Elsevier

Nurse Education Today

Volume 31, Issue 5, July 2011, Pages 456-460
Nurse Education Today

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

https://doi.org/10.1016/j.nedt.2010.09.005Get rights and content

Summary

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 For the second study, semi-structured telephone interviews were conducted with students who had withdrawn.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.

Introduction

It is well recognised that there is a global shortage of health care professionals, including nurses. The National Review of Nursing Education (2002) identified registered nurses in Australia as a worsening national shortage. Figures released by the Australian Health Workforce Institute showed that new undergraduate commencements between 2001 and 2002 were lower in South Australia, Western Australia and Northern Territory, although overall, nationally, they were higher (AHWAC, 2002). A retrospective analysis of the average attrition rate in Queensland universities was estimated at 24.5% (Gaynor et al., 2008) which is consistent with the Australian average and the international experience. Shortages of qualified nurses are reported in Australia, New Zealand, the United Kingdom, the United States of America and Canada (Gaynor et al., 2006, Gaynor et al., 2008).

In response to this shortfall of registered nurses, the University of Adelaide in South Australia introduced an undergraduate Bachelor of Nursing degree in 2006 in order to contribute to expansion of the profession. Unlike most other Australian Bachelor of Nursing programmes, the course was deliberately designed to allow for early exposure to clinical practice, with students from the eighth week of Year 1 through to the final weeks of Year 3 being placed in clinical settings to work alongside registered nurses for 3 days per week over 35–40 weeks per annum. The course is one of the most clinically intensive undergraduate nursing programmes in Australia. For further information go to: http://www.adelaide.edu.au/programfinder/2010/bnurs_bnursing.html [last accessed 8.2.2010].

Dissimilar to most other programmes, entry to the degree is very competitive. Students must demonstrate high academic achievement, falling in at least the upper 75th percentile of all matriculation scores in the year of application. This criterion qualifies the applicant for the offer of an oral selection interview, described later in this paper. Thus, academic excellence is a necessary but not sufficient requirement for entry, as performance in the interview is used as the deciding factor for offer of a place. In the first three years of the programme, on which this paper is based, there were 50, 51 and 52 places respectively. In 2006 there were 230 people interviewed for those places, in 2007 232 people were interviewed and in 2008 213 people were interviewed.

With a need to increase the nursing workforce, and with such small intake numbers, strict entry requirements and labour and time intensive interviewing for selection, the hope was that all applicants offered a place would remain in the course and go on to graduate and to work as a nurse. This has not been the case. In the first three years the attrition rate in Year 1 was 33.7% (N = 34).

Prediction of those who are less likely to succeed and thus should not be admitted entry is probably more desirable than trying to remedy problems once an unsuitable student has entered the course. A number of authors have focussed on interventions post-entry, such as Johnson et al. (2009). Glossop (2001) noted the trend to recruit students and then attempt to retain them when problems emerge, rather than predicting problems and avoiding them before admission. In their integrative review Campbell and Dickson (1996) state: “interventions designed to increase student success should begin at the pre-nursing level” (p57), and on the basis of our results, this would seem to be a more sensible approach.

Section snippets

Literature review

There has been a great deal of interest regarding student nursing retention and attrition (Glossop, 2001), yet there remains a paucity of research into recruitment, attrition and retention (Johnson et al., 2009). Andrew et al. (2008) note that there has been a recent resurgence of research activity in attempting to identify ways in which to increase retention rates in nursing courses around the globe. A number of authors have investigated the reasons for attrition, attempting to identify either

Study one

Oral assessments were conducted in December and January before the February start of the academic year. Each assessment was of 20 min duration. A panel of two assessors, the first a member of the academic staff of the university and the second a Registered Nurse from a clinical setting, assessed applicants. Each applicant was introduced by first name only to panel members. Panel members were provided with an applicant's first name only.

The oral assessment has been designed to assess the skills

Study one

Descriptive statistics were performed to summarise the demographics of the sample. T-tests and chi-square analyses were conducted to help examine the differences between those who successfully completed the 3-year undergraduate nursing course and those who did not. Predictors examined included age, gender, subjects taken during final year of secondary school, prior nursing experience, knowing a nurse previously, matriculation score, whether participants were from a private or government school,

Discussion

The reported studies sought to identify reasons why the attrition rates at the University of Adelaide in the Bachelor of Nursing were reasonably high in the first three years of the programme. The students accepted into the programme are highly selected on the basis of academic achievement, and indeed, cognitive factors such as the subjects taken during secondary schooling and the matriculation scores were not predictive of retention. It should be noted, however, that the matriculation score

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