Nursing Attrition (Based on the literature)

Implications of attrition

A term used to describe the condition of the nursing workforce nowadays by Urwin. et. al (2009, p.203), “the nursing workforce is ageing”, is an exact statement and it is felt mostly in developed countries. Many nurses found to be working in healthcare facilities nowadays are older people and most of them are in their fifties (Urwin. et. al 2009, p.203).  Based on the Code of Conduct for Nurses, they are expected to deliver their practical skill and knowledge to serve the community within their professional ability and responsibility (Hally, BM 2009, pp.80-85). Although there is no evidence stating that the nursing care delivered by these mature nurses is unsatisfactory, presumably, if the health services are delivered by younger nurses, it will be better in terms of quantity and fulfillment of workloads.

Another issue occurring in relation to nursing attrition is the shortage of nurses. Many healthcare providers in developed countries have been recruiting nurses from overseas to come and fulfill the needs of nursing workforce in their countries. Nurses from developing countries are encouraged by the perquisites offered and decided to leave their home countries to pursue a better life by migrating and working in developed countries. Muula. (2003, p.5) explains that the loss of nurses from a developing country, such as Malawi, has resulted in a shortage of nurses within the country. As a result, shortage of nurses becomes an issue in both developing and developed countries which eventually causing problems in social, politic and economic condition.

Causes of attrition

The fact that healthcare institutions and the community are always in need of nurses is an essential reasons that challenged many academics to advance knowledge about this issue and the cause of it. One of the theories in attrition mostly used to scrutinize on this issue is Tinto’s model of attrition (Stickney 2008, p.422).  Pascarella and Terezini (1991, cited in Stickney 2008, p.422) explain attrition based on the theory as “a longitudinal process that starts when students present with individual attributes, family backgrounds, and academic characteristics and skills”. The hypothesis indicates that there are essential factors that influence the attrition and each factor could have different several aspects within one person to another. In regards of the family background, two students who come from different ethnicity may have diverse family value or beliefs that influenced them in making a decision. Thus, research findings explaining the causes of attrition are generally too broad.

Glossop (2001, cited in Mulholland 2008, p.51) lists the contributing factors of nursing attrition according to a literature review, which are ‘academic failure’, private and domestic issues, ‘wrong career choice’, economic issues, transporting issues, health issues, inadequate management of the program, unconstructive attitude of the workforce, requirements expected from the program, insufficient information given before the program started, inadequate reinforcement from the tutors, gap in what they have studied from the theories in classes and applying them in the clinic, and inconsistent clinical placements. There was no further explanation on which factor has higher intensity to cause attrition, but by analyzing the list and correlate it to Tinto’s model, it is unlikely that only a factor, such as transporting issue, provoked a student to leave the program. It could be a possibility that there is an interaction amongst the factors to cause attrition. For example, when a student is having a financial problem, transportation issue may occurs because to attend clinical placements which are usually reasonably far from home may need considerable amount of money for bus tickets or petrol and parking. In addition, student with financial issue may not afford to buy textbooks to keep up with the study and this may lead to lacking of knowledge or information and to fulfill the academic requirements which in turns reinforce the student to think that he or she has made a wrong choice by entering the program.

In other words, attrition cannot solely caused by one factor, as it is also stated by Deary (2003, cited in Pryjmachuk 2008, p.151.) that the explanation of dropping out from the program are complex and in all probability there is a connection between the factors that may cause it. Another method which is emphasized more on the factors related to incompletion of the program instead of attrition is presented by Pryjmachuk (2008) as ‘multi-factorial approaches’. This method offers a better point of view on understanding the issue because it gives explanation of what causes attrition in various aspects and supports the idea of diversity within every people (Mulholland 2008, p.51).


Florida Center for Nursing (2005, cited in Stickney 2008, p.422) classified several approaches to overcome the impact of attrition into three strategies. Firstly, the current nurses are expected to stay by enhancing or transforming the workplace setting. The second strategy is to create a better impression on the profession in order to promote nursing as a promising career. The last is to maintain the number of nursing student who have already set their goals and expect advantages from the profession.

Another strategy that can also be applied to overcome the problem is by improving the nursing education system, this includes the content of curriculum, orientation program, academic or staff attitudes toward student and their need of assistant in learning and a well structured program for clinical placements. As stated by Wells (2003, p.235) a dedication from the institution is required to achieve the goal of retaining students in the program.


Although the attrition rate of nursing is not the highest, attrition itself has always been a phenomenon that needs to be resolved. Stickney (2008, p.422) asserted that there is a recurrent relation between attrition and the deficiency of nursing workforce. This implies that the lacking of nurses in workplace is caused by attrition. This statement may not always be true regarding to the validity of attrition rate data. There are several factors causing students dropping out from the program but each factor that causing it cannot be interpret as an independent factor because of the variable within people and environmental issue that may have influence on the attrition. Although much research has been conducted to better identify this issue, it is still difficult to completely comprehend the nature of it. However, many strategies have been applied to overcome it and expected to bring an end to this issue.

Reference List

Hally, MB 2009, A guide for international nursing student in Australia and New Zealand, Elsevier, Australia.

Mullholland, J, Anionwu, EN, Atkins, R, Tappern, M & Franks, PJ 2008, ‘Diversity, attrition and transition into nursing’,  Journal of Advanced Nursing, vol. 64, no. 1, pp. 49-59.

Muula, Adamson, ST, Mfutso-Bengo, JM, Makoza, J & Chaptiwa, E 2003, ‘The Ethics of Developed Nations Recruiting Nurses from Developing Countries: The case of Malawi’, Nursing Ethics, vol. 10, no. 4, pp. 433-438.

Pryjmachuk, S, Easton, K and Littlewood, A 2008, ‘Nurse Education : Factors associated with attrition’, Journal of Advanced Nursing, vol. 65, no. 1, pp. 149-160.

Stickney, MC 2008, ‘Factors Affecting Practical Nursing Student Attrition’, Research Briefs, vol. 47, no. 9, pp. 422-425.

Urwin, S, Stanley, R 2009, ‘Understanding student nurse attrition: Learning from the literature’, Nurse Education Today, vol. 30, no. 2010, pp. 201-207.

Wells, MI 2003, ‘An Epidemiologic Approach to Addressing Student Attrition in Nursing Programs’, Journal of Professional Nursing, vol. 19, no. 3, pp. 230-236.


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