As enrollment in baccalaureate nursing programs declined in the 1980s, universities experienced significant changes in student populations. The American Association of Colleges of Nursing (1992) reported, for both 1990 and 1991, decreases in baccalaureate program enrollments by 7.0%. Students are now older, more are employed full time, and many are perhaps educationally disadvantaged.
Rosenfeld (1987) indicated results of a national survey of schools of nursing by the National League for Nursing. These results showed that shrinking applicant pools were forcing nursing programs to lower admission standards and offer more remediation to students they accepted. Well over half of the baccalaureate programs offered courses in math, reading, and study skills to retain the students they admitted.
There is growing concern about the issue of retention and attrition factors. In the Rosenfeld (1987) survey, preliminary findings indicated close to 50% of the programs were having problems with retention. Major factors contributing to attrition included students having difficulty with required courses, family obligations, and financial problems.
Heydman (1991) indicated that attrition and retention has surfaced as issues for research and discussion at regular intervals for nursing education over the past 30 years. The most prolific research has focused on predictors of success (thus, retention). Further research is needed to focus on ways curriculum and extracurriculum can enhance the retention of the more diverse and academically less wellprepared students who are entering nursing.
Due to the relevant issues of recruitment and retention found in nursing education, it was felt to be of utmost concern to address the need for a viable retention program for the Bachelor of Science in Nursing program at Midwestern State University. Since its inception in 1988, between 50% and 60% of the students enrolling in freshman-level courses had not been completing the 4-year nursing program. Individual classes needed to be analyzed in order to ascertain attrition rates and factors. Remediation services were needed to offset the significant attrition rates noted.
In the 1989 Legislative session, Senate Bill 1351 was passed to provide funding for special projects that promote or test solutions to the shortages of professional nurses in the State of Texas. The Advisory Committee for Professional Nursing Student Financial Aid Programs designed the Incentive Grant for Professional Nursing Student Retention. Nursing programs throughout the state submitted proposals that addressed the individual institution's needs for the program, services to be provided, impact of the project, evaluation tools, and distribution of funds.
The funded grant divided the services to be provided into two phases: data collection and analysis phase, and remediation phase. The data collection and analysis phase of attrition rates and factors is ongoing. The rates and factors are analyzed per graduating class, and this analysis can assist with modification of retention services provided throughout the entire program. The remediation phase consists of three types of services: academic, financial, and support.
Academic services include an optional nursing student seminar for freshman students taking general academics. This seminar was scheduled in the fall semester twice weekly after a survey was taken to determine student preference for day and time. This seminar provided the students with the opportunity to meet all of the faculty they would have during their nursing courses, as well as acquaint them with advisement procedures, student mentoring and tutorial services, and representatives from the student nurse organization and local professional nurse organizations. Additional time was spent discussing the program philosophy, conceptual framework, and curriculum design. It was thought that an "early connection" with these students would enhance retention by allowing them to feel a part of the BSN program prior to formal admission at the junior level. Although monies from the grant were not used for "pre-nursing" students, this component of the services is considered to be a vital hnk to the actual retention program.
Academic services for junior and senior nursing students are provided through the grant. Any junior or senior student identified as "high risk" through a three-way referral system is assigned to a specified faculty member or the coordinator of the retention program. The referral system is further explained in the "Selection of Students" section. A learning contract is developed to help remediate any academic deficiencies through tutoring, class, and/ or clinical assistance. Group sessions are available for academic problems identified to be common among several students, e.g., test taking, organization of study time, math calculation competency.
Financial services provided by the grant are in addition to those available through the University financial aid office and the nursing scholarship program. The BSN Recruitment, Admissions, and Scholarship Committee have set aside additional funds for junior and senior nursing students in the high-risk category. These funds are used for emergency services in order to facilitate retention of these individuals. Criteria for eligibility of emergency funds is determined by the committee, based on recommendation from the Retention Program Coordinator.
A directory of referral services has been developed and is disseminated to nursing students, faculty, and staff All individualsand agencies Usted consented to being included in the publication. The directory is divided into three sections, which list names, addresses, phone numbers, and services available: On Campus - the counseling center, university health center, and student center; Off-Campus Agencies - mental health association, grief support services, battered women's shelter and support group, and consumer credit counseling services; Off-Campus Individual Services - marriage and family counselors, as well as psychologists.
Individualized advisement sessions are available for junior and senior nursing students to determine the appropriate service and/or referral source. Students are provided the opportunity to meet with the Retention Program Coordinator. The type of service (academic, financial, and/ or support) indicated is identified. If an academic service is needed, a learning contract is developed and the appropriate source is determined to help remediate the identified deficiency. If financial service is needed, the funding source is identified and the process implemented for assistance. If additional support service is needed, the referral service directory is used and contacts are made by the Retention Program Coordinator or the individual student.
Selection of Students
Students eligible for the remediation services are selected according to the following criteria: freshmen and sophomores may be self-referred; referred by the BSN Program Coordinator; or referred by the Certification/Admissions Assistant. Juniors and seniors are classified as "high risk" if formally admitted to the nursing program and have been referred by the "three-way* referral system. This system includes: self-referral by any student who has identified a need for remediation in any one of the three service areas (academic, financial, or support); faculty referral by any faculty member who has identified a student who has a need for academic remediation; and BSN Program Coordinator referral by the Coordinator who has identified a student who needs remediation in any of the three service areas (academic, financial, or support). A junior or senior student receiving less than a "C" at mid-term in any required nursing course is automatically referred.
Impact of the Project
The potential impact of the retention program is to facilitate retention and to reduce attrition rates of the junior and senior nursing students in the nursing program. Remediation services for freshmen and sophomores will improve this group's capabilities to be formally admitted to the nursing program at the junior level and further enhance retention through awareness of additional sources throughout the rest of their nursing education.
Individualized remediation plans for junior and senior students will enhance successful completion of the program, thus increasing the number of graduate nurses for the community and the state.
Evaluation of outcome measurement is being conducted each semester. Three evaluation tools have been developed. All freshman and sophomore students who have attended the optional nursing seminar evaluate the topics covered and their effectiveness. Each student who has received individualized remediation services has been asked to complete an evaluation form that addresses individualized services provided and their effectiveness. Every student who has withdrawn from a nursing course or the nursing program has been asked to complete an exit interview and fill out a summary to clarify reasons for withdrawal.
Distribution of Funds
Monies from the grant have been used to appoint a faculty member and a coordinator to provide remediation services a total of 8 hours per week for 30 weeks in the academic year. Designated counseling hours were announced to the various student populations at the beginning of the term. Individual appointments have been made to accommodate student work or class schedules when necessary.
Grant monies have been used to develop a Directory of Referral Services. This directory has been published and made available to nursing students, faculty, and staff for proper dissemination.
Thus far, data analysis has been conducted to determine attrition rates and factors of all nursing classes. Each class of beginning nursing students was analyzed. Class rosters were used to obtain the names of the students and their progression from the first nursing course through completion of the program. Individual files were reviewed and reasons for withdrawals were obtained. Graphs were developed to demonstrate attrition rates per class and attrition factors per class. Attrition factors have been clustered into specific groups in order to determine commonalties among the individual classes. Attrition factors found to be common among all classes include: a) academic failure; b) transfers to other majors; c) lack prerequisites to be admitted to junior level nursing; and d) withdraw passing (personal reasons or military transfers to other locations).
Remediation services have been provided for 35 students on an individual basis in the fall semester. Services included academic remediation for individual courses. Tutors, mentors, and group sessions were obtained. An additional 14 students have been provided single and group sessions for academic remediation associated with medication calculation competency. These services will assist in offsetting the academic failure, which was identified as the most significant attrition factor.
Financial assistance, ranging from $200 to $500 in emergency funds, has been provided to five students. Support services have been used to include referral sources regarding legal and counseling needs. Financial and support services provide assistance for the withdrawals due to personal reasons. Some stated financial restraints; others indicated health (physical and emotional) as personal reasons.
Each of the evaluation tools, developed and implemented in the fall of 1991, has been analyzed. The results of these tools, thus far, have generated recommendations for change which were to be implemented in the fall of 1992.
The evaluation responses for the optional nursing seminar, which was provided for freshman and sophomore students, generated many positive comments. For example, the information given made them more comfortable with program expectations; it facilitated the opportunity to meet with all the faculty; and they learned what would be expected of them in the nursing courses. As a result of the evaluation, the seminar will be offered for 3 weeks instead of 6. Topics will include faculty member introductions with discussion of positions and responsibilities, BSN program overview and program handbook, academic advisement procedures, nursing organizations at MSU, financial aid options, and specific topics that will be selected by students.
Some of the significant changes that have been made thus far, based on this analysis of rates and factors include:
1. Students who are having academic difficulty in any course may use the self referral system to obtain individual assistance in the specified course. The Retention Program Coordinator helps identify faculty, group, or tutorial intervention early in the course to prevent academic difficulties.
2. Students who transfer to other majors are counseled by the faculty adviser or program coordinator to determine if any advisement procedure could be addressed to prevent the individual transfer and to use the obtained information to prevent other students from changing their major.
3. All faculty advisers have been given inservice education prior to registration to emphasize the importance of reviewing prerequisites for all courses in order to help students follow the appropriate curriculum sequence.
4. Students who withdraw from any course, the BSN program, or the university complete an exit interview and fill out a summary to clarify reasons. Personal reasons have been discussed and appropriate remediation services have been provided to prevent the withdrawal. To date, we have been unable to correct the problem connected with withdrawals due to military transfer. When this is the reason given, we do attempt to assist the student in transfer to another program.
Students receiving individualized or group remediation services completed an evaluation form that addressed the ef fectiveness of services provided. Results of these surveys indicated services were good to excellent. The only recommendation given was to determine if additional information regarding financial aid sources could be obtained. Based on the results of these evaluations, a recommendation has been made to submit a grant proposal to continue remediation services and/or incorporate the time indicated for services into faculty workload. Investigation of additional availability of scholarship monies for emergency purposes is under way. The Coordinator of the Retention Programs explored plans to develop a source listing, in cooperation with several students who have used various sources, and publish the information.
Students who withdrew from a course or the entire program were mailed exit surveys. The results of these surveys have been analyzed and submitted to the BSN Program Curriculum Committee to review as part of the 5-year program evaluation plan.
In addition, the Directory of Referral Services, which was developed as a part of this grant, will be revised and updated on an annual basis. The directory will be made available for all nursing students, faculty, and staff to enhance support services.
It has been exciting to have had the opportunity to develop a comprehensive professional nursing student retention program at Midwestern State University. Gothler and Rosenfeld (1986) stated that the future of nursing manpower is contingent on the future of nursing education. There is a need to document the cost-effectiveness of nursing education systems, particularly retention strategies. This grant has allowed one nursing program to begin the process of such documentation. Students and faculty have seen the tremendous need for such a program and have developed an enthusiasm for active participation. The Student Nurse Organization has volunteered their assistance in remediating and retaining fellow students. Faculty have enthusiastically become involved in referrals and remediation services. Additional grant proposals have been generated as an outcome of this endeavor.
Retention strategies discussed here may have general applicability to other nursing programs. Successful retention of the majority of nursing students will provide the increased manpower needs necessary in nursing today and in the future.
- American Association of Colleges of Nursing. (1992). Enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC: Author.
- Gothler, A.M., & Rosenfeld, P. (1986). Nursing education update: Enrollments and admission trends. Nursing and Health Care, 12, 555-559.
- Heydman, A. (1991). Retention/attrition of nursing students: Emphasis on disadvantaged and minority students. In P.A. Baj & G.M. Clayton (Eds.), Review of Research in Nursing Education (pp. 1-29). New York: National League for Nursing.
- Rosenfeld, P. (1987). Nursing education in crisis - A look at recruitment and retention. Nursing and Health Care, 8, 283-286.