The Not-So-Simple Sources of Student Attrition

This article is adapted from the State of Nursing Education, the authoritative ATI series examining key issues affecting today’s academic nursing programs, deans and faculty. State of Nursing Education content reflects extensive research, evidence, and interviews, with perspectives from nursing industry leaders. To read more from the series, click here.

Attrition isn’t just an academic problem. Every student who fails to graduate represents an aspiring nurse with the potential to make an impact on healthcare. In the long run, attrition not only derails promising students. It also weakens program efficiency and creates increasingly large gaps in the nursing workforce.

Even after students make the transition to clinical practice, the ghosts of attrition still linger. In fact, an estimated 25% of first-year nurses leave the profession. Most of them never return.¹

Why do future nurses walk away? Surveys and systematic reviews reveal a multilayered story that goes well beyond a singular source. These complex challenges start at admission and follow students all the way into their first year of nursing.

Attrition Is a Complex Problem

Understanding attrition requires looking at the full student experience, and no nursing student’s struggle is the same. From an academic perspective alone, there are many variables to learning and many required moments of practical application. Beyond that, personal factors, financial burdens, and the status of institutional support all can be extremely influential on success.²

That said, research does suggest some consistency in the sources of student attrition. These sources are highly diverse. They begin as early as the admissions process, and some can persist well into the first year of professional practice.

Why Nursing Student Retention Challenges Feel Unique

Nursing requires two very distinct things: academic competency and clinical application. These things do not exist in a vacuum, and an aspiring nurse needs both to succeed.

“We are a practice discipline, so it’s not enough to just get an A on a test,” said Beth Phillips, PhD, RN, CNE, CHSE, a former program director who is now Strategic Nursing Advisor for ATI. “You have to go to the lab and work with real patients to demonstrate the things you learn ... It’s a very big responsibility.”

This is a large part of the reason nursing student retention feels uniquely challenging. For starters, students can’t simply recall information and move on. They must adapt to increasingly complex applications of the knowledge they already have — or don’t. What’s more, there is a sense of real-world responsibility to student retention because future nurses impact patient outcomes.

ATI and a Data-Driven Response to Retention

Students leave nursing programs for many different reasons. Academic readiness, financial pressures, confidence, support systems, professional identity, career expectations, and personal relationships can all have an impact on whether a student remains on track for graduation.

Given the many variables, programs are most likely to improve their attrition rates when they have a thorough understanding of why future nurses walk away. Based on that understanding, they can turn insights into action.

ATI helps nursing programs do exactly that. Using student performance data, award-winning learning resources and valid, reliable assessments, ATI helps programs move beyond assumptions with solutions that identify learning gaps, uncover risk factors, personalize remediation, and provide meaningful support throughout the student journey.

Institutions that partner with ATI receive predictive assessments, actionable analytics, and AI-enhanced learning tools that empower faculty to intervene early and help more nursing students reach their careers.

References

1. Mahon P, Crotty Y, Irving K. New graduate nurse self-perception of their readiness to practice: an integrative systematised review. International Journal of Nursing and Health Care Research. 2025;8:1627. doi: 10.29011/2688-9501.101627
   
2. Sheikoleslami RL, Princeton DM, Hansen LIM, Kisa S, Goyal AR. Examining factors associated with attrition, strategies for retention among undergraduate nursing students, and identified research gaps: a scoping review. Nursing Reports. 2025;15(6):182. doi:10.3390/nursrep15060182
   
3. Al-Alawi R, Oliver G, Donaldson JF. Systematic review: Predictors of students’ success in baccalaureate nursing programs. Nurse Education in Practice. 2020;48:102865. doi:10.1016/j.nepr.2020.102865
4. Tacy JW, McElwain S, Fletcher A. Strategies for Success That Led to 99.98% School of Nursing Retention. Journal of Nursing Education and Practice. 2023;13(5):52. doi: 10.5430/jnep.v13n5p52
5. Alhowaymel FM, Saleh MSM, Taref NN, Abd-Elhamid ZN, Abaoud AF, Alenezi A, Fathi RH, Elsabahy HE. Empowering Future Nurses: Enhancing Self-Efficacy, Satisfaction, and Academic Achievement Through Talent Management Educational Intervention. BMC Nursing. 2025;24:875. doi: 10.1186/s12912-025-03512-z
6. Mei XX, Wang HY, Wu XN, Wu JY, Lu YZ, Ye ZJ. Self-Efficacy and Professional Identity Among Freshmen Nursing Students: A Latent Profile and Moderated Mediation Analysis. Frontiers in Psychology. 2022;13. doi: 10.3389/fpsyg.2022.779986
7. Smith BW, Maneze D, Ramjan LM, Stephen CM, Montayre J, Salamonson Y. Impacts of Financial Stress on Mental Health and Wellbeing of Nursing Students: A Systematic Integrative Review. Journal of Advanced Nursing. 2026;82:2766-2789. doi:10.1111/jan.70043
8. Subirana-Casacuberta M, Sanchez-Rueda G, Codern-Bové N, Sanchez-Ortega MA, Martín-Baranera M, Ferrus-Estopà L. Workplace Preferences and Expectations of Nursing Students: Gender and Generational Differences. Nursing Research and Practice. 2026;2026:3221299. doi:10.1155/nrp/3221299
9. American Association of Colleges of Nursing. Schools of Nursing See Enrollment Increases Across Most Program Levels, Signaling Strong Interest in Nursing Careers. May 7, 2026. https://www.aacnnursing.org/news-data/all-news/article/schools-of-nursing-see-enrollment-increases-across-most-program-levels-signaling-strong-interest-in-nursing-careers-1480