Class attendance is essential in the academic performance and professional development of medical students [1]. Attendance is usually considered to reflect students’ level of engagement with their course and to be critical to students’ success; despite the potential for technological alternatives, lectures and other face-to-face sessions still tend to be the primary method of teaching at the universities [2]. The issue of student absenteeism in the South African Higher Education landscape has become a complex educational, political, and social problem that is generating increased interest among educators, researchers, and policymakers [3].

Absenteeism is not only an epidemic peculiar to the universities but to all public and private schools in the developed and developing countries. Absenteeism does not only violate the school rule and regulation, but it also affects the school system, the individual students and the society at large, especially when the students in health-related sciences are involved [4]. It is seen that the absenteeism rate in secondary education is much higher than in other stages of the educational system. Data related to absenteeism shared by the Ministry of Education shows that there is a rapid increase in absenteeism in 2009-2010 as compared to 2008-2009 [5].

Absenteeism refers to the frequent absence from classes without any valid reason and it is thought to be the primary concern in the health profession education worldwide, mainly in the medical schools [6]. Absenteeism inhibits students from attaining appropriate information and contact with relevant materials (clinical skills, lectures, practical sessions) that are required for effective learning to occur [6]. Absenteeism is also associated with poor academic performance, unprofessional conduct and inadequate socialisation within the profession [7].

With reference to nursing, absenteeism refers to being away from scheduled classes and learning experiences irrespective of the reasons and this does not only result in poor academic performance but also poor application of skills. Baccalaureate nursing students often experience high levels of stress during training that may result in psychological or emotional impairment during their professional life, ultimately affecting the quality of patient care they provide [8]. Absenteeism from clinical areas and lectures among nursing students is a significant problem that, if not addressed, will adversely affect the quality of nursing care [9]. Student absenteeism is still a great concern in most of the provinces such as Limpopo, KwaZulu-Natal, Gauteng, Eastern Cape, and North West [10].

Despite explicit policies in place regarding mandatory attendance of lectures and clinical practice sessions, absenteeism is an on-going problem not only in South Africa, but it is a phenomenon that is also on the rise in universities worldwide [11]. Absenteeism as a problem is becoming a concern of every member of society because of its negative consequences at both the individual and social levels [12]. The authors further state that lecturers who spend time in class re-teaching lessons take instructional time away from students who attend class regularly, and this has a negative impact on the lecturers’ planning periods as the time spent on re-teaching can be used for individual assistance [12].

Students’ absenteeism affects the lecturer, as they experience difficulties continuing with a new topic when students lack previous knowledge. In addition, other students who are top achievers become frustrated with the process of repeating work and lecturers view this process as unproductive and time-consuming [13]. The students miss valuable information and the use of specific examples to explain certain concepts that result from peer-lecturer interaction. Therefore, absentees are bound to miss these rich educational resources and the loss may negatively impact on the students’ academic performance and study length [1, 14].

Attendance is a key component in the students’ retention, progression, achievement, and employability. It is, therefore, paramount for universities to have effective mechanisms in place to monitor risky students’ attendance so as to positively engage with them at a premature stage [15]. The extent of student absenteeism is distinct in a number of studies conducted worldwide. In Turkey, 89.6% of students missed lectures in 2012 in a single month, with 37.1% having missed more than seven lectures [16]. The author further states that lecture attendance is an issue that has been neglected amongst students of health science. Student absenteeism has a negative effect on the morale of nurse educators, which results in lecturers being irritated by it [17]. Absenteeism at the higher education level affects the learners’ learning process, and this may affect and obstruct their professional growth [18].

Lecturers are increasingly concerned about students’ professionalism and their ability to serve their respective profession. There is evidence supporting the positive impact of student-lecturer relationship and interactions on a range of students’ outcomes ranging from cognitive skills and behavioural changes to attitudes [19, 20]. Students learn by observing lecturers and preceptors, emulating their behaviour to the extent that their decisions and future goals are shaped by faculty role models [21]. Role modeling has been shown to be a positive educational method and one which is valued by nursing students [22].

It should be noted that every student has unique needs as well as characteristics. Therefore, universities make use of teaching, learning, and evaluation strategies that highly take into account such differences [16]. A central assumption in the learning process is that an individual student’s presence in an educational environment is a pre-requisite for the student to gain from such an environment [23].

Student absenteeism creates a dead, tiresome, and unpleasant classroom environment that makes students who come to class uncomfortable and the lecturer irritable [12]. It furthermore disturbs the dynamic of the teaching-learning environment and adversely affects the overall well-being of classes. According to the authors, in terms of quality, absenteeism is a waste of educational resources, time, and human potential. Student absenteeism also causes rework and wastes time of lecturers [12].

University students are regarded as young adults who are capable of making informed decisions and accepting the results of such decisions. To a program such as nursing, whereby a certain culture of professionalism has to be instilled, this poses a real concern. Professional responsibility and penalties for professional errors render even more essential the adequacy and quality of professional training in the domain of health sciences [16]. Many of the students view class attendance as demanding and stressful as compared to relaxing at their residences and engaging in other activities that are more enjoyable and attractive, like going to the movies and parties [22]. For education aimed at developing members of a profession, non-attendance is disturbing and worrisome.

In South Africa, the undergraduate nursing students undergo training for four years, with scheduled theoretical lectures and experiential learning included (South African Nursing Council Regulation [SANC] R425 of 1985 as amended) [24]. As per the School of Health Care Sciences Calendar Rule, a minimum of 75% lecture attendance in the module is required for students to gain access to the summative examination [25]. The students are also orientated and made aware of these policies at the beginning of the year and each semester. Consequently, if the student did not meet the 75% class attendance, he/she will not be permitted entry into the summative examination. Similarities regarding clinical and theoretical hours for nursing programs have been noted nationally and internationally. In the United Kingdom, in order to register as qualified nurses, the students must complete the components required for each year of the course before progressing to the next level. Overall, the program requires 50% theory and 50% practice [26, 27]. Given the negative impact of student absenteeism on inadequate learning and professional development, the study sought to understand the reasons for absenteeism from the perspectives of the nursing students.

One theme emerged from the analysis of the data reflecting the participants’ views regarding their absenteeism from scheduled learning experiences and recommendations to management. The theme was supported by four sub-themes (see Table 1 below).

This study aimed to investigate the reasons for students’ absenteeism from scheduled learning experiences, as well as to identify which strategies can be designed to curb the problem of absenteeism. The findings revealed that absenteeism was prevalent among nursing students. The main reasons for the non-attendance of classes were negative attitudes of the lecturers, lecturers do not provide prompt feedback, lecturers do not provide guidance, lecturers lack commitment and come to classes late and that the students cannot cope with the workload. Poor lecturer-student relationships have been identified as the contributory factor towards student absenteeism [37].

Lecturers have an important role to play concerning students’ absenteeism. In these cases, it is when a lecturer makes negative remarks about a student, it may result in a student staying at home and not coming to college [38]. Approximately three-quarter of all absenteeism in Sweden involves interconnected issues, such as boredom and stressful relationships with lecturers [39]. There is a relationship between a lecturer and students’ absenteeism. Lecturers should treat students in a similar way and show respect [40]. On the other hand, the above-stated reasons give poor performing students an excuse that classes are boring. Absenteeism results in lower achievement and poor academic performance. It makes students stay longer in school and parents are stressed financially. If the academic standard is not maintained, increasing absenteeism will adversely affect the quality of nursing care and contribute to increased morbidity and mortality rate in the society [41].

It is of importance that the faculty eliminates the factors that have been identified as contributing to absenteeism among nursing students. The nursing students revealed that the negative attitudes of lecturers include destructive criticism, lack of respect, as well as the aspect of no prompt feedback that is given to the students regarding the presentations. Instead of constructive feedback, such as being shown where one went wrong, students are being belittled in class in the presence of other students. The lecturers do not respect the students and they do not adhere to professionalism when speaking to students.

Absenteeism is a major concern for university education worldwide [11, 42]. Student nurses’ absenteeism from lectures and clinical practice may lead to great concern for the society. It can also affect public safety and lead to inadequate learning, especially in the aspect of drug calculation and administration. This could result in drug overdose, poisoning, and nursing error [41]. The problem of absenteeism among nursing students is growing and this issue should be handled properly; otherwise, it will have an adverse effect on the quality of nursing care [43].

As the literature has revealed, students’ absenteeism is influenced by various aspects, which include personal, health, home, as well as study and teaching-related factors [41]. All these factors have an influence on the students’ absenteeism even though the level and magnitude of each reason will differ from one student to another. Studies assert that poor teaching strategies by lecturers lead to boring lectures, unfavorable learning environment, lack of subject interest, and poor relations with lecturers [15]. In the study, half of the respondents conveyed interesting content to be an element in lecture attendance [44]. Absenteeism can be linked to a lack of interest in the subject matter and poor teaching strategies [45]. In a study conducted on medical students, the results indicated that some students could be absent from class due to improper and boring teaching methods [46]. At times, students miss classes because the content is too boring [47].

Moreover, the quality and attitudes of the lecturers are some of the reasons stated by students for non-attendance of classes [15, 48]. Few (33%) respondents agreed that if the lecturer asks many questions everyday, they would be absent from the learning area, while (67%) other respondents disagreed with the statement [49]. The dislike for teaching style and the ease of understanding the subject without guidance are also a contributing factor to absenteeism [11]. The integration of more innovative teaching methods and learning strategies into the lecture, such as games and role play, enhances the probability of meeting the needs of the learners [12].

It is a fact that lecturer-absenteeism could discourage students from being absent from the class. Congruent with study findings is that when a lecturer is absent from the classroom, students’ learning is disrupted; and when he/ she is repeatedly absent, students’ performance can be significantly impacted in a negative way [50].

The lecturers should also consider other strategies they can use to keep students interested amid address and introductions. These ought to empower the great participation of students in the classroom [51]. In this study, the lecturers were found to be the main cause of students’ absenteeism. At times they do not arrive on time to classes, and sometimes they do not attend classes at all. This demotivates students from attending classes because they know that they will not be learning anything in those classes. An affirmation is the theory of planned behavior, which states that when the lecturers are late for lesson presentations, lazy for work, and absent, such factors have an impact on the students’ awareness of absenteeism [52].

The students stated that the workload is too much, which makes it impossible for them to attend classes and be expected to go for experiential learning on some other days. A study conducted at the KwaZulu-Natal College of Nursing, which aimed to explore the causes and effects of student nurses’ absenteeism, revealed a majority of respondents confirming that they had a lot of work to complete and that they could not cope [53]. The study results are further supported by findings that student nurses absented themselves from class when they wanted to prepare for tests and examinations [54, 55]. Contrastingly, the study findings showed that students’ personal factors influenced their absenteeism and the factors included physical illness, family responsibilities and inadequate finance [4]. Oversleeping, part-time work, traffic and other problems were cited as reasons for absence from lectures [56].

The findings of this study highlighted that the main reasons for students’ absenteeism from scheduled learning experiences were lecturer-related factors. From the results of the research, issues that were identified included the lecturers’ attitudes and absence in class, teaching methods used, students not understanding the content, and too much workload, which contributed to students’ absenteeism. It was recommended that effective interactive teaching strategies be introduced, a positive learning environment free from ridicule be ensured, and that the lecturers should be informed about the study findings. This will enable the lecturers to make informed decisions about their practices.