Elsevier

Nurse Education Today

Volume 30, Issue 6, August 2010, Pages 573-578
Nurse Education Today

Student nurse absenteeism in higher education: An argument against enforced attendance

https://doi.org/10.1016/j.nedt.2009.12.003Get rights and content

Summary

Unauthorised student nurse absenteeism in higher education troubles many university lecturers. Anecdotally, absenteeism is occasionally raised as an issue by attending students who resent others “getting away” with non-attendance and some policy documents appear to suggest that attendance should be mandated. This paper argues against enforced attendance in higher education and challenges those who would mandate attendance to explain and justify their position. Drawing on a range of nursing and non-nursing material we here discuss some of the literature on attendance, absenteeism, effort or time spent in study and grade attainment. Informed by this admittedly partial review we maintain that the evidence linking grade attainment with attendance and study effort is less conclusive than intuition might initially suggest. We note that enforcing attendance apparently runs counter to important pedagogic (humanistic and androgogic) principles. We propose that responses to absenteeism cannot be separated from questions of ‘harm’ and we suggest that lecturers should refrain from associating non-attendance with unprofessional behaviour and poor professionalization.

Introduction

Many lecturers are irritated by student nurse absenteeism and, in the theoretical or taught university component of their education (we are not here concerned with attendance on clinical placements) non-attendance is widely considered a problem (Newman-Ford et al., 2008, Hughes, 2005, Rhodes and Jinks, 2005). Unauthorised non-attendance or absenteeism – we use the terms interchangeably – occurs when students miss timetabled teaching sessions (lectures or seminars) without permission or ‘good cause’. Absenteeism is associated with poor academic performance, unprofessional conduct and inadequate socialisation (Doyle et al., 2008). Moreover, non-attendance or absenteeism (we henceforth presume ‘unauthorised’) attracts attention in policy and other documents and, within the UK, it is suggested that attendance should be more closely monitored, encouraged and even enforced (Heriot Watt University, 2007, Sasrty and Bekhradnia, 2007, University of East London, 2007).

Drawing on a range of nursing and non-nursing literature we argue that evidence associating attendance or time or effort spent in study with grade attainment is less convincing than intuition might initially suggest and, in consequence, we propose that nurse lecturers should exercise caution when discussing these relationships. Indeed, if our interpretation is correct, evidence cannot be used to justify mandating or enforcing attendance. We do not suggest that absenteeism is unimportant. Non-attendance clearly raises complex and difficult questions. However, mandating or enforcing attendance appears to run counter to humanist and androgogic principles that many nurse lecturers purportedly maintain. Requiring attendance raises the problem of ‘harm’ (i.e. establishing who is harmed by non-attendance and by how much). Criticising or punishing those who do not attend “for their own good” might be considered paternalistic and linking non-attendance with unprofessional behaviour and poor professionalization is, we believe, problematic.

Section snippets

Reading the literature

This paper is not a literature review. It is a discussion paper. It advances a particular viewpoint and it challenges those who disagree with that viewpoint to respond. That said, to inform discussion we engage with and critique some of the literature.

To explore the relationship between attendance and learning in pre-registration student nurse education a series of electronic literature searches were conducted (between November 2008 and October 2009) using the databases Cumulative Index to

Attendance and grade attainment – the evidence

Ostensibly no ambiguity exists. Studies from multiple disciplines link attendance with performance or course success and, with notable exceptions, a positive relationship is generally cited (see, for example, Douglas and Alemanne, 2007, Cohn and Johnson, 2006, Pierre-Pascal and Pieper, 2005 and Fallis and Opotow, 2003). The consistency of findings is striking. However, a close reading of the literature raises, in our opinion, questions about the use to which this literature can be put.

Although

Time, effort and grade attainment

University modules and courses include both taught and self-directed components and the nature of the taught component may affect the manner in which students approach independent study. Thus, lecturers utilising non-traditional teaching schemes such as managed learning environments (Barrett et al., 2007) or enquiry or problem based learning (Hutchings, 2008) must assume that students are engaged on projects that, whilst prompted by questions or scenarios initially set by academic staff,

Harm and paternalism

Our reading of the literature suggests that, at aggregate level, evidence does not support the assertion that missing lectures is associated with a meaningful or major drop in grade attainment and, by this reading, substantial harm does not ensue at group level (nothing of course can be said about individuals). Nevertheless, if – for the sake of argument – we allow that only non-attending students are affected adversely and meaningfully by non-attendance then it might be argued that lecturers

Motivation and discipline

Timmins and Kaliszer (2002a) explored the extent and causes of third year Irish student nurse absenteeism. Questionnaire data and retrospective record analysis revealed that students were voluntarily absent for 4% of the time. Most absenteeism was of less than 3 days and more than 50% of absences commenced on Monday or Friday. Explanations for absence varied between theory and clinical work. Dissatisfaction with the theoretical component of study, tiredness and paid work were commoner reasons

Nurse professionalisation – counting hours

Mallaber and Turner’s (2006) Competency versus hours: An examination of a current dilemma in nurse education focuses on the “inconsistencies and conflict between professional regulations and the ethos of HE” (p. 110). This paper explores the historic background behind nurse training’s apprenticeship model and the regulatory enforced assumption that hours spent in practice or the classroom correlate with learning. Mallaber and Turner (ibid) cite Hale (2003, p. 18) in declaring that “there is no

Conclusion

Despite reviewing a reasonable body of work we have not conducted a systematic or comprehensive review. Our interpretation of the literature is therefore partial and, as stated, we approached the literature with a priori assumptions regarding appropriate lecturer-student relations that, for a variety of reasons, reject ‘enforcement’. Moreover, whilst we have looked ‘beyond’ the nursing literature to supplement and extend what might otherwise be a narrow and sectarian viewpoint it must also be

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