Global interventions addressing student nurses’ absenteeism in clinical placement: a scoping review

Introduction: Clinical placement is one of the critical aspects of nursing training; it allows students to gain first-hand experience by dealing with confirmed cases in clinical areas, and this helps them to put the theory they learned from the classroom into practice. Absenteeism from the clinical areas might affect the student’s progression to the next level of study.

Aim: This scoping review examined the current literature on interventions addressing student nurses’ absenteeism in clinical placement.

Methods: A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Various databases were used for searching for the relevant articles and were handled in the reference manager EndNote. Ten research studies from global countries were included in this review. Primary data were synthesized using descriptive analysis methodology.

Findings: The findings indicated the available interventions to address student nurses’ absenteeism: (1) adequate clinical accompaniment and supervision, (2) students’ support, and (3) students’ motivation.

Conclusion: By fostering better support systems and recognizing student commitment, healthcare institutions can enhance attendance rates and overall clinical experiences, ultimately contributing to developing competent, motivated healthcare professionals.

1 Introduction

Absenteeism is the practice of missing regularly planned training sessions and classes, regardless of the reason(s) (Randa, 2020). Failing to attend classes or neglecting to submit assignments is considered absenteeism without a valid reason. Clinical placements are a cornerstone of nursing education, providing essential hands-on experience that bridges the gap between classroom learning and real-world practice. Regular attendance is crucial for developing competent and confident future nurses (Nawaz et al., 2018). Although nurses are well aware of their role in providing clinical training, several studies suggest that more research is needed on the role of clinical nurses in reducing nursing students’ absenteeism (Loughlin et al., 2018). Clinical education remains an essential part of degree programs since it allows students to put into practice the knowledge acquired in lectures under the close oversight of clinical instructors (Bwanga and Chanda, 2019; Ravik and Bjørk, 2022). This is supported by Pramila-Savukoski et al. (2020), who emphasized that nursing education places a high value on student learning during clinical placement to ensure that new nurses are competent and apply various skills during clinical placement. The study in London by Brook and Kemp (2021), found that to reduce student nurses’ absenteeism, both students and staff agreed that this could be addressed by developing rostering guidelines. In Australia, another study by He et al. (2018) indicates that students experience difficulties in juggling responsibilities between study, work, and family and the nature of studying externally online.

A study in Europe indicated that 50% of Norway’s nursing bachelor’s degree curriculum comprises clinical practice, which incorporates classroom teaching in a simulation lab (Ravik and Bjørk, 2022). Council and Verpleging (2005) mandates that student nurses complete 80% of the required clinical exposure hours in mental health nursing. On the contrary, unlike other countries, according to the Irish Nursing Council [An Bord Altranais (ABA), 2009], nursing students must complete 100% of their required clinical assignments each year. On the other hand, Finland allows only 5% of nursing students to miss class. However, it requires 95% attendance to pass the course (Magobolo and Dube, 2019), which are similar requirements that exist at the Nigerian University of Abadan for nursing students before they can write an examination for a particular subject (Chukwu et al., 2017). There has been a noticeable shortage of clinical hours during the clinical accompaniment of students at Limpopo College of Nursing because of a high absenteeism rate among student nurses. This is supported by the College Campus Annual Absenteeism Report and Statistics (2019), which show a varying pattern in the absence rate of student nurses, which lends weight to this assertion. A few student nurses who stopped their training owing to a lack of clinical hours and an extension of training are further proof. A paucity of clinical hours resulted from 97.3% of nursing students missing class, according to Magobolo and Dube’s research (2019). Similarly, Randa (2020) raised the issue of absenteeism among university and college students in South Africa as a serious matter. Despite the policies, absenteeism persists as a problem in every university, especially in clinical settings (Vijayalakshmi, 2018).

The South African Nursing Council’s regulation (Nursing Act No. 33 of 2005) stipulates that student nurses must complete at least 80% of their required clinical hours to be eligible for final exams. Failure to meet this requirement can have severe consequences for their academic progress, including the possibility of repeating a level for an entire year, a reduction in the number of students graduating within 4 years, and a worsening national shortage of qualified nurses. Nawaz et al. (2018) stress that absenteeism impedes students’ ability to acquire the necessary knowledge and skills to achieve their personal and professional objectives. Similarly, Ray et al. (2018) highlight that the absence of student nurses negatively affects their capacity to deliver high-quality care. Comly et al. (2020) also point out that absenteeism can lead to low academic achievement and an increased likelihood of dropping out. Furthermore, adverse effects of absenteeism are dropout and attrition, leading to unemployment, poor health, poverty, and the likelihood of committing a crime at a later stage in life. In addition to the above findings, Chukwu et al. (2017) demonstrate that absenteeism from clinical postings has resulted in various academic setbacks for many students, including poor grades, carryovers, and the need to repeat classes. Rankine et al. (2023) also analyzed roles, barriers, and facilitators in addressing chronic absenteeism and found a correlation between chronic absenteeism and poor health and educational outcomes.

1.1 Problem statement

Gottfried and Ansari (2022) developed district strategies in the USA to reduce student absenteeism. Similarly, Ray et al. (2018) in India provided recommendations for addressing this issue. Aseefa (2018) identified potential solutions to student absenteeism in Ethiopia. Shaygan et al. (2023) also conducted a study in Iran on preparing nursing students for mental health clinical engagement. In Nigeria, Chukwu et al. (2017) proposed various strategies to decrease the absenteeism rates of student nurses. Furthermore, Mothiba et al. (2018). recommended that nurse managers provide platforms to address psychological and professional problems experienced by student nurses in the clinical areas of a tertiary hospital in Limpopo province.

The statement highlights that, while the studies mentioned above have been conducted, there remains a gap in understanding the dynamics of absenteeism in clinical placements. Although different interventions have been developed in other countries and in South Africa, like the one by Mothiba et al. (2018), to address absenteeism, it remains a major issue. This suggests that while these strategies exist, they may not be effectively addressing the root causes of absenteeism. Given the persistence of absenteeism despite existing policies, studies, rules, and laws, this study sought to uncover the global interventions addressing student nurses’ absenteeism in clinical placement. Absenteeism during clinical placements is a significant issue, potentially compromising the quality of nursing education and leading to gaps in practical skills and knowledge (Huston et al., 2018). Addressing this problem is vital for both educational outcomes and patient care quality. A scoping review is needed to systematically map the existing literature, identify types of interventions, and highlight areas where further research is needed. This might assist researchers in identifying gaps regarding the type of studies that need to be conducted further. Thus, this paper aims to map the existing literature on global interventions addressing student nurse absenteeism during clinical placement.

2 Methods

2.1 Approach

The study followed the guidelines put forth by Arksey and O'Malley (2005) to conduct the scoping review. Various databases were used for searching for the relevant articles and were handled in the reference manager EndNote. Establishing a research topic, finding pertinent studies by creating eligibility requirements, and choosing pertinent studies were all steps in this approach. Following the extraction and analysis of the data from the pertinent research, the findings were compiled. A scoping review was chosen because of its ability to explore broader topics by mapping the existing literature and making recommendations for future studies.

2.2 Search strategy

The review team worked to design the search strategy. Google Scholar was also used to conduct a preliminary search. The development of the Interventions was done using the PEO (Population, Exposure, Outcome) Framework (Bass et al., 2024). Interventions are actions or processes taken to improve a condition. In this study, interventions mean actions taken to reduce student nurses’ absenteeism from the clinical areas. To answer the research question and create eligibility standards for pertinent studies. Therefore, the search phrases linked to P student nurses, E Interventions, and O Addressing Absenteeism were used to address the question of what interventions address student nurses’ absenteeism during clinical placement globally. A comprehensive search strategy was employed to identify relevant studies across multiple databases. The review used databases such as EBSCOhost, Google Scholar, MEDLINE, CINAHL, EMERALD, Scopus, Sabinet, and Scielo. The search utilized a combination of keywords and Boolean operators, truncations, and MeSH terms to widen the search. This search string was used in the identified databases, and to align with each database’s advanced search, we requested the assistance of a faculty librarian as it is recommended for review studies (Tricco et al., 2018). The developed search string was: (“Addressing OR mitigating OR reducing”) AND (“Interventions” OR “Strategies” OR “Model” OR “Approaches” OR “Methods” OR “Guidelines” OR Programmes”) AND (Absenteeism OR Absence) AND (Student nurses OR Nursing Students) AND (Global).

2.3 Eligibility criteria

Before exporting articles to a reference manager, EndNote 21, we developed inclusion and exclusion criteria for the time frame of the search focused on publications between 2014 and 2024 Peer-reviewed, qualitative, quantitative, and mixed-method studies were included, and systematic reviews were excluded because this is done in Meta-Analysis. While this scoping review only includes English-based studies, studies on global countries were included. The included population was student nurses. Articles that met the inclusion criteria were exported to the reference manager in preparation for performing screening. Table 1 below details the inclusion and exclusion criteria used in this scoping review.

Table 1

Table 1. Eligibility criteria.

2.4 Screening and extraction

To eliminate duplicates, the initial step was to combine all the articles from various databases in the reference manager of Endnote. Three reviewers (TCM, SM, and MM) divided up the articles to do title and abstract (T&A) screening followed by the duplicates and data extraction, with one reviewer (TCM) acting as the mediator for disagreements and process monitor. The three reviewers evaluated the quality of the selected studies and disagreement was addressed through the mediator (TCM). Articles that satisfied the inclusion requirements were transferred to a different EndNote group called full-text screening following T & A screening on reference management. Next, we used the “retrieve pdf” option under the “full-text screening” category. Google Scholar was used to access articles that were not available in the original databases. To aid in data synthesis, a data chart was made in Microsoft Word after all the articles were gathered. The reference management group tab was cleared of articles that did not fit the inclusion criteria during full-text screening, while the data graphing was updated with those that did. Moreover, before producing this article, we used the PRISMA-ScR checklist study (Arksey and O’Malley, 2005) for the rigor of the study.

2.5 Data analysis

After charting the data, the data was analyzed using descriptive analysis. A descriptive analysis was conducted, highlighting the years of publication, countries of publication, the study title, study participants, study methodologies, and study findings were used. Findings generated from the reviewed studies were grouped according to their similarities. The search identified 142 records, which were downloaded into Endnote. After screening titles and abstracts, articles were screened for full-text screening. Thereafter, duplicates were removed, and articles were excluded either because full text was not available or the focus of the study was not related to student nurses’ absenteeism, leaving 10 articles (Table 2).

Table 2

Table 2. Summary of interventions used to address student nurses’ absenteeism.

3 Results

3.1 Characteristics of the included studies

The search resulted in the inclusion of 10 articles. Most of the studies (n = 5) used a qualitative approach (Brook and Kemp, 2021; Masutha, 2023; Hoebes and Ashipala, 2023; Van Hoof et al., 2021; Sethibe, 2023), followed by studies (n = 4) conducted using a quantitative approach (Agyare et al., 2018, p. 27; He et al., 2018; Martin et al., 2020; Jyoti Flinsi, 2019). Lastly, one study used mixed methods (Currie et al., 2014). It is not astonishing that most of the studies used qualitative studies as more individuals required in-depth information on the interventions that worked (Brook and Kemp, 2021; Masutha, 2023; Hoebes and Ashipala, 2023; O’Sullivan et al., 2021; Sethibe, 2023). In context, it became evident that absenteeism is a significant global concern, with most studies conducted in Africa. The provided chart highlights that interventions have been implemented in various countries, including England (Brook and Kemp, 2021), South Africa (Masutha, 2023; Sethibe, 2023), Namibia (Hoebes and Ashipala, 2023), Ghana (Agyare et al., 2018), India (Jyoti Flinsi, 2019), Ireland (Van Hoof et al., 2021), Britain (Currie et al., 2014; Brook and Kemp, 2021), Australia (He et al., 2018), and the USA (Martin et al., 2020). The data showcase that student nurses’ absenteeism is a global phenomenon, with different authors attempting to address it worldwide. In getting the correct interventions, most of these studies relied on the views of student nurses (Masutha, 2023), student nurses (Brook and Kemp, 2021), student nurses (Currie et al., 2014), and registered nurses (Hoebes and Ashipala, 2023) (Figure 1).

Figure 1

Figure 1. PRISMA diagram flow for literature screening and selection. Source: Page et al. (2020).

3.2 The available interventions to address student nurses’ absenteeism

The study aimed to identify the existing interventions addressing student nurses’ absenteeism during clinical placement in South Africa. According to the findings, the existing studies on interventions indicated that for the student nurses’ absenteeism to be addressed in clinical areas, several interventions should be implemented in the clinical areas. Brook and Kemp (2021) highlighted that some staff members faced challenges enforcing proper attendance. Students indicated that these issues could be mitigated by developing clear and practical rostering guidelines. On the other hand, Masutha (2023) reported that student nurses indicated that a comprehensive student’ nurses’ orientation should be done on the layout of the psychiatric ward, types of mental health care users, mental health care users’ behaviors, and how to handle mental health care users. This view is supported by Sethibe (2023), who emphasized the importance of providing orientation programs before starting psychiatric clinical placements, and Jyoti Flinsi (2019), who advocated for ensuring that students are thoroughly oriented in the clinical setting. Similarly, Shaygan et al. (2023) indicated that mental preparation is necessary for students to overcome fears and worries regarding taking care of mental health care users during clinical placement.

3.2.1 Adequate clinical accompaniment and supervision

Another clinical intervention in South Africa indicated regular clinical accompaniment and supervision by nurse educators, where participants suggested that nurse educators should practice adequate accompaniment and supervision to address student nurses’ absenteeism in clinical areas, as students were absent because they did not receive adequate supervision. (Masutha, 2023). Similarly, Magobolo and Dube (2019) in South Africa again found that the academic staff should supervise students in clinical areas to address absenteeism. On the other hand, Hoebes and Ashipala (2023) in Namibia argued that for the accompaniment and supervision of students to take place, there is a need for adequate resources, the need to increase the number of registered nurses, students having a thorough theoretical knowledge, and good communication between the college, students, and hospital staff members. In support of the above, Masutha (2023) in South Africa found that good communication between professionals and student nurses is one of the interventions to address student nurses’ absenteeism.

3.2.2 Students’ support

The second intervention found from the analysis was students’ support when allocated to the clinical areas. In South Africa, Masutha (2023) developed strategies and included that student nurses’ concerns should be identified and established. The study further suggests that appropriate interventions should be applied, and continuous support and counseling of student nurses should be implemented. This is supported by Agyare et al. (2018) from Ghana, who stated that the significant interventions participants used among themselves were seeking peer support and creating a healthy relationship with the nursing staff. Similarly, in Ireland (Van Hoof et al., 2021), there is a need to safeguard the emotional well-being of mental health nursing students and support them to become resilient practitioners. On the other hand, in India, Ray et al. (2018) indicated that students’ counseling should be done regularly to identify the reasons for absenteeism. Shaygan et al. (2023) from Iran supported this and said that understanding concerns of students’ fears and worries when allocated to the clinical areas, especially mental health, should be done. Another study conducted in South Africa by Sethibe (2023) indicated that students need to be supported by mental practitioners and lecturers when allocated in the clinical areas, and the allocation of mental health preceptors and provision of the workbook for learning objectives is very important. The above studies align with the study done in Australia by He et al. (2018), who indicated that students indicated that measures to be implemented include support from family, friends, and a significant other. On the other hand, in India, Jyoti Flinsi (2019) indicated that different recreational activities should be conducted to reduce the stress of student nurses in the clinical areas and support them.

3.2.3 Students’ motivation

Other measures to motivate students such as emphasizing adhering to the attendance policy found by Currie et al. (2014), who conducted a study in Britain and indicated that students who attended regularly seemed pleased that their commitment was recognized as they were given green letters acknowledging good attendance and were therefore motivated. Similarly, a study conducted in India by Jyoti Flinsi (2019) indicated that student attendance should be recorded properly and fairly, and students with high attendance percentages should be encouraged and awarded.

4 Discussions

The study findings indicated that different interventions are available to mitigate student nurses’ absenteeism in the clinical areas. In England, South Africa, India, and Namibia, the studies found that clinical interventions are effective in curbing the absenteeism of students (Brook and Kemp, 2021; Masutha, 2023; Sethibe, 2023; Jyoti Flinsi, 2019; Hoebes and Ashipala, 2023). They indicate that student nurses should be involved in treating and caring for mental healthcare users. Good communication between professionals and student nurses. Healthcare professionals should supervise student nurses adequately. Nurse educators should visit the clinical area more often. Healthcare professionals should involve students in treating and caring for mental healthcare users. On the other hand, student support is an effective intervention method to curb absenteeism in the USA. Lastly, motivation has been noted as an intervention for dealing with students’ absenteeism in Britain and India (Currie et al., 2014; Jyoti Flinsi, 2019) indicated that students should be provided with healthy and nutritious food to reduce sickness, proper study time should be there in the hostel, different recreational activities should be conducted to reduce stress., and students with high attendance percentages should be encouraged and awarded. Masutha (2023), Jyoti Flinsi (2019), and Sethibe (2023) emphasize the need for structured orientation programs and support systems to prepare students for clinical placements in South Africa and India. They further indicate that a comprehensive student nurses’ orientation should be done before commencement with psychiatric clinical placement. On the other hand, Masutha (2023), Van Hoof et al. (2021), He et al. (2018), and Sethibe (2023) highlight the importance of fostering a supportive environment where students feel motivated to attend regularly. Brook and Kemp (2021) and Jyoti Flinsi (2019) suggest developing clear attendance policies and monitoring mechanisms to ensure accountability and improve student participation. Masutha (2023) identifies the impact of absenteeism on patient care and the importance of a collaborative approach to address this issue. Furthermore, Masutha (2023) and Hoebes and Ashipala (2023) encourage healthcare institutions to support student learning through enhanced supervision and feedback while balancing patient needs. They further indicate that students should get support from family, friends, and significant others for the students’ absenteeism to be addressed. Brook and Kemp (2021), Currie et al. (2014), and Jyoti Flinsi (2019) call for integrating recognition programs that motivate students to maintain consistent attendance, which can contribute to improved healthcare outcomes.

5 Conclusion

Absenteeism in clinical settings remains a significant challenge impacting student and professional nurses. Various studies emphasize the need for targeted interventions, such as straightforward orientation programs, supportive clinical environments, and practical rostering guidelines, to address this issue. By fostering better support systems and recognizing student commitment, healthcare institutions can enhance attendance rates and overall clinical experiences, ultimately contributing to developing competent, motivated healthcare professionals. Our review recommended that more studies on mixed methods approaches be conducted globally to examine interventions to reduce absenteeism among student nurses in clinical placement.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Author contributions

TM: Conceptualization, Data curation, Methodology, Visualization, Writing – original draft. SM: Investigation, Software, Validation, Writing – review & editing. MM: Formal analysis, Resources, Supervision, Writing – review & editing.

Funding

The author(s) declare that no financial support was received for the research and/or publication of this article.

Acknowledgments

The authors would like to acknowledge Professor Matlakala F and Professor Makhubele J for the workshop conducted. The acknowledgment of the efforts of the University of Venda’s research office for the workshop regarding the reviews.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declare that no Gen AI was used in the creation of this manuscript.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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