Occurrence and risk factors of leave of absence and dropout among undergraduate nursing students: A survival analysis

The increasing trend in leave of absence and dropouts among nursing students in Taiwan's universities potentially impacts the future nursing workforce. Understanding the patterns and risk factors associated with student attrition is crucial for developing effective interventions.

To examine the temporal patterns of nursing student attrition using survival analysis and identify critical intervention periods; to analyze risk factors through comprehensive institutional data including academic performance, attendance records, and behavioral indicators; and to provide a longitudinal perspective on student attrition patterns over a seven-year period.

This retrospective cohort study analyzed institutional research data from 3526 students (84-88 % female) in a four-year baccalaureate nursing program in Taiwan between 2017 and 2023. Data included academic performance, behavioral indicators, and academic interruption status. A total of 41 academic courses were analyzed across three main areas: general education (12 courses), basic science and nursing courses (20 courses), and clinical practicum (9 courses). Kaplan-Meier survival analysis examined temporal patterns, while Cox proportional hazards models analyzed risk factors.

Academic interruption rates varied from 7.0 % (2018) to 15.2 % (2022) of respective cohorts. Entry period and first year (45.1 %) along with second year (43.0 %) emerged as critical periods, together accounting for 88.1 % of all direct dropouts. Survival analysis identified merit points as the strongest protective factor (HR = 0.896, 95 % CI: 0.865-0.929, p < 0.001), with each point reducing dropout risk by 10.4 %. Each unexcused absence increased risk by 7 % (HR = 1.070, 95 % CI: 1.029-1.112, p = 0.001). Academic performance in Fundamental Nursing II showed a protective effect (HR = 0.952, 95 % CI: 0.929-0.976, p < 0.001), while Psychology course performance unexpectedly increased dropout risk (HR = 1.029, 95 % CI: 1.000-1.059, p = 0.048).

Student attrition risk is significantly associated with academic performance, attendance, and merit records, with early program years being particularly crucial. Implementation of early warning systems, enhanced support during entry period and first two years, and strengthened attendance management are recommended. These findings provide evidence-based guidance for developing preventive interventions in nursing education.