What you’ll learn in this article…
- A 2026 qualitative study found that public labeling and unequal treatment by nurse educators directly fuel repeating students' stigma.
- Five compounding dimensions of stigma, from educator attitudes to psychological consequences, create a cascade that undermines student persistence.
- Institutional progression policies can inadvertently communicate that repeating students are unwelcome when language and enforcement lack equity review.
- Faculty who adopt private advising, normalized remediation language, and structured reentry plans can measurably reduce shame and improve outcomes.
How common is course repetition in nursing programs, and why does the experience still carry so much shame?
Nursing programs routinely report attrition rates between 20% and 50%, making course repetition a structural reality rather than a rare event. Yet students who repeat a course often describe the experience as isolating and stigmatizing, marked by changed relationships with faculty and peers. A 2026 qualitative study published in Frontiers in Education by Mpangane, Mabunda, and Phetlhu provides fresh evidence that this stigma is not simply interpersonal friction.1 It is embedded in institutional practices, educator behaviors, and policy language that together create a compounding harm cycle.
For nurse educators, the findings demand more than awareness. They call for concrete changes in how faculty communicate with repeating students, how progression policies are written, and how programs define support.
What New Research Reveals About Academic Failure Stigma in Nursing
Most nursing education research asks why students fail. Far less asks what happens to them afterward, when they return to a classroom that now treats them differently. A new qualitative study published in Frontiers in Education (Mpangane, Mabunda, and Phetlhu, 29 May 2026) addresses that gap directly, and the findings should prompt every nurse educator to look hard at their own program culture.1
Study Design and Participants
The research team at Sefako Makgatho Health Sciences University in Pretoria, South Africa used Interpretative Phenomenological Analysis (IPA), a qualitative approach well suited to understanding how individuals make sense of difficult lived experiences. They recruited eight repeating nursing students from four campuses of a public nursing education institution and conducted semi-structured in-depth interviews, with follow-up interviews to deepen and verify themes. The sample is small by design: IPA prioritizes depth over breadth, and the goal was rich phenomenological insight rather than statistical generalization. You can read the full open-access article at Frontiers in Education (doi: 10.3389/feduc.2026.1751650).
Five Themes That Form a Framework
The authors identified five interconnected themes that together describe how stigma operates around academic failure in nursing programs:
- Stigmatising attitudes from nurse educators: dismissive tone, lowered expectations, and visible frustration directed at students who had failed a course.
- Institutional practices reinforcing marginalisation: scheduling, grouping, and administrative procedures that singled out repeating students.
- Internalised and externalised blame: students absorbing shame as a personal defect while also recognizing structural causes.
- Coping through withdrawal and fractured identity: disengagement from peers, self-isolation, and a weakened sense of belonging in the profession.
- Psychological consequences of stigma: anxiety, depressive symptoms, and erosion of confidence that further threatened academic recovery.
Why Public Labelling Matters
One of the study's most actionable findings is that public labelling and unequal treatment by nurse educators were primary drivers of stigma. This is not an abstract cultural force. It is faculty behavior, often unintentional, that can be named, audited, and changed. That distinction matters because it places responsibility, and therefore the capacity for repair, squarely within reach of the educators and administrators who shape daily classroom and clinical experiences. For faculty reflecting on their own classroom conduct, reviewing the qualities of a good nurse educator can be a useful starting point for self-assessment.
How Stigma Manifests in Nursing Education Settings
Eight repeating nursing students across four campuses of a South African public nursing education institution described, in their own words, specific and recurring patterns of stigmatization. Their accounts come from a 2026 Interpretative Phenomenological Analysis published in Frontiers in Education by Mpangane, Mabunda, and Phetlhu.1 These accounts paint a vivid picture of what academic failure stigma looks like on the ground, and nurse educators everywhere should pay close attention to the behaviors and structures described.
Public Identification and Differential Treatment by Educators
One of the most striking findings was the role nurse educators themselves played in making repeating students visible in harmful ways. Participants reported being publicly identified as repeaters in classroom settings, singled out by name or through pointed comments that drew attention to their status. This public labelling went beyond administrative necessity; it signaled to the entire cohort that certain students carried a mark of failure.
Beyond labelling, participants described unequal treatment. Educators sometimes directed different expectations, reduced patience, or dismissive language toward students who were repeating a course. These behaviors, whether intentional or not, communicated a clear message: repeating students were less capable, less deserving, or less welcome. If you are a nurse educator, consider whether you have ever introduced or referenced a student in a way that disclosed their repeating status to peers without a pedagogical reason.
Institutional Practices That Reinforce a "Marked" Identity
Stigma did not originate solely from individual educators. The study found that institutional practices reinforced marginalization in structural ways. When repeating students are placed into separate cohorts, required to follow visible re-enrollment processes, or assigned transcript markers that travel with their academic record, these mechanisms create a persistent "marked" identity. Even routine administrative steps, such as requiring students to re-register in person or attend orientation sessions designed only for repeaters, can broadcast their status in ways that feel punitive rather than supportive.
These practices may be implemented with good intentions (tracking progress, ensuring proper advising), but their cumulative effect is to set repeating students apart as a visibly different group, embedding the stigma of failure into the institution's own systems. Addressing these patterns is one way nurse educators promote health equity within their own programs.
Peer Dynamics and Social Isolation
The consequences extended into peer relationships. Participants described how continuing students distanced themselves from repeaters, sometimes avoiding group work partnerships or social interactions. This distancing created a feedback loop: as repeaters became more isolated, their sense of belonging eroded, which in turn reinforced their perception of being unwanted or inferior.
Social isolation in nursing education is especially damaging because collaborative learning, clinical teamwork, and peer support are central to the profession. When a student is excluded from these relational networks, they lose access not only to friendship but to essential learning resources. Compounding the problem, the ongoing nursing faculty shortage means fewer educators are available to notice and intervene when isolation takes hold.
Recognizing Patterns You May Not Have Named
Many of these stigmatizing behaviors and structures operate quietly. Educators may not recognize a passing comment as public labelling. Administrators may not see a re-enrollment form as a source of shame. Peers may not realize that choosing different lab partners sends a message of exclusion.
Consider reviewing your own practices for the following patterns:
- Public disclosure: Announcing or implying a student's repeating status in front of peers.
- Unequal engagement: Offering less patience, fewer opportunities, or more critical feedback to repeaters.
- Structural visibility: Using separate cohort placements, visible registration processes, or transcript markers that identify repeating students.
- Peer exclusion: Failing to intervene when continuing students avoid or marginalize repeaters during group activities.
Naming these patterns is the first step toward dismantling them. The Mpangane et al. study makes clear that stigma in nursing education is not a vague concept.1 It is a set of identifiable, observable, and changeable behaviors and structures that nurse educators are uniquely positioned to address.
The Five Dimensions of Academic Failure Stigma
Academic failure stigma is not a single event. Research by Mpangane, Mabunda, and Phetlhu (2026) reveals it operates as a compounding cascade, where each dimension feeds directly into the next, deepening harm over time. Understanding this sequence helps nurse educators identify where they can interrupt the cycle.
The Psychological and Academic Impact on Repeating Students
Academic failure in nursing education sets off a cascade of psychological and academic consequences that extend far beyond a single failed course, yet the scope of this damage remains poorly measured and, in many programs, largely invisible.
A Problem Without a Yardstick
One of the most striking gaps in nursing education research is the absence of a validated instrument specifically designed to measure stigma associated with academic failure.1 While validated scales exist for related constructs, such as stigma toward people with mental illness in nursing contexts2, no equivalent tool has been developed for academic failure stigma as of 2026. The research that does exist is predominantly qualitative or conceptual in nature3, meaning nurse educators lack standardized data to benchmark how stigma affects their own students.
If you want to explore what is available, search academic databases like PubMed and CINAHL using terms such as "academic failure stigma scale" and "nursing education." You will find that the literature points toward an urgent need for instrument development rather than offering a ready-made assessment. This gap matters: without measurement, the problem stays anecdotal, and anecdotal problems rarely drive institutional change.
What the Numbers Do Tell Us
Although stigma-specific prevalence data are not yet available, adjacent data paint a sobering picture of how common course failure and program delay actually are. A cohort study tracking over 1,000 nursing students in Italy found that 38.8 percent experienced delays or interruptions to their expected program timeline, while only 61.2 percent completed within the standard duration.4 Broader estimates suggest that course failure and withdrawal rates across nursing programs range from 18 to 50 percent.5 These are not outlier figures; they represent a substantial portion of every entering class.
Despite these numbers, attrition data among course repeaters specifically have not been systematically quantified.5 Many nursing programs report overall attrition and repeat rates through their annual accreditation reports, often posted on institutional websites, but these rarely disaggregate the experiences of students who are repeating a course from those who withdrew for other reasons. Professional organizations such as the National League for Nursing and the American Association of Colleges of Nursing publish white papers and survey data on student persistence, and these can be valuable supplementary resources.
Bureau of Labor Statistics data on the nursing workforce capture broad workforce attrition trends but do not specify course repeaters. Pairing BLS data with state nursing board reports on licensure exam pass rates among repeat test-takers can offer indirect insights, though this requires careful interpretation.
The Human Cost Behind the Data Gaps
The Frontiers in Education study by Mpangane, Mabunda, and Phetlhu documented what happens when repeating students navigate these environments without adequate support. Among the eight participants interviewed, themes of fractured identity and coping through withdrawal emerged consistently. Students described internalizing blame for their failure and, at the same time, perceiving external blame from faculty and peers. The psychological consequences included distress, social isolation, and diminished confidence in their capacity to succeed in the profession. Nurse educators who are committed to teaching emotional intelligence to nursing students should recognize that these repeating students may need that support most urgently.
Research on causes of academic failure has also identified relational factors. One study found that family relationship difficulties scored a mean of 3.27 on a scale measuring contributors to academic failure, suggesting that the stressors repeating students face are not purely academic.7 When stigma compounds these existing pressures, the risk of permanent departure from nursing education rises.
For nurse educators, the takeaway is direct: the psychological toll of repeating a course is real and measurable in its effects on retention, even if no standardized stigma scale yet exists. Waiting for a perfect instrument is not a justification for inaction. Reviewing your own program's accreditation data, listening to repeating students' experiences, and advocating for research into validated measurement tools are all steps that can begin now.
Questions to Ask Yourself
Faculty Attitudes and Their Role in Perpetuating or Reducing Stigma
Faculty attitudes are one of the most powerful variables in a repeating student's experience. The way an educator greets a returning student on the first day of a repeated course, whether a remediation plan is discussed privately or in earshot of peers, and the tone used when referencing prior performance all shape whether that student feels supported or singled out. Because attitudes operate largely below the surface, nurse educators benefit from structured ways to examine them.
Where to Find Credible Guidance on Faculty Development
Rather than relying on a single workshop or anecdote, build your understanding from authoritative sources that publish ongoing work in nursing education and health professions teaching.
- Professional associations: Organizations such as the National League for Nursing (nln.org) and the American Association of Colleges of Nursing (aacnnursing.org) publish faculty development resources, position statements, and competency frameworks that address inclusive teaching and student support. Their continuing education catalogs are a practical starting point for self-directed learning.
- Peer-reviewed journals: Journals including Nurse Educator, Journal of Nursing Education, Nursing Education Perspectives, and Teaching and Learning in Nursing regularly publish studies on faculty attitudes, remediation models, and stigma reduction in health professions education. Searching these through your institution's library or PubMed will surface current evidence.
- Accreditation and regulatory bodies: The Commission on Collegiate Nursing Education (CCNE) and the Accreditation Commission for Education in Nursing (ACEN) publish standards that increasingly emphasize student support, diversity, and equity. Reviewing these standards alongside your program policies can reveal gaps.
Use Government and Institutional Data to Anchor the Conversation
When advocating for faculty development investment, ground your case in publicly available data. The Bureau of Labor Statistics (bls.gov) maintains workforce and education statistics for registered nurses and nurse educators, which can help frame the cost of attrition. Your own institution's progression and completion reports, along with NCLEX pass rate trends published by state boards of nursing, give concrete local context.
Translate Awareness Into Practice
Faculty attitude work is most effective when it is ongoing rather than a one-time training. Look for programs that include reflective practice, peer observation, and case-based discussion of student scenarios. Exploring nurse educator roles that your colleagues model successfully can spark ideas for adapting your own approach. Check your school's website and faculty affairs office for available development funding, sabbatical options, and internal teaching academies. Many universities also partner with their centers for teaching and learning, which often offer confidential coaching that lets faculty examine their own assumptions without judgment from departmental colleagues. For a broader collection of professional development tools, see our nurse educator resources.
Institutional Policies That Inadvertently Stigmatize Students
Policies are never passive documents. The language, sequencing, and enforcement mechanisms embedded in academic progression rules send clear messages to students about how an institution values their presence, and repeating students receive those messages loudly.
How Policies Communicate Worth
Many nursing programs were designed with linear progression in mind: one cohort moves forward together, and deviation from that path triggers a formal response. Dismissal thresholds, course repeat limits, and academic probation designations can all serve legitimate quality-assurance purposes. The problem arises when these mechanisms operate without corresponding support structures, leaving a student facing consequences with no clear pathway to recovery. When a policy names what a student cannot do without explaining what they can do, it functions as exclusion rather than guidance.
Public labeling practices compound this effect. Assigning repeating students to separate cohorts, flagging their records in ways visible to peers, or requiring them to reintroduce themselves in clinical placements as students who previously failed all reinforce the sense that their academic history defines them. These are institutional choices, not unavoidable necessities.
Where to Look for Better Models
Accreditation bodies such as the Commission on Collegiate Nursing Education and the Accreditation Commission for Education in Nursing publish standards and resources related to academic progression and student support. Reviewing their current guidance is a practical starting point for identifying whether your program's policies align with principles of equity and inclusion. State nursing boards also set baseline requirements for program completion timelines, and understanding those constraints helps distinguish what is mandated from what is institutional habit.
Professional organizations including the National League for Nursing and the American Association of Colleges of Nursing have developed toolkits and position statements addressing diversity, equity, and student success. These resources often include recommendations for redesigning policies that may unintentionally disadvantage students who require more time or more than one attempt to master content.
Individual program directors and academic affairs administrators at peer institutions can be valuable informal resources as well. Requesting examples of recent policy revisions, and asking specifically about any documented effects on student retention or well-being, surfaces real-world evidence that rarely appears in published literature.
The Revision Mindset
Policy review is most productive when it begins with a direct question: does this rule help a struggling student move forward, or does it primarily manage administrative risk? Policies that conflate quality assurance with punishment tend to rely on restriction and disclosure. Policies grounded in student success tend to pair consequences with resources, communicate expectations clearly and without shame, and create structured re-entry rather than indefinite exclusion.
Redesigning progression policies also creates opportunities to weave in innovative teaching strategies in nursing education that give repeating students fresh pathways to demonstrate competency. No single policy change eliminates stigma. But the cumulative effect of several small revisions (clearer language, fewer public-facing markers of academic difficulty, and mandatory advising rather than optional referrals) can shift the institutional culture that surrounds repeating students in meaningful ways.
Every progression policy sends a message to repeating students, either signaling that recovery and success are expected, or quietly implying that time is running out. Before your next policy review, read your program's requirements through the eyes of a student who has already stumbled once. The language, the timelines, and the consequences all communicate institutional values whether you intend them to or not.
Evidence-Based Strategies to Support Repeating Nursing Students
What specific interventions actually help repeating nursing students succeed, and where can educators find models that work?
Moving from awareness of stigma to meaningful action requires structured approaches grounded in evidence. While research on repeating nursing students specifically remains limited, a growing body of literature and institutional practice offers practical frameworks that nurse educators can adapt to their own programs.
Exploring Structured Remediation Programs
Many nursing programs have developed formalized support structures for students who need to repeat coursework. These often include cohort-based repeat programs where students move through content together rather than being isolated among new cohorts, academic coaching or success coaching initiatives that pair students with trained staff focused on study skills and test-taking strategies, and peer mentoring models that connect repeating students with successful upperclassmen who can offer both academic guidance and emotional support.
To discover what approaches exist, start by reviewing nursing program websites directly. Schools that have invested in remediation infrastructure often publish details about their academic support services, early-alert systems, and student success initiatives. While specific program names and outcomes vary widely, examining how peer institutions structure their support can spark ideas for your own setting.
Consulting Professional Organizations and Research Literature
The National League for Nursing and Sigma Theta Tau International frequently feature published models and discussion of retention strategies in their journals, conferences, and resource libraries. These organizations serve as clearinghouses for innovative practices in nursing education, including approaches to supporting struggling students.
For deeper investigation, search education databases such as ERIC and PubMed using terms like "nursing student remediation," "repeat student support," "academic coaching nursing," or "nursing student retention interventions." Case studies and program evaluations published in nursing education journals can provide both theoretical frameworks and practical implementation details, even when large-scale outcome data remains sparse.
Gathering Data from Regulatory and Professional Bodies
State boards of nursing and professional associations like the American Nurses Association sometimes collect aggregated data on retention and NCLEX pass rates that can illuminate broader trends in how remediation efforts affect student outcomes. Understanding how the next generation NCLEX affects nurse educators can also inform how you design remediation curricula, since evolving exam formats demand updated test-preparation strategies. While this data may not isolate repeating students specifically, it can help educators understand the landscape and advocate for institutional resources.
Contacting these bodies directly or reviewing their published reports may reveal guidance documents, position statements, or compiled best practices that inform how programs approach academic difficulty without stigmatization.
Building Your Own Evidence Base
Given the limited published research specifically on repeating nursing students, consider contributing to the knowledge base yourself. Track outcomes for students in your program who receive various types of support. Document what interventions you implement and measure their effects on retention, course completion, and licensing exam success. Even informal data collection can guide program improvement and, when shared through professional channels, can help the broader nursing education community develop more robust evidence for effective practices. Exploring nurse educator career advancement pathways may also motivate you to turn this scholarship into presentations and publications that advance both your career and the field.
Related Articles
Building an Equity-Centered, Non-Stigmatizing Learning Environment
An equity-centered learning environment is one where students receive the support they need to succeed regardless of their background, identity, or prior academic struggles. For repeating nursing students, this means creating classrooms and clinical spaces where academic failure does not become another layer of marginalization on top of existing barriers.
Understanding Intersecting Vulnerabilities
Students from marginalized backgrounds often experience compounded stigma when academic failure occurs. A first-generation college student who fails a nursing course may face not only the shame of repeating but also family pressure, financial strain from extended enrollment, and self-doubt about belonging in higher education at all. Students from lower socioeconomic backgrounds may lack the safety net of tutoring resources, reduced work hours, or family support that helps others recover from setbacks.
Race and ethnicity add additional complexity. Students who already navigate bias in clinical settings or experience microaggressions in classroom discussions carry that weight into academic struggles. When these students fail, the failure can reinforce harmful narratives they have internalized about who belongs in nursing. The 2026 Frontiers in Education study documented how repeating students described feeling "othered" by peers and faculty1, a phenomenon likely intensified for students who already feel like outsiders in predominantly white institutions.
Applying Inclusive Pedagogy Principles
Nurse educators can draw on established frameworks to create supportive environments for all students, including those who are repeating:
- Universal design for learning: Offer multiple ways for students to engage with material, demonstrate knowledge, and receive feedback. This flexibility benefits repeating students who may need different approaches the second time.
- Culturally responsive teaching: Acknowledge that students bring diverse experiences and perspectives. Avoid assumptions about why a student failed or what support they need.
- Trauma-informed approaches: Recognize that academic failure itself can be traumatic, and some repeating students may carry additional trauma from personal circumstances. Create predictable, supportive structures rather than punitive responses.
These principles align closely with the broader work nurses as educators do when they transition from clinical practice to teaching, where empathy and patient-centered thinking translate directly into learner-centered pedagogy.
Using Data to Identify Equity Gaps
Programs serious about equity must examine who fails, who repeats, and who ultimately leaves. Disaggregating attrition and repeat data by race, socioeconomic status, and first-generation status reveals patterns that aggregate numbers hide. If students from certain backgrounds are disproportionately repeating courses or withdrawing, that signals a need for systemic intervention rather than individual blame.
This data analysis should inform resource allocation, mentorship programs, and policy review. Equity gaps in academic outcomes are rarely coincidental. They reflect structural barriers that nursing programs have the power to address when they commit to looking honestly at who their systems are serving and who they are leaving behind.
Practical Steps Nurse Educators Can Take Today
Reducing academic failure stigma requires intentional, everyday actions rather than sweeping policy overhauls alone. The following table organizes concrete steps across five key domains, each directly informed by the themes identified in recent research on repeating nursing students' experiences. Use this as a working checklist to audit your own practice and your program's culture.
| Domain | Action Step | Why It Matters |
|---|---|---|
| Language & Communication | Replace deficit language (e.g., 'failed student') with growth-oriented terms such as 'student repeating a course' or 'student on a revised progression plan.' | Public labelling was identified as a direct contributor to stigma and exclusion. Neutral language reduces shame and signals respect. |
| Language & Communication | Discuss academic setbacks privately and one on one, never in front of peers or clinical groups. | The 2026 Frontiers in Education study found that public identification by nurse educators deepened repeating students' sense of marginalisation and psychological distress. |
| Classroom Practices | Assign repeating students to groups and clinical rotations using the same process as all other students, with no visible distinctions. | Unequal treatment and separate processes reinforce a visible 'othering' that the research linked to internalised blame and fractured identity. |
| Classroom Practices | Open each course by normalising varied academic paths, noting that repeating content is a legitimate and common part of professional education. | Normalisation at the group level helps counter externalised blame and reduces the isolation repeating students reported in qualitative interviews. |
| Advising & Mentoring | Schedule a structured, supportive advising session within the first week of a repeated course to co-create a personalised success plan. | Early, proactive outreach counters the withdrawal behaviour the study identified as a coping mechanism, reconnecting students before disengagement deepens. |
| Advising & Mentoring | Connect repeating students with peer mentors who have successfully navigated a course repeat, with the student's consent. | Peer connection addresses the fractured identity theme by providing relatable role models and reducing feelings of being alone in the experience. |
| Policy Review | Audit your program's written policies and student-facing documents for language that frames repetition as failure rather than as progression support. | Institutional practices reinforcing marginalisation were a distinct theme in the research. Policy language shapes culture even when no one reads it aloud. |
| Policy Review | Ensure that academic review or progression committees include student advocates or counsellors, not only faculty who evaluate grades. | Broadening committee composition introduces perspectives focused on student wellbeing, counteracting the purely evaluative framing that can deepen stigma. |
| Self-Reflection | Before each advising interaction with a repeating student, pause and ask yourself: 'Am I approaching this conversation with the same warmth and expectation of success I would offer any other student?' | The study documented stigmatising attitudes from nurse educators as a primary theme. Conscious self-checks interrupt unconscious bias before it enters the room. |
| Self-Reflection | Participate in or request faculty development sessions specifically focused on bias, equity, and the psychological impact of academic failure stigma. | Sustained reflection, not a single workshop, is needed to shift the faculty attitudes the researchers identified as central to repeating students' negative experiences. |
Common Questions About Supporting Repeating Nursing Students
Nurse educators frequently ask how they can better support students navigating course repetition. The questions below draw on emerging research findings, including a 2026 qualitative study published in Frontiers in Education, and offer practical guidance grounded in evidence.
