Analysis

Why nursing students leave: causes and remedies for attrition revealed

The long-awaited RePAIR report recommends changes to funding and placement allocation

The long-awaited RePAIR report recommends changes to funding and placement allocation


Academic pressures can take their toll. Picture: iStock

Workload, finances and problems with placements rank high among the reasons why nursing students leave university.

5 top reasons for leaving nursing courses

  • Finances 
  • Academic pressures 
  • Problems with placements 
  • Personal reasons
  • Workload

Source: RePAIR survey

The top ten reasons why students leave their preregistration courses are revealed in Health Education England’s long-awaited Reducing Attrition and Improving Retention (RePAIR) report.

Looking at figures from 16 universities for the 2013-14 and 2014-15 academic years, the RePAIR project found a dropout rate of 33.4%.

The report reveals big differences between the fields of nursing, with the highest dropout rates in learning disability and mental health nursing:

  • Learning disability nursing: 39.1%.
  • Mental health nursing: 34.9%.
  • Adult nursing: 33.3%.
  • Children’s nursing: 29.4%.

Mandated by the government in 2015, the RePAIR project aims to cut dropout rates among students on preregistration healthcare programmes by 50%. 


Professor Christine Beasley: 'Unnecessary
attrition does incur a significant cost to
the system.' Picture: John Behets

England’s former chief nursing officer and RePAIR steering group chair Dame Christine Beasley acknowledges that attrition has been ‘under the spotlight’ for many years.

She says: ‘While not all attrition should be considered negative, unnecessary attrition does incur a significant cost to the health and care system and to universities and healthcare providers.

‘It also affects the health and well-being of healthcare students and those who are newly qualified.’

Defining attrition

One of the 14 RePAIR report recommendations is that national bodies work together to review the current range of definitions of attrition and models for measuring it.

It has been a source of frustration to some in the profession that there has never been an agreed UK-wide approach to attrition based on a universal definition.

63%

of students said they would not have applied for their nursing degrees if they had to pay their fees

Source: RePAIR survey

Nursing workforce expert James Buchan, professor in the health and sciences faculty at Edinburgh’s Queen Margaret University, is sceptical about the call for a standard definition and measure of attrition.

He says: ‘This has long been advocated but seems no nearer a reality – and Health Education England (HEE) does not follow the recommendation, using different definitions and measures of attrition at different points in its report.’

The HEE defines attrition as the percentage of nursing, midwifery and therapeutic radiography students who did not complete within the standard pathway for their programme.

Financial pressures and placement problems

A qualitative survey of 3,447 students by the RePAIR team found that clinical placement experiences, finances and academic pressures topped the list of reasons why students considered leaving courses.

One student said: ‘It is so hard financially during placement. Money is a huge problem. I do not get enough bursary to live on so I need to work and that is really hard while also doing a placement.’

Another student said: ‘In the second year, the workload was very hard to manage and the level of academic writing went up to a much harder level. This was unexpected and demotivating.’

Other issues with placements arise as mentioned by one student: ‘I had an unsupportive mentor. I lost my motivation while on placement and found it difficult to continue the course.’

'Gender is a key issue'

The Council of Deans of Health, which represents universities, issued a briefing note included in the report. It says reasons for attrition are ‘complex and personal’ to students but that gender is a key issue.

Universities and Colleges Admissions Service figures show that women made up 94% of applications in England for the March 2018 intake for nursing and midwifery courses.

The note continues: ‘Members report that care responsibilities and pregnancy are among the major reasons that explain non-continuation.

‘Gender inequality in care responsibilities is still unfortunately a major issue in our society.

‘Other factors such as mental health issues, including anxiety, stress and depression, and issues related to learning disabilities also account for non-continuation in some instances.'

Traumatic experiences while on placement was also cited as a reason why healthcare students dropped out.

 

Inadequate funding

The RePAIR report recommendations attempt to address some of the reasons why students drop out.

It calls for hardship funds to be made available to enable more prospective students to consider a career in healthcare.

This call for increased funding for students stands in contrast to the government decision to withdraw the NHS bursary for nursing, midwifery and allied health professional students in England from August 2017.

Another recommendation is that higher education institutes work more closely with their healthcare provider partners to map out detailed placement allocations for all students throughout their course.

‘The switch to a loan system in England has not so much changed the goal posts as shifted the game to a new stadium, with new rules’

‘They should also review processes relating to placement costs and ensure students are reimbursed in an efficient and timely way,’ the report states.

Buddy schemes, more support for second-year students and clarity over students’ roles in practice by clearing up confusion about supernumerary status are also advocated.

Culture of care

HEE chief nurse Lisa Bayliss-Pratt says: 'RePAIR has provided a unique and fascinating insight into what motivates students to stay or leave their chosen healthcare programme.

'It has been a catalyst for further work to explore some of the emerging themes including valuing second-year students, the culture of care, understanding student confidence and early career choices.'

While the recommendations to address student attrition appear well-informed, it remains to be seen whether the necessary changes can be implemented in a way that has the biggest impact. 

35.1% 

The overall reduction in the number of applications to study nursing in England between 2014 and 2018 

Source: RePAIR survey

Professor Buchan says: ‘The main recommendations from the RePAIR project are sensible, even if many are not new.

‘The challenge will be implementation, given the switch to a loan system in England, which happened after the RePAIR work began and has not so much changed the goal posts as shifted the game to a new stadium, with new rules.’

RCN head of professional learning and development Anne Corrin believes that without proper investment in nursing education it will be hard to make much progress on tackling attrition.


Anne Corrin: 'The government need
to make clear they value students by
properly investing in nursing education.'

Ms Corrin says: 'As the RePAIR report recognises, nursing and midwifery students aren’t like other students and spend almost half their time in practice placements.

'Unfortunately, this experience has too often come at great cost; students are used to making up the shortfall in staffing numbers and experienced nurses aren’t supported to teach students. 

'With the health service facing a shortage of tens of thousands of nurses, we must make sure students aren’t put off by negative experiences of clinical placements, or financial and academic pressures.

Funding reforms

'As the number of vacancies in health and social care continue to soar, the government needs to make clear it values students by properly investing in nursing education.

'Student funding reform, and proper workforce planning, is vital if we are to encourage more people into the profession.'

The eyes of the nursing profession will now be trained on whether the recommendations in this report can deliver the solutions needed to tackle attrition. 


Related material

RePAIR report

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