Nursing Attrition: based on the literature


Argument amongst academics stating that nursing has an uppermost attrition rate is an issue that needs to be clarified. The lack of a standardized method of determining and reporting the number of attrition on each faculty in universities could be a primary reason for debating the previous argument. In spite of the fact that several studies exist that relate to the issue in several countries, there were still arguments questioning about the presented data. Urwin. et al (2009, p.203), stated that there was no reliable recorded data that can be claimed as accurate. Therefore, attrition rate in nursing cannot be stated as the highest. However, attrition in nursing itself has drawn global concerns from governments, health institutions, nursing program educational institutions and the profession’s organization. In this essay, attrition in nursing and its implications, contributing factors that can be assume to be the cause and its underlying facts will be discussed further based on previous literature studies.

Implications of attrition

A term used to describe the condition of the nursing workforce nowadays stated by Urwin. et. al (2009, p.203), “the nursing workforce is ageing”, is an exact statement and it is felt mostly in the 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). Presumably, if the health services are delivered by younger nurses, it will be better in terms of quantity and fulfillment of workloads.

Another implication occurring in relation to nursing attrition is the shortage of nurses. Many 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 to them and decided to leave their home countries to pursue a better life. Muula. (2003, p.5) explained that the loss of nurses from developing country, such as Malawi, had resulted in a shortage of nurses within the country. As a result, shortage of nurses becomes an issue in both developing and developed countries.
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) stated that “The basic premise of Tinto’s model is that departure, or attrition, is 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, such as family backgrounds, could have different several aspects within one person to another, thus, research findings explaining the causes of attrition are generally too broad.

Glossop (2001, cited in Mulholland 2008, p.51) has listed 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 theory and application 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 factor to cause attrition. For example, when a student is having a financial problem, transportation issue may occur because to attend clinical placement which is 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.

In other words, attrition cannot solely caused by one factor, as it is also stated by Deary (2003, cited in Pryjmachuk 2008, p.151.), 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).


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. Each factor that causes attrition cannot be interpret as an independent factor because of the variable within people and environmental issue that may have influence on the attrition. Although there have been many research done to better identify this issue, it is still difficult to completely comprehend the nature of it.

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  S, Joseph M Mfutso-Bengo, Joan Makoza and Elita Chaptiwa 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, Steven, Kathrine Easton and Anne Littlewood 2008, ‘Nurse Education : Factors associated with attrition’, Journal of Advanced Nursing, 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.


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