Planning for a More Inclusive Future

Over the past two years, a pair of crises has shed a stark light on the connections between social inequities and health disparities in the United States. The first was the COVID-19 pandemic, which struck communities of color with death rates up to twice those of their white counterparts. Then came the protests touched off by the murder of George Floyd, which focused national attention on the larger patterns of inequality of which the COVID statistics are a part.

These events prompted soul-searching at many institutions that had long been committed to advancing social justice in health care—Columbia University School of Nursing among them. 

One area that needed improvement, the school determined, was the admissions process. The school had long done its best to attract students from diverse racial, ethnic, and economic backgrounds but had focused mostly on applicants’ academic records.

However, both academics and personal characteristics “are crucial at Columbia Nursing,” says Dean Lorraine Frazier, PhD, “because our graduates go on to become leaders in health care organizations and nursing education. We’re looking for students who are committed to excellence—and who also have a deep understanding of the varied populations that our profession serves.”

Another area of concern, it became clear, was the need to bolster support for students from disadvantaged backgrounds once they were admitted. For Judy Wolfe, EdD, senior associate dean of student affairs, that issue had personal resonance. “I know what it’s like to be a first-generation student,” says Wolfe, who was raised in Washington Heights by a single mother who had immigrated from the Dominican Republic. “The expectation is that if you’ve made it this far, you can handle the work. But there can be imposter syndrome: ‘Am I good enough?’ Students often don’t ask for help when they need it, because they’re afraid it will show they don’t deserve to be here.”

To help solve both problems, a group of administrators and faculty developed a revamped admissions process—one centered on a program designed to address the kinds of challenges that Wolfe describes.

A Holistic Approach

The new process is based on a philosophy known as “holistic admissions.” Although this approach has been widely adopted by medical and dental schools over the past decade, only a handful of graduate schools of nursing have embraced it to date.

The Association of American Medical Colleges defines such an admissions process as having the following core principles:

1. Selection criteria are broad, are linked to the school’s mission and goals, and promote diversity as an essential element in achieving institutional excellence.
2. Applicants are assessed on their experiences, attributes, and characteristics, as well as academic metrics.
3. Admissions staff and committee members consider how each applicant might contribute to the school learning environment and mission and to the profession.

One key step in the holistic process is for a school to create a scoring rubric based on its institutional vision. Administrators typically decide on a “metric floor”—a minimum standard for grade point average (GPA) and test scores—and then develop a checklist of the kinds of experiences and attributes that will count in an applicant’s favor. Each of these criteria is then given a numerical weight, helping to ensure consistency and fairness.

A recent study funded by the National Institutes of Health found that a holistic approach to admissions has a positive impact on health professions schools. The majority of schools using such a method reported an increase in student diversity—and not only in race, ethnicity, and gender, but also in socioeconomic status, life experiences, and general perspectives. Ninety percent reported that the average GPA of the incoming class remained unchanged or increased, 89 percent reported the same for standardized test scores, and 96 percent said graduation rates were unchanged or increased. Furthermore, measures of student engagement, cooperation and teamwork, and openness to ideas different from one’s own rose significantly.

Asking the Right Questions

In early 2021, Wolfe convened a Holistic Admissions Committee, which worked with the consulting firm Hanover Research to develop Columbia Nursing’s scoring rubric. The first task was to define the school’s view of itself. “We have a strong focus on social justice and health equity,” says Heidi Hahn-Schroeder, DNP, assistant dean of academic affairs and director of the MDE program. “We’re a very globally minded school. In addition, our program is very rigorous.”

An ideal applicant, the group agreed, would show evidence of being able to handle that rigor (including a GPA of at least 3.0) and of sharing the school’s vision of improving health care for under-served communities worldwide. But the goal wasn’t just to select candidates who would be a good fit for Columbia Nursing; it was also to recruit students who had the potential to thrive as nurses—and to help advance the profession.

“We spent a few months focusing on the question of what makes a great nurse,” Wolfe explains. The qualities the committee arrived at included empathy, compassion, cultural sensitivity, critical thinking, and a strong ethical compass, as well as the ability to multitask, make decisions under pressure, and advocate for patients. “Another big one was resilience,” she adds. “The pandemic really brought that home. Grit is essential.”

All these attributes (which are revealed largely through the application’s video-essay component) became part of the new admissions rubric. So did an array of life experiences that the committee identified as having the potential to contribute to nursing greatness. “The rubric asks the faculty reviewer to look more closely at parts of the application that, previously, they may only have glanced at, and to measure these elements comparably to the academic record,” says Wolfe. “For instance, does the applicant have work experience? Volunteer experience? Do they help support their family? Have they worked with different cultures? And how might those experiences add to the tool kit they’re going to need as a nurse?”

The first students admitted under the holistic admissions process will arrive on campus in the summer of 2022. “These are young people who’ve been able to overcome obstacles, who care passionately about vulnerable populations, who have a broad view of life,” says Dean Frazier. “We’re excited to welcome them.”

Improving Support

An important feature of the holistic admissions approach is that it doesn’t end when a student is accepted. “Following admission,” explains a 2020 white paper on the topic by the American Association of Colleges of Nursing, “programs must be designed to support students, not only with academics, but to give them confidence and a sense of belonging.”

At Columbia Nursing, coaching and mentoring services have long been available to students in need, alongside a variety of financial aid opportunities. “We’ve always had a motto: If we admit, we commit,” Dean Frazier says. “If we admit you as a student, we have to provide you with the resources to be successful.”

Yet when Wolfe examined the existing support services, she found that they were surprisingly underutilized. “I spoke to some of our student leaders who are from disadvantaged backgrounds and asked them what was going on,” she recalls. “They told me the resources were spread out among too many departments. Students didn’t have time to hunt for what they needed. They didn’t know who to go to or what questions to ask. And some felt a sense of shame in asking.”

In response to that feedback, Wolfe designed a program for incoming MDE students called Path-ways to Leadership and Advancement in Nursing (PLAN). Instead of requiring students to seek help, PLAN would reach out to those who might need it, based on the information in their admissions applications. And it would place several types of support under a single umbrella. “It’s hub, a community,” she says.

PLAN has four components: financial, academic, emotional, and professional support services. Qualifying students receive a $25,000 scholarship. The school has hired academic coaches for the program, to moderate group study sessions and offer tutorials in skills such as note-taking, time management, and organization, as well as individual coaching. The Student Support office works closely with PLAN students, providing group sessions on coping techniques, individual counseling with the school’s resident social worker, or referrals to Student Health, as appropriate. Students in the program are also assigned an MDE faculty advisor, a doctoral student mentor, and a professional mentor to discuss career path issues. In addition, they participate in professional workshops offered by Student Life and attend alumni networking events throughout the academic year.

Because the school’s leadership saw such support as central to a successful holistic admissions process, PLAN was implemented before that process went into effect. “Our first priority was to make sure the program was in place and functioning smoothly,” Wolfe explains.

The inaugural class of 20 PLAN students arrived in June 2021, and their diversity spans many dimensions. But they have one thing in common, Wolfe reports: “They’re thriving. They’re engaged as students. They’ve taken leadership positions in university organizations and are contributing to campus activism. They’re doing very, very well.”

And once they graduate, she adds, they’re likely to do a great deal of good. “We’re not just thinking about having these students in our school for 15 months. We’re thinking, ‘How are they going to change nursing?’ That’s the long-term goal.” 

This letter originally appeared in the Spring 2022 issue of Columbia Nursing magazine.