The major transfer decision-making process among nursing undergraduates: A grounded theory

The global nursing workforce faces a projected shortage of 4.5 million by 2030, exacerbated by high attrition rates among nursing undergraduates transferring to other majors. Studies indicate that 76.7% consider transferring upon enrollment, and 23.3% ultimately do so. Existing research tends to treat this decision as a static outcome, with limited attention to the process by which it unfolds.

To develop a theory explaining the process through which nursing undergraduates navigate the decision of whether to transfer out of their major.

Constructivist grounded theory.

Twenty-seven nursing undergraduates from three Chinese universities who had considered or had already transferred to a non-nursing major.

Purposive and theoretical sampling were used. Data were collected through semi-structured remote interviews and analyzed using constant comparative methods, focusing on processes, meanings, and psychosocial interactions shaping participants' decision journeys.

Analysis produced the Dynamic Deliberation Process Model of Nursing Major Transfer Decision, comprising four stages: intention formation, intention latency, intention weighing, and decision execution. The process is driven by interplay among triggering, underlying, inhibiting, and promoting factors. The outcome, whether a student transfers, abandons the intention, or remains in active retention, passive retention, or postponement, reflects ongoing negotiation among these factors throughout the decision journey.

The major transfer decision is a protracted psychosocial process. Findings advocate shifting from reactive, generalized support to proactive, stage-specific interventions. By identifying signs of each phase and understanding underlying factor dynamics, educators can transition from gatekeeping to navigating students' decision processes. They can foster professional identity early, provide emotionally aware counseling during conflict, and ensure supportive pathways for all outcomes.