By Marcia Frellick Broadening admissions guidelines for nursing schools beyond grade-point averages and test scores will help find the best nurses to move the profession forward, according to proponents of holistic review. Under the concept, basic academic score requirements remain, but in addition, teams consider factors such as life experience, socioeconomic status, references, essays and interviewing skills to increase diversity and strengthen retention within the boundaries of the law. A survey coordinated by the Urban Universities for HEALTH in 2014 on holistic review usage found that using some form of the process is widespread in medical schools (91% for MDs), dental schools (93% for DDS/DMD) and for PharmDs (78%), but it is used less than half the time (47%) for entrance into nursing programs. No nationwide training program for holistic review exists specifically for nursing, and only a few schools have completed the training offered by the Association of American Medical Colleges, according to Greer Glazer, PhD, RN, CNP, FAAN, dean of the University of Cincinnati College of Nursing, who has researched the topic. Medical and dental schools have been helped by foundation funding and have been studying this process longer than nursing schools. But a lack of widespread implementation among schools of nursing also might come from lack of knowledge about the process or uncertainty of outcomes if admissions guidelines change, said Deborah Trautman, PhD, RN, CEO of the American Association of Colleges of Nursing. "You're looking to see not only if an individual has the ability to be successful in the academic program, but their opportunity for success in the profession," Trautman said. AACN wants to help educate administrators about why the approach benefits nurses and the profession. Trautman said scoring high on tests alone doesn't always mean nurses will interact well with patients, families and colleagues or be able to put ideas into action. "I think the future will be that both [strength in academics and personal attributes] will be required," she said.
Diversity, retention outcomes
Glazer was asked to lead the 2014 UUH study that examined whether professional schools used the process and how it had affected outcomes. When the national study found few nursing schools were using holistic review during the admissions process, researchers wanted to learn why. They led focus groups with nursing deans at AACN meetings. "The big thing people were worried about was would they still be as academically qualified ... if you do holistic admissions," she said, adding that study results should help calm those fears. Nursing schools using holistic review that responded to the survey reported positive results. GPA of the incoming class increased for 58% of students, stayed the same for 38% and decreased for 4%. GPAs of graduating classes improved for 47% of students, remained the same for 47% and decreased for 6%. Graduation rates increased for 33%, went unchanged for 61% and decreased for 6%. The number of attempts needed to pass licensure exams was improved for 25% and unchanged for 75%. "That was great information to be able to share with nursing," Glazer said. The University of Cincinnati was an early adopter of holistic review, and its student recruitment includes looking for good communicators who are compassionate, passionate about their profession and driven to succeed. Glazer said she would like to see nursing eventually offer guidelines and training for holistic review similar to the AAMC's version. "I don't believe nursing should reinvent the wheel," she said.
Stony Brook success
Lee Anne Xippolitos, PhD, RN, CARN, CS, NPP, CNAA, BC, dean of Stony Brook (N.Y.) University School of Nursing, said her school has been using holistic review for three years. Students in their bachelor's and graduate programs interview in groups of five, take a basic math test and write a one-paragraph essay on the spot on an assigned topic. Traditionally, Stony Brook examined only prospective nurses' overall GPAs and science GPAs. "It really wasn't giving us the whole picture of the individual," she said. Before adopting holistic reviews, Stony Brook had about 1,200 applicants annually for 160 seats, but wanted to increase diversity and talent. Now the school uses GPA as a cutoff for about 20% of the applicants and uses holistic review to select from the rest, Xippolitis said. Group interviews have been particularly insightful, she said, to look at how students interact with each other, who steps forward and who stays quiet. Information from holistic review can tell who is able to use their knowledge and translate that to action at the bedside or who will emerge as someone who can be a leader among peers, Xippolitis said. Daisy Cruz-Richman, PhD, RN, professor and dean of SUNY Downstate College of Nursing in Brooklyn, said faculty used holistic review for the past two years. Beyond minimum academic requirements, SUNY students write a personal essay, submit references and answer questions about extracurricular activities and their motivations. For the nurse practitioner and nurse anesthetist programs, one-on-one interviews take place where students are asked about unique experiences. "We are looking for an applicant who cannot only be successful in [meeting] our program objectives, but can enhance our mission, which includes diversity," Cruz-Richman said. "Studies have shown when there is a lack of diversity among professionals, this contributes to disparities in access to healthcare and services for minority populations." She said diversity at SUNY reflects that of Brooklyn. According to Cruz-Richman, 70% of the nursing student body is racially and culturally diverse.
Whole-class benefits
Glazer said it would be a mistake to think of holistic review and how it affects individual students. Rather, it is a strategy used to benefit the entire class. "It's not just good for the student admitted," she said. "It exposes the whole class to different individuals with different viewpoints, and the whole group is more open to ideas and perspectives different from their own. They also have much higher rates of cooperation and teamwork and student engagement within the community. Those are important things to all of us." Marcia Frellick is a freelance writer.
Core principles of holistic review
Broad-based selection criteria are linked to school mission and goals. Experiences, attributes and academic metrics are considered and balanced equitably across the candidate pool. Applicants are considered individually as to how they may contribute to the school and the profession. Race and ethnicity may be considered, depending on state law. Source: Association of American Medical Colleges training materials
