Abstract
Understanding the multidimensional process of college student retention and success and faculty’s pivotal role in making a positive difference can be daunting without an easily adaptable organizing framework. Although classic models of college student attrition provided an essential, valuable foundation and a guiding framework for early nursing student retention research and strategy design, several areas for enhancement were identified. This article presents the empirically supported Nursing Universal Retention and Success (NURS) model as an easily adaptable framework for developing strategies that embrace a “diversity of diversity” world view; address the intersectionality of multiple identities and roles; actively involve faculty and students; consider post-graduation outcomes, and incorporate a discipline – focused proactive, culturally congruent, holistic approach. Applied in a variety of undergraduate and graduate settings, over sixty nursing and college-wide professional development programs, and over seventy published studies in the US and abroad, the NURS model encompasses features warranting consideration across disciplines.
Keywords
College student persistence, retention, and success are universally desired outcomes across disciplines, delivery formats, and settings yet remain elusive and challenging. Within critical workforce service areas experiencing shortages, such as nursing, preparing well-qualified graduates equipped to meet the unknown challenges and changes of the future is crucial for a healthy people, society, and economy. Consequently, student persistence, retention, program completion, licensure, credentialing/certification, and swift entry into essential workforce shortage areas require prioritized attention and action guided by theory and evidence-based best practices. This necessitates both a broadened view beyond the institution as well as a discipline or program-focused approach.
“Faculty serve as a primary point of contact for students and play vital roles in shaping students’ experiences that impact persistence, program completion, and future beyond college” (Zerquera et al., 2018, p. 29). Therefore, faculty knowledge, buy-in, caring, accountability, and teamwork concerning student retention and success are essential to optimizing outcomes. Classic and contemporary scholars agree that student retention, achievement, and success is complex and multidimensional; there is no one “quick fix” solution (Barbera et al., 2017; Bean & Metzner, 1985; Jeffreys, 2012b; Metzner & Bean, 1987; Seidman, 2007, 2018; Simmons, 2019; Tinto, 1975, 1993, 1998, 2017). Understanding the multidimensional process and seeing where faculty fit in on making a positive difference can be daunting without an organizing framework.
Recent calls for a universal framework to guide future development of college student retention research, theory, and practice applications that encompass features addressing the diversity of students, faculty, and institutions, and adaptable within and between disciplines, program formats, and degree levels have been advocated (Barbera et al., 2017; Lake et al., 2018; Ocean, 2017; Ruud et al., 2018; Tinto, 2017; Xu & Webber, 2018; Zerquera et al., 2018). Furthermore, Tinto (2017) notes that the “prevailing view of student retention has been shaped by theories that view student retention through the lens of institutional action …” (p. 254) and states that “only when institutions understand how student perceptions shape decisions to persist and how their actions influence those perceptions can institutions move to impact those decisions in ways that enhance the likelihood of greater persistence while also addressing the continuing gap in college completion between students of different attributes and backgrounds” (p. 264). Hence, exploring perceptions of diverse students is an important precursor to assisting students.
The desire to understand student perceptions concerning factors supporting or restricting nontraditional nursing student retention and success in order to assist students prompted a series of grant-supported studies and scholarly work involving the design, implementation, and evaluation of: a) student perception questionnaires, b) retention and success strategies for diverse students, c) faculty development programs, and d) a conceptual model. This article focuses on the Nursing Universal Retention and Success (NURS) model (Jeffreys, 2015, 2016), an empirically supported model applied in a variety of undergraduate and graduate settings and over sixty professional development programs with nursing and college-wide faculty, staff, and administrators. The model (Jeffreys, 2004, 2012b, 2015) and/or its associated student perception questionnaires have been utilized in over seventy published studies in the United States and abroad. Although classic models of college student attrition provided an essential, valuable foundation (e.g., Bean & Metzner, 1985; Nora, 1987; Pascarella & Chapman, 1983; Tinto, 1975) and a guiding framework (i.e, Bean & Metzner, 1985) for early nursing student retention research and strategy design, (Jeffreys, 1993, 2001, 2002), several areas for enhancement, increased visibility, and/or added emphasis were identified.
This article introduces background and establishes need for a broadened view and a discipline-focused, holistic, culturally congruent, proactive, optimization approach. Next, model overview, development, and utility are highlighted. It is not the intent of this article to provide in-depth discussion about all model features and components or its associated questionnaires; this is detailed in other publications. Rather, the intent is to elaborate upon unique model features, address gaps in under-represented topics, stimulate new ideas, motivate faculty, and contribute to college student retention literature. Although this article targets faculty, it also has relevance to student support staff and administrators.
Background and Need for Broadened View and Discipline-Specific Focus
Heightened scrutiny on faculty, program, and institutional accountability; workforce shortages and disparities in essential service areas; increased and changing migration and demographic patterns worldwide; political uncertainties and cultural conflicts; academically, culturally, generationally, and linguistically diverse students entering undergraduate and graduate education; variety of program formats, quality, and costs; fluctuating global economy; planetary environmental changes; a fast-paced and multi-tasking, technologically saturated society; high numbers of adjunct and untenured faculty; faculty shortages in essential workforce service disciplines; and faculty lacking formal preparation in curriculum, teaching, and college student retention best practices must be considered when contemplating the big picture of college student retention and success and when pondering strategies for positive change (Jeffreys, 2015). A comprehensive view must also acknowledge that retention and attrition is not dichotomous, rather it is multifaceted, and several trajectory pathways exist (Jeffreys, 2007b; 2015; Xu & Webber, 2018). Differentiating between retention pathways (ideal, continuous, and interim/stopout), and attrition pathways (first semester failure, voluntary [due to personal reasons], and involuntary [dismissal]) should also be examined in context with accreditation-mandated end-of-program outcome measures of “success” such as graduates’ employment in field, pass rates on credentialing exams, and enrollment in advanced degree or specialty programs. In addition, “success” must be conceptualized as students achieving their potential, that is, going beyond minimum expectations to peak performance. Goals aimed at the minimum level do not prepare graduates to meet the yet unimagined challenges and changes of a future caught up in a whirlwind of rapidly moving people, technology, and global change (Jeffreys, 2014). Tracking students to document and comprehend students’ progress paths and evaluate effectiveness of retention strategies contributes to determining best practices (Jeffreys, 2007b; 2012b; Kruse et al., 2020) (Figure 1).
Progression Pathway. Adapted and Reprinted from Jeffreys (2007b, p. 407). Reproduced with the permission of Elsevier.
Strategies that consider post-graduation outcomes, embrace a “diversity of diversity” world view, address the intersectionality of multiple identities and roles, actively involve faculty and students, and incorporate a discipline, program, career, or specialty – focused proactive, culturally congruent, holistic approach can make a positive difference (Jeffreys, 2004, 2012b, 2014, 2015, 2020a). A “diversity of diversity” world view recognizes that diversity may exist based on birthplace, citizenship status, reason for migration, migration history, religion, ethnicity, race, language, kinship and family networks, educational background and opportunities, employment skills and opportunities, lifestyle, gender, sexual orientation, socioeconomic status (class), politics, past discrimination and bias experiences, health status and health risk, age, occupation, and other variables that go well beyond the restrictive labels of a few ethnic and/or racial groups (Jeffreys, 2016). The “diversity of diversity” also recognizes that culture is more than just “labels” and necessitates individualized appraisal to incorporate culturally congruent caring actions and achieve optimal outcomes (Jeffreys, 2016). Students and faculty (and all individuals) belong to multiple groups (intersectionality) at the same time (Allaire, 2019; Coleman, et al., 2020; Duran, et al., 2020; Jeffreys & Zoucha, 2018; Legg et al., 2020; Williams et al., 2018) and bring their cultural values and beliefs (CVB) into the academic and professional setting.Organizations, disciplines, professions, and occupations also have unique cultural values, beliefs, and practices. CVB influence thinking, decisions, and actions consciously and unconsciously in all aspects of life, and therefore influence persistence and retention (Jeffreys, 2012b, 2016).
Although many of the factors influencing students across disciplines are also relevant to nursing students, there are some distinguishing characteristics. Nursing is a profession that involves human connections, life and death issues, sensitive topics, clinical practice, arts and science, and professional licensure. Nursing students are challenged to develop knowledge, skills, and values consistent with the nursing profession. This necessitates professional integration and socialization within the nursing profession. Without this, students are often lost, disconnected, and academic achievement and persistence are adversely affected. Faculty are pivotal to enculturating nursing students within the nursing profession, role, and specialty area, especially for groups under-represented in nursing (Leininger & McFarland, 2002).
Development and Application of the NURS Model – Select Highlights and Examples Snapshot
NURS Model Overview and Components
The NURS model’s purpose is to present an organizing framework for examining the multidimensional factors influencing nursing student retention and success in order to identify at-risk students, develop diagnostic-prescriptive strategies to facilitate success, guide innovations in teaching and educational research, and evaluate strategy effectiveness (Jeffreys, 2004, 2012b, 2015). The overarching goal is to promote nursing student retention and success.
Underlying assumptions are:
“Nursing student retention is a priority concern of nurse educators worldwide. Student retention is a dynamic and multidimensional phenomenon that is influenced by the interaction of multiple variables (factors). Environmental factors and professional integration factors greatly influence nursing student retention. Psychological outcomes and academic outcomes interact and influence persistence. All students, regardless of prior academic performance and work experience can benefit from professional socialization and enrichment throughout pre-professional and professional education. Nursing student retention is best achieved by focusing more comprehensively on success as going beyond minimal standards towards optimizing outcomes aimed at achieving peak performance potentials. Optimizing outcomes necessitates a holistic approach that focuses on proactive inclusive enrichment (PIE) and avoids exclusive remediation (ER)” (Jeffreys, 2015, p. 426).
Retention decisions and persistence are based upon the interaction of student profile characteristics, student affective factors, academic factors, environmental factors, academic outcomes, psychological outcomes, outside surrounding factors, and professional integration factors (Jeffreys, 2003, 2004, 2012b, 2015, 2016, 2020b). Professional integration factors are at the center of the model, at the crossroads of decision-making. Faculty are the key initiators and advocates of professional integration; they have the power to actively promote, facilitate, and coordinate participation and inclusion within academic and professional settings (Figure 2).
Jeffreys's Nursing Universal Retention and Success (NURS) Model – (2020). Adapted and reprinted from Jeffreys (2016). Reproduced with the permission of Springer Publishing Company, LLC.
Discussion of each variable set follows the aforesaid sequence; however, readers should employ a holistic perspective and envision interaction within and between variables sets and variables. Select components unique to the NURS model and/or warranting increased attention in the college student retention literature are elaborated upon in “Enhancement Spotlight” sections; other components are highlighted. Detailed information may be found in other publications. Brief faculty action examples are integrated within each section.
Student Profile Characteristics – Enhancement Spotlight
Student profile characteristics describe characteristics prior to beginning a course or program of study and includes “age; ethnicity, race, and heritage; gender and sexual identity; first language; prior educational experience; family’s educational background; prior work experience; and enrollment status” (Jeffreys, 2015, p. 426). Because persistence and retention is lower among under-represented groups and first-generation college students (FGCS) (Garvey, 2020; Seidman, 2007, 2018), one purpose is to identify if a student: a) represents the profile of a student traditionally (historically) enrolled in a specific program of study or b) may be categorized as “nontraditional”, such as a member of an under-represented group within the program of study; and/or c) is a FGCS. Students over 24 years of age, commuters, and part-time students have also been considered “nontraditional” and incur higher attrition (Bean & Metzner, 1985; Seidman, 2018). Therefore, a nontraditional prelicensure nursing student is defined as meeting one or more of the following: a) 25 years or older; b) commuter; c) enrolled part-time; d) male or member of a sexual minority group; e) member of an ethnic, racial, religious, national, or other minority group currently or historically experiencing marginalized treatment (or classified as under-represented groups [URG]) within the country of residence and/or nursing program; f) speaks the national language taught in school as a second or other language; g) has dependent children; h) completed secondary education via a different route than usual within the country of nursing program [e.g., general equivalency diploma]; or i) required remedial classes (Jeffreys, 2012b, 2015). A “traditional” nursing student is anyone who does not meet at least one of the above criteria. RNs returning to further their nursing education who met any of the criteria of “nontraditional” in a prelicensure program are considered “nontraditional” in later, advanced degree pathways.
National goals for enhancing nursing workforce diversity of under-represented groups to more closely mirror the US population in order to eliminate gaps in health and health care disparities among diverse populations have not been achieved. Diverse individuals bring different perspectives, insights, and experiences that can enhance nursing, communities, and society, yet social isolation (or the feelings of not belonging) and mismatched expectations among nontraditional and FGCS are reported as factors adversely influencing nursing student persistence, academic progression, retention, achievement, and success across all educational levels from prelicensure through nursing doctorate (Jeffreys, 2020a, 2020b). While understanding student demographic characteristics is an important first step in supporting retention and success, faculty need to avoid stereotypes and a deficit-based approach that assumes membership in an under-represented group is a weakness or obstacle to overcome. Moreover, it is important to assess (not assume) students’ perceptions about self and in context with persistence, performance, and success. For example, a student whose first language is not English may perceive this as restrictive; another student may perceive multilingualism as a strength. Overconfidence or low confidence about any variable or combination of variables can interfere with learning, motivation, persistence, satisfaction, and optimal outcome achievement.
Student Affective Factors
Student Affective Factors include cultural values and beliefs, self-efficacy, and motivation.
Cultural Values and Beliefs – Enhancement Spotlight
CVB may be influenced by background heritage (addressed in student profile characteristics); but they also relate to identity and acculturation. For example, CVB about communication, family, time perception, orientation (individualistic or group), household responsibilities, health, education, teachers, college faculty, careers, work habits, autonomy, help-seeking behaviors, and persistence vary within and between cultures and influence student-faculty interaction, learning, and retention. The American Nurses Association Standard 8 - “Culturally Congruent Practice” distinguishes between cultural competence (ongoing process) and cultural congruence (tailored “fit” between an individual’s CVB and care decisions and actions) (Marion et al., 2016), an important detail prevalent and visionary in Leininger’s seminal and six-decade lifetime work as foundress of the field of transcultural nursing (Leininger & McFarland, 2002; McFarland & Wehbe-Alamah, 2018). Within the NURS model, cultural congruence refers to the degree of fit between the student’s values and beliefs and that of nursing as well as the overall academic environment. High levels of cultural congruence positively influence persistence, academic performance, motivation, retention, and satisfaction (Jeffreys, 2012b). Mismatches (cultural incongruence) creates stress and can lead to dissatisfaction, low self-efficacy, poor academic performance, decreased motivation, and attrition. Additionally, cultural incongruence can adversely affect physiological, emotional, and overall health by causing “cultural pain” (Leininger, 1997; McFarland & Wehbe-Alamah, 2018) and triggering “cultural distress” (DeWilde & Burton, 2017). “Cultural pain refers to suffering, discomfort, or [the state of] being greatly offended by an individual or group who shows a great lack of sensitivity toward another’s cultural experience” (Leininger, 2002 in McFarland & Wehbe-Alamah, 2018, p. 19).
Whether intentional or not, cultural pain hurts. Sometimes faculty may unintentionally cause cultural pain by being “unconsciously incompetent” in their approach with students. Faculty are “unconsciously incompetent” when they are not aware of cultural differences (cultural blindness), make cultural stereotypes without assessing individual’s CVB, or carry out actions that are not culturally congruent (Purnell, 2013). Consciously attempting to implement culturally congruent behaviors and avoiding incompetence necessitates active engagement in the ongoing process of cultural competence development, starting with diversity self-awareness and diversity awareness. “Diversity self-awareness occurs when one engages in active reflection about one’s own cultural identity or identities, realizes one’s own CVB, and recognizes the differences within one’s own cultural group(s)” (Jeffreys, 2016, p. 44). For example, a faculty member whose traditional cultural values favor direct eye contact for all communication and who views lack of eye contact suspiciously will need to be consciously aware of their underlying values and beliefs and aim to consciously avoid distrusting students based solely on this nonverbal cue (Jeffreys, 2015, 2016). “Diversity awareness refers to an active, ongoing conscious process in which one becomes proactively aware of similarities and differences within and between various cultural groups” (Jeffreys, 2016 p. 44). For example, a faculty member learns that perceptions about direct eye contact vary culturally, such as it may be perceived as aggressive, disrespectful towards an elder or authority figure, or promiscuous between males and females.
While it is impossible to know all similarities and differences within and between cultures, possessing some “cultural holding knowledge” and actively engaging in ongoing learning, diversity self-awareness, and diversity awareness using a broad “diversity of diversity” lens assists in one’s cultural competence development (an ongoing process). Culturally congruent faculty actions involve the use of culturally based knowledge in sensitive, responsive and responsible ways to promote inclusiveness, visibility, and cultural safety for diverse students while providing human connectedness and immediate relevance to best practice standards of the nursing profession. Some examples include avoiding stereotypes (such as always referring to an RN as “she” and physician as “he”); asking all students their preferred name and pronoun (rather than a select few); showcasing positive role models representing diverse groups within the nursing program, clinical agencies, or specialty; and acknowledging diverse learning styles. To enhance learning among diverse learners, Brookfield (2015) recommends including at least three different teaching-learning activities within a learning episode followed by critical incident questionnaires (2-minute written reflections) providing feedback about feelings, thoughts, and questions. Help-seeking behaviors vary culturally; hesitancy in seeking help from instructors may be due to CVB whereby seeking help from a teacher may be construed as disrespectful (to the teacher), unacceptable, or stigmatized (Alschuler & Yarab, 2018; Hughes & Gibbons, 2018; Jeffreys, 2016; Southwell, et al., 2018; Uy et al., 2019; Williams et al., 2018). Recognizing that communication patterns and help-seeking behaviors vary culturally have implications across all levels of education, necessitating a variety of proactive, ongoing, and transitional strategies. Soliciting anonymous feedback and/or reaching out proactively to students are some solutions.
One of the best ways to create inclusive communities of learners is to integrate diversity and cultural competence education and topics throughout the course, curriculum, program, college, and career settings. Although cultural competence development warrants detailed discussion beyond the scope of this article, the literature identified several targeted priority areas for enhanced congruence in interactions with individuals who self-identify with the following culture(s): multiracial and/or multiple heritage (Jeffreys & Zoucha, 2018); queer and/or transgender (Coleman et al., 2020; Garvey, 2020), and/or veterans or military (Alschuler & Yarab, 2018; Cox, 2019; Southwell et al., 2018).
Self-Efficacy and Motivation – Highlights
Self-efficacy is the belief that one can perform or succeed at learning a specific task, despite obstacles and hardships, and that one will expend whatever energy is necessary to accomplish the task (Bandura, 1986). Self-efficacy is situation, domain, or task specific and should not be construed as an overall personal attribute or general self-confidence. Empirical evidence links self-efficacy as a significant variable influencing students’ actions, performance, persistence, motivation, commitment, and retention (Bandura, 1986, 1997). Self-efficacy is most strongly influenced by actual performance, followed by vicarious experiences (e.g. role models), encouragement by others, and physiological indicators (e.g., sweating, increased heart rate).
Inefficacious students may avoid tasks, lack motivation and commitment, and give up easily. Supremely efficacious (overly confident) students view tasks as unimportant, see no need to prepare, and may not see a need to perform the task. Both inefficacious and overconfident students are at-risk for less than optimal outcomes, dissatisfaction, stress, and attrition. The NURS model incorporates these assumptions and purports that students with strong, realistic, and resilient self-efficacy appraisals view new tasks as challenges, meet tasks willingly, exert much energy and commitment, prepare diligently, engage in help-seeking behaviors, utilize available resources, recognize limitations, are highly motivated, and “aim to optimize outcomes and reach for the stars, — i.e., go beyond minimum benchmarks.” (Jeffreys, 2015, p. 428).
Students, (especially beginning students), may not know what to expect when entering a new or more advanced program, therefore, they benefit from ongoing guidance and self-appraisal. Because students with poor performance or less than anticipated outcomes may lose motivation, feel embarrassed, or be reluctant to actively seek assistance, faculty play key roles in initiating actions with these students. For example, during interactive small group test preparation activities, faculty can note student strengths and weaknesses, utilize immediate response systems (clickers), and privately reach out to students in person, by e-mail, text, or phone to solicit student perceptions about performance and provide suggestions accordingly.
Academic Factors – Highlights
Academic factors include personal study skills, study hours, attendance, class schedule, and general academic services (e.g., library) (Jeffreys, 2012b). Quality, optimization, and student perceptions are important considerations. Personal study skills refer to specific study skills (e.g., reading, critical-thinking, computer skills, writing, etc.) as well as attitudes about responsibility for study activities, time management and organization, and effort expenditure. Personal study hours refer to the number of hours in which positive study behaviors and attitudes are exclusively used; multi-tasking is avoided. Optimal attendance involves the highest degree of active learning; student as spectator, tourist, or mentally absent is undesirable. Beginning students are particularly vulnerable in under-estimating the time, skills, endurance, and emotional labor required in nursing. To assist students proactively and throughout a program, faculty can publicize approximate time expectations with sample schedules for various types of courses (e.g., online, hybrid, face-to-face, simulation lab, clinical) and programs (e.g., accelerated, full-time, cohort). Sharing recent graduates’ stories and strategies for success during course and program orientation, transitional workshops, nursing student club events, in-class visits (virtual or in-person), videoclips, podcasts, posters, and newsletters are other strategies.
Environmental Factors – Highlights
Environmental factors are factors “external to the academic process that may influence students’ academic performance and retention and include financial status, family financial support, family emotional support, family responsibilities, childcare arrangements, family crisis, employment hours, employment responsibilities, encouragement by outside friends, living arrangements, and transportation” (Jeffreys, 2012b, p. 112). While some students perceive a variable to be supportive, other students may perceive the same variable to be restrictive. Overall, results consistently indicate that nursing students perceive environmental factors as more influential for retention than academic factors (Jeffreys, 2012b, 2015; Kruse et al., 2020; Summers, 2020). As anticipated, retrospective appraisal of environmental factors’ restrictiveness or supportiveness affirm that students are frequently more optimistic at the beginning of the semester and under-estimate the impact of family responsibilities and employment. In addition to strategies suggested previously for “Academic Factors”, faculty can actively engage students in realistic self-appraisal, planning, and actions specific to environmental factors. For example, during orientations and workshops (e.g., career path planning or transitional), faculty can first a) administer one of the Student Perception Appraisal (SPA) instruments (Jeffreys, 2012a) and/or present each environmental variable and b) encourage students to contemplate how academic and environmental variables may interact in their lives. Next, faculty can facilitate group discussion and interactive activities (e.g., brainstorming, role play, think-pair-share) for developing positive action plans (e.g., time management; delegation of nonacademic tasks to designated support person(s); back-up to back-up plans to childcare coverage or transportation) (Jeffreys, 2020a).
Academic and Psychological Outcomes – Highlights
Academic and psychological outcomes (stress and satisfaction) directly influence student retention and success. Academic outcomes include course grade; cumulative nursing grade point average (GPA); and overall GPA. Entry into the college educational process assures an academic outcome at least at the course level (pass, fail, withdraw), all students experience some degree of stress; however, not all students experience satisfaction. Positive psychological outcomes include low (manageable) stress and satisfaction; negative psychological outcomes include high stress and dissatisfaction. While some stressors may be experienced by most college students, (e.g., final exams, and beginning or ending a new educational setting or learning experience), other stressors, such as perceived cultural incongruence, perceived (or fear of) discrimination and bias, acculturation stress, student-role incongruence (lack of fit between self and student role in comparison with peer norm reference role models), womanist identity career choice pressures, caregiver role stress, and parental role stress, may affect specific groups of students. For example, academically strong women who choose a female-dominated field may experience pressure to select a different career path (Constantine & Watt, 2002). In addition, higher levels of stress and dissatisfaction affect under-represented minority groups (Legg et al., 2020; Loeb & Hurd, 2019; Xu & Webber, 2018), nontraditional students (Todorova, 2019), veterans and military students (Cox, 2019; Southwell, et al., 2018), and FGCS (Seidman, 2018).
Throughout a course and program, academic and psychological outcomes interact with each other and with other factors in the NURS model, influencing achievement, persistence, retention, and actualization of one’s highest potential. As proposed by Bean and Metzner (1985), nonacademic factors may compensate for low levels of academic success, and yet high levels of academic success result in persistence and continued enrollment only when accompanied by positive psychological outcomes. Persistence and withdrawal cognitions may occur at the beginning, end, and within a course and series of courses throughout one’s educational journey. Knowing this, faculty can anticipate stressors and introduce stress management techniques and college resources proactively and as needed.
Outside Surrounding Factors – Enhancement Spotlight
Despite students’ positive academic and psychological outcomes, and despite other background, affective, academic, environmental, and professional integration factors favorable for student success, students may still dropout or stopout. Unlike other retention models, the NURS model draws attention to outside surrounding factors (OSF) that can influence academic and psychological outcomes, persistence, retention, and success positively or negatively. Metaphorically and visually the model’s illustration of the cloud, peeking sun, and lightning hovers above the other model components representing the climate that may be predictable or unpredictable and exist outside student and faculty control (Jeffreys, 2012b, 2015). OSF include world, national, and local events; politics and economics; health care system; nursing professional issues; and job certainty. OSF interact to create an outside climate that may change and affect students at any point in their academic and career path. Students’ motivation to overcome challenges and persist may be intensified when OSF are more favorable. In contrast, motivation may be lessened when OSF are less favorable or even obliterated if obstacles seem overwhelming or impossible to overcome. Students’ perceptions about OSF are most important.
Although faculty cannot quickly change OSF, they can take immediate action to change students’ perceptions of meanings (when appropriate) and assist students in realistically appraising the immediate and longer-term impact of individual and combined factors. For example, world, national, and local events with adverse effects include natural disasters (e.g. floods, hurricane, tornado), other accidental disasters (train derailment, plane crash), nonaccidental tragic events (terrorist or criminal acts), and wars, threats of war, or impending war. Such events may impact students directly and/or indirectly and for varied durations. Reallocation of local and national funds to assist in the aftermaths of disasters and tragedies may decrease public education funding, student scholarships, and financial aid. Students in the military or military reserve may need to stopout if deployed or called into active duty. World, national, or local events that involve or feature nurses positively can boost persistence behaviors; however, if students perceive circumstances surrounding the event as fearful or overwhelming (e.g., during a pandemic or its aftermath), it may arouse conflicting emotions, increase stress, and adversely impact persistence and performance.
Faculty have an ethical responsibility to assist students contemplate situations from different perspectives and appraise options, strengths, weaknesses, benefits, and costs before arriving at a decision. Sometimes stopping out is the best option until conditions are more favorable to achieve optimal goals. The “Decision-Making Appraisal Tool for Dropout, Stopout, or Persistence” (Jeffreys, 2012a) offers a systematic approach to the decision-making process that can prompt student self-reflection, group discussion, blog postings, family/significant other consideration, and nursing faculty intervention (Jeffreys, 2015).
Profession Integration Factors – Enhancement Spotlight
Although other classic models depicting college student retention and success emphasize academic integration and socialization (Tinto, 1993, 1998), the NURS model (Jeffreys, 2003, 2004, 2012b, 2015, 2020b) proposes a different approach and variable set (Professional Integration Factors [PIF]) that includes integration and socialization to the undergraduate, masters, or doctoral educational environment and college setting but also emphasizes integration and socialization within the nursing profession, specifically within the desired post-graduation nursing role and/or specialty (e.g., staff nurse; nurse practitioner, nurse anesthetist, nurse scientist, adult-gerontology clinical nurse specialist, nurse educator; nurse executive). PIF include culturally congruent faculty advisement and helpfulness; nursing professional events; memberships in nursing professional associations; encouragement by friends in class; peer mentoring and tutoring; and enrichment programs (multiservice coordinated programs). Professional integration factors are situated at the center of the model; it is here where faculty’s proactive, ongoing, and transitional supportive actions with and for students can make a positive difference and tip the scale in favor of informed decision-making, persistence, and peak performance. It is also proposed that PIF have the greatest power of assisting students to discover and achieving one’s potential. Lack of PIF increases the risk of attrition and limits potential, whereas strong integration increases commitment, persistence behaviors, retention, and optimal outcomes. Notably, student perceptions of “faculty advisement and helpfulness” are frequently reported as supportive for student retention (Jeffreys, 2014, 2015; Summers, 2020).
PIF are vitally important for students across all educational levels and formats (face-to-face, hybrid, online, or other distance education). For example, graduate and doctoral students are now the novice, and must be socialized and feel integrated within all aspects of their desired post-graduation role. Faculty can increase professional integration and socialization by actively promoting activities, recognizing barriers, and offering solutions and incentives (Figure 3).
Select Examples of Professional Integration Barriers, Solutions, Strategies, and Incentives.
In addition, professional integration will be greatly enhanced through the careful orchestration and planned coordination of a variety of activities that creatively combine cognitive, practical, and affective dimensions (Jeffreys, 2012b). Consistent with the holistic perspective that views the whole dimension of integration as greater than the mere total of each separate and distinct part, the combined effect is most beneficial (Jeffreys, 2015). For example, faculty can create caring communities of learners by designing a series of connected learner-centered interactive experiences; linking objectives and outcomes to immediate and future career goals; weaving together cognitive, affective, and practical activities; and rotating groups to promote positive and productive peer partnerships among academically, culturally, and generationally diverse learners.
Conclusion
This article provided background and justification for a broadened view and a discipline-focused, holistic, culturally congruent, proactive, optimization approach; elaborated upon components unique to the NURS model; identified areas for enhancement in the college student retention literature; and shared brief faculty action examples for making a positive difference with diverse students. The NURS model provides a panoramic and up-close framework for understanding the multidimensional process of nursing student retention and success that embraces a broad view of diversity, recognizes the intersectionality of multiple roles and identities, and considers post-graduation outcomes and outside surrounding factors. Results from factor analysis, correlational, cross-sectional, longitudinal, descriptive, quasi-experimental pre and post intervention, and qualitative designs in over seventy studies continue to support model components and its underlying assumptions. Application in the US and abroad attest to its flexibility and utility across degree programs, formats, and settings.
Everyday actions by faculty have the potential to positively influence student performance, persistence, retention, and success. Coordinated, collaborative, well-planned, proactive, and ongoing evidence-based strategies have the potential to make a larger impact. The NURS model has been successfully applied as framework for over sixty nursing and college-wide professional development workshops with faculty, staff, and administrators. Positive post-workshop evaluation survey results support its college-wide utility, especially for assisting diverse students. Across disciplines, faculty have used the acronym of “HOLISTIC COMPETENCE” to remember essential elements for generating ideas and coordinating strategies for optimizing outcomes (Jeffreys, 2012b, 2014, 2015) (Figure 4).
HOLISTIC COMPETENCE – Essential Elements for Optimizing Retention and Success.
Faculty and staff are urged to contemplate, shape, and generate new action ideas and strategies within their spheres of influence using a discipline, program, career, or specialty-focused proactive, culturally congruent, holistic approach that is inclusive, caring, and open. Administrators are encouraged to recognize faculty’s powerful role in influencing student persistence and success and to provide faculty and staff development, assignments, incentives, supports, and rewards that value student advisement and mentoring and other faculty “retention and success work” accordingly. Active engagement in scholarly design, implementation, and evaluation of conceptually and empirically supported retention strategies adaptable within and between disciplines and specialty areas will expand the literature and provide a repertoire of knowledge, strategies, and best practices for college student retention and success.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
