Factors contributing to the dropout of undergraduate nursing curricula according to the year of attendance: A mixed-methods systematic review

Background: The global nursing shortage poses critical challenges for healthcare systems. Understanding nursing student dropout, particularly which factors contribute to this process and when they emerge during the curriculum, is crucial for developing timely and effective retention strategies that support workforce sustainability. Despite growing concern, no systematic reviews have examined the reasons for dropout through a time-sensitive approach. Aim: To understand the factors contributing to dropout from undergraduate nursing curricula with specific attention to the year of attendance. Design: A mixed-methods systematic review was conducted following the Joanna Briggs Institute methodology, adopting a convergent segregated approach. Methods: Data Sources: PubMed, CINAHL, EMBASE, PsycINFO, and Scopus databases were searched from October 2023 to March 2025, according to PRISMA guidelines, without date restrictions. Results: Sixteen articles were included. Thirteen examined early dropout (588 students), mainly during the first year, while three explored addressed late dropout (37 students, third-fourth year). Across 36 primary findings, six overarching factors emerged, supported by qualitative and quantitative evidence: individual, lack of preparedness, unmet student expectations, negative emotional experiences, structural characteristics of the course, and political/professional. Negative emotional experiences and structural characteristics of the course were the most consistent contributors to both early and late dropout. Conversely, factors specific to the early years included family commitments, financial difficulties, low self-efficacy or self-esteem, poor academic performance, unmet expectations regarding clinical placements, course content and workload, restricted social life, and commuting distance. Conclusions: The six identified factors confirm the multifaceted nature of dropout, offering insights to design tailored, time-specific strategies and structural reforms. Rationalising course curricula and strengthening tutor support may enhance engagement and reduce the theory-practice gap. Reinforced orientation could support students' evolving needs, fostering retention and transition to the profession. Future research should explore longitudinal predictors of dropout, particularly the roles of tutorial support and clinical placements.