Breakthrough to nursing. Retention--the problem at hand.
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In the cohort of 1337 former Johns Hopkins medical students from the classes of 1948 through 1964, there were 1248 graduates and 89 nongraduates. In follow-up studies of this cohort, 49 subjects, 3.1% of the graduates and 11.2% of the nongraduates, have been found to have died prematurely. Incipient mental illness and emotional disturbance appear to have contributed substantially to academic failure, poor performance during and after medical school, and premature death. These findings underscore the need for learning to identify and help medical students who are especially vulnerable to stress. Such insights would contribute to the prevention of premature disease and death, not only from mental illness but from other disorders.
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BACKGROUND: Attrition among preregistration nursing students remains a persistent international challenge, contributing to nursing workforce shortages. Although extensive research has examined factors influencing student attrition and retention, the evidence is fragmented across review-level literature, limiting clarity regarding priority and evidence-informed retention strategies. AIM: To synthesize review-level evidence on factors associated with preregistration nursing student attrition and to identify strategies that support student retention in university-based nursing programs. METHODS: An umbrella review was conducted in accordance with the Joanna Briggs Institute methodology. Six electronic databases were systematically searched for peer-reviewed literature reviews published in English between January 2016 and October 2025. Eligible reviews focused on undergraduate preregistration nursing students in face-to-face university programs. Methodological quality was appraised using the JBI critical appraisal checklist. Findings were synthesised using narrative and thematic approaches. RESULTS: Seventeen literature reviews were included. Attrition was consistently described as multifactorial, influenced by academic preparedness, psychosocial wellbeing, socio-demographic factors, and institutional support. Retention strategies reported across reviews were predominantly relational, developmental, and sustained over time, including mentoring, tutoring, academic skills development, psychosocial support, and interventions that foster belonging. Faculty engagement and holistic approaches were repeatedly associated with improved student persistence. However, the evidence base was largely descriptive, with limited experimental evaluation of intervention effectiveness. CONCLUSION: Preregistration nursing student retention is best supported through multifaceted, sustained strategies that begin at admission and extend throughout the curriculum. While current evidence highlights consistent patterns of effective support, further rigorous research is required to evaluate retention interventions and extend evidence to flexible nursing education pathways.
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In an attempt to identify attitudinal orientations that might be used as indicators of attrition, demographic, academic performance, and attitudinal data on 261 students enrolled in the Woodruff School of Nursing at Emory University, Atlanta, between 1968 and 1972, were studied. Traditional measures of scholastic aptitude were not found to be good indicators. The higher the father's educational attainment, the more likely attrition was to occur. The higher the mother's occupational status, the less likely attrition was to occur. Attitudinal measures used in the study seemed to have little direct impact on attrition.
Head nurses and faculty members have their own beliefs on and attitudes towards the process of selecting candidates to schools of nursing. Many times these are based on impressions and/or everyday experiences that might have a crucial influence on perception of the issue. These impressions are not always verified when a study is conducted. This article reports on some of the issues and findings regarding attrition in one school for registered nurses in Israel during the years 1968-1974. It also describes what head nurses and faculty members thought to be valid criteria in the selection process, though findings revealed that things are not always as they are believed to be. For example, psychological tester recommendations were thought to be crucial in selecting candidates and preventing attrition, but no significant correlation was found between the recommendations and attrition. Head nurses thought that the main reason for attrition was dissatisfaction, although this was not found to be a stated reason. This belief of the head nurses should evidently be investigated. Findings support the author's belief that local studies are important and that faculty members and head nurses should communicate on the issue of student nurse selection and education.