Examining Nursing Student Academic Outcomes: A Forty-year Systematic Review and Meta-analysis

Objectives: To synthesize the definitions of nursing students' academic outcomes and provide a quantitative synthesis of their associated and predictive factors.

Design: Systematic review and meta-analysis.

Data Sources: Four scientific databases were searched until January 2020.

Review Methods: Observational studies describing undergraduate nursing students' academic outcomes were included. Studies were analytically synthesized and meta-analyses were performed utilizing the Odds Ratio or Cohen's d as effect sizes.

Results: Eighteen studies, published from 1979 to 2018, were included in the review, nine were meta-analyzed. Studies involved 10,024 undergraduate nursing students and were mostly retrospective cohort (55.6%). Students were mostly female (75.4%) with a mean age ranging from 21.3 to 27.0 years. Meta-analysis revealed that being female (OR = 1.65, 95% CI = 1.26 to 2.12), having attended a Classical, Scientific or Academic high school (OR = 1.30, 95% IC = 1.16 to 1.46), and having reported higher final grades at the upper-secondary high school (Cohen's d = 0.42, 95% CI = 0.18 to 0.65) was significantly associated with student's ability to graduate within the regular duration of the program. Sensitivity analyses confirmed meta-analytic results and meta-analyses heterogeneity depended on study design. Contrasting and limited evidence were found for other investigated factors, and for academic outcomes different from graduation within the regular duration of the program.

Conclusions: Despite meta-analytic results, gender and upper-secondary school would be unethical students' entry selection criteria. Final upper-secondary school grades should be considered for this scope and purpose. Conflicting and limited evidence found for other factors, such as students' background, suggested the influence of local contexts on the phenomenon and its investigation. Investigating the role of modifiable individual variables, such as empathy and critical thinking, could contribute to the open debate about students' entry selection strategies. An improvement in methodological quality of future studies is recommended and expected.