nursing Standard has been investigating the problem for the past decade and little has improved. In 2006, our survey found the drop-out rate to be 24.8%; in 2008 it was 26.3%; and in 2010 it was 28%.

The issue of attrition is made all the more pertinent, now that government has removed bursaries for nursing students in England and replaced them with a student loan and tuition fee model from August 2017.

A major problem with student attrition is that there is no open-access, consistent trend data, according to workforce expert Jim Buchan. This makes the actual size of nursing student attrition and its drivers difficult to pin down, and opinion outweighs hard evidence.

‘Transparent monitoring’

For this reason Professor Buchan, from the Queen Margaret University school of health near Edinburgh, says it is imperative a national standard is developed.

‘We need transparent monitoring and reporting of nursing students’ attrition using a properly agreed definition across the UK,’ he warns.

The Council of Deans of Health declined to comment on Nursing Standard's data, but in a 2015 briefing, the organisation called for a 'consistent measurement of attrition' in England.

Official attrition figures are hard to obtain. The Department of Health in England did not respond to requests for comment.

‘Achilles heel of the nursing world’

Lord Willis, who led the Shaping of Caring review into nurse education and training, described attrition as the ‘Achilles heel of the nursing world’ in his 2016 report.

The Willis review cited the average drop-out rate for nursing students at universities in England as more than 20%. It warned that on some courses the attrition rate was as high as 50%.

Official figures are more optimistic. In July, Higher Education Funding Council for England data put attrition for adult nursing students in England at 10.6%. Nursing Standard calculates the figure for England to be 26.8%.

Lord Willis told Nursing Standard last year that attrition rates on nursing courses were ‘staggering’, and standardised attrition figures should be published by every institution annually, which record why a student has left so that problems can be addressed.

Dropping out

His report said research showed that ‘making the wrong career choice’ was among the top five reasons cited for dropping out. Others include family or academic difficulties, lack of support from tutors or mentors, and financial problems.

The University of Central Lancashire (UCLAN) supplied data showing that of 393 students who started pre-registration nursing programmes in 2013, 251 completed in 2016 – seemingly, an attrition rate of 36.1%.

But UCLAN Faculty of Health and Wellbeing executive dean Nigel Harrison said this data was ‘not a true reflection’ of the university’s overall retention rates on its nursing programmes.

Dr Harrison said: ‘Of the 393 nursing students that commenced their pre-registration nursing degree in 2013, 293 have either completed or are still in study.

Comparable to UK average

‘[This] provides an attrition rate of 25% over the three years of the programme comparable to the UK average.’

Similarly, the University of Hull supplied data showing 267 students began nursing programmes in 2013, with 159 completing in 2016 – an apparent attrition rate of 40.4%.

School of Health and Social Work head Deborah Robinson explains that 71% have completed the course, while 7% took a year out and rejoined the 2014 cohort, and 3% suspended their studies and 1% await results.

‘This means the percentage of students who have left the course permanently is 18%.’

‘Suspend studies’

‘Students wish to suspend their studies for a variety of reasons such as pregnancy, bereavement or family circumstances.

‘We are committed to understanding the issues our students face, the impact these might have on their studies and how we can support them.

‘We are dedicated to reducing attrition rates by ensuring that support is in place to address students’ academic, clinical and personal needs and by identifying and monitoring attrition rates closely.’

RePAIR project

Health Education England was asked by the Department of Health to reduce dropout rates on healthcare courses by 50%, so initiated the Reducing Pre-Registration Attrition and Improving Retention (RePAIR) project in 2015.

A RePAIR update in June said findings from a survey of 3,477 students involved in its project show that 40% had considered leaving their course, despite 96% saying they had made the right choice of course.

Three quarters feared debt and 87% said paying for travel to go on placements was a struggle.

Financial pressures were part of the reason student Alex Kelly had to transfer her studies from King’s College London to a university near her family home.

Not enough

‘When I was at King’s, I knew girls who had left because they couldn’t afford it,’ she says. ‘I did get some extra financial support from the university, but it still wasn’t enough.’

RCN student committee member Francesca Elner says NHS pressures caused by low staffing and funding are also deterring future nurses.

‘Pay for qualified nurses is the lowest for graduate professions. Working conditions continue to be challenging, even dangerous, due to staffing levels and morale,’ she says.

Sheffield Hallam University head of nursing and midwifery Toni Schwarz points out that nursing students are often mature.

‘Additional responsibilities’

Dr Schwarz says many students go through key ‘life events’ during their studies, such as marriage, childbirth or having to care for relatives.

‘Some of those values we recruit for mean these students are caring people in the first instance. That predisposes them to have additional responsibilities.’

Professor Buchan says the UK now needs a ‘properly focused assessment of the reasons for attrition’ at institutional level and by different programmes, based on student surveys and other appropriate methods.

‘A clear synthesis of the findings needs to then be translated into lessons for institutions, with targets for intervening to reduce attrition that should feed back into monitoring.’

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