YNEDT-02671; No of Pages 5 Nurse Education Today xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Review
Facilitating student retention in online graduate nursing education programs: A review of the literature Elizabeth A. Gazza a,⁎, Diane F. Hunker b,1 a b
University of North Carolina Wilmington, 601 S. College Road, 3039 McNeill Hall, Wilmington, NC 28403-5995, United States Chatham University, Woodland Road, 223 Coolidge, Pittsburgh, PA 15232, United States
a r t i c l e
i n f o
Article history: Accepted 21 January 2014 Available online xxxx Keywords: Student retention Online Education Graduate Nursing
s u m m a r y Online education, a form of distance education, provides students with opportunities to engage in lifelong learning without the restrictions of time and space. However, while this approach meets the needs of employed nursing professionals, it poses some challenges for educators. Student retention is one such challenge. Student retention rates serve as measures of program quality and are reported to accrediting bodies. Therefore, it is imperative that administrators and program faculty implement comprehensive programs to ensure student retention. This review of the literature was designed to identify strategies to improve student retention in online graduate nursing education programs. The review includes 23 articles that address models, research, and best practices supported in nursing and higher education. The findings indicate that student retention in online programs is a multidimensional problem requiring a multifaceted approach. Recommendations for facilitating retention in online nursing programs include ensuring social presence and program and course quality, and attentiveness to individual student characteristics. © 2014 Elsevier Ltd. All rights reserved.
Introduction Online education, a form of distance education, provides opportunities for students to engage in lifelong learning without the restrictions of space and time. A 2012 survey of Chief Academic Officers by Allen and Seaman (2013) indicated that total enrollment in online education grew from slightly more than 1.6 million in Fall 2002 to over 6.7 million in Fall 2011. The number of students enrolled in higher education who were taking at least one online course had increased by 570,000 in the previous year. As the number of students taking online courses grows, concerns about student retention have also grown. Indeed, lower retention rates were identified by 73.5% of respondents to the Allen and Seamen survey as an important or very important barrier to growth. According to the American Association of Colleges of Nursing (AACN, 2011), in 2011, 298 of 361 (82.5%) master of science in nursing programs (MSN) were delivered using some form of distance education, including online education. This percentage grew to 85.5% in 2013 (AACN, 2013). In 2011, 70% of research-focused (PhD) doctoral programs in nursing included some form of distance education (AACN, 2011), and this percentage increased to 71% in 2013 (AACN, 2013). The number of doctor of nursing practice (DNP) programs delivered using some degree of distance education was stable at 90% in 2011 and 2013 (AACN, 2011, 2013). ⁎ Corresponding author. Tel.: +1 910 962 7097; fax: +1 910 962 4921. E-mail addresses: [email protected] (E.A. Gazza), [email protected] (D.F. Hunker). 1 Tel.: +1 412 365 1738; fax: +1 412 265 2439.
Online students in higher education can engage in learning from any location where a personal computer with internet access is available. However, while this approach to learning meets the needs of many nursing professionals, it poses unique challenges. One challenge is student retention, or continued enrollment in an online program from admission through program completion. This article is a review of the literature, including research and best practices, aimed at facilitating student retention in online graduate nursing programs and recommends evidence-based strategies for improving student retention. Retention rates for nursing programs delivered via distance education are not available in the published literature, making it difficult to compare rates in graduate nursing programs with those of higher education overall. However graduation rates, an indicator of retention, are assessed as part of the program accreditation process for all levels of nursing education in the United States (Commission on Collegiate Nursing Education, 2009; National League for Nursing Accrediting Commission, 2013). Methods The question that guided the inquiry was, What strategies have been effective in facilitating retention of nursing students enrolled in online graduate nursing education programs? Key concepts used to conduct the search included online education, distance education, student retention, graduate education, nursing education, and persistence. Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Education Resource Information Center (ERIC), and bibliographies of retrieved articles were used in the search process.
0260-6917/$ – see front matter © 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.nedt.2014.01.010
Please cite this article as: Gazza, E.A., Hunker, D.F., Facilitating student retention in online graduate nursing education programs: A review of the literature, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.01.010
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E.A. Gazza, D.F. Hunker / Nurse Education Today xxx (2014) xxx–xxx
The initial search was restricted to the nursing literature and to graduate level nursing education. However, because of the limited research-based results found, the scope was expanded to include studies involving mixed graduate and undergraduate samples, literature reviews, the general higher education literature, and best practices in both nursing and higher education. A total of 48 articles were retrieved. Only those articles that described research or best practices supported by research were included. Studies and best practices that focused only on undergraduates or community colleges were excluded. Twenty-three articles meeting the inclusion criteria, published since 2006, and written in English were included in the review. Results Models Rovai (2003) used models of persistence to develop the Composite Persistence Model (CPM) to predict persistence in online education outside of nursing. Rovai noted the lower persistence of non-traditional students and its implications for distance education. He also noted that other models, specifically those developed by Tinto (1975, 1987, 1993) and Bean and Metzner (1985), were largely based on psychology and minimally explored the notion of student fit within a specific learning environment. The CPM included assessment of student skills and attributes prior to admission, and internal and external factors after admission. This model has been used not only to predict persistence in higher education, but also to direct teaching strategies and promote program attributes for persistence. Another model was developed to predict retention in online education by Holley and Oliver (2010), who studied diverse, nontraditional students in the United Kingdom to gain insight into the students' experiences with higher education in classroom, online, and blended formats. Student life experiences, educational experiences, control of technology, and view of space (private or social) all contributed to students' attitudes towards online learning. The model can be used to predict retention based on student experiences. Moore and Fetzner (2009) used the five pillars of the Sloan-C Quality Framework to identify best practices for student retention used by institutions of higher education who achieved above 85% retention rates in 100 and 200 level undergraduate courses and above 90% in graduate courses. The five pillars are access, faculty satisfaction, learning effectiveness, student satisfaction, and scale. Collectively, these best practices have been shown to contribute to student retention in online education. Concepts Directly Linked to Retention The higher education literature addressing concepts linked to retention in online education includes both research and literature reviews. Lee and Choi (2011) reviewed the literature to identify factors that influence students to withdraw from online courses, approaches to address these factors, and areas that need further exploration. A total of 69 factors were identified that affected students' decision to drop out from an online course, they included student factors, course/program factors, and environmental factors. Student factors associated with a lower possibility of dropping an online course included greater academic aptitude, more experience with higher education, a history of higher levels of academic performance, previous experience with course content, possession of management and technology skills, an internal locus of control, greater self-efficacy, more satisfaction with the course, and more confidence in computer skills. Interestingly, students with less academic aptitude and poorer academic performance were more likely to enroll in online courses. Course/program factors associated with being less likely to drop out from an online course included a well designed course, the availability of systematic support, facultystudent interactions, and high levels of participation. The possibility of student drop out was greater when environmental factors were
involved. Students working full time, feeling pressure to work more hours, and experiencing life challenges and unexpected life events without support were more likely to drop an online course. Lee and Choi (2013) also used structural equation modeling (SEM) to predict dropout rates for students in online courses. The sample included 282 students; the majority were juniors and seniors enrolled in an online course in an undergraduate education program at Korea National Open University. While it was not clear whether graduate students were included in the study, participants were between 20 and 60 years of age and 49.5% were in their 40s. Results indicated that an internal locus of control, or the belief that one controls events and outcomes, and satisfaction with the online course significantly influenced student retention. These findings align with the factors identified in the literature review published by Lee and Choi in 2011. In their literature review, Park et al. (2011) examined strategies to minimize attrition among graduate students enrolled in online courses. Their findings were consistent with a review published by Lee and Choi (2011) in terms of student factors and course/program factors, but included several additional factors such as interpersonal relationships. Findings were organized into four groups: course design, course delivery, program organization, and re-integration to ease the return to online education. Matching learning activities with the needs of the student, and including opportunities for students to receive support from peers were course design strategies. Interpersonal interactions associated with lower retention included being mentored by faculty or a professional staff member, receiving progress reports from faculty, having regular student contact to avoid feelings of isolation, experiencing personalized connections between faculty and staff and student, receiving communication about importance, and being notified that they could contact faculty if help was needed. In addition, possessing computer literacy, information literacy, time management skills, reading and writing skills, and the ability to engage in computer-based communication facilitated retention. Park et al. (2011) also identified program organization strategies to minimize attrition including student participation in a mandatory virtual/multi-media orientation, student access to trained academic advisors and a point person to contact if considering withdrawing from or returning to an online course or program, careful admission screening with attention to academic preparation and attitude towards learning, encouragement of student–university relationships, and attentiveness of all staff to building student relationships. Herbert (2006) reported that the most important institutional variable associated with student retention was faculty responsiveness to student needs and the least important variable was student-to-student collaboration. Student satisfaction with an online course was associated with faculty responsiveness to student needs during the course. Time commitments were the main reason non-completers gave for dropping a course. Time commitment also was identified as a factor contributing to online course withdrawals in a study by Willging and Johnson (2009). Their study was designed to determine why and when students enrolled in an online graduate level principal and superintendent certification program dropped out of the program and to identify factors that could predict the likelihood of dropping out. Participants included students who dropped out of the program any time after starting the first course. The authors found that while students dropped out of the online program after the 1st, 2nd, 3rd, 4th, and 5th course, the largest number left after completing the first course. Reasons for leaving included personal reasons such as too hard to work full-time and be a graduate student; job-related reasons including a change in job responsibilities that eliminated need for the certification; program-related reasons; and technology related reasons. Not being allowed to do coursework at work, falling behind on assignments even though faculty were helpful and encouraging; and feeling information overload were cited as contributing factors. Using a qualitative case study method, Müller (2008) identified factors that affected women learners' persistence or retention in online
Please cite this article as: Gazza, E.A., Hunker, D.F., Facilitating student retention in online graduate nursing education programs: A review of the literature, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.01.010
E.A. Gazza, D.F. Hunker / Nurse Education Today xxx (2014) xxx–xxx
undergraduate and graduate degree completion programs. Only women who were current online learners were included in the study. Findings indicated that factors facilitating persistence included engagement in the learning community, schedule flexibility and convenience, experiences of personal growth and feeling challenged, and peer and faculty support. Barriers to persistence included multiple responsibilities, disappointment in faculty, face-to-face learning preference, emotional challenges, and technology problems. Factors facilitating persistence, however, outweighed the barriers. Rovai and Downey (2010), based a review of the research literature and US Securities and Exchange Commission (SEC) filings, identified student retention as one of the seven factors that determine the success or failure of online programs. These authors reported that distance education courses tend to attract a high percentage of nontraditional students with risk factors that negatively impact retention. In addition, educational institutions do not provide appropriate support services to counteract the risk factors. Because online students may experience isolation due to physical separation from the institution and student services, it is imperative that both academic and social support be readily available and accessible to students to enable them to be successful in completing online courses and programs. Concepts Associated with Retention and Supported by Research The nursing literature on retention has focused on three concepts: social presence, program/course quality, and individual student characteristics. Although these are distinct concepts, there is some overlap in findings. For instance, although a best practice may be presented as social presence supporting retention, course quality may also have been part of the finding. Social presence is defined as the amount of connectedness a student feels to the other students and faculty in a class. Social presence was explored by Mayne and Wu (2011) in an experimental study involving 26 graduate online nursing students (Mayne and Wu, 2011). The investigators reported that students who received social presence and group interaction activities were more likely to feel that their expectations for online learning were being met and more likely to take online classes in the future. This finding was supported by Park et al. (2011) who suggested that interpersonal interaction and regular student contact were needed to avoid feelings of isolation and to experience personalized connections with faculty and staff. Smith (2010) used Kolb Learning Theory to identify learning styles of 217 nursing students enrolled in an online MSN or RN-BSN program. The aim was to devise teaching strategies that were conducive to all types of learning. Kolb's (1984) learning styles include: diverger, assimilator, converger, and accommodator. Smith found that most students in the study were accommodators and preferred learning activities that were hands on, included trial and error, and allowed for social interaction. This finding of the importance of “social interaction” was supported in the study by Park et al. (2011). Avery et al. (2008) identified interaction as an important component of quality online courses. In this study 16 courses were evaluated by two nursing faculty and one technology professional using a researcherdesigned tool. Identified themes included: there must be a match between course objectives and learning activities; faculty and student technical competence is important; students need clear support; diverse learning styles must be supported; the student voice must be present; and finally, interaction is critical. The need for support, student voice presence and interaction was also supported by Rovai and Downey (2010) who reported that online students may experience isolation due to physical separation from institution and student services, and therefore, both academic and social support need to be readily available and accessible in order for students to succeed. Burruss et al. (2009) looked at how class size was related to students' perceptions of the use of technology and to outcomes in online courses in undergraduate and graduate nursing programs. Findings revealed
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that class size was related to both social interaction and participation. This is consistent with Lee and Choi's (2011) finding that a welldesigned online course and high levels of participation were associated with less likelihood that students would drop out. Mancuso-Murphy (2007) reviewed studies examining nursing student perspectives of distance education as a basis for developing effective teaching strategies. Findings indicated that many attributes are needed for effective distance education, including interactions between students and faculty, faculty skills, course design, attention to learning styles of students by faculty, cohort models, and clear evaluation criteria and feedback. According to the students, student–teacher relationships, professionalism, socialization, and technology were critical. Findings from this review were supported by Lee and Choi's (2011) review of the literature, which also identified multiple factors linked to retention, including student factors, course/program factors, and environmental factors. Lenners et al. (2007) indicated that faculty in an online doctoral program recognized the need for quality online education, and promoted student satisfaction with online education. Student feedback indicated that the online doctoral program met their standards for professionalism and socialization, mentoring, and student and faculty interaction. These findings are similar to Moore and Fetzner's, 2009 assessment of best practices for retention using the five pillars of the Sloan-C Quality Framework: access, faculty satisfaction, learning effectiveness, student satisfaction, and scale. Providing newly enrolled graduate students with an orientation to an online course or program was presented by Carruth et al. (2010) as a best practice. The orientation included content about the learning management system, hardware and software requirements and computer literacy skills, and simulated online course work. The goal of the orientation was to boost student confidence with online learning, and improve proficiency and competence in e-learning activities. Another best practice from the nursing literature was flexibility in course delivery options for non-traditional graduate nursing students (Parker and Wassef, 2010). When students in a course were allowed to choose between a fully online or blended format, students created a schedule and selected the course delivery method that best met their needs. Both formats included identical course objectives, activity schedules, and assignments. Enrollment in the program grew because students enjoyed choosing a format that worked best for them. Responses from focus groups echoed prior studies' results pointing to the importance of considering student learning styles (Smith, 2010), internal and external personal factors (Lee and Choi, 2011, 2013; Willging and Johnson, 2009) and issues related to technological competence (Park et al., 2011). A variety of individual student characteristics have been identified as key to retention in graduate level online courses and programs (Lee and Choi, 2011, 2013; Park et al., 2011; Willging and Johnson, 2009; Moore and Fetzner, 2009). Through a qualitative study, Perry et al. (2008) analyzed 86 student withdrawal emails and uncovered personal and program-related factors that led to their departure. Personal reasons included life circumstances, and/or work commitments. This is consistent with findings of Lee and Choi (2011), who identified numerous student and environmental factors that influenced students to withdraw, and Willging and Johnson (2009), who identified multiple issues associated with work-school balance and workload management. Program-related factors included those associated with learning style and changes in career aspirations. Two groups of nursing students enrolled in the same course either in an online (n = 19) or traditional format (n = 15), were compared in an exploratory study by O'Neil and Fisher (2008). Both groups had the same instructor and the demographics of the two groups did not significantly differ. One student dropped out of each group during the course. Findings revealed that online students reported appreciating the course flexibility and being independent learners, and felt connected to the other students in their group. They were highly interactive with both
Please cite this article as: Gazza, E.A., Hunker, D.F., Facilitating student retention in online graduate nursing education programs: A review of the literature, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.01.010
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E.A. Gazza, D.F. Hunker / Nurse Education Today xxx (2014) xxx–xxx Table 1 Recommendations to increase student retention in online graduate nursing education programs. Categories
Recommendations
Social presence
• Educate all staff who interact with online students to be attentive to relationship building • Create virtual student-only lounge for social interaction among students • Welcome students prior to the start of the program and each course • Provide students with contact information for program and course faculty, and key campus departments • Hold virtual office hours • Be available to students through phone, email, and virtual media • Promptly respond to student inquiries • Present clear directions for how and when students can reach course faculty • Include online students in student affairs via remote participation in meetings • Hold social receptions for online students during major professional nursing conferences • Include social activities in campus residency events • Establish clear admission criteria for online programs • Publish technological skills needed for program success in marketing materials • Solicit student feedback via course and program evaluations • Utilize a continuous improvement model for enhancing course and program quality • Offer a mandatory comprehensive online student orientation to the institution and program • Include learning activities that appeal to a variety of learning styles • Notify students of the person to contact if experiencing challenges • Provide virtual academic support services • Establish class size that facilitates student engagement • Consider need for faculty availability when calculating faculty workload • Incorporate asynchronous activities to allow for flexibility • Provide faculty development specific to online teaching • Present frequent, clear feedback to students • Provide quality technology support • Facilitate student-to-student and student-to-faculty interaction • Identify at-risk students and devise academic support plan • Collaborate with withdrawing students to devise clear plan for returning • Consider the following attributes when devising admission and selection criteria: –Academic aptitude –Experience in higher education –Level of academic performance –Previous experience with content –Experience with and confidence in use of technology –Internal locus of control –Time management abilities • Recognize impact of student employment requirements and hours • Assess student satisfaction with online learning
Program/course quality
Individual student characteristics
faculty and peers. The traditional class room students found it more difficult to stay on track and spent more time completing class activities than interacting with students and faculty. They were more likely to cite family and work as barriers to their learning experience than the online students. The online students scored significantly higher on the midterm, but there were no significant differences with the final grades. Overall, however, the online students reported having a better learning experience and appeared more satisfied. Findings suggest that complex factors predict the experiences of different learners. Müller (2008) also suggested that a complex set of factors impact persistence. Discussion Most of this body of research was published in the higher education literature rather than in the nursing literature. However, best practices that have been associated with retention were primarily found in the graduate nursing literature, and the findings from the nursing literature are supported by those from the higher education literature. Retention in online nursing education appears to be a multidimensional problem requiring a multifaceted approach for improvement. After generating a list of all findings included in this review, the authors grouped like findings and identified broad category names that encompass each group. Recommendations for creating multifaceted approaches to retention that are based on the reviewed literature are presented in Table 1. These recommendations are organized according to the identified categories of social presence, program/course quality, and individual student characteristics. Efforts to increase retention should be made during all phases of student exposure and enrollment in the program. For instance, program marketing materials should
highlight student attributes that align with those needed to be successful in online education, and attention to retention should continue throughout the application cycle, program enrollment, course work and program completion. Table 1 highlights specific recommendations for facilitating student retention in online graduate nursing education programs that are based on the results of the review of the literature. Conclusion Student retention in online programs is an area of increasing concern in nursing education as the number of online programs continues to grow. Predicting retention and graduate rates in online programs has been problematic. However literature from both outside of nursing and within nursing suggests that certain factors may directly or indirectly lead to retention in online programs. By understanding what is needed for retention, online nursing educators can take a proactive approach to promoting retention. In particular, careful consideration to incorporation of social presence in online programs, to program and course quality, and to understanding individual student characteristics for success in online courses can lead to increased retention. References Allen, I., Seaman, J., 2013. Changing Course: Ten Years of Tracking Online Education in the United States. www.onlinelearningsurvey.com/reports/changingcourse.pdf. American Association of Colleges of Nursing, 2011. 2010–2011 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. American Association of Colleges of Nursing, Washington, DC. American Association of Colleges of Nursing, 2013. 2012–2013 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. www.aacn.nche.edu/ downloads/ids/2013/EG12.pdf.
Please cite this article as: Gazza, E.A., Hunker, D.F., Facilitating student retention in online graduate nursing education programs: A review of the literature, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.01.010
E.A. Gazza, D.F. Hunker / Nurse Education Today xxx (2014) xxx–xxx Avery, M., Cohen, B., Walker, J., 2008. Evaluation of an online graduate nursing curriculum: examining standards of quality. Int. J. Nurs. Educ. Scholarsh. 5 (1), 1–17. Bean, J., Metzner, B., 1985. A conceptual model of nontraditional undergraduate student attrition. Rev. Educ. Res. 55, 485–650. Burruss, N., Billings, D., Brownrigg, V., Skiba, D., Connors, H., 2009. Class size as related to the use of technology, educational practices, and outcomes in web-based nursing courses. J. Prof. Nurs. 25 (1), 33–41. Carruth, A., Broussard, P., Waldmeier, V., Gauthier, D., Mixon, G., 2010. Graduate nursing online orientation course: transitioning for success. J. Nurs. Educ. 49 (12), 687–690. Commission on Collegiate Nursing Education, 2009. Standards for Accreditation of Baccalaureate and Graduate Degree Nursing Programs. http://www.aacn.nche.edu/ ccne-accreditation/standards09.pdf. Herbert, M., 2006. Staying the course: A study in online student satisfaction and retention. Online J. Distance Learn. Adm. 9 (4). Holley, D., Oliver, M., 2010. Student engagement and blended learning: portraits of risk. Comput. Educ. 54, 693–700. Kolb, D., 1984. Experimental Learning: Experience as the Source of Learning and Development. Prince-Hall, Inc., Englewood Cliffs, NJ. Lee, Y., Choi, J., 2011. A review of online course dropout research: Implications for practice and future research. Educ. Technol. Res. Dev. 59, 593–618. http://dx.doi.org/10.1007/ s11423-010-9177-y. Lee, Y., Choi, J., 2013. A structural equation model of predictors of online learning retention. Internet Higher Educ. 16, 36–41. Lenners, D., Wilson, V., Sitzman, K., 2007. Twenty-first century doctoral education: online with a focus on nursing education. Nurs. Educ. Perspect. 28 (6), 332–336. Mancuso-Murphy, J., 2007. Distance education in nursing: an integrated review of online nursing students' experiences with technology-delivered instruction. J. Nurs. Educ. 46 (6), 252–260.
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Mayne, L., Wu, Q., 2011. Creating and measuring social presence in online graduate nursing courses. Nurs. Educ. Perspect. 32 (2), 110–114. Moore, J., Fetzner, M., 2009. The road to retention: A closer look at institutions that achieve high course completion rates. J. Asynchronous Learn. Netw. 13 (3), 3–22. Müller, T., 2008. Persistence of women in online degree-completion programs. Int. Rev. Res. Open Distance Learn. 9 (2), 1–18. National League for Nursing Accrediting Commission, 2013. NLNAC 2013 Standards and Criteria Master's and Post-Master's Certificate. http://www.nlnac.org/manuaLS/ sc2013_masters.PDF. O'Neil, C., Fisher, C., 2008. Should I take this course online? J. Nurs. Educ. 47 (2), 53–58. Park, C., Perry, B., Edwards, M., 2011. Minimizing attrition: strategies for assisting students who are at risk of withdrawal. Innov. Educ. Teach. Int. 48 (1), 37–47. Parker, E., Wassef, M., 2010. Flexible online learning options for graduate nursing students. Nurse Educ. 35 (6), 243–247. Perry, B., Boman, J., Care, W., Edwards, M., Park, C., 2008. Why do students withdraw from online graduate nursing and health studies education? J. Educ. Online 5 (1), 1–17. Rovai, A., 2003. In search of higher persistence rates in distance education online programs. Internet Higher Educ. 6, 1–13. Rovai, A., Downey, J., 2010. Why some distance education programs fail while others success in a global environment. Internet Higher Educ. 13, 141–147. Smith, A., 2010. Learning styles of registered nurses enrolled in an online nursing program. J. Prof. Nurs. 26 (1), 49–53. Tinto, V., 1975. Dropout from higher education: a theoretical synthesis of recent research. Rev. Educ. Res. 45 (1), 89–125. Tinto, V., 1987. Leaving College. University of Chicago Press, Chicago, IL. Tinto, V., 1993. Leaving College: Rethinking the Causes and Cures of Student Attrition. University of Chicago Press, Chicago, IL. Willging, P., Johnson, S., 2009. Factors that influence students' decision to dropout of online courses. J. Asynchronous Learn. Netw. 13 (3), 115–127.
Please cite this article as: Gazza, E.A., Hunker, D.F., Facilitating student retention in online graduate nursing education programs: A review of the literature, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.01.010
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Review
Facilitating student retention in online graduate nursing education programs: A review of the literature Elizabeth A. Gazza a,⁎, Diane F. Hunker b,1 a b
University of North Carolina Wilmington, 601 S. College Road, 3039 McNeill Hall, Wilmington, NC 28403-5995, United States Chatham University, Woodland Road, 223 Coolidge, Pittsburgh, PA 15232, United States
a r t i c l e
i n f o
Article history: Accepted 21 January 2014 Available online xxxx Keywords: Student retention Online Education Graduate Nursing
s u m m a r y Online education, a form of distance education, provides students with opportunities to engage in lifelong learning without the restrictions of time and space. However, while this approach meets the needs of employed nursing professionals, it poses some challenges for educators. Student retention is one such challenge. Student retention rates serve as measures of program quality and are reported to accrediting bodies. Therefore, it is imperative that administrators and program faculty implement comprehensive programs to ensure student retention. This review of the literature was designed to identify strategies to improve student retention in online graduate nursing education programs. The review includes 23 articles that address models, research, and best practices supported in nursing and higher education. The findings indicate that student retention in online programs is a multidimensional problem requiring a multifaceted approach. Recommendations for facilitating retention in online nursing programs include ensuring social presence and program and course quality, and attentiveness to individual student characteristics. © 2014 Elsevier Ltd. All rights reserved.
Introduction Online education, a form of distance education, provides opportunities for students to engage in lifelong learning without the restrictions of space and time. A 2012 survey of Chief Academic Officers by Allen and Seaman (2013) indicated that total enrollment in online education grew from slightly more than 1.6 million in Fall 2002 to over 6.7 million in Fall 2011. The number of students enrolled in higher education who were taking at least one online course had increased by 570,000 in the previous year. As the number of students taking online courses grows, concerns about student retention have also grown. Indeed, lower retention rates were identified by 73.5% of respondents to the Allen and Seamen survey as an important or very important barrier to growth. According to the American Association of Colleges of Nursing (AACN, 2011), in 2011, 298 of 361 (82.5%) master of science in nursing programs (MSN) were delivered using some form of distance education, including online education. This percentage grew to 85.5% in 2013 (AACN, 2013). In 2011, 70% of research-focused (PhD) doctoral programs in nursing included some form of distance education (AACN, 2011), and this percentage increased to 71% in 2013 (AACN, 2013). The number of doctor of nursing practice (DNP) programs delivered using some degree of distance education was stable at 90% in 2011 and 2013 (AACN, 2011, 2013). ⁎ Corresponding author. Tel.: +1 910 962 7097; fax: +1 910 962 4921. E-mail addresses: [email protected] (E.A. Gazza), [email protected] (D.F. Hunker). 1 Tel.: +1 412 365 1738; fax: +1 412 265 2439.
Online students in higher education can engage in learning from any location where a personal computer with internet access is available. However, while this approach to learning meets the needs of many nursing professionals, it poses unique challenges. One challenge is student retention, or continued enrollment in an online program from admission through program completion. This article is a review of the literature, including research and best practices, aimed at facilitating student retention in online graduate nursing programs and recommends evidence-based strategies for improving student retention. Retention rates for nursing programs delivered via distance education are not available in the published literature, making it difficult to compare rates in graduate nursing programs with those of higher education overall. However graduation rates, an indicator of retention, are assessed as part of the program accreditation process for all levels of nursing education in the United States (Commission on Collegiate Nursing Education, 2009; National League for Nursing Accrediting Commission, 2013). Methods The question that guided the inquiry was, What strategies have been effective in facilitating retention of nursing students enrolled in online graduate nursing education programs? Key concepts used to conduct the search included online education, distance education, student retention, graduate education, nursing education, and persistence. Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Education Resource Information Center (ERIC), and bibliographies of retrieved articles were used in the search process.
0260-6917/$ – see front matter © 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.nedt.2014.01.010
Please cite this article as: Gazza, E.A., Hunker, D.F., Facilitating student retention in online graduate nursing education programs: A review of the literature, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.01.010
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The initial search was restricted to the nursing literature and to graduate level nursing education. However, because of the limited research-based results found, the scope was expanded to include studies involving mixed graduate and undergraduate samples, literature reviews, the general higher education literature, and best practices in both nursing and higher education. A total of 48 articles were retrieved. Only those articles that described research or best practices supported by research were included. Studies and best practices that focused only on undergraduates or community colleges were excluded. Twenty-three articles meeting the inclusion criteria, published since 2006, and written in English were included in the review. Results Models Rovai (2003) used models of persistence to develop the Composite Persistence Model (CPM) to predict persistence in online education outside of nursing. Rovai noted the lower persistence of non-traditional students and its implications for distance education. He also noted that other models, specifically those developed by Tinto (1975, 1987, 1993) and Bean and Metzner (1985), were largely based on psychology and minimally explored the notion of student fit within a specific learning environment. The CPM included assessment of student skills and attributes prior to admission, and internal and external factors after admission. This model has been used not only to predict persistence in higher education, but also to direct teaching strategies and promote program attributes for persistence. Another model was developed to predict retention in online education by Holley and Oliver (2010), who studied diverse, nontraditional students in the United Kingdom to gain insight into the students' experiences with higher education in classroom, online, and blended formats. Student life experiences, educational experiences, control of technology, and view of space (private or social) all contributed to students' attitudes towards online learning. The model can be used to predict retention based on student experiences. Moore and Fetzner (2009) used the five pillars of the Sloan-C Quality Framework to identify best practices for student retention used by institutions of higher education who achieved above 85% retention rates in 100 and 200 level undergraduate courses and above 90% in graduate courses. The five pillars are access, faculty satisfaction, learning effectiveness, student satisfaction, and scale. Collectively, these best practices have been shown to contribute to student retention in online education. Concepts Directly Linked to Retention The higher education literature addressing concepts linked to retention in online education includes both research and literature reviews. Lee and Choi (2011) reviewed the literature to identify factors that influence students to withdraw from online courses, approaches to address these factors, and areas that need further exploration. A total of 69 factors were identified that affected students' decision to drop out from an online course, they included student factors, course/program factors, and environmental factors. Student factors associated with a lower possibility of dropping an online course included greater academic aptitude, more experience with higher education, a history of higher levels of academic performance, previous experience with course content, possession of management and technology skills, an internal locus of control, greater self-efficacy, more satisfaction with the course, and more confidence in computer skills. Interestingly, students with less academic aptitude and poorer academic performance were more likely to enroll in online courses. Course/program factors associated with being less likely to drop out from an online course included a well designed course, the availability of systematic support, facultystudent interactions, and high levels of participation. The possibility of student drop out was greater when environmental factors were
involved. Students working full time, feeling pressure to work more hours, and experiencing life challenges and unexpected life events without support were more likely to drop an online course. Lee and Choi (2013) also used structural equation modeling (SEM) to predict dropout rates for students in online courses. The sample included 282 students; the majority were juniors and seniors enrolled in an online course in an undergraduate education program at Korea National Open University. While it was not clear whether graduate students were included in the study, participants were between 20 and 60 years of age and 49.5% were in their 40s. Results indicated that an internal locus of control, or the belief that one controls events and outcomes, and satisfaction with the online course significantly influenced student retention. These findings align with the factors identified in the literature review published by Lee and Choi in 2011. In their literature review, Park et al. (2011) examined strategies to minimize attrition among graduate students enrolled in online courses. Their findings were consistent with a review published by Lee and Choi (2011) in terms of student factors and course/program factors, but included several additional factors such as interpersonal relationships. Findings were organized into four groups: course design, course delivery, program organization, and re-integration to ease the return to online education. Matching learning activities with the needs of the student, and including opportunities for students to receive support from peers were course design strategies. Interpersonal interactions associated with lower retention included being mentored by faculty or a professional staff member, receiving progress reports from faculty, having regular student contact to avoid feelings of isolation, experiencing personalized connections between faculty and staff and student, receiving communication about importance, and being notified that they could contact faculty if help was needed. In addition, possessing computer literacy, information literacy, time management skills, reading and writing skills, and the ability to engage in computer-based communication facilitated retention. Park et al. (2011) also identified program organization strategies to minimize attrition including student participation in a mandatory virtual/multi-media orientation, student access to trained academic advisors and a point person to contact if considering withdrawing from or returning to an online course or program, careful admission screening with attention to academic preparation and attitude towards learning, encouragement of student–university relationships, and attentiveness of all staff to building student relationships. Herbert (2006) reported that the most important institutional variable associated with student retention was faculty responsiveness to student needs and the least important variable was student-to-student collaboration. Student satisfaction with an online course was associated with faculty responsiveness to student needs during the course. Time commitments were the main reason non-completers gave for dropping a course. Time commitment also was identified as a factor contributing to online course withdrawals in a study by Willging and Johnson (2009). Their study was designed to determine why and when students enrolled in an online graduate level principal and superintendent certification program dropped out of the program and to identify factors that could predict the likelihood of dropping out. Participants included students who dropped out of the program any time after starting the first course. The authors found that while students dropped out of the online program after the 1st, 2nd, 3rd, 4th, and 5th course, the largest number left after completing the first course. Reasons for leaving included personal reasons such as too hard to work full-time and be a graduate student; job-related reasons including a change in job responsibilities that eliminated need for the certification; program-related reasons; and technology related reasons. Not being allowed to do coursework at work, falling behind on assignments even though faculty were helpful and encouraging; and feeling information overload were cited as contributing factors. Using a qualitative case study method, Müller (2008) identified factors that affected women learners' persistence or retention in online
Please cite this article as: Gazza, E.A., Hunker, D.F., Facilitating student retention in online graduate nursing education programs: A review of the literature, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.01.010
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undergraduate and graduate degree completion programs. Only women who were current online learners were included in the study. Findings indicated that factors facilitating persistence included engagement in the learning community, schedule flexibility and convenience, experiences of personal growth and feeling challenged, and peer and faculty support. Barriers to persistence included multiple responsibilities, disappointment in faculty, face-to-face learning preference, emotional challenges, and technology problems. Factors facilitating persistence, however, outweighed the barriers. Rovai and Downey (2010), based a review of the research literature and US Securities and Exchange Commission (SEC) filings, identified student retention as one of the seven factors that determine the success or failure of online programs. These authors reported that distance education courses tend to attract a high percentage of nontraditional students with risk factors that negatively impact retention. In addition, educational institutions do not provide appropriate support services to counteract the risk factors. Because online students may experience isolation due to physical separation from the institution and student services, it is imperative that both academic and social support be readily available and accessible to students to enable them to be successful in completing online courses and programs. Concepts Associated with Retention and Supported by Research The nursing literature on retention has focused on three concepts: social presence, program/course quality, and individual student characteristics. Although these are distinct concepts, there is some overlap in findings. For instance, although a best practice may be presented as social presence supporting retention, course quality may also have been part of the finding. Social presence is defined as the amount of connectedness a student feels to the other students and faculty in a class. Social presence was explored by Mayne and Wu (2011) in an experimental study involving 26 graduate online nursing students (Mayne and Wu, 2011). The investigators reported that students who received social presence and group interaction activities were more likely to feel that their expectations for online learning were being met and more likely to take online classes in the future. This finding was supported by Park et al. (2011) who suggested that interpersonal interaction and regular student contact were needed to avoid feelings of isolation and to experience personalized connections with faculty and staff. Smith (2010) used Kolb Learning Theory to identify learning styles of 217 nursing students enrolled in an online MSN or RN-BSN program. The aim was to devise teaching strategies that were conducive to all types of learning. Kolb's (1984) learning styles include: diverger, assimilator, converger, and accommodator. Smith found that most students in the study were accommodators and preferred learning activities that were hands on, included trial and error, and allowed for social interaction. This finding of the importance of “social interaction” was supported in the study by Park et al. (2011). Avery et al. (2008) identified interaction as an important component of quality online courses. In this study 16 courses were evaluated by two nursing faculty and one technology professional using a researcherdesigned tool. Identified themes included: there must be a match between course objectives and learning activities; faculty and student technical competence is important; students need clear support; diverse learning styles must be supported; the student voice must be present; and finally, interaction is critical. The need for support, student voice presence and interaction was also supported by Rovai and Downey (2010) who reported that online students may experience isolation due to physical separation from institution and student services, and therefore, both academic and social support need to be readily available and accessible in order for students to succeed. Burruss et al. (2009) looked at how class size was related to students' perceptions of the use of technology and to outcomes in online courses in undergraduate and graduate nursing programs. Findings revealed
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that class size was related to both social interaction and participation. This is consistent with Lee and Choi's (2011) finding that a welldesigned online course and high levels of participation were associated with less likelihood that students would drop out. Mancuso-Murphy (2007) reviewed studies examining nursing student perspectives of distance education as a basis for developing effective teaching strategies. Findings indicated that many attributes are needed for effective distance education, including interactions between students and faculty, faculty skills, course design, attention to learning styles of students by faculty, cohort models, and clear evaluation criteria and feedback. According to the students, student–teacher relationships, professionalism, socialization, and technology were critical. Findings from this review were supported by Lee and Choi's (2011) review of the literature, which also identified multiple factors linked to retention, including student factors, course/program factors, and environmental factors. Lenners et al. (2007) indicated that faculty in an online doctoral program recognized the need for quality online education, and promoted student satisfaction with online education. Student feedback indicated that the online doctoral program met their standards for professionalism and socialization, mentoring, and student and faculty interaction. These findings are similar to Moore and Fetzner's, 2009 assessment of best practices for retention using the five pillars of the Sloan-C Quality Framework: access, faculty satisfaction, learning effectiveness, student satisfaction, and scale. Providing newly enrolled graduate students with an orientation to an online course or program was presented by Carruth et al. (2010) as a best practice. The orientation included content about the learning management system, hardware and software requirements and computer literacy skills, and simulated online course work. The goal of the orientation was to boost student confidence with online learning, and improve proficiency and competence in e-learning activities. Another best practice from the nursing literature was flexibility in course delivery options for non-traditional graduate nursing students (Parker and Wassef, 2010). When students in a course were allowed to choose between a fully online or blended format, students created a schedule and selected the course delivery method that best met their needs. Both formats included identical course objectives, activity schedules, and assignments. Enrollment in the program grew because students enjoyed choosing a format that worked best for them. Responses from focus groups echoed prior studies' results pointing to the importance of considering student learning styles (Smith, 2010), internal and external personal factors (Lee and Choi, 2011, 2013; Willging and Johnson, 2009) and issues related to technological competence (Park et al., 2011). A variety of individual student characteristics have been identified as key to retention in graduate level online courses and programs (Lee and Choi, 2011, 2013; Park et al., 2011; Willging and Johnson, 2009; Moore and Fetzner, 2009). Through a qualitative study, Perry et al. (2008) analyzed 86 student withdrawal emails and uncovered personal and program-related factors that led to their departure. Personal reasons included life circumstances, and/or work commitments. This is consistent with findings of Lee and Choi (2011), who identified numerous student and environmental factors that influenced students to withdraw, and Willging and Johnson (2009), who identified multiple issues associated with work-school balance and workload management. Program-related factors included those associated with learning style and changes in career aspirations. Two groups of nursing students enrolled in the same course either in an online (n = 19) or traditional format (n = 15), were compared in an exploratory study by O'Neil and Fisher (2008). Both groups had the same instructor and the demographics of the two groups did not significantly differ. One student dropped out of each group during the course. Findings revealed that online students reported appreciating the course flexibility and being independent learners, and felt connected to the other students in their group. They were highly interactive with both
Please cite this article as: Gazza, E.A., Hunker, D.F., Facilitating student retention in online graduate nursing education programs: A review of the literature, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.01.010
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E.A. Gazza, D.F. Hunker / Nurse Education Today xxx (2014) xxx–xxx Table 1 Recommendations to increase student retention in online graduate nursing education programs. Categories
Recommendations
Social presence
• Educate all staff who interact with online students to be attentive to relationship building • Create virtual student-only lounge for social interaction among students • Welcome students prior to the start of the program and each course • Provide students with contact information for program and course faculty, and key campus departments • Hold virtual office hours • Be available to students through phone, email, and virtual media • Promptly respond to student inquiries • Present clear directions for how and when students can reach course faculty • Include online students in student affairs via remote participation in meetings • Hold social receptions for online students during major professional nursing conferences • Include social activities in campus residency events • Establish clear admission criteria for online programs • Publish technological skills needed for program success in marketing materials • Solicit student feedback via course and program evaluations • Utilize a continuous improvement model for enhancing course and program quality • Offer a mandatory comprehensive online student orientation to the institution and program • Include learning activities that appeal to a variety of learning styles • Notify students of the person to contact if experiencing challenges • Provide virtual academic support services • Establish class size that facilitates student engagement • Consider need for faculty availability when calculating faculty workload • Incorporate asynchronous activities to allow for flexibility • Provide faculty development specific to online teaching • Present frequent, clear feedback to students • Provide quality technology support • Facilitate student-to-student and student-to-faculty interaction • Identify at-risk students and devise academic support plan • Collaborate with withdrawing students to devise clear plan for returning • Consider the following attributes when devising admission and selection criteria: –Academic aptitude –Experience in higher education –Level of academic performance –Previous experience with content –Experience with and confidence in use of technology –Internal locus of control –Time management abilities • Recognize impact of student employment requirements and hours • Assess student satisfaction with online learning
Program/course quality
Individual student characteristics
faculty and peers. The traditional class room students found it more difficult to stay on track and spent more time completing class activities than interacting with students and faculty. They were more likely to cite family and work as barriers to their learning experience than the online students. The online students scored significantly higher on the midterm, but there were no significant differences with the final grades. Overall, however, the online students reported having a better learning experience and appeared more satisfied. Findings suggest that complex factors predict the experiences of different learners. Müller (2008) also suggested that a complex set of factors impact persistence. Discussion Most of this body of research was published in the higher education literature rather than in the nursing literature. However, best practices that have been associated with retention were primarily found in the graduate nursing literature, and the findings from the nursing literature are supported by those from the higher education literature. Retention in online nursing education appears to be a multidimensional problem requiring a multifaceted approach for improvement. After generating a list of all findings included in this review, the authors grouped like findings and identified broad category names that encompass each group. Recommendations for creating multifaceted approaches to retention that are based on the reviewed literature are presented in Table 1. These recommendations are organized according to the identified categories of social presence, program/course quality, and individual student characteristics. Efforts to increase retention should be made during all phases of student exposure and enrollment in the program. For instance, program marketing materials should
highlight student attributes that align with those needed to be successful in online education, and attention to retention should continue throughout the application cycle, program enrollment, course work and program completion. Table 1 highlights specific recommendations for facilitating student retention in online graduate nursing education programs that are based on the results of the review of the literature. Conclusion Student retention in online programs is an area of increasing concern in nursing education as the number of online programs continues to grow. Predicting retention and graduate rates in online programs has been problematic. However literature from both outside of nursing and within nursing suggests that certain factors may directly or indirectly lead to retention in online programs. By understanding what is needed for retention, online nursing educators can take a proactive approach to promoting retention. In particular, careful consideration to incorporation of social presence in online programs, to program and course quality, and to understanding individual student characteristics for success in online courses can lead to increased retention. References Allen, I., Seaman, J., 2013. Changing Course: Ten Years of Tracking Online Education in the United States. www.onlinelearningsurvey.com/reports/changingcourse.pdf. American Association of Colleges of Nursing, 2011. 2010–2011 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. American Association of Colleges of Nursing, Washington, DC. American Association of Colleges of Nursing, 2013. 2012–2013 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. www.aacn.nche.edu/ downloads/ids/2013/EG12.pdf.
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Please cite this article as: Gazza, E.A., Hunker, D.F., Facilitating student retention in online graduate nursing education programs: A review of the literature, Nurse Educ. Today (2014), http://dx.doi.org/10.1016/j.nedt.2014.01.010
