Where do all the undergraduate and new graduate nurses go and why? A search for empirical research evidence.

OBJECTIVE To review the published scientific literature for studies quantifying or examining factors associated with the attrition of undergraduate nursing students in pre-registration programs and the retention of graduate nurses in the workforce. METHODS The following selection criteria were used to systematically search the literature: target populations were either students in pre-registration nursing programs or registered nurses in their graduate year; the studies were to be primary observational or analytical (cross-sectional, case-control or prospective cohort studies) in design; and outcome measures were attrition in undergraduate programs and/or retention of graduates within the workforce. Three authors guided by a standardised procedure performed data extraction and quality assessment independently. Synthesis of the data appears in text and tabular format. Due to the heterogenic nature of the study methods, meta-analysis was not possible. RESULTS This review found only four studies that met all inclusion criteria. All four studies examined undergraduate attrition as an outcome with two studies reporting a range of 25-27% attrition within the first year. No studies were found that quantified or examined retention of new graduates as an outcome measure. Only two of the four studies followed cohorts of students prospectively and were able to provide a high level of evidence, although each of these studies was designed to assess specific exposures as potential predictors of attrition, rather than assess actual factors associated with students leaving their program. CONCLUSION There is a paucity of research studies in the literature from which evidence quantifying attrition and retention and the reasons why students leave undergraduate nursing programs or new graduates leave the profession can be obtained. Clearly there is a need to systematically track undergraduates and new graduates to quantify and understand attrition, retention and workforce choices within the nursing profession and begin to build this evidence-base.