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 2009
Doctoral 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
© 2009 by Wanda Taylor Douglas
All Rights Reserved
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
v
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.
vi
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.”
vii
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 Model................... 13
Astin’s Student Involvement Model ......................................................... 15
Cabrera, Castanedo, and Nora's Integrated Retention Model ................... 15
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
viii
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 Method........................................................................................... 31
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
ix
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 Questions ............................................................................................... 67
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
Conclusions ........................................................................................................... 75
References ......................................................................................................................... 78
x
Appendix A Director Survey ............................................................................................ 86
Appendix B Student Survey.............................................................................................. 90
Appendix C Interview Guide ............................................................................................ 97
Author Resume ................................................................................................................. 99
xi
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
xii
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; WittmanPrice & 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.
2
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
3
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
4
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
5
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.
6
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.
7
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 Models
Author
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, precollege schooling, goal commitment, the
institution’s commitment, and student
integration.
Bean and
Metzner
(1985)
Nontraditional Student Attrition Dropout decision is based on:
Model
background, defining, academic and
environmental variables.
Astin
(1975)
Student Involvement Model
Dropout decision influenced by: student
involvement, institutional advising and
counseling, independent study, and selfpaced instruction.
Cabrera,
Integrated Retention Model
Castanedo,
and Nora
(1993)
Dropout decision influenced by: social
integration, family support, academic
performance, and commitment to
institution.
Benjamin
(1990)
Dropout decision based on: student
satisfaction with their life experiences
during their educational endeavors.
Quality of Student Life Model
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 2year 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 4year 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 presemester 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.
33
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 Items
Variable
Research Question
Survey Item Number
Background and Defining
1. Does high school
4, 5, 6, 7, 9, 10, 17, 18, 19,
Variables:
performance, high school
20
class
rank,
or
prior
 High School
experience in the medical
Performance
field improve retention
 High School Class
rates?
Rank
 Former Medical
Experience
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:
4. Do pre-admission
11, 12, 13, 14
interviews
help
predict
 Extensive, high
student retention?
quality interaction
with people
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 selfaddressed, 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 Responses
Method
E-mail
Mailing 1
Mailing 2
Number Surveys
Administered
45
37
13
Number of Surveys
Returned
8
24
4
Percentage of Total
Response
18
71
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 Items
Variable
Research Question
Survey Item
Number
24, 25, 26, 27,
28, 29, 31, 40,
41, 42, 44, 45,
46, 47, 48
Background Variables:
 Educational
Goals
 High School
Performance
 Medical
Education
1. Do students identify background and
defining variables as affecting their own
persistence?
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:
4. Do students identify social integration
into the college network as affecting their
 School
own persistence?
Memberships
 Faculty Contact
 School Friends
Note. Adapted from Bean and Metzner (1985) and Creswell (2003).
2, 3, 4, 5, 6, 8,
10, 12, 16
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.
41
Students were directed to answer the questions based on how influential they felt each
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
42
all of the surveys and gave the same directions to each group of students. Students were
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.
43
Table 3.4
Variables Related to Student Interviews
Variable
Background Variables:
 Educational Goals
 High School
Performance
 Medical Education
 Family/Friends
 High School Class
Rank
 High School Class
GPA

Academic Variables:
 Study Hours
 Study Skills
 Absenteeism
 Major
 Job Certainty
 Difficulty of
Major







Interview Prompt
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?
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
44
well-paid?
Environmental Variables:
 Finances
 Hours of
Employment
 Outside
Encouragement
 Family
Responsibilities



Social Integration:
 School
Memberships
 Faculty Contact
 School Friends
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?

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
45
they would participate in an interview relating to student attrition and to set up a time that
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
Number of
affirmative
responses
Item
2. What admission tests are required by the college?
a. English
35
b. Math
35
c. Personality test
5
5. Do you require high school class rank for admission?
1
7. Do you admit students with a high school equivalency certificate?
34
8. Do you require prerequisite college-level courses in:
a. Chemistry
7
b. Microbiology
1
c. Anatomy
4
d. Physiology
3
e. English
4
f. Psychology
4
g. Sociology
0
h. Speech
1
i. Other
5
10. Do you allow licensed practical nurses, medical technicians,
29
paramedics, and/or military credit and advanced placement?
11. Do you require a written personal letter of reference for admission?
2
a
12. Do you interview applicants for the program?
4
15. Do you receive more applications annually than you accept?
35
20. Is your program NLN accredited?
7
21. Does your nursing program require additional admission exams in
29
addition to the college’s requirements?
22. Does your nursing program use the following preadmission exams
for entry into the nursing program?
a. TEAS (test of essential academic skills)
5
b. Pre-English of any kind
30
c. Pre-Math of any kind
30
a
Because 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 Groups
Bean 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, 49
Environmental Variables
13, 14, 17, 18, 19, 20, 21, 30, 32, 33, 34,
35, 36, 37, 38, 43
Social Integration Variables
2, 3, 4, 5, 6, 8, 10, 12, 16
Note. 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 Important
1. finding enough time to complete assignments
7.0
15.4
77.5
2. faculty giving me support to be successful
12.9
23.0
64.2
3. interaction with faculty outside of classroom
49.6
26.6
23.8
4. interaction with faculty inside of classroom
11.1
27.1
61.7
5. active class participation by answering questions
19.7
32.1
48.2
6. faculty valuing and caring for me as a person
16.7
22.3
61.0
7. faculty teaching methods help me be successful
7.5
15.5
77.0
8. involvement social activities on campus
80.4
15.7
3.9
9. attending nursing classes on a regular basis
4.4
7.3
88.2
10. participation in group study
41.6
21.3
37.0
11. getting tutoring from the college
72.3
17.8
9.9
12. out-of-class intellectual activities
65.0
27.2
7.8
13. time spent working interfering with study time
33.4
25.3
41.3
14. time with family interfering with study time
14.9
21.8
63.4
15. social activities interfering with study time
55.1
27.7
17.2
16. classmates/friends support and encouragement
8.5
19.8
71.7
17. family support and encouragement
3.7
6.4
89.9
18. place of worship support
23.7
18.6
57.7
19. community member or agency support
60.0
20.5
19.6
20. friends having/planning a college education
51.9
22.0
26.0
21. family sacrifice for me to go to school
13.0
15.0
72.0
22. 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
17.0
56.0
17.0
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
24. overall academic high school preparation
25. English language skills preparation
26. math skills preparation
27. science skills preparation
28. reading skills preparation
Percent
Poor/Fair
29.2
27.0
24.0
23.1
9.5
Percent
Good/Excellent
70.8
83.0
75.9
76.9
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 Skills
Number of
Poor
Fair
Items Selected
n
%
n
%
1
2
3
4
5
32
8
5
1
0
8.9
2.2
1.4
0.3
0.0
54
48
26
12
5
15.0
13.3
7.2
3.3
1.4
Good
n
64
82
57
44
52
%
17.7
22.7
15.8
12.2
14.4
Excellent
n
%
71
50
41
32
33
19.7
13.9
11.4
8.5
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 Students
Number of Credentials Held
n
0
19
1
258
2
77
3
6
4
1
5
0
Credentials Held
%
5.3
71.5
21.3
1.7
0.3
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
No
29. a Certified Nurse Assistant
18.8
29. b Licensed Practical Nurse
92.0
29. c Paramedic
97.8
29. d Associate Degree
86.4
29. e Bachelor Degree
84.8
Percent
Yes
81.2
8.0
2.2
13.6
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 Nurse
Item
40. I always wanted to be a nurse.
41. I have relatives who are nurses.
42. I want a career where I can help people.
43. My high school counselor recommended
nursing.
44. A career counselor recommended
nursing.
45. I want a job that requires skills.
46. I want a steady job without layoffs.
47. I want a job that pays well.
Untrue
n
%
64
24.5
162
67.2
2
1.7
302
86.8
Neutral
n
%
32
12.3
22
9.1
7
5.8
15
4.3
True
n
%
165
63.2
57
23.7
111
92.5
31
8.9
289
84.3
20
5.8
34
9.9
155
15
14
57.2
8.6
8.6
11
13
12
4.1
7.4
7.4
105
147
137
38.7
84
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.
59
Table 4.9
Number of Items Selected by Students as Important Influences to Become a Nurse
Number of Items
Untrue
Neutral
True
Selected
n
%
n
%
n
%
1
2
3
4
5
6
7
8
70
81
66
47
22
5
3
1
19.4
22.4
18.3
13.0
6.1
1.4
0.8
0.3
75
20
3
2
0
0
0
0
20.80
5.5
0.8
0.6
0.0
0.0
0.0
0.0
32
79
124
85
19
1
0
0
8.9
21.9
34.3
23.5
53.5
0.3
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.
60
Table 4.10
Student Identified Reasons for Dropping Out
Item
Not important
38.6
53.7
63.8
71.8
65.4
73.1
67.9
68.1
31. failure to attain minimum grades
32. lack of money
33. family illness
34. problems with children
35. personal illness
36. divorce/separation
37. lack of support from significant other
38. pregnancy
Percentage
Neutral
3.6
7.3
6.3
6.4
6.4
1.3
6.2
5.6
Important
57.8
39.0
30.0
21.8
28.2
25.6
25.9
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.
62
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
minutes
Required Nursing Program Classes
 Took all courses toward nursing
degree simultaneously
Inadequate High School Preparation for
College
3
1
1
1
5
6
63
Academic Variables:
Study Methods
 Inconsistent
 Lacked effective study methods
 Lack of participation in study groups
6
6
3
Lack of adequate study time
5
Absenteeism
1
Inadequate academic preparation for
nursing courses
6
Environmental Variables:
Lack of encouragement from family/friends
Family Responsibilities
Children living at home
Financial Concerns
Employment while enrolled in nursing
program
5
6
6
5
6
Social Integration Variables:
Friendship/contact with classmates
 Lack of supportive friendships
 Lack of participation in study groups
64
5
5
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.
68
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.
71
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 Nursing
NURSING 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?
a.
b.
c.
d.
Yes_____ No_____
If yes, do you do individual interviews? Yes_____ No_____
If yes, do you do group interviews?
Yes_____ No_____
What is the size of the interview group? ______
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)
b. Pre-English of any kind
c. Pre-Math of any kind
Yes___ No___
Yes___ No___
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
89
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
wdoug40@aol.com
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Associate Degree Nursing
Student 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.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
2. My interaction with faculty outside the classroom.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
3. My interaction with faculty inside the classroom.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
4. My ability to actively participate in class by answering questions and/or taking
part in the discussion.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
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5. Faculty valuing and caring for me as a person.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
6. Teaching methods or strategies used by faculty.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
7. My involvement with social activities on this campus.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
8. My attending nursing classes on a regular basis.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
9. My participation in group study.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
10. Getting tutoring from the college.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
11. Out of class intellectual activates such as seminars or discussions.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
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12. The amount of time I spend earning money interfering with my study time.
Least Important
Most Important
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.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
14. The time I spend in social activities interfering with my study time.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
16. Support, encouragement and/or friendship from my classmates.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
17. Support and/or encouragement from my family or significant others.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
18. Encouragement and/or support from my place of worship.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
19. Encouragement and/or help from community members or agencies.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
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20. Most of my friends having or planning to get a college education.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
21. My family willing to sacrifice for me to go to college.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
22. The difficulty of the academic work in the nursing program.
Least Important
Most Important
1 ___ 2 ___ 3 ___ 4 ___ 5 ___
23. My need of financial aid in order to pay for my nursing education.
Least Important
Most Important
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
Poor ___ Fair ___ Good ___ Excellent ___
26. Would you say your math skills preparation for college were
Poor ___ Fair ___ Good ___ Excellent ___
27. Would you say your science skills preparation for college were
Poor ___ Fair ___ Good ___ Excellent ___
94
28. Would you say your reading skills (comprehension/speed) preparation for college
were
Poor ___ Fair ___ Good ___ Excellent ___
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:
Least Important
Most Important
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
95
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
nursing.
1
2
3
4
5
44. A career counselor recommended nursing.
1
2
3
4
5
45. I want a job that requires a lot of knowledge 1
and skills.
2
3
4
5
46. I want a steady job with little likelihood of
layoffs.
1
2
3
4
5
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
96
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
97

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 wellpaid?
98
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, NC
Lead 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, NC
Staff 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 Tau
University of North Carolina at Greensboro, Greensboro, NC
Associate Degree in Nursing (ADN), May1979
Caldwell Community College and Technical Institute, Lenoir NC
Practical Nursing Degree (PN), August 1976
Wilkes Community College, NC
PROFESSIONAL ACTIVITIES
Advisor, Nursing Student Club, 1991-present
Chair, Nursing Pinning Ceremony, 1997-present
Committee 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, 2002
Spirit Award for Integrity Winston-Salem State University, May 2001
Sigma Theta Tau Honor Society, University of North Carolina at Greensboro,
1986.
TRAINING AND CERTIFICATIONS
Certified Cardio-Pulmonary Resuscitation
Certified OSHA Trainer
Registered 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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