Holistic admission in nursing: Policy, process, and a pandemic

There is an increasing demand for a diverse and competent healthcare workforce in the United States. The chasm between job openings and hires has widened since 2014. A confluence of factors contributing to this gap includes U.S. healthcare policy changes, an aging population, and retirement of Baby Boomer healthcare practitioners (Bureau of Labor Statistics [BLS], 2022). The COVID-19 pandemic has further intensified the need to expand the nursing workforce. Nurses are at the frontline of the response to the virus and are central to successful progress in suppressing the virus. They will also be major contributors to post-COVID-19 health management (Catton, 2020).

Healthcare research increasingly supports the assertion that better health outcomes are achieved when nurses are from similar cultural and linguistic backgrounds as their patients (Williams et al., 2014). Increases in workforce diversity, to reflect societal changes, will improve healthcare quality and access, and lead to a reduction in health disparities (Williams et al., 2014).

This article focuses on a nursing program in Wisconsin where the racial minority population increased 500 % between 1970 and 2013, and the white population grew by approximately 50 % (Zaniewski, 2013). According to the Wisconsin Center for Nursing Diversity Report (2016), 95 % of nurses in Wisconsin identify as white. In contrast, according to the United States Census Bureau (2021), 80 % of the Wisconsin population is white. It is critical that the nursing workforce adapt to reflect the changing diversity of the state and the United States in general, as nursing students educated in Wisconsin go beyond state borders to eventually practice as nurses nationwide.

In response to addressing workforce gaps and cultivating diverse healthcare professionals in support of improved health outcomes, nursing schools are intent on recruiting, retaining, and graduating cohorts that are not only successful professionals but also diverse in a multitude of ways. ‘Diversity’ is not solely based on race, ethnicity, or gender, but refers to variability in experiences, socioeconomic factors, and viewpoints (Glazer et al., 2016). Nursing schools that focus solely on quantitative metrics as potential indicators of success (e.g., GPA, science GPA, ACT, TEAS) may not achieve diversity. Evidence suggests that implementing holistic review processes increases diversity without diminishing academic success of students (Glazer et al., 2016; Neubrander & Metcalfe, 2016; Artinian et al., 2017).

Initiatives to implement holistic review for admission in health profession schools are increasing. The National Study on University Admissions in the Health Professions assessed the degree to which health profession schools utilized holistic review of applicants. Of the 163 public universities contacted for the survey, 104 participated, including 228 medical, dental, pharmacy, nursing, and public health schools. Sixty-seven percent of health profession schools reported having implemented a holistic admission process within the past 10 years, and 8 % indicated that they had used a holistic admission process for more than 10 years (Glazer & Bankston, 2014). More frequent use of holistic review was reported by the medical and dental schools surveyed, and less frequent use among the nursing schools surveyed. One of the problems encountered by health profession schools aiming to move to a holistic admission model is the limited dissemination of information on how schools have made the transition from ‘standard’ admission practices to holistic review for admission process (Glazer & Bankston, 2014).

Given that holistic review is not as prevalent among nursing schools, less is known about how holistic review processes are developed, adopted, operationalized, and applied to admission of nursing school applicants. The aim of this article is to describe the development and implementation of a holistic review for admission by a large, Midwestern, baccalaureate nursing program (University of Wisconsin-Milwaukee [UWM], College of Nursing [CON]). This narrative example will also address how the process was adapted and sustained during the COVID-19 pandemic.

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