Adapting for diversity: The case for reshaping nursing education to meet the needs of all students

Background

Nursing education has traditionally assumed students can study full-time without significant external obligations; however, this is becoming increasingly obsolete. Many students work to support themselves and their families. Recent surveys indicate that more than half of nursing students engage in paid employment during their nursing program (Lamswood et al., 2024), with many working substantial hours each week. National data show 40 % of full-time and 74 % of part-time undergraduates work

Impact of flexible scheduling on student outcomes and satisfaction

Research shows that flexible formats—such as online, hybrid, part-time, evening, and weekend programs—can enhance accessibility without reducing student success. A pre-pandemic review of blended prelicensure nursing programs found that well-designed hybrid models improve achievement, especially for distance learners (Jowsey et al., 2020). With proper technology and faculty support, outcomes such as course performance and licensure pass rates remain comparable to those in traditional formats (

What we learned from COVID

The COVID-19 pandemic forced a rapid shift to online learning, revealing both challenges and opportunities in nontraditional education models. Student satisfaction depended largely on the quality of delivery—fewer than half were satisfied with fully online classes, with many preferring in-person learning (Lim et al., 2023). Still, the transition highlighted the potential of flexible, tech-enhanced formats. Faculty introduced virtual simulations, video-case scenarios, and remote skills

Variety of program formats

Traditional nursing programs often rely on rigid, full-time weekday schedules that create barriers for many students, especially those who are older, working, or managing family responsibilities. Research shows that financial strain, more than academic difficulty, is the greatest obstacle to program completion for associate-degree nursing students (Priode et al., 2020). Most undergraduates work part-time (around 16 h per week) to avoid financial hardship; however, working more than that is

Outcomes with various program formats

A systematic review of 19 studies found that online and blended methods for teaching clinical skills are as effective as traditional formats (Barnard et al., 2024). Small cohort studies from the COVID-19 era support this finding; for instance, one study showed no significant differences in specialty or exit exam scores or NCLEX pass rates between online and in-person cohorts (Banjo-Ogunnowo & Chisholm, 2022).

However, national data suggest that program format can affect licensure outcomes. Fully

Childcare support: A basic need for nontraditional students

Nearly 22 % of U.S. undergraduates are parents, the majority of whom are women (Cruse et al., 2021). Within nursing, this percentage is even higher due to the prevalence of adult learners and career changers. Lack of childcare is a significant barrier to persistence; almost 30 % of student-parents have considered leaving school for caregiving reasons (Cruse et al., 2021). Only 18 % earn a degree within six years, compared with over 50 % of peers without children. Family responsibilities remain

Impact of nontraditional schedules

Nursing education often involves early mornings, evenings, and weekend clinical experiences—hours that rarely align with standard childcare services. Students may struggle to find care before a 6:00 a.m. shift or during overnight rotations, which can lead to increased stress and absenteeism. A policy brief from the Institute for Women’s Policy Research highlights that most campus childcare centers lack evening, weekend, or drop-in options—precisely when nursing students need them most (Cruse et

Innovative trends – Childcare as a workforce strategy

Recognizing the connection between childcare and retention, some hospitals and educational institutions have begun offering on-site childcare as a strategic support. Following the pandemic, many healthcare employers identified a lack of childcare as a significant factor contributing to staff absenteeism and attrition (AAMC, 2025). Some hospitals now provide on-site or partnered childcare services to improve nurse well-being and retention.

For example, Parkland Hospital in Texas opened “Annie’s

Academic consequences of inadequate childcare

A lack of childcare support can significantly impact the academic success and retention of nursing students. Nursing coursework and clinical experiences are demanding, and missed days are difficult to recover from, often resulting in failed grades or clinical incompletes. Students without reliable childcare often face difficult choices, such as skipping class, reducing their course load, or withdrawing entirely. Qualitative feedback consistently identifies childcare as a top stressor for

Technology support: Bridging the digital divide in nursing education

Technology is central to modern nursing education, encompassing online platforms, e-textbooks, virtual simulations, and EHR systems. However, not all students, particularly older adults or those from underserved backgrounds, enter programs with strong digital literacy or reliable access. Unlike younger “digital natives,” many nontraditional students feel less confident with technology and may experience anxiety when using new tools (Leonardsen et al., 2023).

These challenges can lead to

Reliable internet as an educational lifeline

The shift to online and hybrid nursing education—accelerated by COVID-19—has made reliable internet access and device availability essential. High-speed internet is now considered “essential educational infrastructure,” and a lack of broadband creates a digital divide that puts students at a severe disadvantage (Makhene, 2023). Online courses, Zoom sessions, and virtual simulations are inaccessible without stable connectivity. Makhene (2023) argues that internet access disparities are a “social

Technology training and support services

Technology literacy is central to success in nursing education. Yet not all students—particularly adult or rural learners—begin programs with strong digital skills or reliable broadband access (Makhene, 2023). This gap creates a digital divide that undermines equity in hybrid and online education (Singh & Masango, 2020). Structured technology orientations, device-lending programs, and ongoing technical support are essential to mitigate these disparities (University of Washington, 2025).

Internet

Preventing burnout for a healthy nursing workforce

Prelicensure nursing students experience disproportionately high stress and risk of burnout compared to other majors (Strout et al., 2023). Major contributors include academic load, clinical pressures, and emotional fatigue (Mumba et al., 2023). Proactive wellness initiatives—such as mindfulness programs, counseling services, and flexible scheduling—have been shown to reduce stress and improve retention (Henderson et al., 2020; Kachaturoff et al., 2020). Institutionalizing resilience training

Supports for English as a second language learners

U.S. nursing programs are enrolling more students for whom English is a second language (ESL), and these learners often face unique academic and cultural challenges. Language barriers are the most cited obstacle, affecting comprehension of medical terminology, lectures, and exam questions—even among students who meet English proficiency requirements (Henry, 2023; Lewis & Bell, 2020). ESL students also face cultural stressors, such as differing communication norms and a reduced sense of peer

Wrap-around student support for academic rigor

Comprehensive wrap-around services—including childcare, technology access, and mentoring—provide essential scaffolding for student persistence (Phillips, 2025). Mentorship is consistently identified as a high-impact strategy for improving confidence, engagement, and retention (Henderson et al., 2020; Kachaturoff et al., 2020). Formal faculty-student mentoring relationships enhance satisfaction and reduce attrition, especially for first-year or at-risk students (Lewis & Bell, 2020). Peer

Mentoring

Mentorship is a proven strategy for improving nursing student retention, confidence, and success. Both peer and faculty mentoring have been linked to higher engagement, better skill development, and improved retention (Kachaturoff et al., 2020). Mentors guide coursework, clinical challenges, and time management, helping reduce stress and isolation (Mumba et al., 2023). Students in peer-mentoring programs report lower stress and anxiety (Henderson et al., 2020). Supportive and caring faculty

Conclusion

Nursing education is at a pivotal moment where inclusivity and adaptability must define its evolution. Today’s nursing students—many of whom are employed, caregiving, or first-generation learners—require structures that reflect their lived realities. Evidence from recent literature demonstrates that flexible formats, paid clinical experiences, childcare partnerships, mentoring, and technology access can preserve academic rigor while broadening opportunity.

By intentionally designing equitable

CRediT authorship contribution statement

Vanessa Segura: Writing – review & editing, Writing – original draft, Supervision, Conceptualization. Emily Canale: Writing – original draft. LeAnne Prenovost: Writing – review & editing.

Declaration of Generative AI and AI-assisted technologies in the writing process

During the preparation of this work, authors Vanessa Segura, Emily Canale, and LeAnne Prenovost used ChatGPT to improve readability and language. Following its use, the authors reviewed and edited the content as needed and take full responsibility for the final version of the publication.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Uncited references

Albloushi et al., 2022

Davidson-Davie Community College, 2023

Loma Linda University, 2022

Rappahannock Community College, 2024

South Texas College, 2024

Veterans Administration, 2023

Villanueva et al., 2021

Declaration of competing interest

The author declares that they have no competing interests.