Nursing students experience difficulties incorporating effective study habits and time management skills while integrating into a preprofessional community. Consequently, nursing student attrition rates approach 50 percent for students enrolled in baccalaureate nursing programs (Harris, Rosenberg, & O'Rourke, 2014; Newton & Moore, 2009). It is evident that there is a need for nursing student support, especially for younger nursing students who lack the academic experience and coping skills necessary in the nursing profession (Griswold, 2014; Stephens, 2013). Many students report that remaining in a nursing program is difficult. Barriers to success include a lack of mentoring and coaching resources, inadequate social and peer support, underdeveloped study habits, poor test-taking and time management skills, and poor self-care routines (Griswold, 2014; Harris et al., 2014).

Mentor programs have the ability to mitigate attrition rates and improve the student experience by providing holistic support. The holistic benefits of mentor programs include connections among peers, socialized learning, emotional support, advice and guidance, motivation, and role modeling (Demir, Demir, Bulut, & Hisar, 2014; Jacobs, 2017). Outcomes include increased self-confidence and an ability to view challenges in school or concepts from class with a different approach (Demir et al., 2014; Harris et al., 2014). The most common types of support programs include faculty-to-student mentorship (Eller, Lev, & Feurer, 2014) and one-on-one peer mentoring (Won & Choi, 2017) to provide social support. There is a paucity of research on student-led programs that combine both social support with academic guidance in a group setting.

IDENTIFYING THE PROBLEM

In-person assessments gathered by a university's tutoring program in the Pacific Northwest aided in identifying student barriers. Student-identified barriers included lack of preparedness, academic confidence, and peer emotional support. Specifically, students attributed difficulties in their first year to confusing expectations associated with the nursing program, lack of awareness of resources, and perceived social isolation from the nursing community. During the assessments, students reported that lack of information about study strategies and difficulty developing time management skills contributed to their anxiety. The findings from these assessments served as an influence for the development of a student-led nursing program during the 2016 to 2017 academic year.

Third- and fourth-year nursing students initiated the development and implementation of the pilot student-led program, Nursing Student Peer Support (NSPS). These upper division nursing students, who were involved in the tutoring program on campus, independently created the NSPS program to provide advice and guidance to new nursing students. They focused on common challenges that incoming students encounter in the first two years of the program prior to beginning upper division nursing courses, exploring these issues during optional quarterly workshops, each averaging an hour long (see Supplemental Digital Content, available at https://www.links.lww.com/NEP/A173, for a Table outlining workshop names, objectives, and content). Workshops were led solely by nursing student facilitators, both nursing student tutors from the tutoring program and upper division student volunteers. Student facilitators discussed new topics in each workshop, including study strategies for specific courses (e.g., biology, chemistry, anatomy, and physiology), advice regarding the start of clinical rotations, opportunities for students, and general tips for success gathered from peers. Each workshop provided a presentation in addition to hands-on activities, group work, and handouts.

Although some handouts were adapted from preexisting tutoring program resources, the majority of presentation material was developed by nursing student facilitators. First- and second-year attendees were split into smaller groups and placed with third- and fourth-year students to facilitate communication, peer bonding, and mentorship. Workshops averaged 40 attendees to approximately eight upper division students who facilitated mentoring during small group discussions.

STUDENT RESPONSES

First- and second-year students completed in-person, anonymous qualitative surveys at the end of each workshop. Survey results indicated a self-reported increase in confidence, enhanced preparedness for nursing courses, an improved sense of community, and a decrease of self-reported anxiety. Six themes emerged from the surveys. Students reported feeling 1) more confident, 2) less stressed, 3) more excited about the program, 4) better prepared to manage the workload, 5) more comfortable approaching and speaking with older nursing students, and 6) more open to receiving study tips for specific nursing courses. Of the 58 participants who responded to the surveys, 70 percent (n = 41) strongly agreed the topics presented were helpful to learning and studying; 96 percent (n = 55) agreed they would use the suggestions and strategies as they continue in the nursing program.

DISCUSSION

The NSPS program addressed academic and nonacademic concerns, the dual barriers to retention. By providing academic resources and promoting social and professional integration from peers, students reported they were better prepared, more likely to seek out help and resources, and less anxious about nursing. Many other programs focus solely on academics, through tutoring, or social aspects, through one-on-one mentoring (Crisp, 2009). The student-led nature of the NSPS program, in addition to its more didactic discussions created by the nursing student facilitators, provided a holistic approach that included emotional, professional, and academic support, as well as role modeling what success can look like.

Programs such as NSPS provide moments of guidance, exploration, and reflection in a safe environment to produce student-initiated and student-driven learning for both the students receiving the workshops and the peer facilitators (Won & Choi, 2017). First- and second-year students actively participate in their education, begin to identify as nurses, and gain control of their learning environment. Mentors enhance their self-reflection and leadership skills, recognizing their responsibility to the nursing community and practicing teamwork (Won & Choi, 2017).

It is important for programs to implement student-led initiatives early on, allowing students to integrate study skills and coping strategies in a timely manner (Harris et al., 2014). To succeed both academically and professionally, it is important to develop resilience and an internal locus of control. When they cannot cope with the challenges of nursing school, many students attribute their lack of success to their environment, thus developing an external locus of control (Demir et al., 2014). The mentorship component of NSPS led to discussions about overcoming challenges and solving problems, highlighting the ability students have in controlling their educational environment.

In addition to shifting the student's locus of control, reflection on overcoming challenges in the first two years creates resilience. When students identify and develop protective factors to overcome adversity and stress, they are creating coping strategies that allow them to succeed throughout their nursing education and in their transition to practice (Stephens, 2013). By instilling coping strategies, role modeling, and student-driven learning, the NSPS program prepares students to transition into practice as nurses who can confidently seek out resources and work with a team-oriented focus. Nurse residency programs use experienced nurses to aid in the professional integration of new nurses and thus parallel student-led programs in schools of nursing (Jacobs, 2017; Rush, Adamack, Gordon, Lilly, & Janke, 2013).

CONCLUSION

By providing tools that address barriers to retention in nursing education programs, it is possible that student-led programs in the long run can prepare novice nurses for the challenges of retention in their professional careers. The NSPS program emphasizes the need for and benefits of greater student involvement, independence, and collaboration in the learning experience. This program has potential to be useful to other four-year nursing programs interested in creating a community-oriented environment that fosters confident, supported, and prepared nursing students. Building community through student-led programs empowers nursing students to be resourceful and team oriented as they transition into practice. This professional development program meets the expected outcomes of nursing programs, preparing confident clinicians and leaders in nursing practice while simultaneously addressing the concerns of new students and promoting program retention.

REFERENCES