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ASSOCIATE DEGREE NURSING STUDENTS:A STUDY OF RETENTION IN NURSING EDUCATION PROGRAMS

A Dissertation

by

WANDA TAYLOR DOUGLAS

Submitted to the Graduate School

Appalachian State University

In partial fulfillment of the requirements for the degree of

DOCTOR OF EDUCATION

May 2009Doctoral Program in Educational Leadership

Reich College of Education

ASSOCIATE DEGREE NURSING STUDENTS:A STUDY OF RETENTION IN NURSING EDUCATION PROGRAMS

WANDA TAYLOR DOUGLAS

May 2009

Approved by:

______________________________________George Olson, Ph.D.Chairperson, Dissertation Committee

______________________________________Jim Killacky, Ed.D.Member, Dissertation Committee

______________________________________John Janowiak, Ph. D.Member, Dissertation Committee

______________________________________Jim Killacky, Ed.D.Director of Doctoral Program

______________________________________Edelma D. Huntley, Ph.D.Dean, Graduate Studies and Research

ABSTRACT

ASSOCIATE DEGREE NURSING STUDENTS:A STUDY OF RETENTION IN NURSING EDUCATION PROGRAMS (May, 2009)

Wanda Taylor Douglas, B.S.N. University of North Carolina Greensboro

M.S.N. University of North Carolina Greensboro

Dissertation Chairperson: George Olson, Ph.D.

Student retention has been a concern since the development of institutions of

higher education. Research that addresses this problem can be found as far back as the

early 1900s. A review of the literature reveals that this topic became more prominent in

literature in the late 1960s, most likely fueled by the Higher Education Act (1965) which

helped finance first-generation college students and students from low socioeconomic

groups to attend universities. Many such students have entered institutions of higher

education academically underprepared for this challenge, thus becoming “low achievers”

with reduced retention rates (Morning, 1991).

Due to the current nursing shortage in the United States, nursing programs are

particularly concerned with the issue of retention; programs are being pressured by the

education as well as the health care systems to produce more graduates to alleviate the

shortage. The American Association of Colleges of Nursing predicts that by 2015 there

will be 114,000 unfilled nursing positions in the U.S. (Wittman-Price & Kuplun, 2003).

The North Carolina Institute of Medicine has predicted a statewide shortage of

iv

9,000 nurses by 2015 and 18,000 by 2020; therefore, they developed a task force in 2004

to study how to ease this issue (North Carolina Institute of Medicine, 2004).

Concerns from the education community and society at large regarding retention

in higher education have prompted extensive research and development of theories to

explain early departure. Unfortunately, very little of this research has focused on nursing

program retention/attrition or even on components that would result in successful

retention of nursing students (Seago & Spetz, 2003).

The current and predicted shortage of licensed nurses, together with the lack of

research regarding the retention of nursing students in higher education reveal the need

for further study of the topic. After reviewing many theories of student retention, I chose

Bean and Metzner’s (1985) Theory of Nontraditional Student Attrition to use as a guide

for my study of student retention in associate degree nursing programs in North Carolina

Community Colleges. I used a mixed methods research design approach to study a small

sample of students who had exited from associate degree programs prior to graduation, a

larger sample of current second-year associate degree nursing students, and a sample of

directors of nursing programs from associate degree nursing (ADN) programs.

The interview guide and the surveys used in this study were constructed to

address the four sets of variables used in Bean and Metzner’s (1985) theory. These sets

include: (a) environmental variables, which Bean and Metzner assert are the most

important in attrition/retention; (b) background and defining variables; (c) academic

variables; and (d) social variables. The challenge was to use these variables to identify

what factors increase nursing student retention. Personal interviews were conducted with

volunteer students who had exited nursing programs prior to graduation. The interview

was designed to provide insight on issues that may have attributed to these students’ lack

of success. In addition to the interviews, surveys were distributed to 362 students

currently enrolled in a nursing program and 37 directors of nursing programs.

The analysis of the data collected for this study provided an understanding of

what students view as the important factors that contributed to their retention and what

selection criteria for entrance into associate degree nursing programs in North Carolina

are associated with higher retention rates. The results of this study may be used to assist

associate degree nursing programs in forming plans and implementing actions that assist

students to better manage the factors which affect their retention. In addition, the results

of the director survey point out the need for nursing programs to reevaluate their

admission criteria and its relationship with student persistence.

ACKNOWLEDGEMENTS

I would like to thank the members of my doctoral committee, my friends, my coworkers, and my family for the patience and support they have provided me during my educational journey. I owe an exceptional thanks to:

Dr. Olson, the chair of my committee, for providing optimal and timely feedback, insisting on the highest standards of research while encouraging diligence in completion. Without Dr. Olson’s expert assistance this dissertation would not have been possible.

Dr. Killacky, a member of my committee, for stepping in at the last “moment,” when one of my committee members unexpectedly left my team, and agreeing to generously provide insights for my work based on his vast experience and knowledge gained from writing books and articles on community colleges, and leadership.

Dr. Janowiak, another member of my committee, for encouraging me to think about and pursue other perspectives that proved to be most helpful in completing my work and making it applicable.

Sandra Bryant, my friend and colleague, for providing me encouragement and support during my studies.

Angela Bond and Larry Taylor, at Wilkes Community College, for providing much encouragement, support, and resources when needed.

My professional colleagues in the community colleges who generously provided access to their associate degree nursing students for this study and completed surveys with accuracy.

Beulah Taylor, my mother, who has always supported and loved me and believed that I could accomplish what I set out to do.

My husband Phillip and my daughter Ashleigh, who have always been supportive, understanding, and patient during my educational endeavors. Thank you for helping me to grow and accomplish my goals. Without you I could not have accomplished this dream. You are truly the “wind beneath my wings.”

TABLE OF CONTENTS

Abstract...............................................................................................................................iv

Acknowledgements...........................................................................................................vii

Table of Contents.............................................................................................................viii

List of Tables.......................................................................................................................x

Chapter One: Statement and Context of the Problem..........................................................1

Statement of the Problem 2

Significance of the Study 2

Organization of Study……………………………………………………………..5

Definitions of Key Terms 6

Chapter Two: Review of the Literature...............................................................................8

Student Retention Models 10

Spady’s Explanatory Sociological Model 10

Tinto’s Student Integration Model 10

Bean and Metzner’s Nontraditional Student Attrition Model13

Astin’s Student Involvement Model 15

Cabrera, Castanedo, and Nora's Integrated Retention Model15

Benjamin’s Quality of Student Life Model 16

Other Relevant Research 16

Student Retention in Undergraduate Programs 19

Retention Four-Year Colleges 19

Retention in Community Colleges and Technical Institutions 21

Retention in Allied Health Programs 23

Student Retention in Nursing Programs 25

Recruitment 25

Retention 26

Retention in North Carolina Associate Degree Programs 28

Research Methods in Literature 29

Qualitative Method 30

Quantitative Method 30

Mixed Method31

Summary of Literature Review 32

Chapter Three: Method for Current Research...................................................................34

The Research Questions 34

Participants………………………………………………………………………36

Mixed Method Design 36

Data Collection Procedures 37

Director Survey Construction and Data Collection 37

Student Survey Construction and Data Collection 39

Student Interview Construction and Data Collection............................................43

Summary 46

Chapter Four: Survey Results and Analyses.....................................................................48

Director Results and Analyses 48

Student Results and Analysis 50

Analysis Using Bean and Metzner’s Construct 52

Academic, Environmental and Social factors That Influence ADN Student

Nurse Retention…….. ..52

Background and Defining Variables That Influence ADN Student Nurse Retention……. 54

High School Academic Preparation 55

Hours Students Spend Studying 56

Number of Credentials Held 57

Factors Influencing Students to Become Nurses 58

Reasons for Having Previously Dropped Out of an ADN Program 60

Conclusions of Student Results 61

Interview Results 61

Chapter Five: Summary, Conclusions, and Recommendations.........................................65

Summary 65

Overview of Findings……………………………………………………………66

Research Questions67

Revised Conceptual Framework…………………………………………………69

Limitations……………………………………………………………………….69

Implications for Policy and Practice……………………………………………..70

Policy Implications………………………………………………………70

Implications for Nursing Faculty………………………………………...71

Implications for Practice in Education…………………………………...72

Implications for Students………………………………………………...72

Recommendations for Future Research…………………………………………73

Conclusions75

References..........................................................................................................................78

Appendix A Director Survey.............................................................................................86

Appendix B Student Survey..............................................................................................90

Appendix C Interview Guide.............................................................................................97

Author Resume..................................................................................................................99

LIST OF TABLES

Table 2.1 Student Retention Models.................................................................................10

Table 3.1 Variables Related to Nursing Director Research Questions and

Survey Items..........................................................................................................38

Table 3.2 Director Responses............................................................................................39

Table 3.3 Variables Related to Student Research Questions and Survey Items................41

Table 3.4 Variables Related to Student Interviews...........................................................42

Table 4.1 Survey Items Yielding an Invariant Response..................................................49

Table 4.2 Survey Questions Supportive of Variable Groups............................................50

Table 4.3 Frequency Analysis of Factors..........................................................................54

Table 4.4 Frequency Analysis of Student Ratings of Their High School Academic

Preparation Skills...................................................................................................56

Table 4.5 Importance of High School Academic Skills....................................................57

Table 4.6 Number of Prior Credentials Held Identified by Students................................58

Table 4.7 Percentages of Type of Credentials Held..........................................................58

Table 4.8 Student Identified Influences to Become a Nurse.............................................59

Table 4.9 Number of Items Selected by Students as Important Influences

to Become a Nurse.................................................................................................60

Table 4.10 Student Identified Reasons for Dropping Out.................................................61

Table 4.11 Interview Results Survey: Variables Students Identified as

Influencing Their Attrition....................................................................................63

CHAPTER 1: Statement and Context of the Problem

This study has been focused on issues related to retention of students in associate

degree nursing programs in North Carolina. With nursing student retention averaging

around 37% in the United States (Petty & Todd, 1985), and reports of increasing nursing

shortages from the North Carolina Institute of Medicine (NCIOM; 2004), the importance

of learning about factors and strategies promoting program retention to increase the

number of graduating students interested in nursing is clear. These are essential

ingredients in the effort to fight attrition and thus ease the nursing shortage, which will

lead to better health care in the United States.

This study examined the relationship between nursing program admission criteria

and student retention, as well as factors that influenced students remaining in nursing

programs until graduation from the students’ perspectives. The goal was (a) to identify

what admission requirements are used by nursing schools and the relationship of these

criteria to retention rates and (b) to determine what factors students themselves identify

as influential to their retention. A sample of 362, 5th semester, 2nd year associate degree

nursing students from six programs was asked to participate in the study. The goals were,

first, to study a group of students considered “successful” (defined as completion of a

major portion of their studies), and second to examine what this group of students

identified as factors for success. The results from this study can be used to develop

guidelines to enhance the success of future nursing students. Currently North Carolina

has 47 associate degree nursing programs in community colleges; all were given the

opportunity and encouraged to participate in this study.

Statement of the Problem

The purpose of this study was to examine factors that contribute to retention of

associate degree nursing students in community colleges in North Carolina in order to

gain insight regarding how to increase the number of student- nurse graduates. The

United States is currently experiencing a nursing shortage that is expected to increase

over the next 2 decades. With the recent declines in enrollment in nursing schools and

predictions of a decline in the current nurse work force of approximately 50% due to

nurses retiring in the next decade, it is essential that the health care system take action to

lessen the shortage and prevent negative effects on patient care (Mikuski, 2001; Wittman-

Price & Kuplun, 2003). The American Association of Colleges of Nursing has predicted

that by 2015 there will be approximately 114,000 unfilled nursing positions in the United

States (Wittman-Price & Kuplun). Associate degree nursing (ADN) programs will play a

major role in the future healthcare system by supplying nurses to fill these positions.

Currently in North Carolina, 60% of all new nurse graduates are from ADN programs

(North Carolina Institute of Medicine, 2004). This creates a challenge for ADN programs

to study the causes of attrition/retention and identify factors that facilitate student

retention. Retaining more students will increase the number of graduates entering the

workforce, thus decreasing the current and future nurse shortage.

Significance of the Study

Institutions of higher education have focused on student retention since their

founding. Research can be found concerning this problem as far back as the early 1900s.

The issue of retention became even more prominent in the literature in the late 1960s

after the Higher Education Act (1965) helped finance first- generation college students

and students from low socioeconomic backgrounds attend universities. Since many of

these students were underprepared academically for study in the higher education system,

some became “low achievers.” Nearly 50% of college freshmen enrolled during the late

1960’s failed to succeed in their first degree. In the past 50 years, retention rates have not

changed significantly; approximately 60% of today’s college students graduate from the

institution they enter as freshmen (Morning, 1991).

Students entering nursing programs in the United States are able to choose from a

variety of programs. Almost every state has programs in which students may enter on

various levels to earn a bachelor, diploma, associate, or practical nursing degree. North

Carolina has more programs than any other Southern Regional Education Board state,

with the exception of Texas, and supports three types of programs providing nursing

degrees. Seventy five percent of these programs are associate degree, twenty percent are

bachelor degrees, and five percent are diploma degree programs. Generally, differences

in a Bachelor of Science in Nursing and an Associate Degree in Nursing programs

include:

BSN

a. 4 years to complete

b. mainly traditional students

c. more liberal art, math, science classes

d. usually taught in universities

ADN

a. 2 years to complete

b. mainly nontraditional students

c. fewer liberal art, math, science classes

d. mainly taught in community colleges

Similarities of BSN and ADN programs include students being taught basic nursing

skills, the same examination for licensure requirement, opportunities for employment as

staff nurses, and program attrition rate of around 50% in both degree programs (North

Carolina Institute of Medicine, 2004).

My decision to conduct this study stems from the fact that North Carolina has the

highest percentage of ADN programs of any state in the Southern Regional Education

Board; therefore the state should provide leadership to improve nursing program

graduation rates. The lack of research in student nurse retention supports my interest in

this area. Research regarding nursing student attrition in the community college system

will hopefully lead to a better understanding of conditions that impact graduation rates in

this population, eventually increasing the number of graduates.

Because of the increasing need for skilled workers in the United States, nursing

programs and the medical profession in particular, the issue of student retention has come

into focus. Concern regarding retention in higher education has prompted extensive

research and development of theories to explain early student departure. However, a

paucity of research has focused on nursing program attrition/retention or even on

components of successful nursing programs (Seago & Spetz, 2003). Due to the current

nursing shortage in North Carolina, the NC Nurses Association, the NC Center for

Nursing, the NC Area Health Education Centers Program, the NC Board of Nursing, and

the NC Hospital Association decided to be proactive in preventing, or at the least in

decreasing, the predicted shortfall of qualified professionals. At the request of these

agencies, the NCIOM partnered with them to develop a task force in 2004 to study the

issues surrounding the present and future supply of nurses and the ways in which nursing

education affects this supply. The NCIOM published a report in May 2004 containing

several recommendations to help offset a severe nursing shortage in North Carolina. One

of the recommendations was for the educational system to lower attrition rates in schools

of nursing in order to supply more graduates (North Carolina Institute of Medicine,

2004). Other outcomes of their study were (a) a prediction of a shortage of nurses in

North Carolina of 9,000 by 2015 and 18,000 by 2020, (b) published guidelines addressing

the quality of nursing education being taught, and (c) the establishment of the educational

degree that would be required for all nurse educators.

Given the shortage of nurses and the expense of operating nursing programs, it is

important that nurse educators identify admission criteria that predict retention so that

schools can implement improved processes using quality criteria for admissions into

ADN programs in order to assure high retention rates. Also, identifying external factors

that help students achieve success would allow colleges to provide more support for

students during their enrollment. Implementing these steps could lead to increased

numbers of graduating students, thus easing the shortage.

Organization of Study

Chapter one provides an introduction to the study; identifying the problem,

purpose, and significance. It also defines terms and provides an overview of the study

organization. Chapter two reviews the literature on major theories that explain

attrition/retention rates in higher education and actions that increase retention. It

addresses theories that explain attrition/retention rates in the educational field in

undergraduate education and in nursing education. Methods that are used in previous

studies on retention in higher education are discussed. Chapter three provides detailed

information on the method for this research including the research questions, mixed

method design, data collection, and survey and interview construction. Chapter four

describes survey results and analyses. Chapter five discusses conclusions and

recommendations and identifies implications for practice and future research.

Definition of Key Terms

To facilitate understanding, the following terms have been defined:

Admission criteria. Admission criteria are the required standards or tests used by

colleges to make the decision of which students to accept into a nursing program.

Associate Degree Nursing Program (ADN). An associate degree nursing program

is a curricular program in a community college that is accredited by the state board of

nursing. The program requires 5 semesters of study and awards the Associate in Applied

Science degree upon completion. Graduates are eligible to take the National Council

Licensure Examination to become registered nurses.

Bachelor of Science in Nursing Program (BSN). A Bachelor of Science degree

nursing program is a curricular program in a university that is accredited by the state

board of nursing. The program requires 2 years of liberal arts and science study, 2 years

of nursing study, and awards the Bachelor of Science in Nursing degree upon completion.

Graduates are eligible to take the National Council Licensure Examination to become

registered nurses.

Low Achievers. In this paper students who make minimum academic grades

and /or who are unsuccessful in their studies are referred to as low achievers.

National Council Licensure Examination (NCLEX). The National Council

Licensure Examination is a standardized exam that each state board of nursing uses to

determine whether a candidate is prepared for entry-level nursing practice. Upon passing

the NCLEX a graduate becomes a registered nurse.

Student attrition. This term, better known as “dropping out,” refers to students

leaving their program of study anytime prior to graduation.

Student retention. This term describes students who persist in and graduate from

their initial program of study.

Student persistence. This term refers to students who continue their existence in

their programs of study.

CHAPTER 2: Review of the Literature

Since its introduction 50 years ago, associate degree nursing education has

had a significant impact on the registered nursing population in the United States.

The need for a new type of degree nurse, the associate degree nurse, was mainly a

response to the nursing shortage experienced during World War II and the need to

train nurses in a short period of time to increase care for wounded soldiers.

Associate degree nursing education remains an attractive choice for students

entering the nursing profession due to its broad access, economical financing, and

reduced time to degree. Today in the United States, we are again facing a nursing

shortage. This shortage can be addressed by recruiting, admitting, retaining, and

graduating qualified students into nursing programs. These actions are crucial to

Associate Degree Nursing programs because the programs are responsible for

supplying the United States with approximately 60% of the Registered Nurse pool

(Mahaffey, 2002).

Review of research in student retention in institutions of higher education

revealed a large corpus of studies conducted since the 1900s. Such studies became even

more plentiful after the late 1960s, and many similar studies are still being published

today. The concern regarding retention in higher education has not only prompted

extensive research but has lead to the development of several theories that attempt to

explain the causes of early departure. Seago and Spetz (2003) report that very little

9

student retention/attrition research has focused on nursing programs, or even on

components of these programs. This chapter focuses on student retention/attrition models

(Table 2.1) and discusses relevant research which addresses student retention and

compares retention in 4-year colleges, community colleges and technical institutions,

allied health programs, and nursing programs.

Table 2.1

Student Retention ModelsAuthor Model Title Dropout Decisions

Spady(1970)

Explanatory Sociological Model

Dropout decision is based on: family background, academic potential, normative congruence, and the institution’s commitment.

Tinto(1987)

Student Integration Model Dropout decision is based on: family background, individual attributes, pre-college schooling, goal commitment, the institution’s commitment, and student integration.

Bean and Metzner(1985)

Nontraditional Student AttritionModel

Dropout decision is based on: background, defining, academic and environmental variables.

Astin(1975)

Student Involvement Model Dropout decision influenced by: student involvement, institutional advising and counseling, independent study, and self-paced instruction.

Cabrera, Castanedo, and Nora(1993)

Integrated Retention Model Dropout decision influenced by: social integration, family support, academic performance, and commitment to institution.

Benjamin(1990)

Quality of Student Life Model Dropout decision based on: student satisfaction with their life experiences during their educational endeavors.

9

Student Retention Models

Spady’s Explanatory Sociological Model

The earliest student retention model I found in the literature was developed by

William Spady (1970) using Durkheim’s (1952) suicide theory as a framework.

Durkheim’s theory discussed “normlessness” as a factor in higher suicide rates. Spady

concluded that students who had a positive interaction between their backgrounds and the

university environment (e.g., parents who were college educated and expected their

children to be also) were more likely to become integrated into the system and more

likely to persist. He also concluded that a negative interaction (such as parents not having

a college education and/or devaluing those who do) would impede the student’s

educational social interaction and put the student in a “normlessness” state which could

possibly lead to the student’s early departure from the higher education system. Spady

conducted studies, supportive of his theory, using young, full-time, residential students.

Tinto’s Student Integration Model

Building upon Spady’s model, Vincent Tinto (1975, 1987, 1993) developed a new

theory, which he called the Student Integration Model. Tinto (1975) asserted that students

enter college with various characteristics and background experiences and with different

educational goals and levels of attachment for the college. According to Tinto (1975,

1993) the interplay of the student’s interaction with the primary college system, both

academic and social, greatly influences the student’s decision to depart or persist. He

noted that the secret to a successful retention program in a higher education system lies in

the foundation of the institution’s strategies to integrate the student both socially and

academically. His theory supports the idea that social interaction with the institution is

10

the most important factor in improving student persistence. Social integration can occur

within smaller subunits such as fraternities, sororities, student government, athletic clubs,

or other groups. Tinto’s work is often cited in the literature and has become the

predominant model of premature departure from college used in research today.

Tintos' (1975) model has been used most often for studying the traditional

student, which he defined as a student who is a recent high school graduate and full-time

resident of a college. Along with using the traditional student status, he identified student

pre-entry attributes which influence student persistence. These attributes are sex, race,

physical abilities or disabilities, family background, social status, value orientation,

various pre-college achievements, and intellectual and social skills. He identified these

attributes as having a bearing on the individual’s level and type of education, as well as

their occupational intentions; such attributes give the student a degree of commitment to

his or her educational career goal and to the institution that he or she has chosen to attend.

He placed particular emphasis on the value of orientation to the college environment to

help retain students as well as their various precollege achievements and experiences.

Tinto (1987) identified three stages in a student’s “rite of passage” into college

that cause varying degrees of stress which may be significant enough to elicit early

departure from college. These stages include the separation phase, the transition phase,

and the incorporation phase; they may overlap each other or occur out of sequence. He

described the separation phase as a breaking away or dissociation from past communities

and interpersonal relationships, as an attempt to adopt the behaviors and norms that are

appropriate for college life. The transition phase typically occurs during and after the

separation phase. During this phase, the student has not totally separated from the norms

11

and values of the old community yet has adopted some of the values and behaviors of the

college community. During this phase, the student may enter the state of “normlessness”

which may result in early departure. The final stage is incorporation into the society of

the college or integration into the college community. The student’s formal or informal

interaction with faculty, staff, and other students is very important in negotiating the final

phase. The student who fails to integrate into the college community is at great risk for

early departure. Tinto asserts that how a student passes through these phases affects

persistence either positively or negatively.

Difficulties in academic course work are identified by Tinto (1987) as the reason

given for only 20% of all dropouts nationally. He identified six other factors that account

for the remainder of higher education dropouts including adjustment, goals, commitment,

uncertainty, congruence, and isolation.

1. Adjustment – inability to adjust to academic and social life of college.

2. Goals – ability to change in individual goals even when the character of prior

experiences have been satisfactory.

3. Uncertainty – having only the vaguest notions of why one entered college…

when stressed are more likely to leave.

4. Commitment – exhibiting commitment to goals, personality attributes, and

prior experience matter but not as much as the quality of individual academic

performance and social experiences within the college with other members of

the institution’s faculty, staff, and students.

5. Integration and Community Membership – having experiences, academic and

social, which serve to integrate the individual to the life of the college (also

12

serves to heighten attachments and therefore strengthens individual

commitment both to the goal of education and to the institution).

6. Incongruence –finding the intellectual demands sufficiently stimulating.

7. Isolation – failing to integrate into the college culture, students in isolation

express a sense of separation from the institution. (pp. 6-7)

Tinto (1975) also stressed the importance of the institution’s commitment to

students and identified this as the second most common feature affecting retention rates.

Commitment to the student by the institution generates a commitment on the part of the

student to the college. Institutions must be clear and straightforward in their missions,

give attention to their admission efforts, make early educational assessments, mandate

academic assistance, conduct orientations, and focus on programs which address

academic and social pressures during the first year of student life. They must be

committed to counseling, advising, and community building.

Tinto’s (1975) theory can be applied across a wide variety of college programs. If

faculty members are aware of the stages of adaptation that students pass through in order

to adjust to college life, they can implement interventions that will aid in this transition,

thus lowering attrition rates. Research generally supports the premise that the easier the

transition to college life, the more likely the student is to persist.

Bean and Metzner’s Nontraditional Student Attrition Model

Another significant model of student attrition is John Bean and Barbara

Metzner’s Model of Nontraditional Student Attrition (1985). In their model, Bean and

Metzner address variables that affect the dropout rate of the nontraditional student. They

define the nontraditional student as:

13

A nontraditional student is older than 24, or does not live in a campus residence

(e.g., is a commuter) or is a part-time student, or some combination of these three

factors; is not greatly influenced by the social environment of the institution; and

is chiefly concerned with the institution’s academic offerings (especially courses,

certification, and degrees). (p. 489)

Bean and Metzner’s (1985) Nontraditional Student Attrition model suggests that

attrition decisions are based on four sets of variables: environmental, background,

academic, and social integration. These variables are similar to variables in other models

that address traditional student attrition, but they are more thoroughly addressed in this

model. The authors concluded that these variables are critical to the nontraditional

student and can predict future student behaviors regarding attrition. Environmental

factors are particularly important and, according to Bean and Metzner (1985), are the

most influential factors for nontraditional student retention. These factors include

finances, hours of employment, outside encouragement, family responsibilities, and

opportunity to transfer to other institutions for degree advancement. Background

variables include age, number of hours enrolled, educational goals, high school

performance, ethnicity, and gender. Academic variables include past and present GPA,

number of hours spent in study, study skills, academic advising, class attendance, degree

major, job certainty, and course availability. Social integration variables refer to campus

club memberships, faculty contact, and friends on campus. Other researchers (e.g.,

Grosset, 1991; Nora, 1987; Nora & Rendon, 1990; Pascarella & Terenzini, 1980) have

used this model, including the four categories of variables, and have arrived at results that

support Bean and Metzner’s findings. Additional research supports the conclusion that

14

student satisfaction, peer relationships, and interfering problems greatly influence

retention (Bean, 1985; Katz & Kahn, 1978; Nettles, Theony, & Gesman, 1986; Pascarella

& Terenzini, 1980).

Astin’s Student Involvement Model

Alexander Astin’s (1975) Student Involvement Model is somewhat related to

Tinto’s model. Astin does not stress the need for full integration into the college

environment but does encourage involvement. He suggests that students may be alienated

in some areas at the college, but persist if they have ties with other factors that are

significant to them: peer interaction, low faculty-student ratio, appropriate advising and

counseling, self–paced study, and interaction sufficient to maintain a connection with the

college. His theory suggests that student success can be attributed to the amount of

physical or psychological energy that the student devotes to his or her academic

experience. In his 1984 work, Astin stressed that requiring class attendance enhances

student involvement and positively affects student commitment. He also noted the

importance of advising, counseling, independent study, and self-paced instruction to

greater factors in retention, concluding that a teaching style focused less on content and

more on student behaviors lead to higher retention rates.

Cabrera, Castaneda, and Nora’s Integrated Retention Model

Alberto Cabrera, Mafia Castaneda, and Amaury Nora (1993) developed the

Integrated Retention Model by combining Tinto’s (1975) model with Bean and Metzner’s

(1985) model. By combining these two theories, they created a more comprehensive

approach to understanding student retention. They identified four important differences

between persisters and dropouts. Persisters demonstrated greater

15

(a) social integration as measured by peer group relations,

(b) encouragement from family to continue,

(c) academic performance (i.e., GPA), and

(d) commitment to institution. (p. 7)

Benjamin’s Quality of Student Life Model

Michael Benjamin (1990) devised a Quality of Student Life Model which

concluded that student satisfaction is related to personal, interpersonal, social, and

contextual factors, all of which affect the student’s academic performance. Competing

demands of parents, friends, romantic partners, employers, and others together with

problems with health, finances, and/or life events that interfere with the student’s coping,

were all noted as influential factors in the student’s decision to persist or to drop out.

Student satisfaction with life experiences during their educational endeavors greatly

influenced their decision to persist in their educational programs.

Other Relevant Research

My review of the literature revealed that most institutional retention research

deals with characteristics of students as persisters and nonpersisters. Amaury Nora (1993)

found that the two variables with the most consistent pattern of significant positive effect

on persistence were academic and social integration. In his study, he found that SAT

scores, student satisfaction, peer relationships, and interfering problems also lend

predictability in relation to persistence.

Ernie Pascarella and Patrick Terenzini (1983) conducted studies based on Tinto’s

(1975) model and found that, in general, students do better when they have an

opportunity to interact positively with faculty in and outside of the classroom. More

16

importantly, they supported Tinto’s (1975) thesis that academic and social integration are

directly related to persistence. They also concluded that a significant portion of student

attrition may be prevented by institutions positively intervening early with the student to

assist with integration, since the largest portions of dropouts occur during the 1st year.

Ernie Pascarella and David Chapman (1983) studied student withdrawal

behaviors using Tinto’s (1975) model at three different types of higher education

institutions. They compared student behavior at 2-year commuter, 4-year commuter, and

4-year residential institutions and concluded that social integration factors have a stronger

positive effect on dropout rates at residential institutions than academic factors. Students

who reside at the institutions that they attend have a stronger tie to social integration than

do those who commute. Academic factors were more strongly identified as having more

influence on persistence at commuter colleges.

Bagayoka and Kelly’s (1992) research focused on variables that appeared to be

neglected in most current retention models: time on task and academic preparedness.

Time on task was defined as the amount of time the student spends in study. According to

the researchers, a 12-contact-hour-course load includes 36 hours of outside study per

week. Students studying less than the recommended time were at risk for dropping out. In

their research, academic preparedness was related to the scaled average of high school

GPA and ACT or SAT score. The higher the student’s score, the more prepared the

student should be. Results of Bagayoka and Kelly’s research showed that academically

prepared students were much more likely to be successful in college.

Educator Amaury Nora was involved in studying student retention. In 1993 he

researched students to determine the most significant positive effects on degree students

17

in two-year colleges and on minority students. His research found that academic and

social integration were the two most important variables influencing student retention and

degree completion. A later study conducted by Nora (2001) supported Tinto’s (1975)

Student Integration Model; it found a positive impact on retention from the three stages

of student integration into college (these stages included significant support from family,

community, faculty, teaching assistants, and academic staff). Nora asserted this positive

effect could cancel out the negative impact on nontraditional students of having to leave

campus immediately after class for responsibilities outside of their studies.

Kenneth Coll and D. J. VonSeggern (1991) claimed that the empirical studies they

conducted at Bronx Community College, Phillips Community College, and Miami-Dade

Community College provided evidence that freshman success courses positively

influenced retention. They concluded that an effective freshman success course should

include topics that are highly correlated with academic persistence such as managing

time, strengthening memory, writing test answers and course papers, as well as coping

with overload anxiety. Their study supported the idea that six informational elements are

necessary for freshman year courses to be successful in retaining students:

1. descriptions of college program offerings

2. college expectations for students

3. information about assistance and services for examining student interests,

values, and abilities

4. encouragement to establish working relationships with faculty

5. information about services that help their students with adjustment to

college

18

6. and financial aid information.

They also believed effective precollege orientation programs that provide students with

elements for success included the above elements. Other research studies support Coll

and VonSeggern’s (1991) findings that an increase in counseling, self-concept

development, career development, problem solving abilities, and coping skills enhance

retention of undergraduate students (Baron, 1997; Crawford, 1999).

Student retention models address general student departure and retention theories.

They provide an overview of the reasons students depart college prior to graduation.

These theories have been applied to a range of students across the university setting and

have shown to be helpful in predicting student attrition. Allen (1994) conducted an

extensive study of attrition models. After reviewing many different attrition/retention

models and their applications in educational institutions, he concluded that Tinto’s (1974)

and Bean and Metzner’s (1985) models were the two most influential containing

elements that accurately addressed student attrition/retention behaviors.

Student Retention in Undergraduate Programs

Retention in 4-Year Colleges

The majority of studies published, including Tinto (1975, 1987, 1993), Bean and

Metzner (1985), and Astin (1975) have investigated undergraduate student

retention/attrition in 4-year institutions. Programs throughout these institutions have

identified certain critical factors influencing retention rates and have identified that these

factors may differ from program to program. Jennings (2002) reports that attrition rates in

4-year colleges can be as high as 40%, which supports the need for continued research to

study this important phenomenon.

19

Pamela Willeford (2003) chaired the Texas Higher Education Coordinating Board

(THECB) which conducted a study of law students at the University of Texas at El Paso

and the University of Texas Pan America. The board found that an attrition rate of 29%

in law school could be attenuated with the intervention of summer programs that provide

skills to assist students in being successful. These programs offered a 6-week orientation

agenda that provided students with an orientation to law, information on financial issues,

training in legal writing and exam taking techniques, and stipends for attendance. In their

research, the THECB noted that a high percentage of persisters had attended the Law

School Preparation Institute for high school juniors and seniors helped them develop

skills in analytical and critical reading, writing, academic preparation, and application

completion. Students who participated in these programs were found to be better

prepared for their study of law and were more successful.

Baille and Fitzgerald (2000) and Seymour and Hewitt (1994) found that

engineering students had a low attrition rate (27%), a finding that was not unexpected due

to the rigorous entry-level requirements of engineering programs. Students in the study

stated that lack of completion in engineering programs is largely due to a discrepancy in

student expectations and reality. Students entering engineering programs have

preconceived ideas about what they are going to learn. When the theoretical course

content does not match their preconceived ideas they are dissatisfied with their program

and drop out, often choosing a different program of study. Other reasons identified by

students for noncompletion were difficult work, excessive math requirements, and

uninteresting content.

20

Nancy Walters (1997) found that in science and mathematical programs

Caucasian students had a 27% attrition rate and African-American, Latino, and Native

American students had a 50% attrition rate. Isolation, a factor affecting high attrition

rates, was seen as the contributing factor in the differences. Isolation leads to depletion of

self-confidence, psychological support, and social integration as well as exclusion from

access to informal sources of professional information (Tinto, 1987; Walters, 1997).

Retention in Community Colleges and Technical Institutions

The applicant pool for community colleges is becoming more and more diverse

as the traditional community college and technical institution student is changing.

Nationally, around 40% of all higher education students attend community colleges

(Crawford, 1999). According to Nora (1993), nearly half of the African-American higher

education students and over half of Hispanic higher education students are enrolled in 2-

year institutions. Attrition rates are expected to rise with these new changing

demographics of the student population.

With the majority of research on student retention/attrition being conducted at 4-

year institutions, little is known about 2-year higher education institutions’ efforts to limit

attrition. According to Mohammadi (1994), the most significant community college

predictors of student success are student goals, hours enrolled per semester, number of

credit hours completed, and grade point average. There is a need to focus on admission

criteria and student perceptions of retention in 2-year institutions in order to determine

and validate factors that predict student success. Validation becomes even more essential

when one considers the general public’s demands for a better return for higher education

dollars spent and the limited amount of financial support that 2-year institutions receive.

21

The issue of retention is also a key concern for nursing programs in community

colleges. The demand by the medical field for an increase in nurses, limited enrollment in

current nursing programs, and the expense of operating a nursing program each

contribute to the necessity of maintaining a high retention of accepted students.

According to the literature I reviewed, a large number of criteria are being used for

admissions; yet few studies have tried to validate the significance of these criteria in

relation to student retention. Investigating the variables that predict student success would

identify the most significant criteria, thus allowing for more accurate student admissions

into the nursing programs. Admitting students who “fit” their programs allows for higher

retention rates.

Boher and Lucas (1981) studied admission requirements of 18 community

colleges and found that they had widely differing requirements. Of the colleges they

studied, 100% admitted nonhigh school graduates, with one third requiring either a GED

or some alternate credential. He found that most health programs required additional

credentials for admission beyond general college requirements. In his studies he reported

that nursing was one of the programs that always had additional requirements for

admission.

A basic difference in the 2-year institution versus the 4-year institution is the

interaction associated with an academic community. It is important to assess and identify

what 2-year students believe to be the most influential factors contributing to their

persistence. For the student whose experience is based on a college campus commons,

dormitory, and daily collegiate environment, being on campus several hours a day is

much different than for the community college student who typically has limited

22

interaction with the academic community outside the classroom. The majority of students

who attend community colleges differ from traditional students in 4-year colleges in that

they tend to be employed outside the institution and come to campus only at class time or

for limited student services (Crawford, 1999).

A significant portion of student attrition might be prevented through timely and

carefully planned institutional interventions designed to meet the profile of a community

college student. Today’s traditional community college student does not meet the

standard student profile of the past: young, unemployed, not enrolled in preparatory

courses, enrolled full time, having high grades, and having high SAT scores (Nettles et

al., 1986). Windham (1994) agrees with Nettles that students who are the least likely to

persist are students who do not fit the former student profile description. Improvement in

retention can be associated with an increase in financial funding, to help offset the

amount of time the student needs to work, and career counseling, so that good choices

can be made and adapted to the students’ current lifestyle (Walker, 1988).

Retention in Allied Health Programs

A significantly smaller pool of research studies have been conducted on retention

of students in allied health programs, with only a very few addressing admission criteria.

The rationale forwarded for establishing improved admission criteria for these programs

was to make the best possible use of talent and facilities available at schools for the most

successful education of students (Nash, 1977). Meier, Miller, and Wilk (1975) studied

630 students who were enrolled in allied health programs and found that high school

GPA, vocabulary scores on the Nelson-Denny test, and preadmission course grade

requirements were consistently related to college GPA performance. Keene (1968) found

23

a positive correlation between high school GPA, ACT ability test scores, and persistence

in health programs. Comparative guidance placement test (CGP) reading and sentence

scores, age, exposure to high school algebras, college science grades and gender of the

student were related to student success in a study by Rogers (1979). Given the variety of

criteria being used by different programs for admission requirements it is difficult to

determine which, if any of the criteria actually predicted student retention.

Petty and Todd (1985) examined the average dropout rates of students in allied

health fields. They studied 1800 students in nine colleges and found the following

attrition rates among allied health programs:

Nursing 37%

Dental Hygiene 40%

Medical Lab Technology 39%

Physical Therapy 27%

Radiology 32%

Respiratory Therapy 15% (p. 14)

They suggested that, due to an open door policy at most institutions offering allied health

degrees, it is hard to produce high graduation rates in programs that are controlled by

external factors. This dichotomy affects allied health programs negatively since admitting

under qualified students to rigorous health care programs frequently leads to major

academic difficulties. Petty and Todd concluded that those students who do not “fit” the

program that they are enrolled in will eventually drop out. A high dropout rate among

students in health care programs, most of which only allow a single entrance per year,

ultimately results in a much smaller graduating class. Furthermore having an open door

24

policy allows for required classes to fill up quickly with first come, first serve students

allowing the more qualified students to be turned away (1985).

The majority of nursing programs in the U.S. have an attrition rate of

approximately 50% (Magnussen, 2001; NCIOM, 2004; Sheffler, 1997). This is largely

due to students having to master a large body of information, remember detailed facts,

and use critical thinking to make practice decisions based on complex subject matter

(Magnussen, 2001). According to Knopp (2004) in North Carolina only about 50% of

students entering ADN programs complete these programs within two years of their

initial admission, making NC ADN programs comparable to those throughout the U.S.

Student Retention in Nursing Programs

Recruitment

Many national leaders, organizations, and individuals have noted the importance

of increasing the numbers of nurses in the healthcare field in order to alleviate the current

shortage and to offset a further shortage of nurses in the United States. The lack of a

sufficient number of nurses negatively affects the quality of care that all patients receive,

resulting in increasing morbidity and mortality rates throughout the nation. Increasing the

total number of practicing nurses must begin with increasing the qualifications and the

total number of persons who seek out and enroll in nursing programs. Recruiting students

more qualified and better prepared for ADN program requirements will decrease attrition

rates, thus producing more nurses.

Historically, the public has viewed the nursing field in an ambivalent manner.

Many regard it as a menial but necessary profession (Hine, 1996). Images of the nurse as

a handmaiden to the physician who follows orders with limited autonomy, power, and

25

authority continue to trouble the profession (Fagin, 1990). Negative perceptions can turn

suitable candidates away from a career in nursing. With the limited number of qualified

students seeking a nursing career, reliable admission requirements to ensure that the most

qualified are selected becomes even more important.

Studies of high school students have shown that nursing is not a popular career of

choice. Many students view nurses as lacking power and autonomy and as employees

who carry out policies rather than use problem-solving skills. Reislan and Haussler

(1994) surveyed a group of urban high school juniors to determine their ideal career

characteristics and their perceptions of nursing as a career. In general, they viewed nurses

as caring people who worked very hard and were busy. They did not perceive nurses as

being leaders, making decisions, having power, or making a lot of money; these

characteristics were not suitable for meeting the requirements they wanted in an ideal

career. Penry (1999) conducted a study on high school students’ attitudes toward nursing

as a career and also found that they viewed nursing as less than an ideal career. More

males than females believed that anyone can be a nurse because it is not highly academic

or technical. With recruitment being an important aspect of obtaining students to fill

classes, it is equally as important to recruit more highly qualified students to decrease

attrition and to increase the number of available nurses. Qualifications of enrolled

students can be improved through applying accurate preadmission criteria.

Retention

Once capable students are recruited into nursing, it is important to retain them.

Astin (1975) has reported that the highest attrition rates occur in both 2 and 4-year

nursing programs during the 1st year of study. The demanding curriculum may account

26

for part of the high attrition rate. Nursing education is founded on the physical and

biological sciences, but nurses are also expected to master and apply interpersonal

communication skills and use behavioral science with problem solving skills.

Previous studies have identified factors that affect student nurse retention. For

example, Boyle (1986) studied the correlation between academic and other admission

variables, final grade point average, and success in nursing licensure. He found the

American College Test Assessment and prior high school and college experience to be

the strongest and most consistent predictors of success and retention. Students who failed

nursing had significantly lower averages in high school and pre-nursing classes. Setting a

higher required GPA, such as a B average, for prerequisite sciences would enhance

retention (Potolsky, Cohen, & Saylor, 2003). Other factors, such as social integration,

academic integration, social support, faculty support, and stable coping strategies, may

influence retention. Students with language skills that are below college level have higher

attrition rates (Boyle, 1986). Retention programs can help decrease attrition rates, but

careful admission screening, would identify students with problems to resolve and also

increase retention. Both retention programs and recruitment qualifications are essential to

maintaining a nursing program with low attrition rates.

Tinto’s (1975) and Bean and Metzner’s (1985) models can be applied to student

nurse retention. Four-year nursing students are usually residential students who are

involved in the campus environment; therefore, Tinto’s (1993) retention strategies can be

used to increase retention rates. Bean and Metzner’s (1985) Nontraditional Student

Attrition Model is applicable to 2-year nursing programs that are mainly housed in

community colleges. These retention models address the issue of preadmission factors

27

that affect student persistence. Along with these retention theories, application of

Bagayoka and Kelly’s (1992) research of academic preparedness for admission criteria

could enhance student nurse outcomes.

Retention in North Carolina Associate Degree Programs

North Carolina is not an exception to the nursing shortage afflicting the United

States. The retention issues discussed in the prior section on retention in community

colleges and nursing programs apply throughout the U.S. With North Carolina’s

population increase over the last few decades, it is on the verge of a major nursing

shortage; it is therefore imperative to, study these issues to help graduate more students

qualified to take and pass the National Licensure Exam. The imminent shortage, coupled

with an attrition rate of around 50% in schools of nursing in the state of North Carolina

will have a severe negative impact on health care in this state (Knopp, 2004). Retaining

and graduating more nurses will help lessen the severity of this nursing shortage. One

way to accomplish this is to apply more selective admission criteria to students applying

to nursing programs. This process should integrate admission criteria that have been

proven to positively affect the retention rate of students. Programs also need to provide

enhanced support to students once they are admitted.

Spady’s (1970), Tinto’s (1987), Bean and Metzner’s (1985), and Cabrera et al.’s

(1992) student retention models all agree that prior academic performance is a factor in

student retention. Tinto’s (1987) and Cabrera (1992) models propose that commitment to

the institution and to individual goals are important variables in student persistence.

Using these variables for admission criteria may help in student retention. More studies

28

need to be conducted to determine which criteria are the most reliable for admission in

order to predict student success.

Research Methods in Literature

In reviewing literature for this study, a variety of quantitative, qualitative,

and mixed methods studies were found. The majority of these studies were quantitative

with information collected from student records, test scores, and/or questionnaires. The

majority of these studies were conducted in 4-year, nonhealth care programs and were

primarily descriptive studies designed to examine the current status of enrolled students’

experiences. For example, Tinto (1975) examined the relationship between students who

persisted in educational programs and variables such as sex, race, physical disabilities,

family background and social status, and intellectual and social skills, all of which were

influential in the student’s persistence. Tinto used questionnaires, student records, and

test results to gather data to study the relationship between these variables and

persistence.

A small number of the studies on college student persistence were qualitative,

emphasizing what students thought were the reasons they persisted or dropped out of

their programs of study. In many of these studies, the qualitative data gathered were

coded and then analyzed quantitatively, a procedure Stake (1995) described as pulling

information apart and putting it back together in a more meaningful way. An even

smaller number of research articles used both quantitative and qualitative methods in a

single study. Overall, using a combination of both the quantitative and qualitative

approach in a research study appeared to provide results that were more thorough and

informative than using a single method.

29

Qualitative Method

The use of qualitative research methods appeared less frequently than did

quantitative methods in the literature reviewed. Qualitative approaches were rarely used

without being paired with quantitative research or the information obtained being coded

to transform the data into a numerical format for data analysis. An example of a typical

qualitative study was Sherrod, Harrison, Lowery, and Edwards’ (1992) study of freshmen

baccalaureate nursing students. They used an interview guide to question 20 students in

order to identify their perceptions of academic and nonacademic experiences that

influenced their retention. Students in this study identified variables such as coursework

guidance with study guides, study groups, and test reviews; involvement in school

through activities, meeting new friends, and living close to the college; and using campus

support such as study skill courses, academic tutors, and orientation to nursing courses as

influential in their retention. Other factors they reported as helpful were social support

programs (such as big brother/big sister programs), registered nurse mentors, faculty

guidance, and financial support.

Quantitative Method

In reviewing research relative to the major theories of retention (Astin, 1975;

Bean and Metzner, 1985; Spady 1971; Tinto 1975, 1987, 1993), I found several studies

supportive of each theory in terms of the explanations they offered for early departure

from educational programs. The two most prominent models, Tinto’s (1975) and Bean

and Metzner’s (1985), were based on large-scale quantitative studies. Tinto’s research

focused on traditional students, whereas Bean and Metzner’s focused on nontraditional

students. Cabrera, et.al (1992) took a different approach and combined these two models

30

in developing their Integrated Retention Model and then used quantitative procedures in

their investigations.

Many of the studies used correlational techniques to examine relationships

between persistence and various background and academic variables. For example,

Berger (1992) used correlational research to study retention among baccalaureate social

worker students. She used existing information from student records and social work

programs at several colleges from 1980-1986 to identify factors that contributed to

student retention in order to develop a method for identifying students at risk. Sandiford

and Jackson (2003) used another correlational procedure, discriminate analysis, to

identify variables that discriminated between persisters and nonpersisters. Their study

concluded that students who were assessed at college language level and had a pre-

semester GPA of 2.5 or above prior to their admission were more successful in their first

semester of associate degree nursing. Yet another correlation procedure, path analysis,

was employed by Allen (1994). He used this approach to examine the effectiveness of

student retention in community colleges with Extended Opportunities Programs and

Services (EOP&S). His data were obtained from students in community colleges in

California and included both students enrolled in the EOP&S and those not enrolled.

Analysis revealed that students enrolled in the program were more successful.

Mixed Method

A mixed method approach was used in several studies. In these studies, data were

collected both through interviews and questionnaires to support the hypotheses or

questions being proposed. Walters (1997) gathered qualitative data through open-ended

interviews and quantitative data from a modified Institutional Integration Scale developed

31

by Pascarella and Terenzini (1980) to address Tinto’s (1975) model of student attrition.

She used the interview process to identify what students acknowledged as factors that

influenced their retention and then developed and administered a survey to analyze how

important each of these factors were to students. She reported her qualitative results in a

discussion of the interview and supported the identified factors with quantitative analysis

results from the survey that included tables and pictures. Her results indicated that

socialization was a critical component in influencing students to continue their studies.

According to Johnson and Onwegbuzie (2004), putting words to numbers or vice versa

and including pictures can greatly strengthen study results.

Summary of Literature Review

To summarize the reviewed literature cited, retaining a sufficient and appropriate

number of postsecondary students on local and national levels has proven to be

problematic. Allied health programs, which include nursing, share this problem.

Significant pressure is being placed on schools of nursing by the medical field and by the

general public to increase retention rates and the overall nursing pool in the United

States.

The initial portion of the literature I reviewed discussed general theories of

student departure. The majority of the discussion has been focused on two of the most

widely used theories: Tinto’s (1975, 1987, 1993) model, originally devised for traditional

student retention, and Bean and Metzner’s (1985), model developed for nontraditional

student retention. Tinto asserts that social integration and academic integration are

paramount to student persistence, whereas Bean and Metzner maintain that background

variables particularly a student's high school educational experiences, educational goals,

32

and family support are the principal influences on retention. Spady’s (1970), Astin’s

(1985), and Cabrera et al.’s (1992) models all have components that support Tinto’s

model. I also cited other articles that primarily focused on academic integration as being

the most significant in nursing student retention.

Nursing education programs, the source of newly licensed nurses, are

academically difficult and have high attrition rates. Efforts to improve retention rates

rally around two concepts: recruitment and retention. Both of these concepts focus on the

importance of selecting admission criteria that best support student retention. Identifying

external factors that help students, once admitted, to remain in their nursing programs is a

large component to success.

With national retention rates in colleges averaging around 40% it is critical to

identify admission guides that will contribute to greater student retention and investigate

factors that support student retention (Jennings, 2002). All higher education institutions,

including their allied health, and especially nursing programs, have a history of struggling

with student retention. Given the impending nursing shortage in North Carolina,

knowledge of admission criteria that increase student retention and factors which

influence retention should greatly support nursing programs. This knowledge could

influence better use of funds, facilities, and resources which, in turn, could assist the

health care system to increase the supply of available nurses and help meet the public

demand qualitative.

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CHAPTER 3: Method for Current Research

The Bean and Metzner (1985) Theory of Nontraditional Student Attrition is an

excellent framework for studying associate degree nursing students in community

colleges as it is based on data regarding the nontraditional student, and therefore more

applicable than theories originated in 4-year university programs. Students who attend

community colleges fit the researchers’ definition of the non-traditional student (i.e.

older, a commuter, not greatly influenced by the social environment of the institution, and

chiefly concerned with the institutions academic offerings; p. 489).

This chapter presents a summary of the methodology used to explore factors that

affect student persistence. A mixed method research design studied factors that encourage

student persistence from the view point of currently enrolled students, drop out students,

and institutional student selection process. Included in this chapter are discussions of

research questions, participants, mixed method design, data collection procedures,

director and student survey construction, and student interview construction.

The Research Questions

This study addresses two major questions: 1. What admission criteria factors are

predictive of student retention in associate degree nursing programs? 2. Does the Bean

and Metzner (1985) Nontraditional Student Attrition Theory represent predictive factors

in retention/attrition behaviors in an associate degree nursing education program? These

questions are broken down further into the following subquestions:

1. What admission criteria are most predictive of student success in associate

degree nursing programs?

Does high school performance, high school class rank, or prior experience

in the medical field impact retention rates?

Do scores on preadmission tests or grades on prenursing courses impact

retention rates?

Are there more qualified applicants than spaces for admission into ADN

programs?

Are preadmission interviews significant predictors of student retention?

2. Does the Bean and Metzner (1985) Nontraditional Student Attrition Theory

represent predictive factors in retention/attrition behaviors in an associate degree

nursing education program?

Do ADN students identify specific background and defining variables as

affecting their own persistence?

Do ADN students identify specific academic variables as affecting their

own persistence?

Do ADN students identify specific environmental variables as affecting

their own persistence?

Do ADN students identify specific social integration into the college

network as affecting their own persistence?

Which, if any, of these factors have a stronger effect on persistence in

associate degree nursing programs?

35

Participants

Second-year associate degree nursing students in community colleges in North

Carolina were surveyed during the academic year 2006. Additionally data were collected

from nursing programs for the years 2004 and 2005. Six programs having both day

cohorts and evening cohorts were selected for the study based on geographic location.

Locations were chosen based on the fact that they were close enough to my residence that

I could travel to and from them in one day and were not close geographically to each

other. All programs contacted agreed to participate. The resulting convenience sample

included day students; evening students; and students from small, medium, and large size

classes. Such a diverse group of students helped increase the generalizability of findings

and provided an adequate pool of participants for the interview portion of the study.

Mixed Method Design

A mixed method research design requires multiple sources of evidence

converging on the same set of facts (Creswell, 2003). Stake (1995) cites using multiple

sources of evidence as an important tactic in promoting construct validity and credibility

of interpretations. He claims observation and interview are the most used protocol and

notes that this protocol can be applied to either case study or mixed method research.

Since it can be argued that a mixed method research design strengthens studies, I chose to

use this method.

Information for this mixed method study was obtained using interviews

questionnaires; and public documents containing information on nursing program

admission criteria, student enrollment, and attrition rates. Data were collected from

36

directors of ADN programs, 5th- semester ADN students, and drop outs of associate

degree nursing programs in community colleges in North Carolina.

Data Collection Procedures

Surveys were administered to two groups of individuals: directors of ADN

programs and 2nd-year nursing students in ADN programs in North Carolina. Directors of

all 47 associate degree programs were sent surveys containing questions addressing

admission criteria and student retention status. The students’ surveys contained questions

to identify factors that they believed influenced retention.

Director Survey Construction and Data Collection

I conducted an extensive review on admission criteria, currently being used at

schools of nursing, not only in North Carolina but nationally. These criteria addressed

prior educational requirements, admission testing, and a variety of other criteria that were

used to admit students (e.g., a point system calculated based upon prior health care

experience, grade point average, prerequisite classes, etc.). Based on the variety and

inconsistency of prior research findings, the survey was designed to be as inclusive of

these criteria as possible.

The director survey (see Appendix A) was designed to examine admission criteria

that could be predictive of student retention. It contained 21 items in the following

format: questions 1-7, 9-13, 15-16, 20, and 21 required a yes or no answer; question eight

required selecting all that apply and questions 14 and 17-19 asked the participant to fill in

the blanks.

Establishing construct validity improves the quality of a survey in which there is

no clear criterion for validation purposes. This approach attempts to establish validity by

37

demonstrating that any single measure is related to a variety of other measures (Schutt,

1996). Carmines and Zeller (1979) describe construct validity as “concerned with the

extent to which a particular measurement relates to other measures consistent with

theoretically derived hypotheses concerned with the concepts (or constructs) that are

being measured” (p. 23). According to Creswell (2003), an instrument contains construct

validity if its items measure hypothetical constructs or concepts (p. 112). Content validity

for the nursing director survey was established by linking items in the survey to the major

constructs of Bean and Metzner’s (1985) theory (see Table 3.1). Items were related to

Table 3.1

Variables Related to Nursing Director Research Questions and Survey ItemsVariable Research Question Survey Item Number

Background and Defining Variables:

High School Performance

High School Class Rank

Former Medical Experience

1. Does high school performance, high school class rank, or prior experience in the medical field improve retention rates?

4, 5, 6, 7, 9, 10, 17, 18, 19, 20

Academic Variables: Scores on

preadmission tests Grades in prenursing

courses

2. Do scores on preadmission test or grades on prenursing courses improve retention rates?

2, 3, 8

Environmental Variables: Number of qualified

applicants

3. Are there more qualified applicants than spaces for admission into ADN programs?

1, 15, 16

Social Integration: Extensive, high

quality interaction with people

4. Do pre-admission interviews help predict student retention?

11, 12, 13, 14

Note. Adapted from Bean and Metzner (1985) and Creswell (2003).

38

Bean and Metzner’s constructs of academic variables, social integration variables,

environmental variables, and background and defining variables.

Following IRB approval*, the survey was administered as a pilot to three nursing

school directors to check for clarity and understanding of the instrument. Only slight

modifications were made for clarification; content did not change.

Following the pilot study, the nursing director survey was administered in four

phases. Directors were informed of the survey via e-mail prior to receiving it. The survey

included a letter of explanation and a “thank you” in advance for participating. Initially

the survey was administered via e-mail to all 47 associate degree programs in community

colleges in North Carolina and elicited eight responses, resulting in only an 18% response

rate (see Table 3.2). The second administration of the survey was through the postal

service. All directors who did not respond via e-mail were sent a survey with a self-

addressed, stamped envelope for return. This elicited a greater response with 24 surveys

being returned. A second postal mailing was sent out 2 weeks after the first mailing to the

13 colleges that had not responded. Subsequent to this mailing four additional surveys

were submitted, resulting in an overall response of 86%.

Table 3.2

Director ResponsesMethod Number Surveys

AdministeredNumber of Surveys

ReturnedPercentage of Total

ResponseE-mail 45 8 18

Mailing 1 37 24 71Mailing 2 13 4 86

Student Survey Construction and Data Collection

In addition to the director survey, a student survey was designed using the Bean

*Institutional Review Board approval 2/6/06

39

and Metzner(1985) Conceptual Model of Nontraditional Student Attrition Theory as a

guide. Again, this model was used because it addressed nontraditional students and

represents community college students. The survey was designed to collect data on

students’ perspectives of what factors they identified as assisting them to persist in the

nursing programs they attended. A total of 361 students in their final semester of school

from six different community college ADN programs participated in the study.

As in the nursing directors’ survey, construct validity for the student survey was

established by linking items to the major constructs of Bean and Metzner’s (1985) theory.

Each item was related to the major constructs of academic variables, social integration

variables, environmental variables, and background and defining variables (see Table

3.3). The student survey was designed to measure students’ opinions and attitudes toward

various aspects of their nursing program and their motivation for staying or leaving.

The survey (see Appendix B) contained a set of 47 Likert-type items, all reflective

of factors that influenced students in their decisions to continue in a nursing program.

These factors were based on Bean and Metzner’s (1985) four sets of variables that

support student retention. They included: (a) environmental factors, (b) background and

defining factors, (c) academic factors, and (d) social factors. Fifteen of the items address

environmental variables (e.g., the amount of time I spend taking care of family and home

obligations interfering with my study time), 15 were related to background variables (e.g.

Would you say your English language skills/writing skill preparation for college was

poor, fair, good, or excellent?), 9 were related to social factors (e.g., faculty giving me the

support and encouragement I need to be successfully academically) and 8 were related to

academic variables (e.g., participation in group study).

40

Table 3.3

Variables Related to Student Research Questions and Survey ItemsVariable Research Question Survey Item

NumberBackground Variables:

Educational Goals

High School Performance

Medical Education

1. Do students identify background and defining variables as affecting their own persistence?

24, 25, 26, 27, 28, 29, 31, 40, 41, 42, 44, 45, 46, 47, 48

Academic Variables: Study Hours Study Skills Absenteeism Major Certainty Job Certainty Difficulty of

Major

2. Do students identify academic variables as affecting their own persistence?

1, 7, 9, 11, 15, 22, 23, 49

Environmental Variables:

Finances Hours of

Employment Outside

Encouragement Family

Responsibilities

3. Do students identify environmental variables as affecting their own persistence?

13, 14, 17, 18, 19, 20, 21, 32, 33, 34, 35, 36, 37, 38, 43

Social Integration: School

Memberships Faculty Contact School Friends

4. Do students identify social integration into the college network as affecting their own persistence?

2, 3, 4, 5, 6, 8, 10, 12, 16

Note. Adapted from Bean and Metzner (1985) and Creswell (2003).

For items 1-23 and items 30-48, students were asked to respond on a scale of one

(least important) to five (most important), according to the strength of their agreement

with the statement. Items 24-28 required a poor, fair, good, or excellent response.

Students were directed to answer the questions based on how influential they felt each

41

variable was. Item number 30 was a yes or no question, and item number 49 was based

on a choice of 0-5, 5-10, 10-15, 25-30, or 30+. For each of these questions, the student

was to indicate which was the most reflective of their circumstances.

Prior to administering the student survey, it was piloted with 23 2nd-year associate

degree nursing students to check for clarity, improve question clarity and format, and to

incorporate any comments and revisions. Each student was given the survey and asked to

provide feedback on the effectiveness of questions asked. The pilot group gave

suggestions for clarification on three questions. These questions were adjusted to better

elicit definitive answers from all students. However, content of the questions was not

changed.

The selection criterion for choosing schools to participate in the survey was based

on information from the North Carolina Board of Nursing (n.d.) Website concerning the

number of students and geographical location of nursing programs. Students from six

community college nursing programs were invited to participate in the survey. Schools

were chosen based on geographic location and student population. Geographic locations

were chosen due to ease of researcher access and to use schools that were different in the

numbers of students attending and were located in areas at a distance as far as possible

from one another. All six schools were located in the northwestern part of North

Carolina, comprised of both rural and metropolitan locations. Schools were chosen to

provide a range of student populations. The lowest number of enrolled nursing students at

any selected school was 70, and the highest enrollment was 328 students. The survey was

administered to 5th- semester students prior to or just after a class period. I administered

all of the surveys and gave the same directions to each group of students. Students were

42

informed that they could refuse to take the survey, however; none refused. All students

who received the survey returned it, resulting in a 100% response rate.

Student Interview Construction and Data Collection

Only six dropout students agreed to be interviewed, therefore I chose to use

qualitative analysis for the interview part of this study. I chose to interview students who

had exited nursing programs, at various points of their studies, prior to completion to

gather qualitative information on attrition issues that were relevant to unsuccessful

students. The interviews were directed toward gathering information to understand

factors in the student’s lack of continuation in their nursing program.

The interview guidelines were in accordance with Bean and Metzner’s (1985) constructs

of the nontraditional undergraduate student attrition model using Patton’s (1987) general

interview guides for developing interview questions. Upon completion of the interview

guide (see Appendix C), a pilot test was conducted with one student who had withdrawn

form an associate degree nursing program prior to graduation to provide an opportunity

to use the framework and address issues that needed revisions and/or clarifications. The

feedback I derived from the pilot interview was that the guideline was well structured and

that it was important to follow the guideline in order to cover all concepts.

The following table (Table 3.4) places each question from the interview guideline

into categories that represent the variables addressed by Bean and Metzner’s (1985)

model. The interview prompt on the right was used to obtain information addressing the

specific variables on the left. These constructs were used in discussing reported student

experiences.

Table 3.4

43

Variables Related to Student InterviewsVariable Interview Prompt

Background Variables: Educational Goals High School

Performance Medical Education Family/Friends High School Class

Rank High School Class

GPA

Tell me about yourself (high school education, your original educational goals).

How did you come to choose nursing as a career? Do you have family members who are nurses? What do your family and friends think about nurses in general?

Tell me about your nursing education. When did you start taking courses for your nursing degree? How many courses or credits did you take each semester? Did you ever attend any other nursing program?

Academic Variables: Study Hours Study Skills Absenteeism Major Job Certainty Difficulty of

Major

Tell me how things were for you academically while attending your nursing program. I’d like for you to tell me about how you organized yourself for studying and attending classes, labs, and clinical. What was your opinion about the academic difficulty of your courses? Did you feel you had enough time to study? Did you feel that your academic preparation was sufficient, or did you get help for your study skills? If yes to the latter, how did you decide to get that help? Did you sit in on study sessions with your friends or classmates?

What do you think about the academic advising you received while you were in the nursing program? Who was your advisor or how were you advised?

Did you attend classes on a regular basis, or were you absent from any classes, labs, or clinical: If yes to the latter, how did that come about? Please describe your absences. Were they occasional or more extensive? What was the faculty response to your absences?

Please tell me about the most difficult part of attending the nursing program and about the best part of attending the program. If you had any sad or difficult times in the program, please describe them. Were they related to the program itself or to personal issues? Did you keep going at that point? If so what encouraged you to continue?

How certain were you that you had chosen the right career? How easy do you think it would be to get a job in nursing? Do you regard these positions as well-paid?

44

Environmental Variables: Finances Hours of

Employment Outside

Encouragement Family

Responsibilities

While you were in this nursing program, did you have difficulty with finances? Was this a problem before you attended the program, or just related to being a student in the nursing program? Did you work while you were in school? If yes, about how many hours each week did you work while classes were in session?

Did you have family responsibilities while you were in the program? Children? Elder care? Housework such as cooking, cleaning, and laundry?

Did your family and friends encourage you while you were in school? Do you have anyone (or any group of people) that you would consider to have been the most supportive?

Social Integration: School

Memberships Faculty Contact School Friends

While you were in this nursing program, did you have any opportunity for socialization? Can you describe this? Did you belong to any campus clubs or groups?

Tell me about your classmates. Did you socialize with any of them after class or clinical? Did you participate in any formal or informal study groups?

Please tell me about the faculty. Did you find them supportive and helpful? Did you speak with them outside of class?

Note. Adapted from Bean and Metzner, (1985) and Patton (1987).

Students chosen for the interview process were students who had exited a nursing

program prior to completing it. The interviewees were volunteers previously enrolled in

ADN programs in Western North Carolina who had exited a nursing program between

January 2005 and January 2006. The reason for their attrition or at what point they had

exited in a program was not a factor in their participation in the study. These students

were selected by the student service department of each school and were contacted by

telephone for permission for the researcher to contact them. Telephone interviews were

conducted with dropout students from each of the six schools that participated in the

survey process earlier in the study. At the time of my initial call students were asked if

they would participate in an interview relating to student attrition and to set up a time that

45

was convenient for them to answer questions. None of the students requested a call back

and all participated in the interview upon the initial call. Each interview lasted

approximately 1 hour. If students spoke at length on a topic not pertaining to the original

question they were redirected back to the original question.

The interview protocol was developed following guidelines provided by Patton

(1987). Patton’s guidelines for a more structured, but open-ended, form of interview

technique were used. His recommendations of preparing for the interview by reviewing a

list of questions and issues to be explored during the interview with participants were

followed. The interviewees were also informed of what the study was about, its

importance, and approximately how long the interview would take. A pleasant and

professional atmosphere was created at the beginning of the interview. Questions that

only required a yes or no answer were not asked so that the interviewee had to be more

detailed with their answers.

Summary

In the literature review for this study, the majority of studies I found were

conducted on student attrition/retention in 4-year undergraduate programs. Furthermore,

the majority of these studies involved students from varied educational majors.

Comparatively, few studies were found that directly addressed a group of students from a

single program, for example, physical therapy concentration. An even smaller collection

of research was found in allied health programs, with few of these studies addressing

nursing programs.

In reviewing the two major retention theories, Tinto (1975, 1987, 1993) and

46

Bean and Metzner (1985), both theories could be applied to nursing students to help

explain early departure decisions. Bean and Metzner’s theory is best suited for

community college students based on the fact that these students are nontraditional. Both

the Tinto and the Bean and Metzner models were developed in the quantitative paradigm

based on large-scale studies, making them reliable theories to apply to current student

populations.

Due to the current national nursing shortage, more research needs to be conducted

regarding retention of student nurses. This research needs to focus on how admission

criteria relates to retention, methods of improving student retention programs, and

students’ perceptions of what factors support them in their persistence in relatively

rigorous programs. Educators being knowledgeable of information leading to student

retention will enhance the number of students retained, therefore increasing the number

of graduate students who are qualified to take the NCLEX. This in turn will lead to an

increase in the number of licensed nurses in North Carolina.

This study used a mixed method investigation of factors that contribute to the

retention of associate degree nursing students. The components of the study are a survey

—with descriptive and statistical analysis completed by department chairs and students—

and interviews with student drop-outs. The surveys and interviews were based upon Bean

and Metzner’s (1985) Nontraditional Student Retention Model since it relates closely to

the goals that I set out to accomplish with my study.

47

CHAPTER 4: Survey Results and Analyses

The purpose of this study was to discover a set of predictor variables that would

best predict student persistence and identify admission selection criteria that would best

support student persistence in associate degree nursing programs: These predictors are

based on Bean and Metzner’s (1985) categories of background and defining factors,

academic factors, environmental factors, and social factors. Included in this chapter are

Director Results and Analyses

The director segment of this study investigated the correlation between admission

requirements and student retention. Though there are no standard protocols in North

Carolina for nursing school admission criteria, most schools had similar admission

requirements, yet they varied widely in attrition rates.

Frequency and correlation analyses were performed on the data from the director

survey. Several of the items on the Nursing Directors Questionnaire yielded little or no

response variation (i.e., at least 80% of the respondents had identical responses). These

items are listed in Table 4.1. In the table, items with low numbers of affirmative

responses indicate that nearly all respondents did not require these criteria for admission.

Attrition rates varied widely from program to program, yet the nursing directors

were nearly uniform in their replies to all the items on the Nursing Directors

questionnaire. Hence, there was no possibility of a correlation between admission criteria

and attrition rates. Therefore, data did not prove useful in determining what admission

criteria are predictive of student retention.

Table 4.1

Survey Items Yielding an Invariant Response

Item

Number of affirmative responses

2. What admission tests are required by the college?a. English 35b. Math 35c. Personality test 5

5. Do you require high school class rank for admission? 17. Do you admit students with a high school equivalency certificate? 348. Do you require prerequisite college-level courses in:

a. Chemistry 7b. Microbiology 1c. Anatomy 4d. Physiology 3e. English 4f. Psychology 4g. Sociology 0h. Speech 1i. Other 5

10. Do you allow licensed practical nurses, medical technicians, paramedics, and/or military credit and advanced placement? 29

11. Do you require a written personal letter of reference for admission? 212. Do you interview applicants for the program?a 415. Do you receive more applications annually than you accept? 3520. Is your program NLN accredited? 721. Does your nursing program require additional admission exams in addition to the college’s requirements?

29

22. Does your nursing program use the following preadmission exams for entry into the nursing program?

a. TEAS (test of essential academic skills) b. Pre-English of any kind c. Pre-Math of any kind

53030

aBecause of the lack of variation in response to Item 12, responses to Items 12 a-13 c were not considered.Note. N = 36 on all items.

The lack of significant correlations with respect to the selection criteria

examined was disappointing. Even so, it was obvious that some differential selection

occurred. All of the programs indicated they had more applicants than they accepted, so

they must have had some procedure in place for excluding applicants. One possibility

49

might involve the various examinations they administered. Although in my survey I did

not include any items about the use of cut scores on these examinations, in hindsight, it

appears likely that the programs used such scores to differentially select students.

Certainly any extension of this research should examine specific uses of admission test

data—such as which tests are used, where cut scores are set, and so forth—in the

selection process.

Student Results and Analyses

The student survey, administered to ADN students in their final semester at six

North Carolina Community Colleges, yielded 361 responses. As described earlier, the

student survey was modeled after Bean and Metzner’s (1985) Nontraditional Student

Attrition Theory. The survey included four subscales roughly comparable to the four

major constructs, or categories of variables, specified in Bean and Metzner’s theory:

background and defining variables, academic variables, environmental variables, and

social integration variables. Table 4.2 shows the items in the student survey that were

allocated across these four constructs.

Table 4.2

Survey Questions Supportive of Variable GroupsBean and Metzner’s Variable Groups Survey Questionnaire Items

Background and Defining Variables 24, 25, 26, 27, 28, 29, 40, 41, 42, 44, 45, 46, 47

Academic Variables 1, 7, 9, 11, 15, 22, 23, 31, 49Environmental Variables 13, 14, 17, 18, 19, 20, 21, 30, 32, 33, 34,

35, 36, 37, 38, 43Social Integration Variables 2, 3, 4, 5, 6, 8, 10, 12, 16Note. Questions 39 and 48 are not listed due to being narrative answer questions.

Background and defining variables, according to Bean and Metzner (1985),

include student age, number of hours enrolled, educational goals, high school

50

performance, residence, ethnicity, and gender. Educational goals, high school

performance, and ethnicity were considered to be the most influential background

variables affecting student attrition. The defining variables recognized as the most

influential were age, enrollment status, and residence.

According to Bean and Metzner (1985), important academic variables include

past and present GPA, number of hours spent in study, study skills, academic advising,

class attendance, degree major, job certainty, and course availability. These are expected

to have indirect effects on attrition through GPA, psychological outcome, and intent to

leave.

Important environmental variables identified by Bean and Metzner (1985) include

finances, hours of employment, outside encouragement, family responsibilities, and

opportunity to transfer to other institutions for degree advancement. These are variables

over which the institution has little control but which might influence the student to drop

from the institution.

Finally, Bean and Metzner (1985) identified the following as important social

integration variables: campus club memberships, faculty contact, and friends on campus.

They concluded that the more involved students are in social activities related to the

college, the more likely students are to succeed. However, they identified the extent and

quality of students’ interaction with the social systems of the college as the least

important of the four variable groups.

An analysis was performed on the results from the student survey. The data were

analyzed using the subscales that were intentionally designed according to the construct

51

categories identified by Bean and Metzner (1985), described previously, and placed in

subscales according their Likert-type responses.

Analysis Using Bean and Metzner’s Construct

Scale scores for each of the Bean and Metzner (1985) related constructs were

analyzed for frequency of occurrence. Questions 1-23 provided information on what

general factors related to academic, social, and environmental variables, students viewed

as influential in their retention. Questions 24-28 were analyzed using data from the

students’ point of view on how well high schools prepared them academically for college.

Question 30 was analyzed alone to determine how many surveyed students had dropped

out of a nursing program prior to their current admission, followed by questions 37-38 to

determine background factors that had influenced their dropping out. Questions 40-47

addressed factors that influenced students’ decisions to enter a nursing program. The

remaining question, 48, was analyzed to see how many hours retained students spend

studying per week.

Academic, Environmental and Social Factors That Influence ADN Student Nurse

Retention

Questions 1-23 in the student survey addressed general factors related to Bean and

Metzner’s (1985) academic, environmental, and social constructs and their relationship to

student retention. These questions were designed to measure the student’s perspective on

how influential each factor was to his or her retention in the current nursing program.

Five of the questions addressed student/faculty interaction (questions 2, 3, 4, 6, and 7),

two addressed students’ social interaction at college (questions 8 and 10), eight questions

addressed family, friend, and/or community support (questions 14, 15, 16, 17, 18, 19, 20,

52

and 21), two questions addressed financial support (questions 13 and 23), and six

questions addressed study habits and academic activities (questions 1, 5, 9, 11, 12, and

22). All answers were scored on a 5-point Likert-type scale from least important to most

important.

For each item the average response (1 to 5) was computed. Over the 23 items, the

average item score was 3.28 with a median of 3.26. Hence, across all the items, the

average response was slightly positive. The alpha reliability of the 23-item scale was

0.87. An inspection of the responses to each item (or groups of items) individually

provided more useful information, particularly with respect to family support,

faculty/student interaction, and academic involvement (see Table 4.3).

The responses with high ratings of importance relate to questions that support

Bean and Metzner’s (1985) academic and environmental constructs. The most influential

retention factors identified by students were “attending class regularly,” “family support

and encouragement,” and “faculty/student relationships.” Approximately nine out of ten

students identified attending class on a regular basis and support and encouragement from

their families as influential in their retention. A little less than 75% of the students

indicated that their families sacrificing things such as money or time for their schooling

was important. Three-fourths of the students said that finding enough time to complete

assignments was important. Interestingly, faculty involvement was rated highly by the

students. Two-thirds of the students related faculty support and interaction inside the

classroom as important and three-quarters of them rated faculty teaching methods as

important to their success. This emphasizes the importance of faculty developing a good

rapport with students.

53

Influential factors that were identified by students as not important to their

retention were social involvement at college and student tutoring. Eighty percent of the

students responded that involvement in social activities on campus was not important to

their decision to remain or dropout. Additionally, approximately two thirds of the

students answered that tutoring was unimportant in being success. These results are

consistent with Bean and Metzner’s (1985) concept that a nontraditional student’s

retention is not strongly affected by lack of social interaction with colleges.

Table 4.3

Frequency Analysis of Influential Factors______________________________________Item Percent

Not Important Neutral Important1. finding enough time to complete assignments 7.0 15.4 77.52. faculty giving me support to be successful 12.9 23.0 64.23. interaction with faculty outside of classroom 49.6 26.6 23.84. interaction with faculty inside of classroom 11.1 27.1 61.75. active class participation by answering questions 19.7 32.1 48.26. faculty valuing and caring for me as a person 16.7 22.3 61.07. faculty teaching methods help me be successful 7.5 15.5 77.08. involvement social activities on campus 80.4 15.7 3.99. attending nursing classes on a regular basis 4.4 7.3 88.210. participation in group study 41.6 21.3 37.011. getting tutoring from the college 72.3 17.8 9.912. out-of-class intellectual activities 65.0 27.2 7.813. time spent working interfering with study time 33.4 25.3 41.314. time with family interfering with study time 14.9 21.8 63.415. social activities interfering with study time 55.1 27.7 17.216. classmates/friends support and encouragement 8.5 19.8 71.717. family support and encouragement 3.7 6.4 89.918. place of worship support 23.7 18.6 57.719. community member or agency support 60.0 20.5 19.620. friends having/planning a college education 51.9 22.0 26.021. family sacrifice for me to go to school 13.0 15.0 72.022. difficulty of academic work in nursing program

11.1 24.9 61.0

23. need of financial aid in order to pay for school 27.0 17.017.0

56.0

Background and Defining Variables That influence ADN Student Nurse Retention

54

Background and defining variables that may influence ADN student nurse

retention were addressed in questions 24-29 and 40-47. These variables were broken

down into subcategories that were defined as high school preparation (questions 24-28),

number of credentials held (questions 29a-29e), and influences to become a nurse

(questions 40-47). These questions were designed to solicit responses that would either

support or not support Bean and Metzner’s (1985) non-traditional student theory of

background variables being important in ADN student’s retention.

High School Academic Preparation

High school academic preparation skills that influence ADN student retention

were addressed in questions 24 through 28. These questions requested the student to rate

their high school academic preparation in the areas of in general overall skills, English

language skills, math skills, science skills, and reading skills. Responses were scored on a

4-point Likert-type scale from poor to excellent. For each item the average response (1 to

4) was computed. Over the 5 items, the average item score was 3.46, indicating that the

average response was strongly positive. The individual responses for each of these items

indicated that more students responded “good” or “excellent” than “fair” or “poor”.

Overall results from the high school academic preparation analysis support the

conclusion that background preparation is an important influence in ADN student

retention, thus supporting Bean and Metzner’s (1985) nontraditional student theory. Their

theory stresses that strong educational preparation increases student retention. All five

items (questions 24-28) on the student survey had a large number of responses in the

“good” and “excellent” categories, translating to positive percentages as follows: in

academic high school preparation (70.8%), English language skills preparation (83.0%),

55

math skills preparation (75.9%), science skills preparation (76.9%), and reading skills

preparation (90.5%). Students reported these factors were influential on their preparation

for college. Less that 30% of students answered “fair” or “poor” in all five categories (see

Table 4.4) indicating that these factors were not influential from the students, perspective.

Table 4.4

Frequency Analysis of Student Ratings of Their High School Academic Preparation Skills

Item Percent PercentPoor/Fair Good/Excellent

24. overall academic high school preparation 29.2 70.825. English language skills preparation 27.0 83.026. math skills preparation 24.0 75.927. science skills preparation 23.1 76.928. reading skills preparation 9.5 90.5

A further analysis showed that most of the students rated their skill preparation

“good” or “excellent” in all, or most, of the areas (see Table 4.5). Under the “poor”

category, 8.9% of the students rated their preparation as “poor” in only one skill area,

whereas 0.3% rated their preparation in four of the areas as “poor.” None of the students

rated all five skill areas as “poor.” On the other end of the continuum, 19.7% rated a

single skill area as “excellent” and 9.1% rated all skill areas as “excellent,” thus

supporting the Bean and Metzner (1985) theory that the better a student’s prior academic

skills preparation is the more successful the student will be in college.

Hours Students Spent Studying

Item number 49 was analyzed individually. According to Bean and Metzner

(1985), the number of hours a student spends studying per week is an academic variable

that can be used to predict retention. Question 49 asked the student to identify how many

hours a week he or she spent studying. Students could choose from categories of 0-5

56

hours, 6-10 hours, 11-15 hours, 16-25 hours, 26-30 hours, or 31 + hours. A total of 73.7%

of students surveyed reported studying between 5 and 20 hours weekly. Only 11.2%

reported studying less than 5 hours a week, and 5.0% reported studying greater than 30

hours a week. Overall 78.7% of students surveyed studied 5 or more hours a week.

Table 4.5

Importance of High School Academic SkillsNumber of

Items SelectedPoor

n %Fair

n %Good

n %Excellent

n %

1 32 8.9 54 15.0 64 17.7 71 19.72 8 2.2 48 13.3 82 22.7 50 13.93 5 1.4 26 7.2 57 15.8 41 11.44 1 0.3 12 3.3 44 12.2 32 8.55 0 0.0 5 1.4 52 14.4 33 9.1

Number of Credentials Held

A prior college education can have a positive effect on student retention. Students

who have had the experience of attending college classes and being successful in

obtaining a certificate or degree are more likely to be successful in subsequent college

classes (Mohammadi, 1994). Item 29 asked students to identify which of five credentials

they held in the medical or health care field, prior to their current enrollment. These areas

included certified nurse assistant, licensed practical nurse, paramedic, associate degree,

and bachelor degree. The average number of prior credentials held was 1.2 with a median

of 1.0. Nearly all the students (94.7%) held a prior credential. Seventy-two percent of the

students had at least one credential (see Table 4.6).

57

Table 4.6

Number of Prior Credentials Held Identified by StudentsNumber of Credentials Held Credentials Held

n %0 19 5.31 258 71.52 77 21.33 6 1.74 1 0.35 0 0.0

Of those students who held credentials, the majority were certified as a nurse

assistant. The most likely reason for this is that the majority of ADN programs in North

Carolina require students to have their certification as a nurse assistant prior to admission

to an ADN program. Only 8% of the students had a prior nursing degree (LPN), whereas

nearly 30% held an associate or bachelor degree in another field (Table 4.7).

Table 4.7

Percentages of Types Credentials Held Identified by Students Item Percent

NoPercent

Yes29. a Certified Nurse Assistant 18.8 81.229. b Licensed Practical Nurse 92.0 8.029. c Paramedic 97.8 2.229. d Associate Degree 86.4 13.629. e Bachelor Degree 84.8 15.2

Factors Influencing Students to Become Nurses

In addition to those discussed previously, factors that Bean and Metzer (1985)

describe as background and defining variables that effect nontraditional student retention

were addressed on the student survey in questions 40 through 47. These items dealt with

factors that may have influenced students to become nurses. Questions ranged from “I

have always wanted to be a nurse to “I want a job that pays well.” Responses to these

questions were rated on a 5-point Likert-type scale and later converted to a 3-point scale

58

(2 through 4) by collapsing the two extreme response categories into their adjacent

categories. Together, the eight items constituted a scale of influence having an alpha

reliability of 0.54. The mean item response to this scale was 2.9 with a median of 3.0. An

analysis of the students’ responses to individual items showed that nine out of ten

students wanted a career in which they could help people. A little over half of the

responses indicated that students had always wanted to be a nurse. Very few responses,

less than one fifth, indicated that counselors recommended nursing to students. A large

number (four fifths) of the students responded that they wanted a steady job without

layoffs and a job that pays well. Survey items focused on influences to become nurses

and the percentage of students answering each item are presented in Table 4.8.

Table 4.8

Student Identified Influences to Become a NurseItem Untrue

n %Neutraln %

Truen %

40. I always wanted to be a nurse. 64 24.5 32 12.3 165 63.241. I have relatives who are nurses. 162 67.2 22 9.1 57 23.742. I want a career where I can help people. 2 1.7 7 5.8 111 92.543. My high school counselor recommended nursing.

302 86.8 15 4.3 31 8.9

44. A career counselor recommended nursing.

289 84.3 20 5.8 34 9.9

45. I want a job that requires skills. 155 57.2 11 4.1 105 38.746. I want a steady job without layoffs. 15 8.6 13 7.4 147 8447. I want a job that pays well. 14 8.6 12 7.4 137 84

Table 4.9 provides a summary of the numbers of factors that students felt

influenced them to become nurses. In the table, for example, under the “untrue” category,

19.4% of the students rated only one of the influences as untrue whereas 0.3% rated 8 of

the items as untrue. Under the true category 8.9% rated only one item as true, 53.5%

rated 5 of the items as true, and 0.0% rated all 8 items as true.

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Table 4.9

Number of Items Selected by Students as Important Influences to Become a Nurse Number of Items

SelectedUntrue

n %Neutral

n %True

n %

1 70 19.4 75 20.80 32 8.92 81 22.4 20 5.5 79 21.93 66 18.3 3 0.8 124 34.34 47 13.0 2 0.6 85 23.55 22 6.1 0 0.0 19 53.56 5 1.4 0 0.0 1 0.37 3 0.8 0 0.0 0 0.08 1 0.3 0 0.0 0 0.0

Reasons for Having Previously Dropped Out of an ADN Program

Another area addressed in the survey was previous enrollment in a nursing

program resulting in drop out. Item 30 asked students “have you ever exited an ADN

program for one semester or more prior to this admission.” This item was followed by

items 31 to 38 which asked students to indicate reasons for dropping out (Table 4.10).

The results showed that 24.2% of the students had been enrolled previously. The more

salient reasons for their failure to progress were: failure to attain required minimum grade

point average, lack of money, family illness, problems with children, personal illness,

divorce or separation, lack of support of significant other, and/or pregnancy. The most

important contributing variable to attrition was failure to maintain minimum grades, with

57.8% of students identifying this as the cause of their dropping out.

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Table 4.10

Student Identified Reasons for Dropping OutItem Percentage

Not important Neutral Important31. failure to attain minimum grades 38.6 3.6 57.832. lack of money 53.7 7.3 39.033. family illness 63.8 6.3 30.034. problems with children 71.8 6.4 21.835. personal illness 65.4 6.4 28.236. divorce/separation 73.1 1.3 25.637. lack of support from significant other 67.9 6.2 25.938. pregnancy 68.1 5.6 26.4

Conclusions of Student Survey Results

Conclusions gathered from the results of the student survey conducted for this

study provided information that can be used to influence ADN student retention. Factors

that were identified as positively affecting retention were regular class attendance; good

high school preparation for college; studying for 5-20 hours a week while in a nursing

program; and wanting a career that is steady, without layoffs, and pays well. The main

factor that influenced students to drop out of ADN programs was failure to maintain

minimum grades. Also, the results identified that high school or career counselors

recommended a nursing career to very few students.

Interview Results

Six ADN student dropouts were interviewed to determine what influenced their

lack of success. One of the six participants was male but all participants are referred to as

female to protect the male participant’s identity. The interview guidelines were developed

using Bean and Metzner’s (1985) Nontraditional Student Attrition Model, and the results

were assessed to determine any relationship between the guidelines and student

responses.

61

Bean and Metzner’s (1985) indicate that four sets of variables influence student

attrition: a) poor academic performance, b) background and defining variables, c)

environmental variables, or d) social variables. Any of these variables alone or in any

combination can influence student retention/attrition. Table 3.1 in Chapter Three outlines

the variables adopted from this model that were used in the interview process to gather

information. Each of the four sets of variables was broken down into subunits that made

understanding of the model more straightforward.

All six former students identified environmental variables as the most important

factor in their decision to stay in or drop out of their program. According to Bean and

Metzner (1985), environmental factors that may affect student attrition are finances,

hours of work per week, outside encouragement, and family responsibilities. In their

research they also have found that nontraditional students having at least one child living

at home have a greater dropout rate than those who do not.

The researchers concluded that attrition rates increase with the number of children

living at home due to an increase in family obligations. The interviewed students all had

children living at home and four had spouses or significant others. One student continued

to run the family business while enrolled in order to support her family financially. All

interviewees still had family responsibilities such as child care, household chores,

cooking, car pooling, car maintenance, and holding down a job to support their families.

Five of the six students reported that, in their case, academic factors also had a

strong influence on their dropout status. Academic variables included management of

study time, study methods, absenteeism, and preparation for college courses.

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Review of the interview data revealed that students reported factors affecting their

success were the same as those identified by Bean and Metzner (1985) in their

Conceptual Model of Nontraditional Student Attrition. The following table is a summary

of factors that were identified by the students as contributing to their attrition.

The interview results suggest that associate degree nursing programs have a

subculture that is a natural support system for students. The student to student and student

to faculty interactions seen in the day to day activities of nursing programs provide an

added dimension of support for students. This additional support and encouragement

reinforces support provided by family and friends and leads to greater retention rates.

Each of the students reiterated that their nursing programs provided friendships and study

groups that, if utilized, would have greatly helped them to remain in college.

Table 4.11

Interview Results Summary: Variables Students Identified as Influencing Their Attrition

Variables Identified Number of Affirmative Student Responses

Background and Defining Variables:

Major Life Events Single parent Divorce Hospitalization Drive to school greater than twenty

minutesRequired Nursing Program Classes

Took all courses toward nursing degree simultaneously

Inadequate High School Preparation for College

3111

5

6

63

Academic Variables:

Study Methods Inconsistent Lacked effective study methods Lack of participation in study groups

663

Lack of adequate study time 5

Absenteeism 1

Inadequate academic preparation for nursing courses

6

Environmental Variables:

Lack of encouragement from family/friendsFamily ResponsibilitiesChildren living at homeFinancial ConcernsEmployment while enrolled in nursing program

56656

Social Integration Variables:

Friendship/contact with classmates Lack of supportive friendships Lack of participation in study groups

55

64

CHAPTER 5: Summary, Recommendations, and Conclusions

Summary

This mixed method study explored factors that affect student attrition. The

purpose was to discover if background and defining, environmental, academic, or social

factors can predict student persistence. The goal was to obtain current and dropout

student’s opinions as well as an analysis of admission criteria of students entering

associate degree programs related to student attrition. This data can then be applied

toward improving retention rates.

The construct of this study is designed to glean information from experiences of

nursing students and directors of associate degree nursing programs. The sample

population has the unique experience of being current 5th-semester nursing students, and

can accurately answer survey questions since their experience as a nursing student is

recent. The directors of ADN programs are in positions that allow them to have the

ability to set standards for program admissions. In particular, this study quantitatively

examined the following basic questions: 1. What admission criteria factors are predictive

of student retention in associate degree nursing programs? 2. Do the Bean and Metzner

(1985) Nontraditional Student Attrition Theory predictive factors indentify

retention/attrition behaviors for students in an associate degree nursing education

program? Subquestions specifically addressing these questions include

Does high school performance, high school class rank, or prior experience

in the medical field impact retention rates?

Do scores on preadmission tests or grades on prenursing courses impact

retention rates?

Is there a greater number of qualified applicants than spaces for admission

into ADN programs?

Are preadmission interviews significant predictors of student retention?

Do ADN students identify specific background and defining variables as

affecting their own persistence?

Do ADN students identify specific academic variables as affecting their

own persistence?

Do ADN students identify specific environmental variables as affecting

their own persistence?

Do ADN students identify specific aspects of social integration into the

college network as affecting their own persistence?

Which, if any, of these factors have a stronger effect on student

persistence in associate degree nursing programs?

The results of this study indicate that Bean and Metzner’s (1985) Nontraditional

Student Attrition Theory is applicable to associate degree nursing students in North

Carolina. Quantitative analysis of student surveys show that the most important factors to

student persistence are class attendance, adequate high school preparation, studying more

than 5 hours a week, and personal desire for a dependable and well-paying job. Results of

the student interviews also support these findings. The director survey analysis shows

there was not a significant difference in the selection criteria for admissions in ADN

66

programs. Therefore, these results are not useful in identifying admission criteria that,

when used, would predict student success.

Overview of Findings

The following pages address the research findings relative to each research

question and supporting literature. Revision to the study’s conceptual framework is

discussed. Next, limitations of the study and implications for policy and practice are

discussed. Lastly, topics for future research are addressed.

Research Questions

What admission criteria factors are predictive of student retention in associate degree

nursing programs?

There are no set standards in North Carolina for admission into associate degree

nursing programs. Therefore, each school is at liberty to develop its own criteria for

admission. The data obtained through the director survey reveals that most schools have

similar admission requirements, yet they vary widely in attrition rates. Since 80% of

directors surveyed had identical responses, it is impossible to determine if the criteria

currently used supports student retention. In retrospect, the survey should have addressed

cut scores and/or point systems that each school used to determine student selection. A

correlational analysis of such data with retention rates could have revealed more useful

information concerning retention.

The majority of supporting literature focused on individual factors that affect

student nurse retention (Bagayoka & Kelly, 1992; Boyle, 1986; Potolsky, Cohen, &

Saylor, 2003; Spady, 1970; Tinto, 1987). These researchers focused their studies on

academic GPAs and prerequisite sciences. Their results supported that higher academic

67

grade point averages of high school and college courses and B or better averages in

prerequisite science courses resulted in greater student success. This study was unable to

support previous findings because no data was gathered on cut scores and required grades

of individual students seeking admission to ADN programs.

Do the Bean and Metzner (1985) Nontraditional Student Attrition Theory predictive

factors indentify retention/attrition behaviors for students in an associate degree nursing

education program?

The results of this study supported constructs forwarded in Bean and Metzner’s

(1985) Nontraditional Student Attrition Theory. All four major constructs (background

and defining, academic, environmental, and social categories) were found to be

influential. Nursing students identified environmental constructs as the most important

factor influencing their persistence. Of these environmental constructs, attending class

regularly, family support and encouragement, and faculty/student relationships were

viewed as major components. Other factors identified as important included high school

preparation, being able to manage time to complete assignments, academic rigor in

nursing programs, and need of financial assistance for school and living expenses.

Dropout student interviews also provided important results of this study.

Although the sample was too small to provide statistically significant findings, these

students all identified that the main reason for their dropping out was poor academic

performance. This poor performance was attributed to a variety reasons, such as lack of

family support and insufficient financial support. Ultimately these factors affected the

students’ academic performance resulted in their failure.

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Studies reported in the literature by Grosset (1991), Nora (1987), Nora and

Rendon (1990), and Pascarella and Terenzini (1980) have all used Bean and Metzner’s

(1985) theory; they found that the four categories of variables to be helpful in identifying

student persistence. This study extended Bean and Metzner’s theory into the nursing field

and also produced findings consistent with their predictions.

Revised Conceptual Framework

The four variables that influence student attrition according to Bean and

Metzner’s (1985) theory background and defining, environmental, academic, and social

were used in this study. These adequately identified the student’s perception regarding

their attrition, but they did not address factors associated with retention from the

institutional perspective. In a revised framework, additional information could have been

obtained from the director’s survey including items such as required scores for entry

exams and GPAs. Using this information, a correlation could have been drawn between

institutional requirements for entry into nursing programs and student attrition rates.

Limitations

There are limitations in both the director and the student sections of this study.

In both areas the surveys were limited to community colleges in northwestern North

Carolina. There may be differences in community college programs in other regions due

to economic and environmental issues. Regarding accessibility, the survey was given to

current nursing students, not students who exited prior to graduation and had not returned

to a program or students who had already graduated. Had either of these groups been

interviewed, they may have provided different answers especially if students experienced

a decrease in emotional response to a failure or to the stress of a rigorous program as time

69

passed. In other words, surveying a broader group or a different variety of students may

have impacted results. Also, general, self-report directors’ survey produced limited

information; this may have been alleviated by interviewing the directors. More in-depth

data collection from directors may have lead to information that would have brought out

the need for further data to find out specific admission requirements.

Implications for Policy and Practice

Policy Implications

Recommendations for national and regional policy include an increase in federal

and state funds to provide grants, scholarships, and loans to augment the number and

training of faculty and financial support to students in nursing school. A greater number

of nursing faculty could lead to more faculty/student interaction and allow institutions to

expand the overall number of students in nursing programs. Organizations such as the

National League for Nursing, American Nursing Association, National Nursing

Associations, and State Nursing Associations need to become more involved in financing

and supporting nursing students. Further, it is recommended allocated funds for tutoring,

mentoring, counseling, and informing prospective students about the expectations of

nursing school.

State policy recommendations include an increase the number of scholarships and

loans for nursing students and provision education in elementary, middle, and high of

schools to inform students about a career in nursing. North Carolina should increase the

number of scholarships that can be repaid by working as a registered nurse in the state.

Counselors need to be informed and encouraged to screen students regarding their

70

interest and ability to become nurses and to encourage students with the highest

probability of success to attend nursing school.

Regionally, hospitals, postsecondary institutions, doctors, and nurses need to be

more proactive in recruiting, supporting, and financially assisting nursing students.

Similarly, nursing programs in community colleges should recruit, provide academic

support, and also counsel students on how the demands of nursing school can cause stress

to the family unit and how to deal with this added stress.

Implications for Nursing Faculty

The findings of this study identified that nursing students are more successful

when they feel supported by nursing faculty. Nursing faculty need counsel to provide

instructions on how to support students in nursing programs. As role models and leaders,

faculty mentors should share their practices for successful nursing and support and

encourage students in their endeavors. They can encourage students to develop a sense of

togetherness and community which is essential in the nursing field. Students who have

these bonds are more likely to be retained.

Since strong mentor relationships were found to increase retention and the

national nursing student attrition rate averaging around 37% (Petty & Todd, 1985, North

Carolina Institute of Medicine, 2004) student nurses are unlikely to be receiving adequate

mentoring. This might be due to professionals in the field and nursing faculty never

having mentors themselves. If they were exposed to mentoring what was the quality of

this support? Perhaps more faculty would understand the need for supporting student

nurses if they themselves had personally been involved in a strong mentorship as a

student.

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Implications for Practice in Educational Institutions

In practice, administrative leaders at schools of nursing need to recognize the

importance of factors affecting student retention rather than relying on current acceptance

and placement practices. Leaders cannot rely solely on the desire of students to become

nurses and ignore the psychological and academic support that students need in order to

succeed. Student service/support departments need to become more involved by offering

tutoring, financial counseling, and psychosocial counseling. Schools should encourage

faulty/student interaction as well as student/college interaction. With 64% of students in

the survey identifying that faculty support was helpful and 61% identifying that faculty

valuing and caring for them as a person was supportive of their persistence, implementing

a faculty mentoring program would be very beneficial. The development of faculty

mentoring relationships with students could be a key component to student success by

providing students with fulfilling experiences that support them throughout their

program.

Lack of significant findings involving requirements for student entry suggests that

schools need to start analyzing their admission requirements to determine those that

influence retention. With over 50 associate degree programs in North Carolina, there is a

significant pool from which data can be collected. Obtaining research results would be

useful in selecting students who are more likely to succeed.

Implications for Students

Students in the study sample had limited knowledge regarding nursing program

requirements or expectations in the field. It is important for entry-level nursing students

to fully understand the environment they are preparing to enter and how to manage the

72

demands placed upon them. They will bear the burden of upholding academic excellence

associated with an institution or working to improve this status for some institutions.

Students need to have an awareness of the issues related to persistence and to set goals to

succeed. To accomplish these goals, they should be aware of the organization’s

commitment to excellence as well as services such as mentoring and tutoring. Students

should anticipate the need for socialization and networking into the college environment.

Another recommendation is development of mentoring programs between senior

students and underclassmen. This would help socialize students as they enter into the

nursing school environment. Such programs increase student confidence in their ability to

succeed, provide encouragement, provide a study partner, and help develop friendships

with peers who are personally involved with the students’ success.

Recommendations for Future Research

Future research should continue to build upon factors that enhance student

persistence. Data from this study identified factors that improve student persistence.

Continued research needs to be performed to identify more specifically how to support

students in these areas. The following paragraphs suggest two directions for future

research.

First, further research needs to be conducted, possibly experimental research, to

identify factors that will assist nursing programs to admit students who will be successful.

This study has not uncovered any identifying factors in admission criteria that correlate

with retention rates. With today’s cost of nurse training programs and the increasing need

for nurses, schools of nursing have even more responsibility for graduating a greater

number of students qualified to take and pass the NCLEX.

73

Secondly, this study identifies factors that facilitate retention once students enter a

program of study. These include improved social integration and environmental

variables. Faculty can educate and support students simultaneously on factors that have a

positive impact on retention and encourage students to strive to obtain success. Student

services departments in community colleges can also help students to identify these

factors prior to being admitted in order to assist them to become more aware of what

enhances their success once they are admitted. Increased retention rates are positive for

students as well as for schools. Students spend a tremendous amount of time, effort, and

money to attend nursing programs. Further research needs to be conducted in this area to

support the present research and to identify new factors that support student retention.

The interview phase of the study gathered information from a small sample of

students to collect information that may have attributed to their attrition. The result of the

interviews with these students supports Bean and Metzner’s (1985) four concepts in their

model of nontraditional student retention. The student’s position in their life, their

responsibilities, time management, financial needs, and outside support all contributed to

their failure. In-depth interviews in specific areas and focus groups could be conducted

with an expanded sample, and provide much needed research results.

Nursing educators are obligated to protect the safety and welfare of the public by

ensuring that all students who graduate from nursing programs are competent. With

today’s limited budgets in higher education and increased requirements for colleges to

demonstrate accountability, it is important to admit students who are likely to succeed

and to support those who are admitted in order to retain them. Each of the nursing

programs in this study had well established admission requirements. These criteria were

74

created in an effort to alleviate admitting students unlikely to succeed as competent

nurses. However, high attrition rates among nursing students reflect the need for

additional research to uncover more effective admission standards.

Although researchers have conducted many studies on predictors of success, a

limited number of studies have been conducted on nursing education, and even fewer of

these address associate degree nursing. Unfortunately, none of the studies have

consistently identified a unique set of criteria for admission into nursing programs which

improve student success. Because change continues to occur in nursing education, both in

the type of student recruited into nursing and the information and skills needed to be

successful in programs, it is difficult to achieve a single consistently accurate method to

select students who are likely to succeed. However, each school can benefit by evaluation

of institution-specific student academic information and by studying research conducted

at similar institutions that identifies factors contributing to successful student retention.

Conclusions

This study was conducted using community college ADN programs in North

Carolina; it sought to discover if admission criteria for nursing school were a predictor of

student persistence and to determine whether Bean and Metzner’s (1985) Student

Attrition Theory was applicable for associate degree nursing students. Information on

students admitted into each college in the class of 2005 and the class of 2006 across the

state at selected institutions were studied. The admission criteria for each school were

compared with the retention rates of these classes. The study also evaluated student

responses to a survey which focused on variables that led to their success via retention.

75

The final phase of the study was to interview students who had been unsuccessful in their

ADN program studies to identify barriers that may have affected their attrition.

This three-part study consisted of nursing directors and student nurse surveys and

student interviews. The outcomes from the director surveys of the study provided little to

no helpful data. The student surveys and interviews revealed useful information.

The director survey did not provide information that could be useful in predicting

student retention. Due to the fact that nearly all the respondents were uniform in their

responses to all the items on the Nursing Directors Questionnaire, the results were not

useful in predicting what admission criteria can predict student retention. It was

determined that all ADN programs in North Carolina had very similar admission criteria

and a wide range of retention rates. There was not a correlation found between any

admission variable and retention data for the students admitted classes of 2004 and 2005.

This led to the conclusion that further research needs to be conducted to identify

admission criteria that will assist ADN programs in admitting students who will be

successful.

The student survey phase of this study did provide information that can help

students and educators identify factors that support retention. For example, students who

have social integration and environmental support are much more likely to be retained

than those who do not. Also students who exit programs were shown to be less socially

integrated. These conclusions were supported by the student interviews.

The urgency of the current nursing shortage makes understanding student

persistence a necessary step to help alleviate this problem. Nursing programs need to find

ways to enhance institutional retention of their students. The goal is to apply admission

76

criteria that increase student success and to assist students with dealing with the stressors

of nursing school once they are admitted. It is time for educational institutions to assist

students in making their environment and workload in nursing programs as conducive to

success as possible – for future nursing students and the future of nursing.

77

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APPENDIX A DIRECTOR SURVEY

Associate Degree NursingNURSING DIRECTOR QUESTIONNAIRE

This questionnaire has been designed to assess the selection process of associate degree nursing programs of North Carolina.

1. Does your department have an “open door” policy? Yes___ No___

2. What admission tests are required by the college?

a. English Yes___ No___

b. Math Yes___ No___

c. Personality test Yes___ No___

d. Other (please specify) _____________________________

3. What tests are required by the nursing program in addition to the tests required by the college?______________________________________________

4. Do you require a minimum grade point average for admission? Yes___ No___

If yes, please specify. High school__________ College______________

5. Do you require high school class rank for admission? Yes___ No___

If yes, please specify class rank required ___________

6. Is successful completion of the following high school courses required for admission to your program?

a. Biology Yes___ No___

b. Chemistry Yes___ No___

c. Computer Yes___ No___

d. Basic Mathematics Yes___ No___

e. Algebra Yes___ No___

f. Physics Yes___ No___

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g. Other (please specify) ____________________________________

7. Do you admit students with a high school equivalency certificate? Yes____ No____

8. Do you require prerequisite college level courses? If yes, please check below.

a. Chemistry _______b. Microbiology_____c. Anatomy ________d. Physiology_______e. English__________f. Psychology_______g. Sociology________h. Speech__________i. Other____________

9. Do you require a CNA (certified nurse assistant) certificate prior to admission to the nursing program? Yes___ No___

10. Do you allow licensed practical nurses, medical technicians, paramedics, and/or military credit for advanced placement? Yes_____ No_____

a. If yes, are they required to take an entrance exam? Yes___ No___

b. If yes, do you require the completion of science courses prior to admission? Yes____ No_____

c. Specify science course required.

Psychology Yes_____ No_____Anatomy Yes_____ No_____Physiology Yes_____ No_____Microbiology Yes_____ No_____

Other__________________________

11. Do you require a written personal letter of reference for admission? Yes___ No___

If yes, please state preference of source for above references. a. Minister Yes_____ No_____b. Former teacher Yes_____ No_____c. Employer Yes_____ No_____d. Other ________________________

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12. Do you interview applicants for the program? Yes_____ No_____

a. If yes, do you do individual interviews? Yes_____ No_____b. If yes, do you do group interviews? Yes_____ No_____c. What is the size of the interview group? ______d. How many individual interviewers are required? ______

13. Who does the interview?

a. College counselors Yes_____ No_____b. Nursing faculty Yes_____ No_____c. Other (please specify) ______________________

14. What major interview techniques are used?

Please provide a concise summary ____________________________________ ________________________________________________________________

15. Do you receive more applications annually than you accept? Yes_____ No_____

16. What method do you use for handling the oversubscription of applications? Check the appropriate box (es):

a. Random selection Yes_____ No_____b. Highest scores on required entrance test Yes_____ No_____c. Performance in interview Yes_____ No_____d. High school performance (this includes GPA and recommendations) Yes_____ No_____e. Grade point average of college courses Yes_____ No_____f. Grade point average of college based courses required for nursing Yes_____ No_____g. “First come, first served” acceptance after testing until quota is reached Yes_____ No_____h. Select a certain quota of applicants from predetermined groups (i.e. high

school students, applicants with health-related work experience, licensed practical nurses, technicians, certified nurse assistants, etc.), age and/or sex, minorities, bilingual or socio-economically disadvantaged students.

Yes_____ No_____i. If yes, briefly describe your predetermined method:

________________________________________________________ ________________________________________________________j. other ___________________________________________________

17. How many students did you admit in 2003? _______ 2004? _______

18. How many students did you graduate in 2005? _____ 2006? _______

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19. What was your student retention percentage for your graduating class of 2005? _______ 2006? _______

20. Is you program NLN accredited? Yes___ No___

21. Does your nursing program require additional admission exams for the nursing program in addition to the colleges requirements? Yes_____ No_____

22. Does your nursing program use the following preadmission test for entry into the nursing program?

a. TEAS (test of essential academic skills) Yes___ No___b. Pre-English of any kind Yes___ No___c. Pre-Math of any kind Yes___ No___

23. Would you like a summary of the results of this survey? Yes_____ No_____

If yes, please provide the following contact information:

Name________________________________________

Address______________________________________

_____________________________________________

E-Mail Address_________________________________

Please attach a copy of your admission criteria application form.

I sincerely thank you for your participation in this survey.

Wanda Douglas

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APPENDIX B STUDENT SURVEY

To the nursing student filling out this survey:

I am a doctoral student at Appalachian State University and am collecting information for

a study addressing student retention in associate degree nursing programs in the state of

North Carolina. This questionnaire is designed to determine what factors promote

retention in associate degree nursing students. By filling this out, you consent to be part

of this research. These questionnaires are absolutely anonymous, so there is no need

to put any personal identification such as your name, initials, or signature on this

document. I will distribute and collect the questionnaire myself, and the only other

persons to see these will be my research committee. It should take about twenty minutes

to complete, and your response will be most helpful to the field of nursing.

Thank you for your assistance with this survey,

Wanda Douglas

Doctoral Student Appalachian State University

145 Fairview Lane

Wilkesboro, NC 28697

336-838-8977

[email protected]

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mailto:[email protected]

Associate Degree NursingStudent Questionnaire

This questionnaire has been designed to assess what students feel are their reasons for remaining in associate degree nursing programs.

Please rate the following statements on a 1-5 scale (1 being the least important and 5 being the most important) in influencing you to remain in your associate degree program.

1. Being able to find enough time to complete my study assignments.

Least Important Most Important

1 ___ 2 ___ 3 ___ 4 ___ 5 ___

1. Faculty giving me the support and encouragement I need to be successful academically.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

2. My interaction with faculty outside the classroom.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

3. My interaction with faculty inside the classroom.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

4. My ability to actively participate in class by answering questions and/or taking part in the discussion.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

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5. Faculty valuing and caring for me as a person.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

6. Teaching methods or strategies used by faculty.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

7. My involvement with social activities on this campus.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

8. My attending nursing classes on a regular basis.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

9. My participation in group study.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

10. Getting tutoring from the college.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

11. Out of class intellectual activates such as seminars or discussions.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

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12. The amount of time I spend earning money interfering with my study time.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

13. The amount of time I spend taking care of my family and home obligations interfering with my study time.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

14. The time I spend in social activities interfering with my study time.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

16. Support, encouragement and/or friendship from my classmates.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

17. Support and/or encouragement from my family or significant others.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

18. Encouragement and/or support from my place of worship.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

19. Encouragement and/or help from community members or agencies.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

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20. Most of my friends having or planning to get a college education.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

21. My family willing to sacrifice for me to go to college.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

22. The difficulty of the academic work in the nursing program.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

23. My need of financial aid in order to pay for my nursing education.


1 ___ 2 ___ 3 ___ 4 ___ 5 ___

The following are questions about your academic skills in preparation for college.

24. Overall, would you say your academic high school preparation for college was

Poor ___ Fair ___ Good ___ Excellent ___

25. Would you say your English language skills/writing skills preparation for college were


26. Would you say your math skills preparation for college were


27. Would you say your science skills preparation for college were


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28. Would you say your reading skills (comprehension/speed) preparation for college were


29. Do you hold (or have you ever held) any of the following credentials?

Certified Nurse Aid Yes ___ No ___

LPN (licensed practical/vocational nurse) Yes ___ No ___

Paramedic Yes ___ No ___

Associate Degree in any field Yes ___ No ___

Bachelor Degree in any field Yes ___ No ___

30. Did you ever withdraw, fail out, or stop attending an associate degree nursing

program for a semester or more?

a. No ___ (Skip to question 40) b. Yes ___ (complete questions 31-39)

When you left nursing program, how important was each of the following reasons:


31. Failure to attain minimum grade 1 2 3 4 5

32. Lack of money 1 2 3 4 5

33. Family illness 1 2 3 4 5

34. Problems with children 1 2 3 4 5

35. Personal illness 1 2 3 4 5

36. Divorce or separation 1 2 3 4 5

37. Lack of support from significant other 1 2 3 4 5

38. Pregnancy 1 2 3 4 5

39. Other (please specify) _____________1 2 3 4 5

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How true was each of the following factors in your decision to enter nursing as a career?

Not at all true Very true

40. I always wanted to be a nurse. 1 2 3 4 5

41. I have relatives who are nurses. 1 2 3 4 5

42. I want a career where I can help people. 1 2 3 4 5

43. My high school counselor recommended 1 2 3 4 5 nursing. 44. A career counselor recommended nursing. 1 2 3 4 5

45. I want a job that requires a lot of knowledge 1 2 3 4 5 and skills.

46. I want a steady job with little likelihood of 1 2 3 4 5 layoffs.

47. I want a job that pays well. 1 2 3 4 5

48. Other (please specify) __________________ 1 2 3 4 5

49. How many hours per week do you typically spend studying?

0-5 ___ 6-10 ___ 11-15 ___ 16-20 ___ 21-30 ____ 31 + ____

Comments:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

I sincerely thank you for your participation in this survey.

Wanda Douglas

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APPENDIX C INTERVVIEW GUIDE

Associate Degree Nursing Interview Guide

The following questions represent the interview guide for a semistructured interview that

will be conducted with students who have dropped out of associate degree nursing

programs. All participants will be volunteers. The interview will have a conversational

tone and will come directly from the guidelines. The questions are organized around the

variables present in the Bean and Metzner Model of Nontraditional Student Attrition.

Background and Defining Variables

Age

Enrollment status

Residence / distance traveling time to and from school when in nursing program

Work / full / part time

Sex

Ethnicity

Parent’s education

Tell me about yourself (high school education, your original educational goals)

How did you come to choose nursing as a career? Do you have family members

who are nurses? What do your family and friends think about nurses in general?

Tell me about your nursing education. When did you start taking courses for

your nursing degree? How many courses or credits did you take each semester?

Did you ever attend any other nursing program?

Academic Variables

GPA

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Class rank in high school

Tell me how things have been for you academically while attending the nursing

program. I’d like for you to tell me about how you organized yourself for

studying and attending classes, labs, and clinical. What is your opinion about the

academic difficulty of your courses? Do you feel you had enough time to study?

Do you feel that your high school academic preparation was sufficient, or did you

get help for your study skills? If yes to the latter, how did you decide to get that

help? Did you sit in on study sessions with your friends or classmates?

What do you think about the academic advising you received while you were in

the nursing program? Who was your advisor or how were you advised?

Did you attend classes on a regular basis or were you absent from any classes,

labs, or clinical? If yes to the latter, how did that come about? Please describe

your absences. Were they occasional or more extensive? What was the faculty

response to your absences?

Please tell me about the most difficult part of attending the nursing program, and

about the best part of attending the program. If you had any sad or difficult times

in the program, please describe them. Were they related to the program itself or to

personal issues? Did you keep going at that point? If so what encouraged you to

continue?

How certain were you that you had chosen the right career? How easy do you

think it would be to get a job in nursing? Do you regard these positions as well-

paid?

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Environmental Variables

While you were in this nursing program, did you have difficulty with finances?

Was this a problem before you attended the program or just related to being a

student in the nursing program? Did you work while you were in school? If yes,

about how many hours each week did you work while classes were in session?

Did you have family responsibilities while you were in the program? Children?

Elder care? Housework such as cooking, cleaning, and laundry?

Was there anyone (or any group of people) that you would consider to have been

the most supportive?

Social Variables

While you were in this nursing program, did you have any opportunity for

socialization? Can you describe this? Did you belong to any campus clubs or

groups?

Tell me about your classmates. Did you socialize with any of them after class or

clinical? Did you have any formal or informal study groups?

Please tell me about the faculty. Did you find them supportive and helpful? Did

you speak with them outside of class?

Do you have any comments or questions about this study? Do you have any advice for

future nursing students based on your experiences?

Thank you for your time.

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AUTHOR RESUME

Wanda Taylor Douglas, Ed.D, M.S.N., B.S.N.145 Fairview Lane, Wilkesboro, NC 287967

EXPERIENCE

Wilkes Community College, Wilkesboro, NCLead Instructor, Second Year Nursing, 1986-present

Winston-Salem State University, Winston-Salem, NC Out-Reach RN-BSN Instructor, 1991-present

Wilkes Regional Medical Center, North Wilkesboro, NCStaff nurse (obstetrics and cardiac/intensive care), Supervisor, 1976-1986

EDUCATION

Doctor of Education in Educational Leadership (Ed.D), May 2009 Appalachian State University, Boone, NC

Master of Science in Nursing (MSN), May 1991 University of North Carolina at Greensboro, Greensboro, NC

Bachelor of Science in Nursing (BSN), May 1986 Sigma Theta TauUniversity of North Carolina at Greensboro, Greensboro, NC

Associate Degree in Nursing (ADN), May1979Caldwell Community College and Technical Institute, Lenoir NC

Practical Nursing Degree (PN), August 1976Wilkes Community College, NC

PROFESSIONAL ACTIVITIES

Advisor, Nursing Student Club, 1991-presentChair, Nursing Pinning Ceremony, 1997-presentCommittee member: ADN Council, Acclimate Weather, Fall Festival, Nursing Admission, Nursing Advisory, and Domestic Violence

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HONORS

Student Nomination Who‘s Who Among America’s Teachers, 2002Spirit Award for Integrity Winston-Salem State University, May 2001Sigma Theta Tau Honor Society, University of North Carolina at Greensboro, 1986.

TRAINING AND CERTIFICATIONS

Certified Cardio-Pulmonary Resuscitation Certified OSHA TrainerRegistered Nurse

PROFESSIONAL PRESENTATAIONS

Douglas, W.T. (1992, May). The amount and type of research conducted in maternal-child nursing. Paper presented at the 10th Annual National League for Nursing Council for the Society for Research in Nursing Education, San Francisco, CA.

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