Contents lists available at ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/locate/nedt Nursing students' experiences of repeating units in an undergraduate program: A qualitative study Rakime Elmir ⁎ , Lucie M. Ramjan, Bronwyn Everett, Yenna Salamonson Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Australia ARTICLE INFO Keywords: Academic failure Education Nursing Retention Students ABSTRACT Background: Academic failure in undergraduate nursing education programs is a growing concern globally. While some students choose to continue with their nursing course by repeating units of study, others discontinue from their respective nursing programs contributing to a marked increase in nursing attrition rates. This aca- demic failure can be attributed to competing demands of paid employment and family commitments. Aim: The aim of this study was to explore first year students' experiences of repeating a unit of study in the undergraduate nursing program. Methods: A descriptive qualitative design informed this study which involved undergraduate nursing students enrolled at a large metropolitan multi-campus nursing school in Australia. Data were collected from nine nursing students who had repeated one or more units of study using face-to-face and telephone interviews and data were analysed used thematic analysis. Findings: Four themes emerged from the data ‘struggling to meet workload expectations’, ‘making the adjust- ment’, ‘utilising academic supports and resources’ and ‘the strength to carry on’. The struggles faced by nursing students repeating units of study included the university's academic environment, heavy workload and issues encountered to meet academic writing standards, juggling to balance the demands of paid employment and personal commitments. Participants demonstrated strength and resilience in their quest to fulfil their dreams and goals of becoming a Registered Nurse, and some reassessed their financial situations to make changes to paid employment hours or reduce study workload to part-time. While peer support was valued, participants expressed their desire for further tutor support to consolidate learning. Conclusions: Support strategies tailored for students repeating nursing units are needed to ensure students continue successfully with their nursing programs. 1. Background Retention of nursing students is a major issue and challenge worldwide. In the United Kingdom, as many as 27% of nursing students may never become registered, with some nursing programs reporting incompletion rates as much as 50% (McLaughlin et al., 2010). In the United States incompletion rates in nursing programs have been re- ported up to 20% (Brown and Marshall, 2008) and in Australia 24.5% (Gaynor et al., 2007). There has been a shift from the traditional to non-traditional nur- sing student entering nursing studies, with students being academically diverse, older, and ethnically diverse suggesting student perseverance, retention and entry into the workforce is a challenge (Jeffreys, 2007; Merkley, 2016). Some of the reasons for students discontinuing from their nursing studies include academic pressure, financial hardship and stress from the clinical environment (Hamshire et al., 2013). Kenny et al. (2011) highlighted the difficulties of work-study life balance among mature aged nursing students, particularly managing academic work and family commitments compounding the difficulties the stu- dents experienced. Often the time spent on family commitments re- duces the time available for study and careful planning needed for as- signments and exams. Threats of failure and high stress levels are widespread in the pro- cess of becoming a nurse (kantek, 2010). Bakker et al.'s (2018) study of dropout and retention of nursing students during their education found that student nurses required more direction and support, particularly https://doi.org/10.1016/j.nedt.2019.05.024 Received 12 December 2018; Received in revised form 18 April 2019; Accepted 13 May 2019 ⁎ Corresponding author. E-mail addresses: r.elmir@westernsydney.edu.au (R. Elmir), l.ramjan@westernsydney.edu.au (L.M. Ramjan), b.everett@westernsydney.edu.au (B. Everett), y.salamonson@westernsydney.edu.au (Y. Salamonson). @RRakime (R. Elmir), @LucieRamjan (L.M. Ramjan), @bron_everett (B. Everett), @salamonson (Y. Salamonson) Nurse Education Today 79 (2019) 147–152 0260-6917/ © 2019 Elsevier Ltd. All rights reserved. T