Implementation of Holistic Admissions Review in Associate Degree Nursing Programs: An Interpretive Description

Holistic admissions review (HAR) is a mission-based approach to selecting applicants for higher education using a combination of experiences, attributes, and metrics. The purpose of HAR is to diversify the nursing workforce and promote health equity. The purpose of this interpretive description was to examine HAR practices in ADN programs from the perspective of deans and directors and develop recommendations for broader implementation. The following research questions guided this study: Q1 How do deans and directors of associate degree in nursing programs describe holistic admissions review? Q2 What, if anything, have deans and directors done to implement holistic admissions review in their associate degree in nursing programs? Q3 What are the facilitators and barriers for implementation of holistic admissions review in associate degree in nursing programs? A convenience sample of 15 deans and directors of ADN programs were recruited using purposive and snowball techniques. During semi-structured interviews, participants were asked about current admission practices, understanding of HAR, and barriers and facilitators to HAR implementation. Using reflexive thematic analysis, nine themes were developed. Participants were largely unfamiliar with HAR and described admission practices that included some holistic practices but were metric heavy. Facilitators to implementation included the value participants placed on student and nursing workforce diversity and commitment to their students and communities. Barriers included fear of decreased student success, need for increased student support, increased workload, a focus on accessibility instead of equity, and the perception of programs as diverse enough. Six recommendations to increase implementation in ADN programs were developed. Recommendations included providing evidence-based training on HAR; implicit bias training; improved dissemination of outcome data related to implementation of HAR; consideration of student diversity and HAR implementation in accreditation standards; additional research related to implementation of HAR in ADN programs; and embrace of ADN programs as potential pipelines for workforce diversification on behalf of national nursing education entities.