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Research project

SPRiNG: Starting Strong in Nursing

Status: Ongoing (November 2015 - 2020)

A cohort study investigating dropout and musculoskeletal complaints in nursing students.

What we do

About our project

Dropout of nurses due to physical and mental workload is substantial and includes dropout from nursing education and at the beginning of the career. Scientific knowledge about early identification of risk factors leading to dropout is limited and the implementation of effective interventions to handle dropout is faltering. That is why practice-oriented research into the risk factors of dropout is important to recognize the risk factors at an early stage. The development of an instrument for professional practice may contribute to the retention of nursing students.

We hypothesize that musculoskeletal problems in nursing students due to work-related activities already arise during nursing training and lead to early dropout from training and occupation.

A prospective cohort study of 750 nursing students, in which determinants for dropout are monitored, will form the basis for a prediction model. A systematic review and a qualitative study will contribute to identify evidence-based interventions. For the most promising intervention precursors of an RCT are pilotted.

Our research focus

Primary outcome
The primary outcome of the study is dropout from nursing education. Drop out data (y/n) will be retrieved from the student administration and is defined as the students who stopped studying for a bachelor of nursing degree, without having obtained a certificate.

Secondary outcome
The secondary outcome of the study is development of musculoskeletal complaints. This is retrieved from self-administered student data from the SPRiNG questionnaire.

Funds & Grants

Regieorgaan SIA RAAK PRO / Netherlands Organisation for Scientific Research (NWO) Projectnummer: 2014-01-31 PRO.


  • Rotterdam University of Applied Sciences, Innovations in Care, Work and Health
  • Amsterdam UMC, Amsterdam Public Health
  • deRotterdamseZorg
  • Albeda College


Bakker EJM, Kox JHAM, Miedema HS, Bierma-Zeinstra S, Runhaar J, Boot CRL, van der Beek AJ, Roelofs PDDM. Physical and mental determinants of dropout and retention among nursing students: protocol of the SPRiNG cohort study. BMC Nurs. 2018 Jun 22;17:27. doi: 10.1186/s12912-018-0296-9. eCollection 2018.

Bakker EJM, Verhaegh KJ, Kox JHAM, van der Beek AJ, Boot CRL, Roelofs PDDM, Francke AL. Late dropout from nursing education: An interview study of nursing students' experiences and reasons. Nurse Educ Pract. 2019 Aug;39:17-25. doi: 10.1016/j.nepr.2019.07.005. Epub 2019 Jul 15.

Our team

Dr. P.D.D.M. Roelofs (co-promotor), p.d.d.m.roelofs@hr.nl
Dr. J. Runhaar (co-promotor), j.runhaar@erasmusmc.nl
Prof. S.M.A. Bierma-Zeinstra (promotor), s.bierma-zeinstra@erasmusmc.nl

Contact address for the project: j.kox@erasmusmc.nl.