Curriculum design and attrition among undergraduate nursing students: A systematic review

Attrition rates among nursing students are a global issue, and a possible factor in current nursing shortages. Numerous studies have been conducted to determine why students drop out of nursing programmes. The limitations of previous studies have included overly small sample sizes, being largely descriptive, and not focusing on attrition as an outcome. The aim of this study is to review the issue of attrition among undergraduate nursing students in relation to curriculum design. Five electronic databases, namely CINAHL, Medline, Cochrane Library, British Nursing Index, and PsycINFO, were adopted. Using the Population-Intervention-Comparison-Outcome model, search terms were identified, such as ‘student nurse’, ‘undergraduate programme’, ‘curriculum design’, and ‘attrition’. Mixed Method Appraisal Tools were used to evaluate the methodological quality of the identified research papers. A total of 16 publications were reviewed and four themes were identified: pre-enrolment criteria for recruiting nursing students; curriculum content; clinical placement-related policies; and student support services. Institutional-level risk factors that could be reduced were identified, including academic failure, poor clinical performance, stress, and unrealistic expectations of nursing. This review gives insights into how a curriculum for undergraduate nursing programmes can be designed that will engage students and increase the nursing workforce.