Staying the course: Examining enablers and barriers to student success within undergraduate nursing programmes

In line with current trends towards a positive and enhancement-led perspective, this account of a research project carried out in a Scottish university considers the student nurse experience as a lens for examining retention enablers. Two phases of interviews with final year students from a diverse cohort, many of whom were adult learners, informed the development of a series of themes and recommendations for better understanding factors which encourage persistence. A combination of grounded theory thematic analysis and narrative interpretation was used in this research to encourage a rich biographical component.

Further work specifically identifies additional variables such as assessment and approaches to new forms of learning and teaching (Yorke, 2001;Packham, Jones, Miller & Thomas, 2004), attendance (Dancer & Fiebig, 2004), the significance of peer support and social networks (Wilcox, Winn & Fyvie-Gauld, 2005;Beder, 1997), appropriateness of choice of programme (Yorke, 1999;Davies & Elias, 2003), as well as variances in background characteristics such as gender, race, ability and work experience and the demographic characteristics of families and students' activities and prior achievements (Bank, Biddle & Slavings, 1992). All of these components are synthesised in Thomas's influential concept of 'institutional habitus ' (2002), which promotes effective social integration through building academic communities and engaging students in collaborative learning and teaching activities.
Institutional habitus is notable for its focus on widening participation amongst 'non-traditional' students. The conceptual framework considers types of scaffolding and provision that institutions can implement in promoting retention, and in affording an opportunity to ask 'in what ways can institutions support non-traditional students to succeed?' (Thomas, 2002, p. 425). Such strengths highlight the research and framework as instrumental in providing scope to better understand the complex nature of the adult learner experience, and a context in which to locate the learning experiences and changing dynamics of the nursing student journey.

Nursing context
Attrition studies of nursing students comprises a considerable body of literature within mainstream withdrawal research, though the rate of students withdrawing from nursing programmes within the UK is favourable in comparison with trends in other countries and other programmes (Hall, 2001;Pryjmachuk, Eaton, & Littlewood, 2009). Significantly, however, outcomes of the nursing-specific research not only improve understanding of the student nurse experience and factors influencing their decision to stay on or withdraw from a programme, but have tangible implications for funding, future work-force planning, and the ongoing development and implementation of effective student support.
As with mainstream withdrawal studies, evidence from research into the experiences of nursing students suggests the interplay of a variety of complex and interlinked variables (Glossop, 2002). Within the literature, the familiar causes of academic failure (White, Williams & Green, 1999), balancing personal commitments with work and study (Glossop, 2001) and the impact of financial difficulties (Glossop, 2002;Last & Fulbrook, 2003) all feature. They are cited as potentially having significant enough an effect on the student experience to precipitate withdrawal from a programme of study.
The literature also suggests that there are additional factors which affect the student nurse experience and which may impact on the decision to continue on or withdraw from a programme in a particular way. For example, the pivotal role played by placement, (Last & Fulbrook, 2003;Bouden, 2008) and how this may affect levels of stress amongst nursing students (Steele, Lauder, Caperchione & Anastasi, 2005) appear key.

Common themes
Two central themes in withdrawal and retention studies are the roles played by effective engagement in the first year of study (at whatever academic level) and clear expectations on the part of the student. It is widely recognised that engagement within the first year of study has a significant effect on student retention and progression (Yorke, 2001), as well as on the longitudinal learning journey (Yorke & Longden, 2008;Pitkeithly & Prosser, 2001). It has also been generally agreed that the first year is a pivotal juncture in the creation of learner identities (Trotter & Roberts, 2006) in the context of adaptation to new teaching, learning and assessment methods (McInnis, 2001). Indeed, in Scotland, the first year has become a specific area of dedicated focus within the Quality Assurance Agency's Enhancement Themes (QAA, 2005).
For nursing students, this need for integration additionally extends to professional requirements, competencies and identity. Joining a degree programme for a nursing student requires more than just joining an academic institution, and students must adapt to learning in both an academic and clinical setting at an early stage (Carr, 2005;Andrew, McGuinness, Reid & Corcoran, 2007. This balance of the clinical as well as the academic in terms of skills and knowledge is a concurrent theme throughout literature surrounding the student nurse experience. It carries significance, not only for learning, but also the creation and management of the dual identities of clinician and student, which propose challenges for any student, but arguably more so for adult learners who may have a variety of responsibilities and priorities to manage. The complementary theme of expectations stands alongside issues raised in considering the first year experience. Unclear expectations and lack of preparedness on the part of the student have been identified as a core part of the complex and interlinked processes which can influence disengagement and eventual withdrawal (Ozga & Sukhnandan, 1998). However, the responsibility for managing expectations does not lie solely with the student. Fitzgibbon and Prior (2006) acknowledge a mismatch between the expectations outlined by the student and the institution, and both Lowe and Cook (2003) and Ramsden (2008) underscore the duty of care placed on the institution to offer targeted, accurate and supportive information, advice and guidance in assisting new students to clarify expectations and negotiate the transitional space of the new academic environment. For those students returning to or embarking on study later in life, this is clearly of vital importance.
In the case of nursing students, distinct modes of learning such as Problem Based Learning (PBL) are a central feature of many nursing programmes (Barret, 2005;Murray, 2003). However, adult learners returning to study, who may not have had any direct experience of this type of learning may not necessarily have particularly clear expectations (as borne out in the interviews conducted as part of this research). By engaging in this type of scenario-based research exercise, students are given an opportunity to take responsibility and ownership of both learning and the decisionmaking process within the context of a shared hypothetical clinical situation. This clearly has advantage in terms of engagement, helping learners to develop confidence, and vital skills for the profession, but in order to fully participate, the roles and outcomes must be made clear to students in advance.

Characteristics of withdrawal studies
Though many themes run throughout the vast body of research on retention, progression and withdrawal, the only real consensus is the acknowledgement of a hugely complex and multi-faceted explanation for attrition trends. Tumen, Shulruf and Hattie (2008) have suggested that there are three types of withdrawal study: firstly, largely demographic; based on the characteristics of the student. Secondly, those based on the student's academic achievement and approach to study, and thirdly, those specific to the area or subject of study. However, a fourth subset of studies looks at the role played by the institution: its responsibilities, the systematic data it makes available for the purposes of research (Caison, 2007;Braxton & Hirschy, 2005) and what action/ intervention can be put in place to better understand or even actively discourage withdrawal. The research which will be discussed within this paper is a fusion of all these types of study.
By drawing on institutional data at an overall population level, we have been able to build a comparative picture of the characteristics and persistence of the students involved in the research (according to the first and fourth types of study). We were also able to investigate, through interview, students' individual learning preferences and approaches (as per the second type), and incorporate within this their experiences of being embedded within a specific subject discipline and prospective profession (the third).
Methodological criticisms have been made of many withdrawal studies, in that data is often collected after withdrawal has occurred (so-called 'post-mortem' studies), and that those students who contribute to such research are a self-selecting sample, and have also already, arguably, disengaged from the institution. Furthermore, a reconceptualisation of the 'deficit discourse' (Lawrence, 2005) has been identified as one way of taking a more pro-active understanding of what can practically be done to promote positive student choice and autonomy in decision-making, rather than focussing on the existence of barriers and obstacles.

Student persistence
As with mainstream retention studies, increasingly, research surrounding the experience of nursing students has turned its attention from deficit approaches to focussing on retention enablers, such as the role played by key staff in delivering information, advice and guidance (Bouden, 2008;Royal College of Nursing (RCN), 2008). An accompanying trend has developed throughout contemporary retention, progression and withdrawal research to see withdrawal as, for some, a positive choice; one which underscores ownership of an informed decision-making process and, thus, promotes flexibility in future learning and learner autonomy (Quinn, 2005;Yorke & Longden, 2008).
Within this research literature, varying terms are used to represent 'at risk' students; i.e. those considering withdrawal. These adapted terms sit under the broad auspices of 'student persistence', a term which itself has roots in Pascarella and Tintos' work of the 1980s and 90s. They include 'student doubters' (used in some UK studies, and arguably a terminologically problematic label which risks pathologisation), 'student resilience' and 'student enablers'. References to 'dropping out' still persist, despite having been aligned with the 'deficit discourse'.

The research
A research project within a Scottish university sought to identify some of the aspects of support and the overarching student experience which contribute to resilience. The aim of the research was to better understand the factors which allowed students to overcome potential difficulties and resolve to persist in their studies. The research questions were: • How might features of the holistic nursing student experience allow us to understand retention enablers? • Which personal or institutional factors contribute to students considering withdrawal? • Which personal or institutional factors facilitate student retention?
The research was conducted by two members of academic staff in the School of Health at the university over two consecutive academic years (08/09 and 09/10) and comprised two cycles (phases) of data collection. Semi-structured interviews were carried out with final year nursing students in both phases.
Appendix one shows the questions used in both phases of the interviews. Following a grounded theory approach (Glaser & Strauss, 1967;Strauss, 1987), the researchers sought to identify a number of shared experiences amongst the participating students which would constitute thematic commonalities. The use of grounded theory permitted the researchers, through analysis and coding, to establish patterns of recurrence and significance amongst factors which influenced retention from within the student interviews (the data) (Stern, 1985). The nature of the research area itself is particularly suited to such a methodology as grounded theory allows for focus on meaning through interpretive understanding (Charmaz, 2003), and looking for this meaning in the shared experience of the students provides an opportunity to identify areas for intervention, as well as to consider the individual lived experience.
As a result of the rich, biographical nature of much of the data collected, the researchers were also keen to incorporate an element of narrative analysis, not least because of the central importance of making meaning from direct experience within this methodology (Mishler, 1986). In addition, we also wished to incorporate the notion of temporality; the roles of past and present in the formation of the learner identity/ identities (Williams & Keady, 2008;Bruner, 2004) and in the students' reflections and projections towards their future career.
Thematic and narrative analyses can be combined to illustrative effect (Floersch, Longhofer, Kranke & Townend, 2010) in facilitating capture of both the communal and individual experience. Both methods strongly uphold the cornerstone of interpretivism within the postmodern tradition (Denzin, 1989), providing an opportunity to question assumptions and offer a space for conceptual re-building within the context of the lived experience (Derrida, 1972). The researchers considered it important to foreground the biographical aspect of the students' identities by using narrative analysis to consider transformational learning and the creation of learner identities, as well as to provide scope to draw recommendations from the identified themes, and thus encourage discussion. The methodology, therefore, borrows elements from both thematic analysis and narrative approaches.

Interviews
Ethical consent was acquired from within the institution and an email circulated to all final year nursing students, inviting them to participate in a short, informal interview about their experiences of learning. Students in the final year of their degree comprised a unique population, who inhabited the liminal state between student and nurse, novice clinician and professional. This transient phase was of particular interest in that students at this stage of study were equipped with the opportunity to reflect on their university experiences to date, discuss reasons for considering withdrawal and what consequently made them stay, but also to project to the future and registration. At this juncture (spring), students were approximately one month away from their final placement, and approximately eight months from graduation and entry to the nursing register. As a consequence, the students interviewed spoke about still feeling very much a part of the institution.
As part of the call for participants, the researchers highlighted that the research was, in particular, interested in the experiences of those students who had made a conscious, positive decision to stay on their programme. It is worth noting that by choosing to take part in the research, the students who opted in were essentially a selfselecting sample.
In the first phase of research, six third year students responded to the call for participants and took part in interviews. All six noted that at some point in their three years of study they had been close to withdrawal, but had subsequently chosen to stay. All students were given participant information, the opportunity to discuss any queries about the logistics or intent of the research, and consented to the recording and transcription of the interviews in which they took part. A summary table of these students is presented below: The researchers conducted and transcribed the interviews. We both then individually read all transcripts, noted observations as regarded themes (at this stage engaging in open coding to identify categories), and also recorded contextual, biographical components of the interviews which we thought important to include in locating student 'stories' of identity creation, transformational learning and lifelong learning. These biographical components enhanced the richness of the theoretical and selective coding processes. The researchers then met to discuss and cross-reference our interpretation of the interview content and mooted categories to establish emerging themes and compare narrative components. Overall, five key themes emerged in the first phase.
The same process to recruit students in phase one was also used in phase two at the same juncture in the following academic year (spring 2010). Five students responded and took part in interviews. These interviews used the schedule from phase one, and in addition, in adopting a grounded theory, iterative approach, also asked students to comment on the five themes identified from the initial analysis. The purpose of including these themes was to seek comment from the students interviewed in the latter phase as to their perceived value of the continued relevance of the phase one themes.
A summary table of phase two students is presented below:

Discussion
Emerging themes A number of factors emerged that appear to play a major role in positively influencing students' decisions to stay on their course. Themes one to five emerged during phase one of the research. As noted, students' perceptions of the validity of these themes were sought in phase two, and observations are made within the discussion (and summarised in the thematic matrix in Table three) on how these were either corroborated or seemed to increase in complexity. Themes six and seven were additional themes that were identified from analysis of the phase two transcripts. A third phase was not planned as sufficient saturation had been established within the data during cycles one and two. Furthermore, the logistics of incorporating additional narrative components risked the possibility of excessive detail without scope for mapping themes to experience.
One: The value of problem based learning All students noted the usefulness of problem based learning (PBL) as a learning strategy and its effectiveness in developing critical skills, learner confidence in using research to inform decision-making and enhancing students' ability to participate in group work. Students discussed the importance of this critical, evidence-based approach to problem solving in developing effective skills for practice: This investment in professional qualities and attributes, in Student 2's eyes, validated this pedagogical approach for her as a learner. As an adult learner, and with considerable work experience in the clinical area, she acknowledged the significance of developing effective communication skills, confidence and autonomy as core attributes for effective engagement in learning and practice. In this context, other participants highlighted inherent value in the scope for selfdirected study and active participation in learning afforded by PBL, in the appreciation of a move away from traditional, didactic information delivery modes and, again, alignment with professional attributes: PBL I like in the sense that you can split up all the work. And go away and get stuff and come together. (Student 7 -phase two) It's all our ideas…and then we go away and learn it and it's our work. And instead of somebody just standing there lecturing and then you going away and doing it on your own, everybody comes back and feeds back their opinion and their perspective and …I really like it. (Student 3 -phase one) Recurring theme. Lack of clarity of learning outcomes a key feature of students' reflections.
Role of placement Universally raised. Positive and negative aspects highlighted as key factors in decision to stay on course.
Reinforced as pivotal aspect of learning, identity formation and motivation.
Readiness for practice Students recognised learning with their 3 years of study, but were still apprehensive about final registration.
Pre-registration anxiety and uncertainty widespread in phase two.
Career as motivator A key motivator for all students which acted as a focus in times of doubt.
Corroborated as a main theme, but with more visible stratifications: is motivation vocation based or strategic employment decision? Support of staff Staff commended by those students who had experienced difficulties in both academic and personal aspects of student life.
Supported as a key reason for students staying on their programme. Staff encouragement and empathy praised. Staged persistence N/A Emerged through biographies in phase two. Many students spoke of setting short-term goals during difficult times to enable completion. Peer support N/A Not evidenced in phase one, but central to many students' experience in phase two.

Source: Authors
Both of the students quoted above noted an ownership of the learning process (e.g. 'it's our work'), which was important for them as adaptable, responsive learners and clinicians (Student 7 having joined the programme after raising a family, working and studying at a local college, and Student 3 having joined directly from school).
Approaching the end of their third year of study and nearing registration, this alluded to an increased sense of identification with the autonomy of professional values.
Indeed, this value placed on the skills developed, according to the students as a direct result of participation in PBL, interestingly was not acknowledged until third year, with many of the students citing challenges with the learning method until then. …once you're at the end, you see everything coming together. I hated PBL! But now I understand that the idea of that was to teach you how to continue you learning…even after you've finished university. (Student 5 -phase one) Again, having joined the programme from college, Student 5 as a mature learner took time to adjust to this new independent way of learning. However, on reflection in her interview, she stated that in the interests of the professional competencies which the method afforded, the pedagogy was well-placed and highly valued within the curriculum.
From a logistical point of view, students noted that where explicit links were made with programme content, engagement with the process of PBL was more straightforward, as this facilitated prioritisation and focus within a large volume of programme material. Where this focus was not present, students suggested that a lack of clarity in learning outcomes meant that they were at risk of disengaging with the process: Sometimes, you're not 100% sure of what it is they (staff) want you to get out of it (PBL). I know it's all supposed to be so that you go off and learn what you want to learn...but sometimes I think it's good for someone to turn around and say, you know, you should have learned this, this, this and this. (Student 6 -phase one) I don't think they ever really explained problem based learning to us. Why it was useful and… I do think it's a good thing. But I think they should maybe just give a lecture and say, this is why we do PBL, because we want you to get to a stage when you've finished university that you do continue to learn. (Student 5 -phase one) In recognising a need for transparently articulated purpose earlier in the degree programme, Student 5 reflected on the assumptions made about clarity and expectations within learning, which map clearly to concerns raised within student retention literature (Fitzgibbon & Prior, 2006;Lowe & Cook, 2003;Ramsden, 2008).

Two: The pivotal role of the placement experience
Unsurprisingly, all students commented on the crucial role played by placement learning. Both positive and negative placement experiences were underscored, and the students demonstrated a pragmatic approach to the evaluation of these. Students 3 and 11 noted that although challenging, balancing placement and university offered a necessary variation in routine and stimulus within the programme; an aspect of the course that they valued and regarded as vital in maintaining interest and motivation. I enjoy it all, I like being on placement…I mean, there's good points and bad points about being on placement …but I do love getting to do things. (Student 3 -phase one) I love being at uni, but then at certain points I'm so fed up of uni, I'm like 'I just want to go to placement!'. When you first come off of placement going back to uni's hard… you want your twelve hour shifts and to chat with patients and to get your hands on and do something, whereas uni's obviously all academic. (Student 11 -phase two) Both Students 3 and 11 were younger students who had joined the programme from school, and for whom a range of learning experiences was important in ensuring effective and continued commitment, echoing the significance of two of Bean and Metzner's (1985) themes, namely learner confidence and engagement and the significance of prior educational experiences on shaping approaches/ adoption of new ones.
Students recognized the importance of good placement experiences in buoying their enthusiasm, and the potential for negative placement experiences to play a role in making them question their motivations and commitment. As Student 6 stated, this need not even be from personal experience, but rather as a direct result of knowing about other students' experiences. I haven't had a placement that's been absolutely disastrous, which I think has been good. And I know there have been a few people who have had that experience... and that's really rocked their confidence in their abilities to do things. (Student 6 -phase one) The ownership of learning which emerged in the first theme related to PBL was also present in students' statements of assuming control of opportunities during placement, in the interests of maximising their inclusion in different clinical scenarios.
... with placement, you just have to make the most of it. And …if you see an opportunity that's there on the ward, if they're going down to theatre maybe, or going with the incontinence nurse for a day… just ask, you know. (Student 1 -phase one) I've had really good mentors that have supported me. And I'm not scared to ask either. If I don't really know something or remember how to do something I'll always ask. (Student 8 -phase two) Student 8 raised an important issue related to her confidence that was not a universal attribute for other participants. Student 8's occupational background was in the Royal Air Forces, and as such she was very self-aware and confident. But for other students (notably younger students, wary of repercussions from vocalizing negative placement experiences, for example) looking for learning opportunities may not be such a straightforward process. The central importance of personality, identity, and the arguably strategic approach to learning of seeking out new and diverse learning experiences on placement underscore the students' recognition of their inhabitation of a transient space between novice/ student and professional/ nurse.

Three: Playing nurse?
Another key similarity across all students' experiences was a feeling of not quite being ready for registration/ practice, and the uncertainty associated with the liminal space between the two identities. Though in their third year of study, students could reflect on their accomplishments to date, yet the prospect of being a fully registered staff nurse and the associated responsibilities weighed heavily. In both phases of the research, many of the students pinned hope on their final year placement in consolidating their knowledge, experience and confidence: ... my placement this year was quite stressful because obviously …I'm nearly a staff nurse so I need to go out and be a staff nurse, as opposed to just playing nurse. (Student 3phase one) I feel at the moment that, personally, I'm maybe not at a stage where if someone said to me, 'well, tomorrow you can be a nurse', that I would actually be ready. I feel like I definitely need the next twenty odd weeks that we've got left. (Student 6 -phase one) In the case of all the interviewees across both phases of the research, the obvious enthusiasm of the students was tempered by anxiety and uncertainty in their own abilities and the associated professional responsibilities that entry to the register necessitates. In this way, the significance of 'institutional habitus' (Thomas, 2002) in fostering engagement and familiarity extends from beyond the academic sphere to also apply to the clinical, and as such, potentially increases its scope and function.

Four: Nursing career as motivator
In both phases of the research, several students spoke not only of the importance of nursing as an aspiration in choosing their area of study/ profession, but also of the pivotal role it played in maintaining momentum and motivation when they had considered withdrawal. For many students, their commitment to the course and academic achievement was based on a love of caring, and a desire to become a registered nurse. Again, the importance of personal attributes was raised as significant for Students 3 and 8. Discourses of 'love' and 'caring' highlighted their enthusiasm and commitment, and the significance of this in their persistence on the programme of study.
Not all students enjoyed the academic demands of being a student nurse, though they recognised its necessity. Despite alignment of key academic skills within programme documentation to core activities of the profession, many students remain more motivated by the clinical aspects of the course (and profession) than the academic ones: That's the thing that's keeping me going. The fact that I want to be a nurse. And I've been working towards this goal for the last three and a half years. It's that prize at the end of it as far as I'm concerned. (Student 7 -phase 2) Interestingly, during phase two of the research, it became apparent that some students were taking a more pragmatic approach to their career choice, and that the career of nursing as a motivator was more complex and comprised more dimensions than initially established in the phase one interviews. Without exception, the fact that a nursing degree leads/ or will very likely lead to a career in nursing was of huge importance to each student. For some, the strong desire for a caring career was the most important motivator and was described in emotional and passionate language or in terms of a personal desire or attribute 'to care' (as quotations above illustrate). For others, however, the outcome was held in much more pragmatic terms; a good career with strong prospects and many options. Notably Student 11, a younger student who had joined her programme from school commented: I made a very rational decision on doing nursing. I wrote a list of pros and cons and I just decided I was going to be a nurse.  Returning to the measured aspect of her nature at several points during the interview, Student 11 actually documented her dispassionate approach as an advantage in practice, and an attribute that in fact enabled her to perform her role in a more effective, professional and less subjective manner: …it was just an inclination, I just decided I was going to be a nurse. But I don't think it makes me any worse a nurse, and sometimes I think it might make me better cos I'm not sooo desperate to do it…and I think sometimes that kind of desperation might affect people in not such a positive way. (Student 11 -phase two) The financial opportunities involved in the choice of career were also significant for many of the students, notably those interviewed in phase two of the research who discussed the current economic uncertainty and the importance of the expectations of their families, a key feature for many adult learners (Elliot & Brna, 2009). In the students' views, becoming a nurse would afford a lifestyle that would not have been achievable otherwise. The long-term prospect of increased future earnings allowed both Students 7 and 9 to make negotiated, short-term sacrifices with their families, and additionally kept their enthusiasm on track in times of doubt.
And I know that once I get a job as, a nurse, then my family finances will be better. As well as getting job satisfaction I'm going to have money. To do the things that I want to do with my family. (Student 7 -phase two) And I've apologised probably about ten million times to them… especially like last Christmas, because we had our exam in January…I went over for Christmas dinner to my mum and dad's, and then that was it. I got my head back in the books…so, things like that. But I'll pay them back. (Student 9 -phase two) Five: Support of staff in times of crisis As previously noted, all students had at some point considered withdrawing from their programme of study, and many highlighted moments in their student journey which were particularly problematic. During these times, the support and guidance of members of academic staff was underscored as vital in enabling continuation. I had to leave and take time out, and the only reason I came back was because I was supported by the staff. (Student 3 -phase one) I did actually have some quite serious family circumstances. And lots of people I think possibly expected to drop out. But I didn't. And I'm so glad that I didn't. I got lots of support…I got the support to do things the way I wanted to.  This empathy with the complexity of the student experience also extends to placement, and the key role which clinical mentors play not only in facilitating learning but also providing support. Again, in times of difficulty, students noted how central mentors had been in influencing their decision to stay on the course: There was a family tragedy, and I was just miserable. I spoke to the uni because I needed time off…but I didn't...I told them about it, and they were really lovely. I was on placement at the time and my mentor was brilliant as well…if I looked like I was about to drop, she would give me a little 5 minutes to go and collect myself, just that time to sort myself out…  Students commended the richness of support when communication between placement areas and the institution was transparent, again insinuating that the boundaries between the academic and clinical/ professional were blurred and mutable.

Six: Staged persistence/ sticking on in
In phase two of the research, students spoke of being able to continue on their course despite difficult personal circumstances/ troubling placements or problems with academic demands by crossing small hurdles and taking a staged approach. Students used language of persistence or perseverance in describing how they set themselves goals (e.g. 'by the end of April', 'give it til Easter').
I've just told myself by the end of April all I've got left is that one little essay. (Student 7 -phase two) I decided I was going to give it to Christmas, then I was going to give it to Easter...then I was going to give it to the end of the summer. (Student 11 -phase two) For Students 7 and 11 above, observations about innate characteristics were also key; their ability to be persistent (or show 'stubbornness', as they both said) and also to manage time/ workload effectively. These attributes helped the students to negotiate each barrier, and persist until the next stage, before evaluating whether they chose to stay on the course: The only thing that's kept me here is my total stubbornness and determination because I do want to be a nurse, you know. (Student 7 -phase two) It was just stubbornness. It was 'I'll give it til Easter' because I don't want to...I suppose I don't want to fail., and I didn't want to disappoint people…but I didn't want to disappoint myself either, because I knew I'd probably regret it, if I did. (Student 11 -phase two) Seven: Peer support Also within phase two of the research, students increasingly described how they encouraged one another to stay on their programme when experiencing academic, personal or placement-related difficulties; a recurring topic in much of the retention literature (Wilcox et al, 2005;Beder, 1997). Interestingly, none of the six students who took part in phase one attached any significance to the role played by peer networks in assuring persistence, despite it being included in the interview schedule.
Those students who noted the importance of friends and classmates related how these groups were one of the main reasons that they had decided against withdrawal from the programme. Student 7 discussed the importance of emotional support as well as academic: And my friends. If I didn't have them… we all just pull each other through and help each other out. With physical things and emotional things as well. Even just to have a rant with them, you know. (Student 7 -phase two) Many students also recognised these supportive and encouraging qualities in themselves, and reflected on how they had assumed their own role of empowering, empathically in the mutually nurturing relationship. Both Students 8 and 9 were mature learners, and confident in their roles and identities as learners, and as empowered leaders within their peer groups: I did encourage her to stay on, well not just kind of encourage her. I told her she would be mad to leave and while she's nearly finished. (Student 8 -phase two) I remember one of the girls saying, in third year, I'm not going to do the degree. I was like, 'yes you are! I see you as a specialist nurse. You've got to do this. I know you can do this'. I think sometimes you just need someone to say, you're doing amazing. (Student 9 -phase two) There appears to be a complexity of reasons behind the formation of peer networks; assessment driven, understanding course content, or socialisation and integration, for example. Students also spoke of the importance of enduring friendships, and the need to maintain these throughout the course. I said 'Let's do this 1 st module and see how we get on. Because we've got a good wee group. Let's do it together. And we can help each other out.' (Student 9 -phase two) I remember the people I met on the first day…I think those are probably the people I speak to the most, even now…apart from people on my course that I see every day...but people that I met, you know, within first year are still friends. (Student 11 -phase two)

Conclusions
Analysis of research from the two phases enabled the researchers to gather and interrogate the experiences, perspectives and reflections of students at a key transitional point in learning and the development of their professional identity. Particular areas of interest that were examined included the characteristics, both personal and institutional, which influenced students' decisions to stay on their programme of study. Whether these factors, as enablers, have motivational aspects, are personal in nature or have resonance in institutional logistics, the emergent themes resonate with the key areas identified both within mainstream withdrawal research, as well as work which has been more nursing specific.
For example, the students evidenced the importance of adaptation to new forms of learning and teaching in embracing PBL (Yorke, 2001;Packham et al, 2004), reinforced appropriateness of choice of programme in using a career in nursing as a motivator (Yorke, 1999;Davies & Elias, 2003) as well as the undeniable impact of personal attributes and circumstances (Bank et al, 1992). In nursing terms, the complex nature of developing, managing and nurturing dual identities (Carr, 2005;Andrew et al, 2007Andrew et al, , 2008 was also well-documented. However, additional considerations for ongoing support may also be shaped by new perspectives of staged persistence, and the central theme of balance; that from the shared biographies of these students it is vital to consider the progress, engagement and support of students as a transitional continuum within a specific and complex discipline.
The 'stories' of the research participants which illustrate this continuum are populated with accounts of negotiating support to overcome personal, academic or professional obstacles; of accessing flexible, tailored and appropriate provision to facilitate achievement of 'the prize at the end of it all'; of their own personal resilience, and the complexity of motivations which enable them to achieve. In moving away from the 'deficit discourse', the joint responsibility of both the student and institution must be acknowledged. Moreover, scope must be attributed to both when considering the provision of transparency of choice in learning experience and the development of professional identity in nursing education.

Recommendations
Based on the interviews and emergent themes, and in line with common themes from the literature, a number of recommendations can be made towards providing effective support across the learning continuum. Although the research was located within nursing, these recommendations, no matter how simplistic, have implications for all students on professionally aligned degree courses.
Firstly, positive feedback was requested by the majority of the research participants as a possible mechanism for fostering engagement and improving learner/ professional confidence. Students commented that, although constructive, most feedback had highlighted areas for improvement rather than of strength, and certainly at the juncture of joining the nursing profession they were keen to know where they had performed well, in addition to areas of their performance which they needed to address.
The need for institutional recognition of logistical considerations inherent amongst the student population was also of vital importance for the research participants. A spectrum of responsibilities is characteristic of a diverse student demographic, including issues surrounding financial constraints, part time work commitments and family/ caring commitments, for example. Students underscored an absolute need for the institution to be aware of the potential (and often unpredictable) effect of these facets of their lives on their study, suggesting that staff could adopt a practical role in signposting to further, appropriate information.
As a result of some of the uncertainties surrounding raising concerns about placement learning, the students also mentioned scope for a generic feedback mechanism, to offer an anonymised facility for students to share learning or placement anxieties or uncertainties. This may take the form of an impartial, pastoral adviser or an online environment, and was highlighted as one way of allowing students to raise issues which they may find difficult to discuss in other fora.