ARTICLES

 

Nurse educators' challenges and corresponding measures to improve the academic performance, success and retention of undergraduate nursing students at a university in the Western Cape, South Africa

 

 

Katlego Dumisani Trevor Mthimunye; Felicity Megan Daniels

University of Western Cape, South Africa

 

 

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ABSTRACT

The aim of this study was to explore and describe the challenges experienced by nurse educators at a selected School of Nursing regarding the academic performance, success and retention of undergraduate nursing students and the measures implemented to overcome these challenges. An in-depth qualitative research approach with an exploratory and descriptive design was implemented. Stratified purposive sampling technique was used to recruit nurse educators to participate in the study. Data were analysed by means of thematic analysis using Atlas, ti. Mac Version 1.6. software. Trustworthiness was safeguarded by employing the principles of credibility, transferability, dependability and confirmability. Research ethics was safeguarded by obtaining a written consent as well as ensuring privacy and confidentiality of the study participants. The findings of this study indicate that nurse educators are faced with challenges related to: (1) Nursing students' lack of interest, motivation, dedication, commitment and poor class attendance; (2) Lack of academic readiness of students admitted into the undergraduate nursing programme; (3) Students' socioeconomic backgrounds and employment responsibilities; (4) Lack of proficiency in English; (5) Structure of the undergraduate nursing programme; (6) The physical teaching and learning environment not being conducive to learning; and (7) Unfavourable working conditions. The recommendations emerging from this study indicate the need to address student related as well as school related matters.

Keywords: academic performance, challenges, measures, nurse education, qualitative research, South Africa

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INTRODUCTION

The rapidly changing nursing system is remodelling the role and scope of nurse educators in the academic environment. The change in focus from hospital-centred health care to primary health care, as well as the proposed new curriculum for undergraduate nursing by the South African Nursing Council (SANC), poses challenges for the approach to and quality of teaching and learning. Therefore, nurse educators need to reassess teaching methods in order to prepare nurses for the work environment (Bell et al., 2013). Nurse educators also need to be resourceful and implement innovative methods that will enhance the academic performance, success and retention of nursing students.

The national and global shortage in the nursing workforce (Buerhaus et al., 2009), together with the implementation of the recommendations of the National Plan for Higher Education (2001) has led to an increase in the number of students being admitted to higher education, particularly in undergraduate programmes. The National Plan for Higher Education (2001) addresses the transformation of higher education to remedy previous inequalities experienced by historically disadvantaged populations. This increases the nurse educators' workload, which impacts the quality of the teaching and learning process and requires additional efforts by nurse educators to promote the academic performance, success and retention of nursing students. This includes an acknowledgement of and appropriate response to the diversity of students, including offering emotional support, extra classes and individual consultations.

In addition, the nurse educators' preparation for conducting teaching and learning sessions before each semester requires insight into preparing comprehensive and detailed lesson plans as well as organising all teaching material needed to ensure that quality teaching and learning takes place (Cherry & Jacob, 2016). Apart from being experts in nursing content, nurse educators are also expected to support students on emotional, psychological and spiritual levels. Without this additional support, students are at risk of unsatisfactory academic performance and may drop out of the programme (Jeffreys, 2012).

The challenges faced by nurse educators to perform their duties effectively, unless resolved, have serious consequences for students, Higher Education Institutions (HEIs) and ultimately the nursing profession and patient care. Given the current global demand for qualified nurses, efficient education and training is essential for ensuring that the quantity and quality of nurses is sufficient to sustain the required nursing workforce. Thus, it is pivotal to understand the challenges experienced by nurse educators that hinder them from ensuring satisfactory academic performance, success and retention of nursing students.

Nurse educators are expected to take responsibility for implementing effective, reasonable solutions to counter the numerous challenges they face within their profession. The South African Nursing Council (SANC) guides the professional practice of nurse educators. The core competencies stipulated by SANC (2013) for nurse educators provide guidance in quality nursing education. These competencies include: scholarship of teaching and learning; academic and student management; curriculum development; management and leadership; personal development of the nurse educator; and research and knowledge creation. Literature research has highlighted two main challenges associated with the core competencies of nurse educators. These relate to the facilitation of learning, as well as curriculum design and programme evaluation (Adamson, 2012; Cambier et al., 2013).

Adamson (2012) reported that nurse educators' competency as related to the facilitation of learning is complicated due to the fact that teaching and learning approaches are multidimensional. Nurse educators are challenged with the responsibility of creating a multidimensional programme and employing a range of teaching methodologies to ensure that quality teaching and learning takes place, thereby positively influencing academic performance, success and retention of nursing students (Cambier et al., 2013). Thus, it is essential for nurse educators to demonstrate commitment to and accountability for the education of nursing students to guarantee satisfactory academic performance.

Apart from participating in curriculum design and evaluation of programme outcomes under the SANC competencies, nurse educators are also at the forefront of the implementation of the curriculum. However, the literature search indicated that nurse educators face numerous challenges in their endeavour to fulfil this essential competency (Stanley & Dougherty, 2010). Cambier et al. (2013: 7) reported that 'the changing healthcare system and the need to stay relevant taking into consideration the current issues add to the challenges'. While changes in the healthcare system have initiated debate around increasing the content in nursing programmes, Fong, (2016) as well as Thomas, Bantz and McIntosh (2019) warned against content overload which adds to the educators' and students' workload. The repercussions of content overload in nursing programmes can have a detrimental impact on the academic performance, success and retention of nursing students. Another curriculum design, implementation and evaluation challenge relates to evolving technologies such as web-based classrooms, virtual reality simulations and online classes (Stanley & Dougherty, 2010).

This paper is grounded on the conceptual framework for reducing the School of Nursing (SoN) success gap and promoting success for all as adapted from Perna and Thomas (2006). This model assumes that students' academic success cannot be comprehended without considering that such success is shaped by four contextual layers: (1) the individual's internal context, (2) the family context, (3) the school context, and (4) the social, economic and policy context (Perna & Thomas, 2006).

 

PROBLEM STATEMENT

Previous studies have placed emphasis on exploring the challenges faced by nursing students during the course of their undergraduate studies (Killam & Heerschap, 2013; Porteous & Machin, 2018). According to two studies conducted at the university under study, the university is challenged with a decline in academic performance of nursing students (Swart, 2013; Mthimunye, 2015). Although much is known about the challenges faced by nursing students (Killam & Heerschap, 2013; Porteous & Machin, 2018), very little attention has been given to understanding these challenges from the nurse educators' perspective. Poor academic performance and failure by nursing students does not only affect the nursing students and their families, but also has an impact on the nurse educators as they strive to perform their primary responsibility of ensuring students' success. Likewise, the current study formed part of the larger project that aimed to 'develop an intervention towards the improvement of academic performance, success and retention among undergraduate nursing students at a university in the Western Cape, South Africa'.

 

AIM OF THE STUDY

The aim of the study was to explore and describe the challenges experienced by nurse educators at a selected SoN regarding academic performance, success and retention of undergraduate nursing students and measures implemented to overcome these challenges.

 

METHODOLOGY

Research approach and design

A qualitative exploratory and descriptive research design allowed for an in-depth understanding of the challenges and restorative measures used by nurse educators to ensure satisfactory academic performance, success and retention of nursing students. According to Grove, Burns and Gray (2012), a qualitative research approach increases our in-depth understanding about some aspects of the phenomenon.

Research setting

The study was conducted at the SoN in the Western Cape, South Africa. The main focus of this research was the undergraduate Bachelor of Nursing (BN) four-year programme and the five-year Extended Curricular Programme (ECP), which are regulated by R425 according to the Nursing Act 2005 (Act 33 of 2005) and culminate in registration as a nurse with SANC. This enables graduates to practise as general nurses, midwives, community health workers and psychiatric nurses.

Population and sampling

The population included all nurse educators involved in the mainstream Bachelor of Nursing programme as well as Extended Curricular Programmes. The total nurse educator population was 20, with each year level of the programme having one to four representatives. Stratified purposive sampling was used to recruit nurse educators for participation in the study. The sample started with one to two nurse educators in each of the year levels of the programme. Sampling ended when data saturation was reached (Grove et al., 2012). In this study, data saturation was reached when all new information was able to fit into the newly established codes, i.e. when new data reflected the same data that is already collected (Creswell & Poth, 2018).

Data collection and management

Data were collected between April and July 2017 through individual face-to-face in-depth interviews, which lasted from 45 to 60 minutes. The following research question was posed to participants: what challenges are faced by nurse educators regarding teaching and learning and what measures have they implemented to overcome the challenges? Interviews were digitally recorded and password protected to ensure confidentiality. The recordings facilitated accurate verbatim transcriptions of the interviews (Onwuegbuzie et al., 2009).

Data analysis

ATLAS, ti. Mac Version 1.6. software was used for the organisation of text along with coding and memos (Creswell, & Poth, 2018). Thematic analysis (Braun & Clarke, 2013) was an iterative process involving coding of data until themes and sub-themes were generated. Identification (ID) codes were used to present verbatim quotes.

Rigour

Rigour was safeguarded by employing the principles of credibility, transferability, dependability and confirmability (Thomas, Nelson & Silverman 2015). Member checking was done to gauge the accuracy of the interpretation of data and to enhance credibility. A detailed description of the research setting, the participants, as well as the method of data collection and data analysis were provided to ensure transferability. During data collection, dependability was ensured using in-depth interviews, which allowed the researcher to ask a question and change the follow-up question depending on the answer (Ritchie et al., 2013). The enquiry auditor verified the processes and procedures used by the researcher and confirmed that they were acceptable and dependable.

Ethical considerations

The study was approved by the university's Research Ethics Committee (S17/1/42). Permission to conduct the study was granted by the university Registrar and the Director of the SoN. Prospective participants were provided with written information about the study before being requested to sign a written consent for their participation. Permission for the use of an audiotape to record the interviews was sought from the participants. The participants were made aware of their rights, including voluntary participation, the right to withdraw from the study, confidentiality and anonymity. All data were kept safe in password protected electronic files. Participants were assured that their privacy would be protected and that no form of data will be traced back to them. Furthermore, to safeguard the principle of confidentiality, the researcher used identity codes for quotations provided in the result section of this paper instead of using the actual names of the participants.

 

FINDINGS

A total of seven themes and eight categories were generated from the data. The categorisation and interpretation of the data were grounded on the two layers of the framework for reducing the SoN success gap and promoting success for all as adapted from Perna and Thomas (2006). The findings indicate that educators are challenged with various student related factors (theme 1 to theme 4) and school related factors (theme 5 to theme 7) that hinder them from ensuring that students perform optimally, thereby achieving the desired level of performance, success and retention of nursing students.

Theme 1: Nursing students' lack of interest, motivation, dedication, commitment and poor class attendance

Educators discussed the measures implemented to create a positive teaching and learning environment. Opportunities were provided for active participation of students, ensuring that these challenges do not lead to academic disengagement and have a minimal impact on their academic performance.

Category 1: Low levels of student motivation, commitment and dedication towards programme responsibilities and irregular class attendance

Educators reported that students display low levels of seriousness towards their studies.

...my group of students last year were really disinterested. They were a tough group. [P4]

...for me they're not at the level of the fourth year in terms of motivation and dedication towards their studies. [P6]

It was also mentioned that students were selective and intentionally gave less attention to certain modules.

I've heard students say, oh, that HDP is a boring subject...I didn't even know what was going on there. I just want to pass the module... [P3]

Further reports indicated that students do not take programme responsibilities seriously, fail to participate and are disengaged.

..they might understand the topic, but they don't go into sufficient depth. They will just say the normal things, superficial things... [P7]

Students are not participating, not producing, not listening...but there may be more to it. [P1]

...students' lack interest. Some students they just don't come...especially at the end of the term or at the end of the semester...the level of attendance declines...once I saw one student sleeping in class. [P8]

Category 2: Positive teaching and learning environment, student involvement and support

Educators highlighted the importance of treating students as individuals and providing them with personalised attention.

I just feel that students want to be known and they feel a sense of belonging if the lecturer knows their name. [P3]

...I make a rule...let's talk about what makes you feel uncomfortable before we start a lesson. What are you fears? So, what do they do? They immediately open up. [P5]

Despite the challenge posed by large numbers of students in the classroom, educators want to ensure that there is interaction and sharing of ideas among students.

Students need to participate fully within their groups. They need to engage with each other... I can see that there's improvement because when students start disagreeing with each other it means that something is happening...! don't expect students to give me the correct answer. I expect them to have a discussion to debate with each other... [P6]

Educators discussed their efforts to provide emotional support to students who experience emotional stress.

I don't know maybe I'm an idealist, but I think that students must also feel loved; [...] made to be feel as a person and not just a number sitting there, for me - that's my personal view... [P1]

I just tell them if you cannot cope or it is too traumatic you need to come to me... [P5]

One educator reported that providing emotional support to students was overwhelming and had to advise them to seek professional help:

I personally decided to withdraw from this other student when she couldn't [cope]... But I told her one evening that you cannot contact me every time. So that's when I told her that you need to get some professional help. [P6]

Theme 2: Lack of academic readiness of students admitted into the undergraduate nursing programme

Educators discussed their efforts to ensure that poor previous academic performance has a minimal impact on the academic performance of undergraduate nursing students.

Category 1: Poor academic background of students

Educators reported that the academic background of students that are recruited for the nursing programme is not up to standard and that the SoN accepts students that have been rejected by other departments, which results in their inability to cope with the basic demands of the programme.

...the level of education that a lot of the students come into the programme with is not high. [P4]

...They didn't get in anywhere because of their poor marks and then nursing would take them, and you can imagine... [P7]

Category 2: Provision of academic support

Some educators reported their commitment to providing academic support through consultations, conducting regular assessments and providing feedback and guidance to students at risk of unsatisfactory academic performance throughout the undergraduate programme.

...And we have a discussion. And then I say let's revise your work. Go and prepare and then we revise what we have covered. It really helps them to empower them a lot...consultation time, it's open time for them... [P5]

...when I see the students are struggling, I will sit there and I will get them kind of like triggers - think about this, think about that. Think back. [P6]

Theme 3: Student's' socioeconomic backgrounds and employment responsibilities

Educators discussed their efforts to ensure that challenges relating to the socioeconomic status and employment responsibilities of students, which lead to academic disengagement, have a minimal impact on their academic performance.

Category 1: Lack of basic needs and employment responsibility

Most educators agreed that nursing students' socioeconomic backgrounds significantly impact their academic performance, success and retention in the programme. Educators indicated that students cannot afford basic needs such as food, which negatively affects their concentration in class.

You can see students sitting in your class they can't pay attention because they're hungry. Like how is that not a problem? [P4]

I guess it does play a role. Because the hungry students would be unable to concentrate in class and I mean if you don't have the finances to come to class you also miss out. [P7]

It was also alluded that students from poor socioeconomic backgrounds are forced to seek and participate in paid part-time employment.

...so, weekends or maybe night shift, they are working, waitressing or shops...so they will tell you, Ma'am, I'm working. That's why I didn't come to class. I have to work for my fees...Her eyes were red. I asked her what was wrong with you. So, she said, Ma'am, I've been working last night. So, I said why do you work and come to class in the morning? She said I don't have a choice. [P8]

Category 2: Provision of financial assistance to students

The caring nature of nurse educators drives them to provide much needed financial assistance to needy students.

They tell me when they don't have food and I provide that for them, as best as I can. Some of them don't have transport money and I try to be of assistance there in my own personal capacity. [P2]

Theme 4: Lack of proficiency in English

Educators highlighted that language differences and poor language proficiency are some of the challenges they face in the classroom. These challenges hinder effective communication which negatively impacts academic performance.

Some educators reported that one of the major challenges that students experience in the classroom due to differences in cultural backgrounds is to communicate effectively in English.

I have experienced that students do struggle with English as the medium of instruction. [P1]

They don't understand the language. It is just too difficult for them. [P5]

Theme 5: Structure of the undergraduate nursing programme

Educators highlighted challenges that the current structure of the nursing programme poses on the academic performance, success and retention of undergraduate nursing students. These include timetable arrangements and asynchrony between modules and content being taught across the undergraduate nursing programme. Measures that educators put in place included departmental and interdepartmental collaboration to ensure nursing and non-nursing modules are synchronised.

Category 1: Lack of synchrony between modules and poor timetable arrangements

Educators reported on the asynchrony of programme modules and content which negatively influence integrated learning. Some modules are being taught in isolation with no attempt to pair related modules, resulting in students not being able to understand and comprehend the link between programme modules.

...human biology lecturer, she was doing work in the second year that we already do in first year...so the best practices is by aligning our modules with what we call service modules, which is the science department modules. Otherwise they teach and we teach our own and we don't align it. The students will tell you but we don't know what you're talking about. They will actually say that. [P3]

Educators indicated that the structure of the programme does not take into account that nursing students have both theory and clinical/practical responsibilities. Reports also indicated that timetable arrangements for nursing modules are problematic.

. ..with our students, our students are working tonight and tomorrow night again. On Wednesday morning, they've got lectures. That's another thing, students are tired when they come to their class. [P6]

...there is tutoring classes but because apparently is happened during lunch times so they were not able to attend most of them. [P8]

....we have classes on Friday so they did not want to come on Friday. So when you ask the student, they said it is the timetable they don't feel like coming just for that. [P2]

Category 2: Departmental and inter-departmental collaboration

Some educators reported on their efforts towards departmental and interdepartmental teamwork through meetings and discussion to ensure that content taught in different modules of the undergraduate nursing programme is aligned.

...we actually meet up with the science department...(and) Every week we've got a meeting, maybe Wednesdays and discuss the programme and content as the year level collective... [P2]

Theme 6: The physical teaching and learning environment is not conducive to learning

Educators highlighted environmental challenges that negatively impact the academic performance, success and retention of students. Some educators expressed dissatisfaction regarding the physical environment that does not promote quality teaching and learning.

...the state of the classrooms, broken windows, a hole in the floor, and things like that...your physical environment has to be conducive for learning [and] They are really not conducive. When it is so hot there is no fan. There's nothing. It is very hot there. And when it is cold it is very cold...those classes, they are really not good. [P1]

One educator also reported challenges related to digital resources such as internet connectivity which negatively affects the learning process.

Now the internet connection isn't working...if you want to use blended-learning you need students obviously can use textbooks and there's articles. But to get access to an article you need the internet. [P6]

Theme 7: Unfavourable working conditions

Educators highlighted various work-related challenges that hinder them from ensuring that students perform optimally and result in job dissatisfaction. Some educators reported feeling overwhelmed with the large number of students in the classroom.

I mean, we have groups of students of like 60 or more. It's not easy to do that... [P4]

So, it becomes an issue for the lecturer just to control the class, especially if it's big groups. [P7]

Some educators highlighted their frustrations regarding the fact that their areas of specialisation and preferred choices are not considered during work allocation, which negatively impacts the quality of the teaching and learning process.

But I see they normally just swop people - you go there. I didn't do psychiatry and finish but now I'm teaching psychiatry. [P3]

One educator also highlighted frustrations with the unreasonable workload which impacts negatively on time for student engagement.

...I've got so much admin to do as well and a lot of students come in here with things. [P4]

 

DISCUSSION

The findings of the study identified challenges experienced by nurse educators which may have a significant impact on the academic performance, success and retention of nursing students. Furthermore, the study identified several measures implemented by nurse educators aimed at enhancing academic performance of undergraduate nursing students. The findings of this in-depth study will be discussed within the two layers of the framework for reducing the SoN success gap and promoting success for all as adapted from Perna and Thomas (2006).

Layer 1 - Internal context

According to Perna and Thomas (2006), the internal context gives attention to the cognitive and motivational aspects that shape an individual's behaviour. For this study, the internal context was operationalised as a cluster of three main categories: (1) student profile, (2) academic factors, and (3) psychological and emotional factors. It is argued that students' profile characteristics (such as language proficiency, previous educational experience and employment responsibilities), academic factors (such as class attendance, academic services and course grades), as well as psychological and emotional factors (such as self-efficacy, motivation, gratification and cultural beliefs/background) have a significant impact on the academic performance, success and retention of nursing students (Fernandez et al., 2012; Everett et al., 2013; Glew et al., 2015).

Students profile characteristics

Poor English proficiency, previous educational experience and students' socioeconomic backgrounds were identified as student profile challenges facing nurse educators. This study found that students' inability to express themselves adequately in English is one of the major challenges experienced by educators. Previous studies are consistent in concluding that proficiency in English has a significant impact on the academic performance and success of nursing students (Everett et al., 2013; Glew et al., 2015). These findings strengthen the importance of English proficiency as a school leaving subject requirement for admission to the undergraduate nursing programme (Dube & Mlotshwa, 2018).

Academic factors

Furthermore, this study found that prospective students with poor academic qualifications are being admitted into the nursing programme. This could be due to the global shortage and demand for nursing personnel (Buerhaus et al., 2009), resulting in nursing schools admitting students to the nursing programme even when they do not meet the minimum entrance requirements (Jeffreys, 2012; Mooring, 2016). Thus, it is imperative that screening and selection of prospective nursing students be done by fully competent personnel. These findings are consistent with previous studies (Safadi et al., 2011; Lancia et al., 2013).

The findings of this study suggest that students admitted into the undergraduate nursing programme at the SoN come from poor socioeconomic backgrounds. Furthermore, this study found that due to these conditions, students resort to paid part-time employment during their studies, which results in poor class attendance due to employment responsibilities. These findings are consistent with previous finding (Everett et al., 2013; Salamonson et al., 2014). Previous studies have found a significant correlation between class attendance and the number of hours spent engaging in employment responsibilities, i.e. the higher the number of hours spent engaging in employment responsibility, the poorer the class attendance leading to academic disengagement (Everett et al., 2013; Salamonson et al., 2014).

Psychological and emotional factors

The study revealed that nurse educators are faced with challenges associated with nursing students' lack of interest, motivation, dedication and commitment. These findings confirm findings of previous studies (Fernandez, Salamonson & Griffiths, 2012; Clements et al., 2016). This requires nurse educators to identify students with low levels of motivation and commitment as well as those who show signs of lack of interest in programme responsibilities and to implement corrective measures to reduce the risk of unsatisfactory academic performance. Early identification of at-risk students may be fundamental to ensure that corrective measures are implemented timeously and thus ensure satisfactory academic performance (Missildine et al., 2013; Mthimunye, 2015).

The study also indicated that there is a need to promote student engagement as well as to create a safe and conducive educational environment that will not pose a threat to students and will allow students space to engage with the study content, the environment and the educators without any fear. A study conducted by Patterson, Kilpatrick and Woebkenberg (2010) in the United States (US) with the purpose of describing students' perceptions of using a Student Response System (SRS) in the classroom revealed that increased engagement and interaction in the classroom is beneficial to students. However, it is important that nurse educators at the SoN scrutinise their own practices in the classroom with regards to the activities that they believe are engaging. In addition, it would also be essential to explore what students believe would engage them in the classroom.

Layer 2 - The school context

According to Perna and Thomas (2006), the school context gives attention to the compounding effects associated with educational resources, academic preparation, and educational orientations that are necessary for success at a university level. The school context was operationalised for the study as a cluster of four main categories: (1) school background, (2) professional integration, (3) teaching and learning environment, and (4) funding. However, this study found no evidence to support category 1, 2 and 4 of the school context, thus only category 3 was discussed below.

Teaching and learning environment

The study revealed that the curriculum preparation, particularly timetable arrangements and synchrony of modules of the nursing programme, were some of the challenges faced by nurse educators while endeavouring to obtain optimal academic performance by nursing students. Jeffreys (2015) suggests that timetable arrangements have a significant impact on the academic performance and success of nursing students. The findings of this study provide supplementary evidence that issues related to macro and micro curricula such as timetable arrangements and coherent pairing of modules of the nursing programme should be addressed (Iwasiw & Goldenberg, 2014).

Furthermore, this study found that the physical teaching and learning environment, large numbers of students and poor internet connectivity were additional challenges reported by nurse educators. Studies conducted by Marchand et al. (2014) and Wilson and Cotgrave (2016) revealed that students' perceptions of their educational environments relied highly on physical characteristics such as classroom layout, furniture and number of students in the classroom, and immediate surroundings that include temperature and air quality. Therefore, these findings illustrate the significance of improving the design, organisation, functioning and maintenance of the educational environment (Jennings et al., 2013).

Work environment

In addition to the school context, the findings of this study revealed that some nurse educators face work related challenges such as large numbers of students, high workload and problems with module allocation. The findings are consistent with previous studies conducted by Bittner and O'Connor (2012) and Tourangeau et al. (2014). A study conducted by Bittner and O'Connor (2012) in the New England region, with the aim of identifying the factors that lead to job dissatisfaction as reported by nurse educators, found that the work environment as well as workload are significant factors to job satisfaction. Furthermore, according to Hornsby and Osman (2014), large numbers of students typically make it challenging for educators to create a conducive educational environment in which students feel that their own personal needs are being met. These findings could be explained by the pressure that university nurse educators receive from the faculty as well as from the SoN, i.e. taking on large numbers of students, producing research output, local and international collaboration, continuous professional development, community engagement, as well as various faculty committees' responsibilities. This pressure adds to the already demanding competencies for nurse educators, i.e. administration, teaching and learning, research and clinical supervision. Several studies have reported that nurse educators take on various roles, which may lead to burnout and job dissatisfaction (Gerolamo & Roemer, 2011; Baker, Fitzpatrick & Griffin, 2011). These findings suggest that in order for nurse educators to perform their primary duty of ensuring academic performance, success and retention of nursing students, the university and the SoN should ensure a favourable work environment that promotes job satisfaction.

 

LIMITATIONS OF THE STUDY

The main limitation was that a limited number of nurse educators formed part of the study and that they only provided the theoretical perspective of the programme and not the clinical perspective. Furthermore, data were only collected from one SoN in South Africa, therefore the findings of this study may not be generalised beyond that setting. However, the findings of this study provide important information regarding the challenges experienced by nurse educators as well as the measures they have put in place to ensure optimal academic performance, success and retention of nursing students and thus may be generalised with caution to similar educational practices in other countries.

 

IMPLICATIONS FOR NURSING EDUCATION

The teaching and learning implications of this in-depth study include: (1) reinforcement of student engagement though active participation and promotion of experiential learning; (2) alignment of the curriculum across the entire programme by reviewing the content of the modules and aligning modules based on their objectives and content; (3) advocating for and creating a conducive physical environment by ensuring well maintained and climate controlled classrooms, adequate lighting, as well as access to reliable internet connectivity; (4) encouraging a safe environment for students to reflect and express themselves without fear and obtain emotional support and encouragement where necessary; and (5) early identification of students with language barriers (poor English proficiency) and ensuring that they are referred for language support.

The findings of this study can be used to develop interventions to alleviate the challenges experienced by nurse educators. Furthermore, the findings re-emphasise the significance for proper screening of prospective students. The implications of this study point out the need for a favourable work environment for nurse educators to ensure job satisfaction and reduce the risk of burnout, which has an impact on the quality of the teaching and learning process, thus negatively influencing the academic performance of nursing students. Addressing the challenges identified in this study could result in an improvement in the quality of the undergraduate nursing programme offered at the SoN.

 

RECOMMENDATIONS

Nursing education and practice

The recommendations emerging from this study indicate the need to address student related matters, i.e. motivation, commitment, screening processes and socioeconomic backgrounds as well as school related matters, i.e. timetable arrangements, module and content alignment, large numbers of students in classrooms and an unconducive educational environment. Therefore, it is recommended that the SoN should focus on the following:

• Review the current recruitment strategies and admission criteria to ensure recruitment and admission of students who are highly motivated and ready for the nursing programme and where the at-risk students are identified, actions to remedy and support those students should be mobilised.

• Consider ways in which financial challenges experienced by students can be minimised through sourcing of additional financial support.

• The provision of a physical environment that promotes physical comfort in classrooms (adequate space, enough chairs for students, minimal noise, adequate ventilation and temperature regulation).

• The distribution of modules across the undergraduate nursing programme should be done taking into account the relationship between modules, the module content, complexity of each module, and the clinical requirements.

• Review the workload for nurse educators on a regular basis to ensure that work is distributed equally as well as to ensure a favourable work environment and to reduce the risk of burnout. This may also include ensuring a fair nursing student-nurse educator ratio.

Future research

This study recommends that for future studies, researchers expand the scope of the study to include more schools of nursing. In addition, more stakeholders linked to students' academic performance, success and retention such as heads of departments, clinical supervisors and faculty staff members should be included to ensure that the limitations of the study are avoided and that a more comprehensive understanding of the phenomenon is gained.

 

CONCLUSION

The study revealed the challenges faced by nurse educators at a university in the Western Cape as well as measures they put in place to ensure satisfactory academic performance by undergraduate nursing students. The findings mainly describe the student (internal) as well as school related factors and indicate the need for more measures to be put in place to remedy the identified challenges. This study did not address the challenges related to the family context or the social, economic, and policy context as suggested by the theoretical framework used for this study. In addition, the framework did not address the influence that the work environment of nurse educators has on their job satisfaction and on the academic performance, success and retention of nursing students.

 

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Date of submission 3 November 2018
Date of review outcome 5 March 2019
Date of acceptance 1 April 2019

 

 

1 The authors would like to acknowledge the language editor of the paper, Gareth Lowe. The authors would also like to thank all the participants who formed part of the study.