Review identifies barriers to success for nursing students

Review identifies barriers to success for nursing students

A small group of NMIT Academic Staff Members in Nursing has published a literature review designed to explore attrition and retention of ethnically diverse student nurses in undergraduate programmes.

There is a recognised shortage of ethnically diverse registered nurses worldwide with attrition rates reaching up to 85%. Within New Zealand, 15% of the population identify as Māori, yet only 7% of registered nurses identify as Māori. In the United States, the number of Hispanic health professionals remains low. This trend is also seen in Australia.

But, there is clear evidence to suggest that health outcomes for patients improve if nursed by health professionals who share the same language and culture. So, why is attrition among ethnically diverse students so high? What can be done to increase retention?

The review, spearheaded by NMIT Senior Academic Staff Member in Nursing Chris Gaul, aimed to understand the barriers to success and to explore initiatives and strategies to identify practical solutions to minimise attrition rates.

Chris Gaul had been interested in attrition for some time. She asked fellow colleague Siobhan Tranter to lead the review team, which included Susannah McKenzie and Karen Graham who teach on the Bachelor of Nursing Programme.

CINAHL, PubMed, ProQuest, ERIC and Cochrane databases were searched using the key terms student nurse, attrition and retention to identify papers. The CASP tool was used to evaluate relevant studies for rigour (Critical Appraisal Skills Programme [CASP], 2017). Seventeen papers were identified for inclusion. The findings from these studies were analysed using thematic analysis.

Four themes emerged from the literature:

  1. Prediction
  2. Increasing recruitment and incorporating retention
  3. The single approach
  4. Multiple approaches

“Prediction refers to the tools that we can use to predict whether students are going to stay on the programme,” explains Siobhan, spokesperson for the team.

“The second theme was increasing recruitment and incorporating retention strategies. Therefore, it was things like going out to high schools, talking to them about nursing as a career.

“The third theme was the single approach. More academic support, English language lessons, money or pastoral support. The fourth theme was multiple approaches, so offering two or three strategies.

“Some of the studies were fraught with methodological problems," says Siobhan. "But there was evidence to suggest that the more you can offer through multiple approaches the better.”

Among the findings:

  • High attrition rates link to financial difficulties and lack of academic support and pastoral care.
  • There is a gap between social and academic language skills, which contributes towards high fail rates.
  • Informing potential students of the reality of nursing is a key element to recruitment.
  • Indigenous content and culturally appropriate care within the curricular and learning environment promotes retention.
  • A tutor with the knowledge and skills to support multicultural students boosts retention.

After looking at the literature, the team found they were providing many key requirements.

“It made us feel like we’re ticking a lot of the boxes,” says Siobhan. “We were unwittingly, if you like, already doing much of what is needed for retention.”

During the academic year, NMIT Academic Staff in the Department of Health – Nursing visit local secondary schools. They talk to school students about nursing, entry criteria and the Bachelor of Nursing Programme expectations before they apply.

Students in school can spend a day at NMIT through the STAR Programme(external link). They learn about entry requirements, visit the nursing department’s simulated learning environment, and take part in an activity. They can also earn credits on a part-time basis with Trades Academy(external link), which runs every Friday of the school academic year.

If someone is interested in nursing as a profession, they can shadow a year one student for the day.

Siobhan teaches Professional Responsibilities at the beginning of year one, with a session devoted to the question: What do you think nurses do?

Chris Dunn, Deputy Head of Department Health – Nursing, says that while numbers of Māori learners studying on the Bachelor of Nursing (BN) Programme at NMIT are low, they have a higher course and qualification completion rate than Pākehā.

“We have good support in place for Māori learners on the BN Programme. There is a Māori Cultural Advisor, we’ve got a whānau group, a supportive Kawa Whakaruruhau Advisory, in addition, all Māori learners are supported to attend the annual Māori Student Nurses Hui”.

International learners at NMIT are supported by the International Team, Pasifika learners by the Pasifika Advisory and all students are supported by SANITI – the Student Union providing independent support, advocacy and employment advice.

“There is a pathway of support," says Chris. "We have an open door policy and will support, advise and refer all our learners who seek assistance.” Our international learners have no family, and often no support systems in New Zealand, which makes them more vulnerable. We check in.”

For Chris, the review highlighted the importance of partnership. “For the team, it’s about working in partnership with our learners to able to go on that journey with them, if they let us in. It’s not just one person’s journey, it’s all of ours.”

For Siobhan, the review provided reassurance. “We are more aware of the factors that affect retention, and it is reassuring to know that, while we still have much to learn, everything we should be doing, we are doing.”

Contact Siobhan Tranter by email at: if you would like to learn more about the literature review or find out more about our Bachelor of Nursing programme.


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