Nursing Diversity: Why Backstories Matter

Three medical professionals walking together down a corridor in a hospital, rear view
Three medical professionals walking together down a corridor in a hospital, rear view

'Tis the season for college admissions questions.

What's the required GPA for an incoming nursing student? How important are the SATs? Does coming from a rural area, neighboring states, or overseas give you a boost, even if you need financial aid? What if you come from a family of clinicians, or are a first-generation college student? And is there hope for applicants looking to transition from community college?

While it's no picnic to be a prospective nursing student vying for admission at a top school, neither is it easy to assemble academic cohorts who will ultimately make their professional trade in care and compassion based on the "predictive" powers of high school GPA, essays and personal statements. A good nurse is not the sum of his or her test scores, high school grades and extra-curriculars. And in a field like ours, which over the last dozen years has surged in popularity -- being a meaningful, fulfilling job and largely recession-proof -- it has never been more critical to assemble classes of future nurses that are diverse in experience, well-educated and culturally agile and humble. The kind of nurses you'd want to care for you, no matter who you are.

Those aren't traits that just happen, however; they're cultivated, nurtured, taught, and learned. And while lessons come from classroom work and practice, they're also developed through plain, ordinary lived experience. Persevering through a challenge or hardship -- a parent's cancer, a sibling's disability. Language and cultural fluency. Emotional intelligence earned through work and community service. The sorts of intangibles that build empathy, resilience and leadership skills that truly make a good nurse.

Though such qualities have long been conveyed through applicants' personal statements and essays, starting this year at UVA Nursing, these sorts of characteristics will earn equal consideration with more traditional metrics as we comb through nursing applicants after our January 1 deadline. A change in the way we select nursing students is imperative because where you come from and what your life's experience has been has everything to do with the sort of nurse you will become.

Nursing admissions, unlike other disciplines, has a history that compels our action. Like many of our peer institutions, we've watched our school's acceptance rate drop precipitously, alongside double-digit increases in applicants over the last dozen or so years. Year after year, the American Association of Colleges of Nursing finds that nursing schools repeatedly turn away tens of thousands of qualified applicants due to space constraints and a dearth of nursing faculty that keep program sizes static or force them to contract. So while more people want to become nurses, fewer and fewer are able to make the cut, especially at highly ranked flagship institutions like UVA.

While growing interest in nursing is surely heartening, our growing selectivity also gave us pause. At the end of the day, who were we excluding? What perspectives did we lose? And why might it matter?

From the U.S. Supreme Court to the coffee machine, we debate why diversity in higher education matters, what form it should take, and the manner in which diverse groups should be engaged in campus life. It remains a difficult, confusing, gray area especially for public schools where budgets strain taut against government and the public's demand for test scores and rankings and the honest-to-goodness need for full-fare paying students.

And while we don't profess to know how diversity among engineers, biologists or physicians is best cultivated, what we do know is that diversity in nursing matters more than it ever has. As our population shifts to majority minority by mid-century, and nurses grow ever-more-central to care delivery under the Affordable Care Act, American nursing schools must be intensely thoughtful about how and who they admit. More than ever, nurses' ability to interact across difference expands their world view, their ability to understand, to accept and empathize. We're also taking a long, hard look at our School's culture to consciously transform it into a more inclusive and welcoming space where all have a voice, all feel respected and a part of our community, no matter their background.

In nursing, our job requires us to work competently and respectfully with patients from many backgrounds -- in race, ethnicity, socioeconomic status, sexual orientation, gender identity, physical ability, and spiritual and political beliefs. No matter who you are, we will care for you. The moment has come to hit refresh.

While research has shown that having a nurse who looks like you and speaks your language improves outcomes for minority patients -- an impossible guarantee to fulfill at our nation's clinics and hospitals -- we also know that educating all nurses within a diverse and rich learning environment enhances the delivery of sensitive and culturally appropriate care for all patients. Expose nursing students to difference in school, and they become more capable and compassionate nurses.

We're giving this new way our wholehearted effort not because we're experts at it, but because educating a diverse nursing workforce to be our caregivers is imperative, and worth every bit of what is and will continue to be a labor-intensive and painstaking process. And even if we don't have all the answers, we are committed to moving forward with tangible actions.

This isn't the diversity of checked boxes and quotas; it's about gathering together and nurturing sensitive, compassionate, culturally humble nurses. It's about creating the kind of nurses we'd all want to have caring for us, and our loved ones.

Susan Kools, RN, PhD, FAAN, is the director of Inclusion, Diversity and Excellence Achievement at the University of Virginia School of Nursing where Dorrie K. Fontaine has been dean since 2008.