Traditionally, colleges and universities have evaluated applicants to their nursing programs based almost entirely on academic criteria such as cumulative grade point average and scores from standardized test scores (Schmidt & MacWilliams, 2011). Unfortunately, despite extensive research regarding the effectiveness of nursing school admissions criteria, there remains a lack of understanding regarding the specific competencies and personal characteristics related to successful program completion (Alden, 2008; Rogers, 2009; Dolinar, 2010; Schmidt & MacWilliams, 2011; Fayette, 2012; Cline, 2013; Shoemake, 2017). As a result, there is an obvious need for colleges and universities to reevaluate the criteria used to assess candidates for their nursing programs. Doing so may help nursing programs admit students that are more likely to complete the program and, as a result, increase the production of licensed nurses.
As Atchinson (2016) argues the current, and forecasted, nursing shortage pose a grave threat to our healthcare system and may have a seriously negative effect on the health of many Americans. These threats include restricted access to healthcare, increased rates of medical errors and hospital-related mortality, as well as lengthened hospital stays (Atchinson, 2016). Furthermore, the current supply of nursing graduates is not keeping pace with our current healthcare needs and changes to our population demographics and the forecasted nursing retirements will only exacerbate the demand for more nurses (Atchinson, 2016). Specifically, according to the Bureau of Labor Statistics’ Employment Projections 2012-2022, the RN workforce is expected to grow from 2.71 million in 2012 to 3.24 million in 2022 (Bureau of Labor Statistics [BLS], 2013). This represents an increase of 526,800 nursing positions and represents only half of the projected demand for nursing as the Bureau also projects an additional 525,000 replacements nurses to offset forecasted retirements during this period (Bureau of Labor Statistics [BLS], 2013). In total, the Bureau projects a need for at least 1.05 million additional nurses by 2022 and the growing number of older adults in the United States will further strain our nursing schools to produce more qualified graduates (USR Healthcare, 2015).
However, despite strong interest in nursing programs, colleges and universities have not been able to graduate a sufficient number of nursing graduates to meet current healthcare demands (Faison, 2012). This shortfall is the result of both programmatic limitations where nursing schools are restricted to the number of students they can admit based on a limited number of faculty and clinical sites available, as well as low completion rates (Juraschek, Zhang, Ranganathan, & Lin, 2012). As a result, the majority of nursing programs have limited enrollment into their schools of nursing and, as such, closely evaluate applicants in order to improve admission decisions, reduce attrition rates, and increase graduation yields (Hernandez, 2011). Traditionally, colleges and universities evaluate applicants to their nursing program based solely on academic criteria such as previous grade point average (G.P.A.) and standardized test scores. This practice is done to only admit students that are likely to successfully complete the program (Kenny, 2010). However, this approach has not proved successful as our nursing program graduation rates have declined from approximately 70% to about 50% over the past ten years (Harris, Rosenberg, & O’Rourke, 2014).
One approach to improving nursing school completion rates may involve reevaluating the effectiveness of the criteria most often used in assessing applicants. Traditionally, nursing schools have only used academic criteria to base admission decisions in an effort to only admit those that are most likely to successfully complete the program (Newton, Smith & Moore, 2007). However, a review of the literature indicates that very little is known regarding the effectiveness of traditional nursing school admission standards and many schools of nursing consistently struggle with their completion rates (Peterson, 2009). Although there has been significant research conducted on student persistence, there is a lack of understanding regarding the relationship between admissions criteria of a baccalaureate nursing program and student completion rates (Cline, 2013). Furthermore, there is a gap in the literature regarding the impact nonacademic factors play in nursing student success (Kenny, 2010). Consequently, in order to increase the production of nursing graduates to meet the current, and future, healthcare needs of our society, we must develop a better understanding of the factors related to nursing student persistence.
The purpose of this sequential explanatory mixed-method research study is to investigate nonacademic factors associated with program persistence for students who were admitted into a Bachelor of Science Nursing program at a private, Midwestern University. At the research site, the university uses two opportunities for admission into the nursing program: unconditional and conditional. Students gain unconditional admittance into the nursing program by meeting all of the criteria including a 2.5 G.P.A. and a score of 58 or higher on the Test of Essential Academic Skills (TEAS) (Research Site Catalog, 2017). In addition, applicants who have a G.P.A. of at least a 2.0 and score a 51 or higher on the TEAS can gain conditional admittance into the nursing program. In order to gain a better understanding of the complexity of factors affecting persistence, this study focused on students conditionally admitted into a nursing program using a sequential explanatory mixed-method design (Research Site University, 2018).
The first phase utilized a quantitative approach to attempt to identify specific variables related to program persistence. These variables covered a broad range of data including academic, financial and demographic information collected from student records from all conditionally admitted nursing students who were enrolled at this institution between 2011 and 2016. In addition, all of the conditionally-admitted students were sent a 17-point Grit survey in an effort to obtain additional information from their perspective regarding the factors related to their academic performance and persistence in pursuit of a BSN degree (Duckworth, Peterson, Matthews, & Kelly, 2007). These data were analyzed through a process known as discriminant analysis which compares a set of variables for two groups while controlling for all other variables and then identifies the most salient variables in the array. The purpose of this phase of the study is to determine if a relationship exists between certain student characteristics and student persistence within the BSN program.
Once this analysis was completed, the qualitative phase of research began. During this phase respondents of the Grit survey were then purposefully selected to participate in individual structured interviews in order to collect additional data pertaining to their experiences as BSN students. Specifically, respondents were divided into two groups based on whether they successfully completed the program, or not, and their outcome was not accurately predicted through the quantitative analysis. The intent of this phase of the study entailed interviews with 8-10 of the individuals from each group. Data collected from these interviews were analyzed and coded to identify trends or themes related to the nonacademic factors associated with the successful completion of the nursing program. Together, this study used both quantitative and qualitative data to add to the knowledge of nonacademic factors related to the successful completion of a nursing program that might better inform college administrators on factors to look for when evaluating nursing school applicants.
The implications of the research are that the present admission criteria used by the study site are not effective predictors for students who do not meet basic admission criteria. As a result, adding the nonacademic variables found to influence student persistence in this study may help enhance the effectiveness of their admission criteria and increase the production of nurses.