Career choices, retention, and graduation among Generation Z undergraduate nursing students: A JBI scoping review

Generation Z is now a dominant cohort in undergraduate nursing programs, yet evidence on their career choices, retention barriers, and graduation facilitators remains dispersed.

To map factors influencing Generation Z students' decisions to enter nursing, barriers affecting retention and graduation, and facilitators supporting successful program completion.

A JBI-guided scoping review was conducted and reported using PRISMA-ScR. Five databases (CINAHL, Embase, MEDLINE, ERIC, Scopus) and supplementary sources (reference lists, Google Scholar) were searched for English-language empirical studies published from 2015 onward. Two reviewers independently screened records and extracted data in Covidence. Content analysis was used to synthesize findings aligned with the review questions.

The search yielded 11,674 records plus 21 records obtained from supplementary methods. After deduplication (4667), 7007 titles and abstracts were screened, and 425 full texts were assessed. Fifty-seven studies were included, representing more than 16,415 Generation Z undergraduate nursing students across diverse regions. Four categories shaped nursing career choice: 1.) intrinsic motivations and personal values; 2.) prior personal or vicarious healthcare experiences; 3.) extrinsic, pragmatic, and structural considerations; and 4.) social, cultural, and societal influences. Retention barriers were clustered into academic and program demands, clinical placement and role realities, wellbeing and competing life demands, and social climate and inclusion. Graduation facilitators were grouped into academic preparedness and performance, supportive relationships and learning environments, and personal motivation, resilience, and coping resources.

Generation Z nursing students' entry, persistence, and completion are shaped by intersecting motivational, structural, and socio-cultural influences. Integrated strategies that strengthen academic and clinical supports, promote inclusive learning climates, and address wellbeing and practical constraints are needed to improve retention and graduation.