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.
Nurses play a significant role in healthcare systems. According to the World Health Organization (2018), nurses and midwives comprise nearly 50% of the global health workforce. They provide primary care and treatment to patients, educate the public about the importance of health in the community, and participate in controlling diseases and infections (World Health Organization, 2018). Therefore, the importance of nursing education and training cannot be overemphasized. Today, most registered nurses are trained in universities, where the emphasis is on critical thinking, leadership, systems analysis, and teamwork (American Association of Colleges of Nursing, 2016; The Nursing Council of Hong Kong, 2016). Students need to complete a bachelor's degree to become registered nurses. However, a significant number of students worldwide drop out from undergraduate nursing programmes (ten Hoeve et al., 2017). Hence, the complex reasons behind such attrition need to be investigated, such as personal, institutional, course-related, and financial factors (Urwin et al., 2010). Of these, it is practical to explore the design of the undergraduate nursing curriculum, because it can potentially be modified and improved so that students can better enjoy and appreciate their learning experience (Taylor, 2005). This will encourage more students to complete their nursing programme and increase the supply of nurses, easing the burden on public healthcare systems.