The number of students seeking associate degree education far exceeds the available space in prelicensure programs throughout the United States. According to the National League for Nursing (NLN) (2012b), 85% of associate degree programs turned away qualified applicants due to lack of clinical placements, nursing faculty, and classroom space. At the same time, a significant number of students who enter associate degree nursing programs do not graduate. In fact, approximately 20% to 42% of nursing students nationwide leave the program after the first year (Fraher, Belsky, Gaul, & Carpenter, 2010; NLN, 2012a). Last and Fulbrook (2003) found that attrition among nursing students is not only an issue in the United States but is a major problem globally. Attrition rates were reported to be as high as 24% in Scotland and 25% in England (Pryjmachuk, Easton, & Littlewood, 2009).
Nursing student attrition results in wasted time and effort by faculty and, more importantly, wasted time and effort by students who were unsuccessful in completing their nursing programs (Pryjmachuk et al., 2009). The costs to universities when students leave prior to graduation are significant in terms of lost tuition and fees, as well as future contributions to support the institution. Taxpayers are spending $240 million per year in federal and state grants and loans to associate degree students who leave before their second year (Schneider & Yin, 2011). In addition, society, dependent on an educated workforce, does not benefit when students are not successful in completing their degree (Ackerman & Schibrowsky, 2007). This is particularly true for students who fail out of nursing programs, given that attrition reduces the number of nurses available to fill vacant positions in health care settings. Increasing the number of students who successfully complete their nursing program would positively impact the communities in which they may eventually become employed; in addition, it would decrease economic costs to higher education. Associate degree nursing programs and programs with accelerated nursing curricula are responsible for graduating students in a relatively short time, compared with traditional baccalaureate programs. Therefore, early identification of at-risk students is essential to develop interventions to enhance student success and decrease attrition rates.
Several student retention studies have examined strategies for decreasing student attrition, including early identification of students at high risk for failure and early implementation of interventions designed to contribute to program success (Hopkins, 2008; Jeffreys, 2007). Despite these efforts, associate degree nursing programs continue to face growing concerns about attrition rates among students, indicating a need to determine more accurate predictors of attrition.
A global shortage of nurses has increased the interest in attrition rates among nursing students (Bowden, 2008). Nursing student attrition attracts political, organizational, and social interest for many reasons but especially because of the persistent nursing shortage and the economic costs of attrition (O’Donnell, 2009). To meet the challenges of the nursing shortage, it is important to increase retention of students in schools of nursing (Williams, 2010). Predicting students’ successful completion of a nursing program is critical and has become a focal point of higher education institutions (Higgins, 2005).
The literature suggests that factors such as self-esteem, self-efficacy, and stress may be associated with college student attrition. Several studies have examined the relationship between self-esteem and student attrition. A study of first-year college students found that issues related to self-esteem were the most commonly cited concern and were significantly related to attrition (Fletcher, Bryden, Schneider, Dawson, & Vandermeer, 2007). Toews and Yazedian (2007) found that high levels of self-esteem were predictive of better adjustment to college and lower rates of attrition.
Among the factors influencing student attrition and persistence in college is self-efficacy. A study of first-generation college students found that the likelihood of completing a semester and returning the following semester was significantly related to self-efficacy (Vuong, Brown-Welty, & Tracz, 2010). In earlier studies, self-efficacy was found to be associated with decisions to remain in a program and, consequently, attrition rates (Bong, 2001; Zimmerman, 2000). A study of four cohorts of nursing students indicated that personal attributes, such as self-efficacy, have a significant influence on attrition rates (Pryjmachuk et al., 2009). Conversely, Zajacova, Lynch, and Espenshade (2005) found that self-efficacy did not have a significant effect on student attrition among a cohort of nontraditional college freshmen.
Research suggests that life stressors among nursing students are recognized as important risk factors for later attrition (Brodie et al., 2004; Evans, Brown, Timmins, & Nicholl, 2007; Evans & Kelly, 2004; Gibbons, Dempster, & Moutray, 2008; Jones & Johnston, 1997; Pryjmachuk & Richards, 2007). High stress levels in nursing students have been associated with low self-esteem, which leads to poor learning and academic performance and, subsequently, poor retention and higher attrition rates. Jeffreys (2007) noted that multiple-role responsibilities, multiple-role stress, and feelings of cultural incongruence were factors associated with student attrition.
This study is guided by Bean’s and Metzner’s (1985) model of student attrition. Bean and Metzner’s model posits that a student’s drop-out decision is based primarily on four sets of interacting variables: poor academic performance; psychological variables, such as loss of motivation, dissatisfaction with the program, and stress; demographics, including age, place of residence, educational goals, ethnicity, and gender; and environmental variables, such as family income, hours of employment, family responsibilities, and social support. Bean and Metzner considered psychological factors, such as positive self-esteem and self-efficacy, to be important enough to influence students, even those with poor academic ability, to stay in college. Our investigation explored the relationship of two components of the Bean and Metzner model—psychological variables of self-esteem and self-efficacy and life stressors—to associate degree nursing student attrition rates.
This study was designed to answer three questions:
- Is there a relationship between self-esteem, as measured by the Rosenberg Self-Esteem Scale, and student attrition in a student’s first semester in an associate degree nursing program?
- Is there a relationship between self-efficacy, as measured by the General Self-Efficacy Scale, and student attrition in a student’s first semester in an associate degree nursing program?
- Is there a relationship between life stressors, as measured by the Holmes and Rahe Social Readjustment Rating Scale, and student attrition in a student’s first semester in an associate degree nursing program?
Study participants were recruited during the first 2 weeks of their first semester in the associate degree nursing program. The sample was limited to full-time students who gave written consent to participate in the study. A nonprobability convenience sample was used, with no limitations of gender, age, or ethnic background. Data on demographics, self-esteem, self-efficacy, and life stressors were collected immediately after informed consent was obtained. The study was approved by the college’s institutional review board.
The participants’ end-of-semester grades and grade point averages, as well as a list of students who withdrew from any or all of their nursing courses during the semester, were obtained from the department of nursing. At the end of the semester the data were analyzed.
Self-esteem was measured using the Rosenberg Self-Esteem Scale. The Rosenberg Self-Esteem Scale has high reliability; test–retest correlations range from 0.82 to 0.88, and Cronbach’s alpha for various populations range from 0.77 to 0.88 (Rosenberg, 1965).
Self-efficacy was measured using the General Self-Efficacy Scale. The General Self-Efficacy Scale has been widely studied, and its reliability and validity are well established. In samples from 23 nations, Cronbach’s alphas ranged from 0.76 to 0.90, with the majority in the high 0.80s (Jerusalem & Schwarzer, 1979).
Life stressors were measured using the Holmes and Rahe Social Readjustment Rating Scale. The Holmes and Rahe Social Readjustment Rating Scale is a 100-item questionnaire, composed of 43 life events. An individual’s total score measures the amount of stress the individual has experienced in the past year. The tool has been extensively studied, and its reliability and validity are well established. Cronbach’s alpha for various populations range from 0.82 to 0.90 (Holmes & Rahe, 1967).
Student attrition was measured using the student’s grade point average at the end of their first semester of study in the associate degree nursing program. To remain in the nursing program, a student has to achieve a grade point average of 2.5 or greater in all of the courses they registered for in their first semester.
The sample consisted of 34 participants (71% female, n = 24; 29% male, n = 10) enrolled in the first semester of an associate degree nursing program. The percentage of male nursing students in this study was significantly higher than the national average of 15% (NLN, 2012b). In addition, 76.5% (n = 26) of the study participants were Caucasian, 8.8% (n = 3) were African American, 8.8% (n = 3) were Hispanic, 2.9% (n = 1) were Asian, and 2.9% (n = 1) were Other. This is similar to the national profile of nurses in regard to race/ethnicity; approximately 73% of associate degree nursing students are Caucasian, 9% are African American, and 6% are Hispanic (NLN, 2012b). The mean age of the sample was 32 years, with a range of 20 to 56 years. Of note, although participants were enrolled in an associate degree nursing program, 41% (n = 14) held bachelor’s degrees in other disciplines and 21% (n = 7) had associate degrees in a discipline other than nursing. This is reflective of nursing’s response to the needs of the current health care system, offering a nursing program of study to students already in possession of a degree in another field. Accelerated programs for second-degree students have increased significantly during the past several years. In 1990, 31 accelerated baccalaureate programs were offered around the country; currently, there are more than 235 (American Association of Colleges of Nursing, 2012).
In the current study, there was a 29% (n = 10) attrition rate among associate degree students at the end of their first semester of the nursing program. The attrition rate was based solely on grade point average, and no students in good standing withdrew for reasons unrelated to academic disqualification. Age, gender, and ethnicity were not found to be significantly correlated with student attrition using the Pearson r correlation coefficient. A total of 82% (n = 28) of associate degree nursing students reported high self-esteem, and 77% (n = 26) indicated high self-efficacy. Forty-four percent (n = 15) of study participants reported low stress, and 35% (n = 12) indicated a moderate level of stress. Correlational analysis indicated that self-efficacy was positively related to self-esteem (r = 0.540, p = 0.001).
A chi-square test was used to examine relationships between the dependent variable, student attrition, and the independent variables of self-esteem, self-efficacy, and life stressors. Self-esteem, as measured by the Rosenberg Self-Esteem Scale, was categorized as low, moderate, or high for data analysis. Similarly, the General Self-Efficacy Scale measuring self-efficacy and the Holmes and Rahe Social Readjustment Rating Scale measuring life stressors were categorized as low, moderate, and high. Results of the chi-square tests indicated that there was no significant relationship between student attrition and self-efficacy, self-esteem, or life stressors.
The Pearson r correlation coefficient was used to analyze data based on the total scores of each scale. Findings revealed a significant negative correlation between self-esteem and student attrition (r = −0.403, p = 0.05), suggesting that the higher the level of self-esteem, the lower the attrition rate of associate degree students in the first semester of their nursing program.
Discussion and Implications
The attrition rate of 29% for the study sample is within the national average of 20% to 42% of nursing students who leave their program within the first year (NLN, 2012a). As with previous research (Fletcher et al., 2007; Toews & Yazedian, 2007), in this study self-esteem was significantly correlated with student attrition in the first semester. However, self-efficacy and life stressors were not significantly related to student attrition. Students with high self-esteem may have greater aspirations and more persistence when faced with the possibility of failure. Baumeister, Campbell, Kreuger, and Vohs (2003) posited that self-esteem was associated with persistence and a decreased sense of incompetence and self-doubt. It is important for nurse educators and educational institutions to identify factors that influence student attrition (Johnson, Johnson, Kim, & McKee, 2009). A retention program focusing on self-esteem issues may be beneficial in addressing the high attrition rates in associate degree nursing programs. Enrichment programs that identify and address noncognitive factors, such as personal growth, mentoring, peer support, and networking, have achieved promising results (Johnson et al., 2009) and may increase self-esteem in first-semester students. Given the time and resource constraints of associate degree programs, research indicates that educational programs designed to focus on noncognitive factors have been a successful and efficient approach to address self-esteem issues (Miranda, 2009). Importantly, early identification of students at risk for failure or withdrawal from the first semester of their nursing program allows for early support interventions and may decrease attrition rates (Jeffreys, 2007).
Limitations of this study include a focus on a single associate degree program and small sample size. Future research should include a larger sample of nursing students and multiple study sites to increase the generalizability of study findings.
It is important that schools of nursing have a clear understanding of variables associated with student attrition, particularly in the first semester of the program. This study’s results suggest that self-esteem is associated with attrition in first-semester associate degree nursing students; therefore, early recognition and provision of interventions designed to target these at-risk students may provide the necessary support for them to continue in their programs.
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