Foundational Elements for a Holistic Admissions Process
The Association of American Medical Colleges' Roadmap to Diversity (Addams et al., 2010) laid the early groundwork for consideration of the development and implementation of a holistic admissions process. Others (Artinian et al., 2017; DeWitty, 2018; Glazer et al., 2016; Glazer, Tobias, & Mentzel, 2018; Grabowski, 2018; Scott & Zerwic, 2015; Wros & Noone, 2018) have subsequently provided informative discourse on the development and use of a holistic admissions review. When first considering a holistic admissions initiative, several critical foundational elements must be addressed prior to the development and implementation of a holistic admissions review process. These substantial issues are outlined below.
Express Value of Diversity in Organizational/College Mission, Vision, and Strategic Goals. A diversity initiative must be mission-driven, with language and activities embedded throughout the organization that reflect diversity as an important element for institutional excellence (Addams et al., 2010). According to Rosenberg and O'Rourke (2011):
Creating a culture of inclusion underlies any effort to promote diversity, and explicit demonstrations of these efforts must be apparent. For example, organizational mission, vision and value statements; university, school and department strategic plans; faculty, staff, and student development activities are fundamental vehicles whereby the words and actions of diversity are infused into the culture and functioning of the institution.
Solidify Stakeholder Buy-In at All Levels. Administration, faculty, and admissions staff need to demonstrate a solid commitment to enhancing diversity in the nursing workforce—the use of a holistic admissions process is an important step in achieving this outcome. Stakeholder involvement during the planning, implementation, and evaluation stages of the process is essential—otherwise the likelihood of success is greatly diminished. The architect Cameron Sinclair said, “A true architect is not an artist but an optimistic realist. They take a diverse number of stakeholders, extract needs, concerns, and dreams, then [together] create a beautiful yet tangible solution that is loved by the users and community at large” (Center for Health Innovation and Implementation Science, 2018).
Corollary to Stakeholder Buy-In. Address the issue of faculty time in doing a holistic admissions review. Faculty workload is a frequent topic of conversation when any change in a critical process, such as admissions, is suggested (Glazer et al., 2016). A faculty and staff that believe in the importance of a diversified nursing workforce will be more fully engaged in learning to use the tools of holistic admissions. Although additional faculty time may be required, for example, to conduct applicant interviews, it has been our experience that faculty enjoy the personal nature of these interactions with applicants and their contribution to the shaping of the incoming class.
Define the Experiences, Attributes, and Metrics That Comprise Your Holistic Review. There must be a common, agreed upon understanding of which noncognitive variables are important in providing the diversity sought in the student body. There is not only one preferred way to understand these variables. One school may value students who are bilingual, whereas another may place greater significance on leadership experience. Whatever the set of experiences, attributes, and metrics may be, each school must determine what those variables are and then have the ability to measure them during the application process (Association of American Medical Colleges, 2014).
Implement the Modalities in the Application Process to Collect Data on the Desired Noncognitive and Cognitive Variables. This may take the form of a requesting a curriculum vitae (CV) or resume, essay statement, and recommendations, conducting an interview with the applicant, or collecting specific grade point average (GPA) or standardized test scores (Wilson, Sedlacek, & Lowery, 2014).
Recruit a Large Enough Pool of Qualified, Diverse Applicants. A school's definition of diversity will direct their recruitment priorities (Rosenberg & O'Rourke, 2011). For example, a school may decide that they wish to increase the number of Hispanic students based on a growing Hispanic population in their state. In any of the conversations and articles about using a holistic admissions review, it is assumed that a school can use a holistic process because they have a pool of qualified, diverse applicants from which to choose. Using the above example, if a school wished to mirror their state in the percentage of Hispanic students accepted, they would need greater than that number of Hispanic applicants (by at least 25%) in their pool. If that is not the case, then implementing a holistic review may be premature. An applicant pool that is not diverse—as defined by the school—will require different recruitment tactics to make a holistic review meaningful.
Create the Metric Floor. This may be the most critical paradigm shift in thinking that must occur. Schools need to establish not the usual metric ceiling but the metric floor (e.g., GPA, standardized test scores) that is essential to academic success. It means moving away from the priority of high metrics as the most important selection criteria to a more balanced consideration of metrics, experiences, and attributes in choosing who will be successful in nursing and what value they bring to the profession (Scott & Zerwic, 2015). Even after consideration and collection of applicant noncognitive variables, there is still a risk of falling into old admissions committee review habits, such as using a spreadsheet that presents candidates from highest to lowest GPA. The use of a scoring rubric that incorporates ratings on a variety of cognitive and noncognitive factors should ultimately enhance student retention, as metrics alone will never account for the characteristics necessary for success as a health professional.
NursingCAS Scoring Rubric
In order for these variables to be evaluated across candidates, a scoring rubric was developed to express a numerical range for each identified metric, attribute, and experience. The scoring rubric was created within the admissions platform, NursingCAS—the centralized application system endorsed by the American Association of College of Nursing. WebAdmit™ is a part of the admissions software that allows staff to manage and faculty to review and evaluate the applicant pool in NursingCAS. The school has the ability to create a scoring rubric that will populate in each application. Some of the categories for scoring can be generated automatically—for example, cumulative GPA. Other categories require manual entry and have appropriate response drop-down menus (e.g., yes or no for military experience; exceeds, meets, or is below expectations for languages spoken). Numerical scores are created for each answer (e.g., 1 = military experience, 0 = none; 2 to 0 range = languages spoken). A total of 17 factors were identified, five of which are generated automatically and 12 scored manually (Table 2). After the rubric is completed for a candidate, a total score is created. Applicants have the ability to earn a total of 32 points. Metrics, experiences, and attributes each respectively contribute approximately one third to the total points, thus providing a more balanced overall scoring profile.
Scored Experiences, Attributes, and Metrics
One important method for assessing an applicant's attributes and experiences is the personal interview. There is much evidence in the literature (House, Sturgeon, Garrett-Wright, & Blackburn, 2015; Knorr & Hissbach, 2014; Roach et al., 2019; Rosenberg, Perraud, & Willis, 2007; Wilson et al., 2014) to support the use of interviews for making holistic admissions decisions, as well as a number of different methods used by schools to interview applicants (e.g., one-to-one, group, multiple mini interviews, video interviews).This article is not meant to discuss or favor one method versus another.
The nursing program referenced in this article uses individual, 30-minute interviews that follow a set interview guide. It is important to note that the interview rating is considered separately from the rubric in making admissions decisions. With the experience of interviewing comes the knowledge that what is on paper does not always match reality. The interview is a venue in which the interviewer can confirm that the candidate is mature, understands the work of nursing and the rigors of the program, and has a caring attitude toward other human beings and the flexibility and perseverance to be successful. It can also help uncover those candidates that are overtly ill prepared or ill equipped for nursing school or the nursing profession. Should that be the case, the interview can be considered separately as a reason to deny admission.