Holistic Admissions Criteria in Prelicensure Nursing Programs

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As a high school student, Gaby worked nearly full-time to support her family. She also helped care for her grandfather who was in failing health, giving him daily insulin injections and attending to his care. She dreamed of going to nursing school after graduation. Still, her classroom grades, which suffered because of her other commitments, were insufficient for admission to the nursing program of her choice.

Philip, a high school athlete, was captain of a championship basketball team. He had the passion and personality to be a great nurse and wanted to follow in his mother’s footsteps in the profession. Unfortunately, his grade point average (GPA) was below the cutoff for admission to his local nursing program.

Dreams of joining the nursing profession were halted for both of these potentially excellent nurses, both of them first-generation Americans and members of populations underrepresented in nursing. Some prelicensure nursing schools use a comprehensive approach for admission, but far too many still use academic achievements and standardized test scores as the sole criteria for accepting students into their program. Admission to nursing schools in the United States remains far from standardized, even though all nurses must pass the same national licensing exam to practice their profession.

Intangible qualities like emotional intelligence and compassion count in nursing.

Perhaps achieving greater representation in nursing should begin during the application process for nursing school. This requires a less rigid, more holistic perspective in which applicants’ lived experience, extracurricular activities, and nonacademic successes are considered in addition to the traditional quantitative measures. For a profession rooted in social justice, and one that strives for a workforce that reflects the diversity of the population, the holistic admissions review process seems like an obvious choice, especially considering that minority nurses make up only 19.4% of the current workforce.

The nursing discipline is a blend of science and art. Nobody will deny that courses in anatomy and physiology are needed to perform a physical assessment, or that mastering pathophysiology helps students to appreciate what happens to the body when illness occurs. But equally important in nursing are life experiences, communication, emotional intelligence, and the intangible attributes of compassion, commitment, and empathy, which can significantly affect patient outcomes—mastering them rarely comes from a textbook.

No decline in academic performance with holistic admissions.

Envision an admissions process that considers a student’s community service or work experience, one that requires a personal essay or letters of reference, or a program where a student displays their personality during an interview with nursing faculty. A secondary analysis of U.S. associate and bachelor’s degree programs by Hampton and colleagues (2022) found that only 43% (n=1547) of schools had implemented this type of process.

Following the adoption of a more expansive and inclusive admissions process at one school, Jung and colleagues (2021) reported a shift in the student population to one that better reflected the ethnicities of the population served. Additionally, there is growing evidence that academic performance has not declined in schools that report using more holistic admissions criteria, with an increase in retention and graduation rates among underprivileged and underrepresented minority students and maintenance of NCLEX pass rates following the implementation of holistic admissions in two accelerated BSN programs.

Nursing trails other disciplines in achieving an integrated approach to admitting students to health professions education. Relying solely on traditional quantitative data to gain admission to a nursing program does not automatically equate to being a good nurse. Adopting a holistic admissions process will create a diverse workforce; however, it requires a collaborative effort by an institution’s administration, faculty, and students.

Recall Philip, the star high school athlete who did not have the highest GPA. The characteristics of teamwork and communication learned from playing sports are also essential in nursing. “Doesn’t that count for anything?” he might have asked. And Gaby, who works two jobs to support her family and cares for her ailing grandfather, could have echoed, “Doesn’t that count for anything?”

How could I say no? But I had to.

Margaret Hickey, MSN, RN, is a PhD nursing student at Lienhard School of Nursing, Pace University

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