Preventing Student Withdrawal From Nursing Education: A Model Based on Reality Shock and Affective Commitment

Abstract

Problem Statement: In the context of the global nursing shortage, retaining students in nursing education programs is a strategic priority for health care systems. Clinical placements, a central component of nursing education, expose students to complex situations that can trigger reality shock, caused by the gap between expectations shaped during education and the actual conditions of practice. This experience can undermine students’ affective commitment to their education and increase their intention to withdraw from the program.

Objective: This study aims to examine the mediating role of affective commitment in the relationship between reality shock and the intention to withdraw from a nursing education program.

Method: A cross-sectional quantitative correlational study was conducted with 139 students enrolled in the third or fourth year of a 4-year entry-to-practice Bachelor of Science in Nursing program at a participating francophone Canadian university (outside of Quebec). Data were collected using an electronic questionnaire and then analyzed using a simple mediation model (Model 4) estimated with the PROCESS macro for SPSS.

Results: Reality shock is negatively associated with affective commitment to the educational program and positively correlated with the intention to withdraw. Affective commitment is negatively associated with the intention to withdraw. Mediation analysis reveals a significant indirect effect, suggesting partial mediation by affective commitment in the relationship between reality shock and the intention to withdraw.

Conclusion: These findings highlight the central role of affective commitment in the relationship between reality shock experienced during clinical placements and the intention to withdraw from the educational program. They suggest that clinical experiences likely to undermine students’ emotional attachment, as well as their sense of identification with and belonging to their program, may contribute to withdrawal intentions. Paying particular attention to the shock experienced in clinical placements, along with the pedagogical and relational conditions that support students’ affective commitment, represents a meaningful avenue for reflection to promote retention in nursing education programs.