Review European nursing students' academic success or failure: A post-Bologna Declaration systematic review Angelo Dante a , Cristina Petrucci b , Loreto Lancia b, ⁎ a Nursing Science Doctorate School, University of L'Aquila, Italy b Department of Internal Medicine and Public Health, University of L'Aquila, Italy summary article info Article history: Accepted 1 October 2012 Keywords: Achievement Academic success Academic failure Attrition Student dropouts Student nursing Retention Withdrawal Objectives: The aim of this systematic review is to synthesise the available evidence in the European scientific literature produced after the Bologna Declaration and to evaluate studies that quantify and examine the fac- tors associated with the academic success or failure of nursing students. Design: A systematic review of the literature was conducted. Data Sources: Major health literature databases were searched for studies published from 2000 to 2011. Review Methods: This review includes only European observational studies that were submitted to a quality assessment by two researchers before inclusion. Results: Only five studies were included in this review. There are discordant results regarding the predictors of success or failure, which were common objects of study (gender, age, qualification on entry, ethnic group). other factors were studied individually (student personality, gendered view of nursing careers, intention to leave, family commitments, working while on course, student performance, clinical learning environment) need to be confirmed in additional studies. Although the predictors may be relevant at the local level, given their low external validity and the conflicting results, it is not possible to state with certainty that these factors are effectively predictive of success or failure in the context of post-Bologna Declaration Europe. Conclusions: This review showed that over the last ten years, in the European context, only a few high-quality observational studies have been performed. In this regard, given the small number and heterogeneity of the available studies, there is little useful evidence available for Higher Education Institutions (HEIs) to effective- ly address the problem. In the future, European researchers should focus not only on the documentation of the predictors but also on the documentation of the outcomes produced by the HEI strategies that have been implemented to prevent avoidable academic failure and contain physiological academic failure. © 2012 Elsevier Ltd. All rights reserved. Introduction Academic success or failure in undergraduate nursing pro- grammes is an international issue that has been investigated by researchers from many countries to determine its impact on students (Pryjmachuk et al., 2009; Waters, 2006a), on the future availability of nurses to the healthcare system (Cameron et al., 2011a; Gaynor et al., 2006), on Higher Education Institution (HEI) performance (Cameron et al., 2011b) and social costs (Waters, 2006b). The reasons underlying the constant scientific investigation of this phenomenon are evident based on the complexity of the involved factors (Urwin et al., 2010) and the different definitions of academic success or failure (Glossop, 2001; Urwin et al., 2010), making the systematic comparison of research results difficult. Today, it is widely accepted that there is rarely one single reason that determines why a student will leave or stay in the course (Cameron et al., 2011a; Gaynor et al., 2006; Cameron et al., 2011b; Dante et al., 2009). This decision seems to be the product of complex interactions between individual student factors and institutional, political and professional factors (Urwin et al., 2010). Furthermore, although numerous studies have been conducted in different coun- tries (e.g. The UK, Australia, Canada and the US) over several decades, there seem to be surprisingly few high-quality observation- al studies underpinning these discussions (Gaynor et al., 2006), making it difficult to develop international recommendations that will reduce academic failure among nursing students and promote their success (Glossop, 2002). Furthermore, according to Fowler and Norrie (2009), many studies have low ecological validity, and the transferability (Campbell, 1986) of their results remains an open question. Research evidence can be used only if it has some relevance to settings and people outside of the contexts studied (Polit and Tatano Beck, 2010). Unfortunately, studies on academic success or failure have not been consistent regarding the students enrolled, the educational setting, the sociopolitical context and the study period. Although, Urwin et al. (2010) have shown that the Nurse Education Today 33 (2013) 46–52 ⁎ Corresponding author at: Nursing Science, University of L'Aquila, Department of Internal Medicine and Public Health, Edificio Delta 6, Via San Salvatore, 67100 Coppito, L'Aquila, Italy. Tel.: +39 0862 434641; fax: +39 0862 434688. E-mail address: loreto.lancia@cc.univaq.it (L. Lancia). 0260-6917/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.nedt.2012.10.001 Contents lists available at SciVerse ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/nedt