A Model for Retention of Undergraduate Nursing Students in Universities in Eastern Cape Province, South Africa

Monday, 30 October 2017

Nonyaniso Trustina Nkutu Sr., MCur (NsgSc), BCur (EetA), RN, RM
Faculty of Health Sciences, University of Fort Hare, East London, South Africa


Setting: the setting was in the three universities in the Eastern Cape Province, South Africa. Design: A quantitative research paradigm which is descriptive in nature was used. Population was nursing students in the undergraduate programme. A multistage, clustered stratified random sampling was conducted from first to fourth year level of study. Sample size: 352 students. Inclusion criteria: nursing students 18 to 50 years of age; males and females; full time students in the undergraduate nursing programme; irrespective of ethnicity. Universities in the Eastern Cape Province that have Schools of Nursing. Exclusion: Universities not having a nursing degree programme in the Eastern Cape Province; Distance learning students.This study adapted Jeffreys Nursing Undergraduate Retention and Success (NURS) model Toolkit in order to develop a questionnaire for the study. Testing of instrument was done with experts in the department. Piloting of this instrument to ensure validity and accuracy was done. Ethical Clearance was obtained from the three universities and the Department of Health in the Eastern Cape Province. However due to the strike by students (#fees must fall)” only two universities continued with the study and the other one fell off. Data collection from all respondents took 30-45 minutes.

 Results: Undergraduate nursing student retention could not be fully understood without tackling the issue of dropout in universities. The factors for dropout were multidimensional and complex in nature. These factors had to be grouped into 3 distinct contexts as the macro relating to the Higher Education, the meso relating to the institution (policies and procedures) and the micro relating to the individual student. The sample was distributed as 186 (52.8%) from one of the universities and were almost equally distributed across the four years of study with 251 (72.3%) being female students. This is not surprising that the number of females was high in this study because from long ago nursing has been known to be a female profession. Although now recently the profession is encouraging gender equity to increase the number of male student nurses. These students were distributed such that 314 (93.7%) were in both clinical and nonclinical settings. Because nursing is science and arts it is vital that nursing students be allocated in all the settings in order to correlate nursing with practica. 269 (76.6%) were younger than 25 years of age. Younger generation of students are sometimes regarded or expected not to have exceedingly many challenges in academe than the grown- ups who are already involved in many roles including family. However, there is a need to actively involve them in mentorship programmes so that they can realise and master their goals with ease. Most of these young ones usually have transition problems hence the need for mentorship. 340 (97.4%) were black and 281 (94.3%) were Xhosa first language speakers. The two universities under study are in the Eastern Cape Province and it is not surprising to get the majority of respondents black and Xhosa first language speakers because the province itself is predominantly Black and isiXhosa is the common language spoken by many. 332 (94.9%) were single. The marital status also can have a significance for young and single respondents because if single it is expected that one will be able to focus and give her studies an undivided attention than one who is married, with multiroles of being a woman,wife, and having children to look after. 268 (76.5%) stayed in university accommodation on campus which has a potential to allow enough time for students to study away from home and family responsibilities. All of them entered the undergraduate nursing programme with a matric educational background (100%) and 122 (54.7%) take less than 15 minutes to get to campus. Looking at the performance specific variables, 62 (17.6%) of the students had ever repeated a course and most 281 (93.3%) of the repeating happened in the first two years of study with the major reason for that being poor performance in specified subjects (67.8%). Repeating a class and poor academic performance has been seen as a recipe for dropout for many students in the undergraduate programmes at these levels. There were 13 (3,7%) students who admitted that they are still at risk of withdrawal. This is a worriesome finding for the Province as a whole and for the institution and students themselves because given the amount invested in nursing education institutions for training of the students and the state of services in the Province it is a great loss if students should dropout as a result of pitfalls during training. The performance of the students was measured using their marks in four subject areas, namely, general nursing sciences, midwifery, community nursing sciences and psychiatric nursing. The average performance in these subject areas ranged between 62% (midwifery) and 67.9% (community nursing). Higher education in South Africa puts an obligation to Nursing Education Institutions to provide highly qualified nurse practitioners to be able to man the services on completion and registration with the South African Nursing Council. Hence the support they give to all nursing students during their training. However, 332 (94,9%) of the respondents in the study reported lack of funding for their education as an interference and an obstacle in them realising their goals during training. 345 (98%) of the respondents in the study reported that there is too much content in their curriculum and that there is very little time to cover this. It is not surprising that there will always be such complaints with students and academics because the majority of students come to the classroom not well prepared and with divided attention which makes it difficult for them to focus and master their content. However, the issue of time as a constraint to completion and mastery of the content has been dealt with in trying to assist the students to cope and still needs to be emphasised through time management skills in all levels of training. The study also revealed that 85 (22,7%) of the respondents find some attitudes of staff unacceptable and they feel that they have made wrong career choices. 302 (85,7%) respondents in the study alluded to the fact that they found clinical settings overwhelming and they feel frightened and overworked because they do not have time to themselves which is why 85(22,7%) they resort to drinking and drug abuse. The issue of attitudes of academic and clinical staff has been reported in literature and this is a concerne that needs to be handled tactfully.