Mental health and dropout of nursing students

Elisabeth Judith Maria Bakker

    Research output: PhD ThesisPhD-Thesis - Research and graduation internal

    290 Downloads (Pure)


    There is a global shortage of nurses due to the increasing demand for healthcare with an ageing population, while the labour force is demographically declining. Therefore, it is important to educate and retain more nurses for the healthcare sector. More nursing students will have to be trained within healthcare organisations that are already under pressure. Retention of nurses should, therefore, already start within education. However, little is known about the determinants and reasons for dropping out of nursing students in a late stage of the degree programme (late dropout) and the role of mental health in this. This thesis provides insight into i) nursing students' experiences and reasons that contribute to late dropout from nursing education, ii) the associations between modifiable psychosocial work characteristics and mental health and late dropout of nursing students, and iii) available interventions for improving the mental health of student and novice nurses to prevent dropout. The results show that mental health complaints are common among nursing students. Late dropout can be related to negative experiences during clinical placements, such as lacking a safe learning and working environment and missing perspectives for future career opportunities. Psychological demands, such as experiencing excessive work, and frequent exposure to aggression were found to be risk factors for distress. Co-worker support reduced the risk of intending to leave nursing education in a late stage of the programme. A wide range of interventions for improving mental health to prevent dropout exist, but evidence of their effectiveness is limited. Following these findings, a training based on connecting communication to improve interpersonal trust-based relationships, was tested for feasibility in two classes of nursing students. Students were positive regarding the feasibility of the training, preferably to start before the first clinical placement. This dissertation contributes to the understanding of the multifactorial phenomenon of nursing students' dropout and the role of mental health. It provides evidence supporting the recommendations on how to improve the mental health and retention of nursing students; a joint task of nursing degree programmes and healthcare organisations. Thereby, it might contribute to a future-proof, healthy and resilient nursing workforce.
    Original languageEnglish
    Awarding Institution
    • Vrije Universiteit Amsterdam
    • van der Beek, A.J., Supervisor, External person
    • Francke, A.L., Supervisor, External person
    • Roelofs, Pepijn Demetris Desiderius Maria, Co-supervisor, External person
    • Boot, C.R.L., Co-supervisor, External person
    Award date24 May 2022
    Place of Publications.l.
    Print ISBNs9789464581669
    Publication statusPublished - 24 May 2022


    • nursing students
    • nursing education
    • mental health
    • psychosocial work characteristics
    • distress
    • Intention to leave
    • attrition
    • dropout
    • prospective cohort study
    • nonviolent communication


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