The decision to seek employment while in college does not escape those who are enrolled in a Bachelor of Science degree in Nursing program. Yet, limited research exists exploring the implications of working during nursing school and its impact on academic success. Considering suggestions from the education literature on the number hours worked per week for the general undergraduate student, along with the current nursing literature involving the number of hours worked per week and its relation to academic success in the nursing student, a best practice model can be developed to help guide nursing students in their decision with paid employment during nursing school.
College student employment prior to graduation is prevalent and will likely not change in the immediate future. According to the National Center for Education Statistics (2017), 43% of full-time and 78% of part-time undergraduate students were employed in 2015. General education literature suggests that working more than 16 to 20 hours has a negative effect on collegiate success (Bozick, 2007; Callender, 2008; Kulm & Cramer, 2006; Pike, Kuh, & Massa-McKinley, 2008). Additional evidence points to a negative relationship between hours worked and academic achievement when students work over 30 hours per week (Torres, Gross, & Dadashova, 2010). Collectively, the general suggestion from the education literature is to counsel students to work less than 20 hours per week to improve their chances of being successful in college.
Contrary to the volume of literature speaking to employment for general undergraduate students, definitive employment suggestions for undergraduate baccalaureate nursing students is limited. Yet, the undergraduate baccalaureate student nurse population requires special attention as student nurses have different requirements and experiences than many other college students. For example, the nursing student must accommodate clinical experiences, performance examinations, exit examinations, and a national licensing exam (Billings & Halstead, 2016).
Additionally, according to the American Association of Colleges of Nursing (2018), nursing students comprise more than half of all health profession students. In 2014-2015, there were approximately 216,000 students enrolled in health professions and related programs (National Center for Education Statistics, 2018). Thus, at least 108,000 nursing students were enrolled in 2014-2015. Moreover, the Bureau of Labor Statistics (2018) anticipates a projected occupation growth of 15% from 2016 to 2026 for registered nurses. As the demand for nurses perpetuates, so does the need to support students in their academic endeavors. With such a large volume of students studying nursing in the United States accompanied by increased occupational demand, it is worth exploring the impact student employment has on this specific population. Additionally, working too much may negatively impact performance and learning. In turn, this could lead to fewer graduates or increased NCLEX failures, further reducing the number of working professionals. Thus, the purpose of this review of literature is to examine the issue of undergraduate pre-licensure baccalaureate student nurse employment during nursing school and its connection with nursing school success.
A literature review for nursing student employment while pursuing an undergraduate degree was conducted by searching through scholarly journals contained in multi-disciplinary online databases. These databases included Academic Search Complete, CINAHL Complete, ERIC, and Health Source: Nursing/Academic Edition. The key words of nursing, student, and employment were utilized to conduct this search. Results were limited to peer-reviewed journals in full-text. These search criteria yielded 75 articles which were further limited to publications dated beyond 2008 to improve relevancy of this review. An additional search to include dissertations on the topic of interest was conducted with the same previously mentioned criteria but in the ProQuest Dissertations & Theses Global database. Selection of articles and dissertations for review occurred by following the aforementioned criteria and through evaluating the relevancy and appropriateness to the topic of interest.
The aforementioned search criteria resulted in four articles and one dissertation that collectively provide a current state of nursing literature involving undergraduate student nurse employment. Critique and comparison of these studies allows for synthesis of information. Ultimately, the synthesis of this information provides input for best practice recommendations to facilitate nursing student success for undergraduate pre-licensure baccalaureate nursing students that are employed during nursing school.
In regard to student employment during baccalaureate nursing school and its connection to nursing school success, the current nursing literature explores two main areas. Primarily, studies focus on the number of hours worked and the connection to academic success. The majority of studies support the notion that a negative relationship exists for students working more than 16 to 20 hours per week as measured by GPA and exam scores (Reyes, Hartin, Loftin, Davenport, & Carter, 2012; Schoofs, Bosold, Slot, & Flentje, 2008). This coincides with the general education literature in which there are negative findings associated with college students working more than 20 hours per week (Bozick, 2007; Callender, 2008; Kulm & Cramer, 2006; Pike et al., 2008; Torres et al., 2010). Additionally, a reduction in hours worked per week in high-stakes courses or when credit loads increase as a student progresses through a program may assist with achieving academic success (Reyes et al., 2012; Schoofs et al., 2008).
The literature also explores specific employment in the healthcare setting for undergraduate baccalaureate nursing students. Although some negative aspects of working in healthcare as a student nurse were established, a negative correlation between hours worked and employment in healthcare as a student nurse was not found in the literature. Thus, with no significant findings to oppose working in healthcare a student nurse, it is likely beneficial to explore this option as there are positive aspects to functioning in the clinical setting before graduation (Hasson, McKenna, & Keeney, 2012; Rochford, Connolly, & Drennan, 2009; Warren, 2014).
Collectively, the nursing literature reviewed consistently utilized a convenience sample of students from singular schools of nursing. This limits the generalizability of findings as student demographics vary from region to region and institution to institution. Moreover, some of the studies were international which also limits generalizability. The reviewed studies also frequently relied on student input for number of hours worked and perception of impact from the hours worked. Student based input may have decreased the reliability of data, which could affect results. Capturing the failing or failed student was also lacking, as none of the reviewed articles implored a longitudinal approach and some only included students that had graduated in their sample. Although significant findings were distinguished in many of the articles, interpretations from the review of this literature should be utilized cautiously as methodology in many of the articles could have been more transparent and robust. Additionally, as previously mentioned, there are substantial concerns with generalizability as no multi-site studies were conducted and the studies that were conducted occurred throughout the world.
Based upon the aforementioned review of literature and accompanying synthesis of information, the following are best practice recommendations to promote academic success of undergraduate baccalaureate students who are employed while in nursing school:
- Aim to limit employment during nursing school to less than 20 hours per week.
- Consider planning to reduce hours worked during high stakes courses and/or when required credits per term increase.
- Contemplate employment in the healthcare setting when seeking out employment.
In addition to offering best practice recommendations, this review of literature identified many gaps in the literature and identified several indications for future research. Suggestions for future research include conducting multi-site studies, integrating randomization, increasing the volume of studies in the United States, implementing more longitudinal research, and continuously conducting research in this area to maintain relevancy.
Ultimately, considering recommendations from the education literature on the number of hours worked per week and student success, along with the nursing literature on undergraduate baccalaureate student nurse employment and academic success, best practice recommendations can be offered to support nursing student success. Although there are a limited number of studies that examine this topic, synthesis of relevant articles and a dissertation provide current evidence-based recommendations for students who are seeking employment while attending nursing school. Further research studies are needed to improve validity and generalizability of findings. Recurrent visitation of this topic is indicted to best match findings with the currently enrolled students in baccalaureate nursing school programs.
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