The relentless nursing shortage seems to resist every effort toward relief. The most recent information from the U. S. Bureau of Labor Statistics (2015) listed 2.8 million vacant nursing positions, with a 16% increase in that number expected by 2024, or 450,000 more vacancies. Twenty-one percent of U.S. hospitals have a nurse vacancy rate above 10% (ANA, 2017), with an estimated 550,000 nurses retiring by 2022.
Factors related to nursing workplaces; the physical and psychosocial stress of the work; and limited nursing school placements due to faculty shortages are placing increasing pressure on healthcare agencies and educators to manage more complex care with less experienced nurses than ever before.
Given the current vacancies and the impending retirement of a large percentage of the workforce, colleges and universities are examining nursing student retention more intensely. In the U.S., almost 50% of students do not progress in nursing programs (Mooring, 2016). Problems related to nursing student retention and the shortage of nurses are not limited to the U.S. In Canada, the percentage of students lost to nursing school progression is 25%; in Australia, 10-40%; in the U.K., 27-40% (Mooring, 2016).
Strategies to improve retention include identifying student-candidates capable of the rigorous work; identifying at-risk students who are already enrolled; establishment of mentoring/tutoring/coaching/advising relationships; standardized instruction and testing; and remediation efforts such as supplemental courses aimed at enhancing student critical thinking (Freeman & All, 2017; Hopkins, 2008)
The author describes one instructive experience faced by the leaders of one BSN program during a time of significant challenge and change. The perfect storm included (1) the introduction of both a revised traditional BSN curriculum and a new second-degree BSN curriculum; (2) a decreasing NCLEX-RN pass rate; and (3) increasingly tense student-faculty relationships. Administrators, faculty, and a few influential students rallied to respond to these nursing academic challenges. Scientific theory holds that knowledge is achieved by altering one element at a time, so that results can be measured and assessed. In the case presented, urgency for improvement did not allow for individual changes. What is postulated here, interestingly, is that it was the layering of strategies that had the intended effect. The program was layered with remediation plans (Keller, 1968); with academic coaching (Brown-O’Hara, 2013); with standardized instruction and testing; and with faculty development.
After the first year of the improvement plan, the greatest changes were in faculty-student relationships. From the outset, administrators were transparent about the seriousness of the issues, and solicited student feedback and cooperation. As faculty members and students engaged in improvement activities, trust between faculty and students improved. By the second year, results of the interventions continued as NCLEX-RN scores improved and curricular adjustments began to show steady improvement in satisfaction.
Attendees will leave the session with ideas, tools, and motivation that can be applied in programs of all sizes to improve nursing student retention.