Holistic Review for Admissions is,

a university admissions strategy that assesses an applicant’s unique experiences alongside traditional measures of academic achievement such as grades and test scores. It is designed to help universities consider a broad range of factors reflecting the applicant’s academic readiness, contribution to the incoming class, and potential for success both in school and later as a professional. Holistic review, when used in combination with a variety of other mission-based practices, constitutes a ‘holistic admissions’ process.
(American Association of Colleges of Nursing [AACN], 2017, p. 12)

The Indiana NEEDS Initiative developed the toolkit items to assist any college, university, or program to engage in holistic admissions review. We believe that to develop and implement a successful holistic admissions process the following areas must be addressed:

Mission Fit is foundational for a successful holistic admissions process. The program must determine whether a holistic admissions review is consistent with the university/college and program missions. If consistent, then proceeding to develop a holistic admissions review is appropriate. The organization should identify what outcomes you wish to achieve through changing to a holistic review process. For instance, do you want to diversify your student body, or increase the number of students from under-represented populations, or attract a particular group to your program? After you have established your desired outcomes, the next step is to develop a program admissions mission and program admissions priorities to operationalize your plan. Additionally, an admissions process that is closely aligned with the mission of the organization supports a process that is legally defensible. When you have drafted a holistic admissions process, a discussion with your legal representatives about holistic review for admissions is recommended.

Stakeholder Engagement is vital to the implementation of a holistic admissions review process. Programs must consider who the stakeholders are and who would be interested in your admissions processes? In addition, consider how you will get university administrators, clinical partners, faculty, staff, alumni, and students on board. How might you involve your advisory committees in the process? Be sure to include sound rationale and evidence as to why this change is desirable, as well as what you hope to achieve through its implementation. A clear, consistent message tailored to these various groups will help communicate your new direction and garner their support.

Implicit Bias and Cultural Intelligence must be considered when evaluating students holistically. We all have unconscious beliefs about others. Whether the bias is about professional behavior or ethnicity, these values and beliefs color the way in which we view the world and impact many of the decisions we make. Be sure to address the role implicit bias may play in your process. Determine how you will help those involved in creating the process and making admissions decisions identify and acknowledge their own implicit bias. Identify how you will review your process to make sure it is fair and just for all students. Only when implicit bias is acknowledged and addressed will your holistic review for admissions be a fair process. Application of information related to cultural intelligence is essential as well. You should create processes that are explicitly equitable and inclusive by including diverse voices in the admissions process and assure that persons who participate in the holistic review of student applications receive training regarding implicit bias.

Holistic Review of Student involves determining the best method to assess the applicant. The emphasis should be on identification of appropriate information to request from the student based on your holistic review model. Admissions selection criteria should be identified and clearly defined prior to the implementation of the holistic review process. Holistic review includes consideration of non-cognitive factors to provide a broad overall picture of the applicant. We recommend using the Experiences, Attributes, and Metrics (E-A-M) model (AACN, 2017, p. 30) or a similar model to assist in determining and defining non-metric data points and the methods that will be used to collect and examine those variables in each application. Common methods of data collection include essays, resumes, references, group interviews, individual interviews, multiple mini-interviews, standardized examination scores, and grade point average. The application review process, scoring rubric, and decision making should also be developed and communicated to all persons who will serve on the Admissions Review Committee. Data for each student should be viewed individually and compared to a pre-established scoring rubric for acceptance into your program.

Academic Success Strategies should be available to foster student academic advancement. Academic supports may include tutoring, financial and scholarship support, mentoring, and other opportunities that facilitate an inclusive learning environment for all students. Schools/programs will need to identify the necessary resources to support student success, determine how these services will be delivered, and engage the department with the necessary knowledge, skills, and resources to design and implement academic success practices. In addition, programs should consider how to fund these success services.   Student outcomes are usually closely aligned with the overall organizational goals and objectives; thereby, making a compelling argument for student support.

Evaluation of Processes requires examination of your holistic admissions process and determination if your outcomes are in line with your goals. Reflection and evaluation of the process provides accountability and evidence to make admissions processes and decisions legally defensible and leads to improvements over time. The following examples include key questions to evaluate the process and the outcomes. Were you able to access the data you wanted to use for decision making? Did the data you collected give you a holistic picture of each applicant? Was the student data used as a basis for decision making in a fair manner? Was implicit bias training effective or did you still see evidence of bias in your process? What indicators would you like to collect to demonstrate a change or achievement of outcome measures? As we often say in nursing, start with the end in mind and plan for evaluation from the beginning. Don’t be afraid to revise your policy, processes, data collection, or implementation when something doesn’t work. Remember, we learn as much from that which works as from that which doesn’t.

Holistic Review for Admissions is defined as a flexible, individualized way of assessing an applicant’s capabilities by which balanced consideration is given to experiences, attributes, and academic metrics (E-A-M) and, when considered in combination, a method of assessing how the individual might contribute value as a nursing student and to the nursing profession (Association of American Medical Colleges, 2020).

Under a holistic admissions review process, the admissions team considers a student’s life experiences and personal qualities alongside traditional measures of academic achievement such as grades and test scores.

 

Researchers reported that holistic admission processes have been adopted by 93% of dentistry schools, 91% of medical schools, 82% of public health schools, 78% of pharmacy schools, and 47% of nursing schools.

 

Further analysis of the survey results showed that 72% of the schools utilizing holistic admissions review reported an increase in diversity of their incoming class.

 

Schools using holistic admissions review also reported positive changes to the learning environment, including increased community engagement, student cooperation and teamwork, and students’ openness to perspectives different from their own.

 

Holistic admissions review exists on a continuum, and schools may choose to implement some practices over others. Nonacademic criteria that may be included as part of a holistic admissions process include first generation college student, experience with disadvantaged populations, origin in a geographic area specifically targeted by the school, and/or an applicant from a medically underserved region.

 

(Glazer, et al., 2016, p. 307-312)

Many medical schools, schools of nursing, and allied health programs are seeking ways to increase diversity in their student populations (Kandray & Larwin, 2017; Harrison, 2019; Spencer, 2020). The anticipated outcome of the effort to increase diversity in allied health, medical, and nursing education student populations is a hoped-for increase in diversity within health-related careers (AACN, n.d.). Kandray and Larwin (2017) note that ethnic and racial diversity are lacking in the dental hygiene profession. Kilburn, Hill, Porter, and Pell (2019) suggest that inclusive recruitment efforts may go a long way to eliminating disparities in health and improving quality of care. In a time when the need to increase diversity in our nursing student populations is very evident, we need to first understand what has been written about holistic admissions. We also need to identify how that information can then help us make decisions about what efforts are most important.

The Indiana NEEDS initiative conducted a review of articles regarding holistic admission’s potential to increase diversity in nursing and allied health programs was completed. Kilburn, Hill, Porter, and Pell (2019) describe a study that explored inclusive recruitment and admissions strategies as well as their impact in increasing diversity in CRNA education programs. They reported several successful efforts including holding program information sessions in large cities and areas with racial diversity located within a 130-mile radius of the program, working with undergraduate and community colleges to host information sessions and partnering with the college or university office of Equity and Diversity to gain internal support. In addition, strategies such as ensuring that marketing efforts are inclusive and reflect the diversity of the program’s student body and faculty and focusing recruiting efforts on nurses of color through attending and exhibiting at conferences for nurses of color such as National Association of Hispanic Nurses and Black Nurses Rock have been successful in increasing numbers of applicants of color.

In a study of the impact of holistic review on student interview pool diversity, Grabowski (2018) discussed holistic review processes for screening candidates that resulted in increased numbers of holistically and academically prepared applicants. When compared with applicants admitted without holistic screening, student groups admitted with holistic review screening practices were more diverse. In this study, each application in the holistic review pool was read by two application screeners. Academic criteria were reviewed; however, the applications were also reviewed for applicant experiences that aligned with the mission and values of the school/program. Screeners reviewed applications for exposure to medicine, enthusiasm for the medical field, a service mind set, ability to overcome adversity, ability to work with teams, and aptitude to overcome adversity. Disadvantages such as distance traveled to campus were used to understand potential barriers that would need to be addressed if applicants were to be successful in the medical field.

Several articles discussed the need to change admissions processes to increase diversity. O’Neill, Vonsild, Wallstedt, and Dornan (2013) concluded that establishment of admissions criteria is not what drives diversity in medical program admissions, but rather attracting an  appropriately diverse applicant pool can improve diversity in medical education admissions cohorts. Griffin & Wu (2015) found that attracting a diverse applicant pool alone is ineffective in increasing numbers of students from diverse backgrounds in admission cohorts. They found that reduction of stereotyping accompanied by efforts to assist in reducing low self-efficacy resultant from socio-cultural factors is needed to aid in the increase of students from diverse backgrounds in admission cohorts. Furthermore, Conway-Klaassen (2016) found that a medical laboratory science program that increased academic requirements for admission experienced a subsequent number of students from diverse backgrounds. While their changes were not made to exclude those with diverse backgrounds, the result pointed to the need for greater work to remove barriers and provide services that assist students with perseverance.

Leduc, Rioux, Gagnon, Bourdy, and Dennis (2017) conducted a mixed-method study including a demographic questionnaire, multiple mini-questionnaire scores, semi-structured interviews, and information from focus groups of applicants and evaluators. Results of the study identified that many applicant scores were related to language as a barrier in age, gender, ethnicity, and socioeconomic status when rated by evaluators. These results demonstrated the need for evaluative raters to become aware of their bias when evaluating potential applicants.

From this selection of readings, it is evident that one effort alone may not be enough to increase numbers of students admitted from diverse backgrounds. It is equally important to support academic advancement and completion. Changing efforts in marketing of programs to students of color and students from diverse backgrounds in admission processes as well as efforts to retain these students, once admitted, is needed to increase diversity in the workforce and help remove disparities in healthcare.

Consistency with the University and Program Mission
When considering the change to holistic review for admissions (HRA), the program must decide if the change will be consistent with the university or college’s mission. Review of the mission consistency should include university/college administrators. If there is consistency with the university/college, the next step is to determine if HRA aligns with the mission of the School of Nursing and/or the program targeted for the change. A frank and open discussion with faculty and staff where all stakeholders are encouraged to participate is essential to gain the necessary buy-in for successful implementation.

Identification of Outcomes for Using a Holistic Review for Admission
One of the first things that a program needs to do is to determine what outcomes you wish to accomplish by changing to a HRA process. Identifying your goals will assist in developing your program, your approach, your outreach and marketing, and the metrics that will guide evaluation.

Your program should reflect on the following prompts to help establish your goals. Is your goal to increase compositional diversity? What does diversity look like for your program? Are there underrepresented groups that you would like to target for admission into your program? Target groups may be out of state students, second degree students, direct admits from high school, and/or those from educational or economic disadvantaged groups. Your program will need to decide which group(s) to target and then integrate them into a statement of admission priorities for your program. In addition, review of current admission data and trends related to diverse and underrepresented populations will provide insight into this process.

Developing a Program Admission Mission
It is wise to develop a mission statement for admission. This statement should be reflective of the campus, school, program, and outcomes. It should be a succinct statement that provides direction for the continued development of your admission policies and processes.

An example of an Admission statement from the Indiana University School of Nursing BSN program (2019) follows:

The mission of the School of Nursing and Health Science BSN admission process is to contribute to a diverse, engaging, and nurturing environment for students, faculty, and staff. Through a holistic review of student metrics, attributes, and experiences, we seek to promote a culture of learning in the School of Nursing and Health Sciences consistent with the values of our program and learning community. Admission to the traditional BSN program at Indiana University East is based in the idea that a foundation of critical thinking, effective communication, leadership, and cultural intelligence creates a mindset that allows for enhanced growth of the individual and the academic community. Through our admission process, we seek to align with students who will thrive within the culture of the School of Nursing and Health Science and grow into knowledgeable, competent, and caring professionals prepared to creatively and capably contribute to the healthcare landscape of east central Indiana and beyond.

Program Admission Priorities
Program admission priorities should clearly identify the target populations you identified when determining the program’s outcomes. By stating admission priorities, the program decreases the potential liability that could be a result of preferential treatment of a given candidate. A statement of priorities should be available to potential applicants. It is important to let applicants know that identified groups will be given priority if similarly, qualified candidates are being considered for the same open position. Candidates should also be made aware that being in a priority group does not guarantee admission into the program. Examples of priority groups might be:

• Out of state students
• Students who live or work in the service area of the college/university
• 21st Century Scholar status
• Identifies as a member of an underrepresented cultural group (as defined by your program).

Admissions Policy
A revised admissions policy must be developed indicating the new holistic admissions priorities, criteria being evaluated, processes for review, expectations of the applicants, matriculation requirements, and timelines. The policy should be developed overtime as pieces of the HRA process are finalized. The policy should be completed and available to students at least one semester prior to its implementation.

Legal Considerations
The U.S. Supreme Court upheld the University of Texas-Austin and Harvard University’s holistic admission policies (Harvard University, 2019). In both of those cases, the ruling pointed out that neither university had quotas for specific ethnic groups. The Supreme Court stated the universities may continue to consider race as one factor among many to ensure a diverse student body. Justice Kennedy stated, “Considerable deference is owed to a university in defining those intangible characteristics, like student body diversity, that are central to its identity and educational mission” (Liptak, 2016, para. 9).

It is imperative that a school/program identify the legalities of moving to a holistic review of admissions. We advise that programs discuss admission goals, priorities, and process with legal counsel to make sure policies are legally defensible, decision making is consistent, and bias is minimized. Legal consultation should occur before moving to the implementation phase. One step toward ensuring transparency, is to publish the admissions mission and priorities.

The success of any Holistic Review for Admissions process is grounded in engaging those who will be involved or who have an interest in your making this change. So, you must identify these folks and decide how will you convince them HRA is the right thing to do. Stakeholders could include university/college administrators, faculty, staff, alumni, students, clinical partners, advisory board members, and community supporters.

Be sure to develop a clear message tailored to the specific groups you wish to engage. Topics that might be relevant to garnering stakeholder support include:

• Mission/vision congruence at institution level
• Legal ramifications
• College policy ramifications (admissions processes, student info sharing processes, etc.)
• Definition of holistic admissions
• Information on the E-A-M model
• Benefits of using the HRA process for students, school, university/college, and the community/potential clients. 

University/College Administration   
The key to success for any nursing school/program seeking to enroll and graduate a broadly diverse class is the connection the school/program makes between the diversity it seeks and the educational mission-driven goals to which it aspires. Programs should discuss how diversity objectives reflect the individual school/program’s unique goals, settings, and culture as well as address how the process enhances the admissions of the type of students the institution wants to educate and the nurses it wants to graduate. The university/college’s unique mission, goals, diversity, and admissions criteria must align directly with your program’s holistic review process (Urban Universities for Health, n.d.). To ensure alignment, consider the following goals.

• Diversification of your student body and increasing numbers of students from under-represented cultural groups- Diversity is student-specific and multidimensional. Diversity does not exclusively refer to race, ethnicity, and gender. Rather, diversity encompasses multiple dimensions such as socioeconomic status, life experiences, sexual orientation, languages spoken, and personal characteristics among others.
• Increase the student fit to your program- Diversity is an essential tool for achieving a school/program’s mission and core educational goals. When well-conceived and intentionally fostered, diversity can act as a catalyst for institutional excellence with the end goals of student success, quality patient care, and improved community health.
• Meet your university/college mission of supporting a diverse student population- Diversity is an important means toward achieving key educational and workforce goals as defined by the school’s mission (Gurin, et al., 2002; Milem, 2003).
• Meet your university/college mission of supporting your community’s need for a diverse population and workforce– Diversity is associated with improved access to care for racial and minority patients, greater patient choice and satisfaction, and better educational experience for health education students. Language and cultural barriers limit providers’ ability to serve the needs of minority patients in ways that are linguistically and culturally relevant. The decisions you make concerning admissions results in who becomes a nurse and will ultimately reduce health care disparity (Institute of Medicine, 2004; Manetta, et al., 2007; Micheals, 2016).
• Move toward competency-based education– Evolving curricula will address advances in healthcare and healthcare education (Michaels, 2016).
• Increase Cultural Competence– Holistic review for admissions increases diverse student population and results in exposure to new ideas and cultures. Nurse-patient interactions must understand the way cultural, racial, and socioeconomic lifestyles are expressed and the way they influence outcomes. All students and faculty benefit from being exposed to different experiences, cultures, and perspectives in the educational process (DeWitty, 2016).
• Capitalize on economic advantages employing a diverse workforce is good business practice– Admissions and educational programs are enhanced through a holistic admissions process. The process provides a clear message for recruiting students and faculty and may also address rising student debt (Williams, 2016).

Program Faculty and Staff
Faculty and staff are an integral part of a transition to holistic review for admissions. Without their support, HRA will be a no go in your program. Programs should identify champions for the process and use them to assist in leading the discussion and providing sound evidence for why the change will be beneficial to the school, program, nursing profession, students, and the clients served. These champions can also be the group that develops drafts of important aspects of the HRA process for faculty and staff discussion, review, and eventual approval. Topics that should be addressed include:

• Advantages and disadvantages of holistic review for admissions
• How to determine qualifications of students admitted through this process
• Discussion of how the change will facilitate a better match of demographics of the community/service area
• Congruence with university/college, school, and program mission
• Potential supports and wrap around services needed for students admitted via this process
• Time involved in development of the process and implementation of the process
• Benefits to the school/program, students, nursing, and health care
• Legal ramifications and concerns.

Community Stakeholders (Healthcare Employers, Clinical Sites, Etc.) 
Addressing community stakeholders and engaging them to gain their support is an important step in making the transition to HRA. Be certain to make it applicable to the specific group with whom you are discussing the change. Use targeted evidence to explain why moving to HRA is desirable. Topics to discuss should include:

• Advantage of holistic admissions for employers
• Diversification of the workforce and ultimate impact on health disparities
• Assurance of qualified graduates through maintenance of program curricular standards and outcomes
• How stakeholders can assist with recruitment and spreading a positive word about the use of HRA processes for admissions.

Students, Parents, and Families
Students, parents, and families will have many questions. They will have a strong desire to understand the why and how of a HRA process for admissions. Details are important. The more details and evidence provided in the discussion with them, the better. Students, parents, and families also want contact with those who they consider “in the know,” including faculty and students already enrolled in the program. Topics to address include:

• Rationale for the use of a HRA process and the benefits to the applicants and admitted students
• Admissions mission, priorities, and admissions policy
• Criteria for HRA with as much detail as possible. Address all elements being considered such as interviews, essays, personal attributes, grades, test scores, and experience
• Process for decision making
• Timeline for decision making
• What happens if not admitted
• Supports available for admitted students throughout the program.

Marketing
Marketing is an integral part of transitioning to a HRA policy and process. Stakeholders, and especially students and potential applicants, need to be made aware of the new policy and processes through detailed marketing efforts. Below are content suggestions for HRA informational and explanatory documents aimed for applicants and their support networks (teachers, counselors, family, etc.).  Marketing strategies could include a comprehensive overview of your HRA process on the program webpage, print materials such as mailings to secondary schools, and admissions handouts at college fairs, etc. Images, language, and examples throughout HRA explanatory documents and other recruiting materials need to be inclusive and representative of a diverse population of nursing students. Materials should assure that students SEE THEMSELVES in the nursing program and feel a “YES I CAN” attitude towards the nursing program admissions process. The program should consider including content as outlined below in marketing efforts. Keep in mind that the marketing department on campus can be a valuable resource in getting your message out to targeted groups.

• Holistic Admissions Definition/Introductory Statement – The statement should include a definition of what holistic admissions is, why your college or program is using it, how the application process might be different than current processes, and the benefits to the program and to applicants. This statement might include assurances that an HRA process is being implemented while maintaining program quality, standards, and reputation. A sample HRA definition from the American Association of Colleges of Nursing provides a starting point:

Holistic review is a university admissions strategy that assesses an applicant’s unique experiences alongside traditional measures of academic achievement such as grades and test scores. It is designed to help universities consider a broad range of factors reflecting the applicant’s academic readiness, contribution to the incoming class, and potential for success both in school and later as a professional. Holistic review, when used in combination with a variety of other mission-based practices, constitutes a “holistic admission” process. Many colleges and universities have employed a holistic admission process to assemble a diverse class of students with the background, qualities, and skills needed for success in the profession. 
(AACN, 2017, para. 1)

• Overview of Applicant Eligibility – Marketing materials should include your program’s baseline eligibility requirements such as status in college, minimum GPA, prerequisites, and testing requirements to name a few. Some of this information is likely already in place on the current program website and in other documentation. Applicants will value specificity and clear, concrete language around eligibility requirements.
• Details of Prerequisite Courses – Materials and postings to applicants should include a list of prerequisite courses, grade requirements, and timelines for completion as well as information about acceptance of advance placement, credit, and transfer credit.
• Steps in Application Process – The steps to apply through HRA should be detailed and itemized; again, some of this may already be in place in current application process. Clear and specific language about processes and timelines is valuable. It is recommended that nursing faculty and recent graduates be involved in the application process as role models and sources of real-world information for applications. Make clear when and where applicants might have contact with faculty, recent graduates, or current students through tours, interviews, Q&A sessions, etc.
• Guidance on Holistic Admissions Elements, Documentation, and Requirements – Marketing materials should include institution specific lists of the required tasks to complete the application such as:
  • Work Experience
  • Community Involvement
  • Personal Statement
  • Writing Sample/Essay Questions
  • Leadership Experience
  • Personal Interview(s).

Regardless of the specific elements required by a program, the goal of this section is to define the HRA elements and explain how applicants can document experiences and respond to requirements. Concrete examples are important and valued by students.  If specific elements are weighted in overall applicant scoring or if a type of experience or involvement is valued more highly than others, that information must be transparent to applicants. Programs should consider offering mentoring, service learning, or community involvement opportunities to help students complete HRA requirements.

• Information on Decision Process and Notifications – The HRA information available to applicants should include decision timelines, how applicants will be notified, student requirements, and expectations upon admissions.
• Next Steps Following Notification – Details regarding what the applicant needs to do next in preparation for moving forward with admissions or reapplying at a future date must also be specified.
• A list of Frequently Asked Questions (FAQ) – A listing of frequently asked questions should be customized to your program’s admissions process and include previous and ongoing experience with applicants’ most common questions. You may build on something already in place on your current website. This could be another opportunity to provide specific examples by using current students’ or recent graduates’ approaches to meeting requirements.

:a In their article, Implicit Racial Bias in Medical School Admissions, Caper, and colleagues (2017) examined how awareness of implicit bias might change the culture of a selective admissions program. They administered the Race (Black-White) Implicit Association Test (IAT) for all 140 members of the Ohio State University College of Medicine (OSUCOM) Admissions Committee and surveyed them on their explicit preferences. While self-reported White preference was “trivial,” a statistically significant number of people surveyed scored as having implicit White preference on the IAT. While the authors indicated a need for more training and discussion around diversity and unconscious bias overall and active inclusion of diverse people in their admissions committee, they noted that the class that was accepted in the admissions cycle in which the IAT was first administered to the committee was the most diverse in the OSUCOM history.

Implicit bias is unconscious, which makes it challenging, yet manageable. It is often developed over a long period of time without your knowledge or awareness. Once you become aware of a bias, however, the medical school study suggested that you may be less likely to allow it to impact your rating decisions. By approaching unconscious bias as an inevitable byproduct of being a social species and taking time to identify and dismantle the biases that you have developed, you are contributing to a more diverse, more fairly selected class of nursing students.

According to the Cultural Intelligence Center (2021), “Cultural intelligence (CQ) is the capability to relate and work effectively in culturally diverse situations. Going beyond existing notions of cultural sensitivity and awareness, it is important to identify the recurring capabilities of individuals who can successfully and respectfully accomplish their objectives, whatever the cultural context. Awareness is the first step, but it’s not enough. A culturally intelligent individual is not only aware but can also effectively work and relate with people and projects across different cultural contexts.” (para. 1)

There are four main capabilities that allow a person to put their cultural awareness and knowledge to use. These four areas will frame our overview of applying a culturally intelligent perspective to the role of rater. The Cultural Intelligence Center (2021) defines the capabilities as:

• CQ Drive—Your level of interest, persistence, and confidence during multicultural interactions.
• CQ Knowledge—Your understanding about how cultures are similar and different.
• CQ Strategy—Your awareness and ability to plan for multicultural interactions.
• CQ Action—Your ability to adapt when relating and working in multicultural contexts. 

Based on the research of the Cultural Intelligence Center (2021), people with these capabilities are better able to relate within culturally diverse situations beyond tolerance and appreciation for cultural differences. This ability will be important to students, so it is logical and necessary that cultural intelligence in practice would be a critical component of the admissions process as well.

While each institution is different, examples of best practices can provide a useful starting point in developing appropriate materials for a new holistic review process. Each institution must adapt their procedures and processes based on their institutional needs, structure, and goals. Selection of admissions tools must be deliberate; the mission-based focus of holistic review extends to the selection of tools that support the goals of the process at every step.

Developing the Experiences-Attributes-Metrics (E-A-M) Model

The E-A-M model is consistently used by professions who are selecting students in a holistic review of admissions process. By assessing experiences, attributes, and metrics, the elicited data provides a more holistic approach to review applicants with the goal of enhancing the applicant pool and ultimately the class selected. “Selection criteria are broad-based, are clearly linked to school mission and goals, and promote diversity as an essential element to achieving institutional excellence.” (AACN, 2017, p. 16).  No one area is given greater consideration than the other.

Experiences

Holistic review does not abandon the assessment of aptitude in science. Rather, it places such measures in the broader context of the applicant’s life experiences, with a particular focus on adversities overcome, challenges faced, advantages and opportunities encountered, and the applicant’s demonstrated resilience in the face of difficult circumstances.
(Witzburg & Sondheimer, 2013. para. 5)

When reviewing experiences, you should consider what experiences align with the school mission and vision, goals, and contribute to the requisite skill set for professional nursing practice. Examples of pertinent experiences include life experiences, health care experience, research experience, affiliations, leadership roles, educational background, and community service as well as the kind of events which a student has been involved such as historical, cultural, or political events.

Attributes
A school/program must determine what attributes are consistent with the school/program’s mission, vision, and goals as well as attributes that are necessary to be a nursing professional. There are many attributes to choose from for applicant evaluation in the HRA process. It is advisable to choose only those that are deemed informative for your admissions decisions. Attributes should be defined in terms of what the school or program are looking for in the applicant and class (Harvard College Admissions and Financial Aid, 2021). Examples of attributes include integrity, intellectual curiosity, leadership, maturity, socioeconomic status, ethnicity, values and beliefs, and individual interests.  For example, the University of Michigan (2020) has listed the following attributes of what they consider to be a successful candidate:

•  Academic Excellence
• Altruism
• Effective Written and Verbal Communication
• Desire to Learn
• Integrity and Ethics
• Reliability and Dependability
• Resilience and Adaptability
• Social/Interpersonal Skills and Teamwork
• Competency

 Metrics
Metrics that are commonly used for HRA include grade point average (GPA), test scores, and grade trends (Kyllonen, 2005). We appreciate how metrics allow for objectivity with decision making. However, when using the E-A-M model, metrics should not be given any more consideration or weight than the experiences or attributes that are being evaluated.

Use of the E-A-M Model
Once a program or school determines what experiences, attributes, and metrics they wish to measure, the faculty must then determine how these will be measured and evaluated. Attributes should be defined, experience expectations created, and metric levels identified, as well as a determination of how the data will be collected and evaluated. Data can be gathered through essays, interviews, resumes, tests, grade point average, grade trends. The school decides which methods of data collection will best provide the information they need for sound decision making that is consistent with their policy.

Essays
Essay questions should be developed in a manner that elicits responses which provide information on identified attributes and experiences. Essays should be proctored and time limited. It is recommended that students be given practice questions so that they have an idea as what to expect during the proctored essay session. Students should be encouraged to work with the campus writing center on practice questions to be better prepared for telling their story and providing the information needed to demonstrate the attribute and/or experience sought. Essay content should be evaluated by considering how it relates to the attribute and/or experience in the writing prompt, as well as the way it is written. Evaluators should keep in mind the conditions of the proctored writing including that it is timed, proctored, and without access to a dictionary, a thesaurus, or spell check.

Resumes
Resumes provide information about the various types of experiences the applicant will bring to the program. The submission could be a formal resume or a set of prompted queries that direct the applicant to tell about experiences such as employment, leadership, service, etc. Remember, the purpose is to evaluate the information, rather than to appraise the attractiveness or format of the information.

Metrics
Metrics such as GPA, test scores, and grade trends offer insights about the potential success of a student. Many programs have a core set of general education courses that must be completed prior to admissions and use the GPA for these courses for admissions. Tests such as the Test of Essential Skills and Abilities (TEAS), critical thinking exams, the SAT/ACT, or other standardized tests may be used to identify potential academic strengths and weaknesses. Programs will need to decide to what extent metrics will weigh in the admissions review decisions. It is recommended that metrics play an equal role with the other data collection methods that illustrate attributes and experience.

References
Professional references can provide insight into an applicant’s qualities that the applicant might not provide for themselves. Well-written prompts for references should elicit information that targets the attributes and experiences that the program wants to evaluate. Reference forms and/or letters of reference can be requested. Applicants should be educated on whom would be appropriate references such as employers, supervisors, faculty, high school counselors and teachers, etc.

Interviews
Interviews are another way to gain information vital for decision making. A variety of interview types may be used such as group interviews, mini-multiple interviews, or single interviewer sessions with multiple questions. Interviews may be conducted in person or virtually, as circumstances dictate. When conducted effectively, interviews can provide some of the richest data for consideration. However, interviews can also be extremely time consuming depending on the number of applicants interviewed. Some programs will interview all students, whereas some programs opt to only interview students from whom they believe additional information will assist in decision making.

Evaluation of Collected Data
The program must determine how collected data will be evaluated. The use of clear definitions for the desired attributes and clear expectations for the applicant’s metrics and experience should be communicated prior to the collection of the data. Rubric development for each data collection method will facilitate the evaluation process and assist the evaluators in inter-rater reliability.

The selection of evaluators will be determined by the resources available to the program. Some programs will use faculty and staff for data evaluation. Other programs may use stakeholders who support the program. The program will decide who the evaluators (also called raters) will be, what they will rate, and how they will be trained. Regardless of whom the evaluator is, training is essential to prepare them for the task and to enhance inter-rater reliability. Training can be accomplished individually, in face-to-face groups, or virtually through webinars or modules. The training must include an explanation of the rating process and the data being evaluated. Good training programs will provide opportunities for the rater to practice rating data and to compare their scores to provided examples.  Raters will need to sign a confidentiality agreement and conflict of interest form. These forms will outline what to do if the rater knows an applicant and what not to discuss with others.

The Admissions Decision
Once all data is rated, results should be collated for each applicant. Results should be de-identified by someone who is not involved in the decision making process. The admissions committee (composed of faculty) should then review each applicant individually. Committee discussion of each candidate should result in an admissions decision with all data considered in the decision making process. When final decisions are made, students should be notified of admissions decisions at the same time.

When the details about the HRA process are finalized, the school/program will need to decide how to support students once they are admitted. This is an individual decision based on campus resources and individual student and group needs (anticipated and/or self-identified). Programs should consider resources that assist students with socialization, time management, skill development, financial management, stress management, and academic support such as how to read college textbooks.

Most campuses will have some existing resources for all students such as career services, writing and math laboratories, financial aid, and counseling. It is important to link students with these services early in their nursing program and to encourage student use of these resources throughout their time at the college/university.

Programs will need to implement nursing specific resources which develop essential skills and provide academic support. Programs such as jump start pre-beginning sessions that cover what to expect, how to prepare for class, how to read a college textbook, information on notetaking, how nursing tests may be different from other class exams, time management, and similar topics help prepare the student for a more positive educational experience. Tutoring or another type of supplemental instruction will also assist students who may be struggling with difficult content or concepts.

Implementation of a strong, intrusive advising system should be considered such as having advisors follow and check in on students who are struggling academically or are at higher risk for academic difficulties. Fostering student relationships with advisors will provide students with an advocate, cheerleader, and confidant while in the nursing program. This intrusive advising relationship should positively impact the continued enrollment of students in the nursing program.

Another important aspect of promoting student success post admissions is the implementation of a mentoring program. The development of relationships with those who are more experienced with nursing school and the nursing profession provides the opportunity for students to gain additional socioemotional and professional support and helps to build a strong foundation for success. For specific information on developing and implementing peer and professional mentoring programs, please refer to the Peer-to-Peer Mentoring Toolkit.

The evaluation component of HRA is a critical step in providing compelling, data-driven messages regarding a program’s successes. Data from evaluation will also help determine if the intended outcomes of HRA were achieved. Evaluation of the adaptation of a holistic review is dependent upon whether the overall mission and vision of the institution was met as well as determining if diversity of the nursing student population affected the learning environment. The evaluation plan includes process and outcomes regarding students, faculty, and the institution.

While it is ideal that an evaluation plan be established from the beginning of the HRA implementation, it is not required. Even if HRA has already been adopted, there is still great benefit to establishing and implementing a thorough evaluation plan. In addition to measuring outcomes, a structured evaluation plan will also enhance continued performance efforts, if it is “regular, ongoing and thoroughly integrated into institutional planning and work” (American Academy of Medical Colleges [AAMC], 2013, p. 6).

Although there are many evaluation frameworks, the framework selected for this toolkit is adapted from the American Academy of Medical Colleges (AAMC, 2013). The strength of this framework is apparent in its simplicity and supplemental guidance. Specifically, the AAMC highlights six key areas programs should examine when evaluating HRA: why, which, where, when, who, and how.

1. Why is evaluating holistic admissions and related programs critical?

HRA must be evaluated to document if the change to holistic admissions review process met the mission and goals of the institution related to increase diversity in the accepted nursing student pool. This evaluation must include more than just the selection process. It should include an assessment of policies, processes, and practices to examine if these are contributing to both short and long-term goals. Through evaluation, a nursing program can determine what worked, what didn’t and why, and most importantly, substantiate decisions with data (both qualitative and quantitative) instead of assumptions or anecdotal evidence.

2. What data are needed and where the data can be found?

What data is needed to answer HRA key questions (and where the data can be found) depends on each institution. Data gathering decisions will be based upon current or future data collection methods. The following list, while not all encompassing, provides recommendations about key data points to consider when developing an evaluation plan:

• Student academic performance including faculty feedback, course and clinical grades, licensure exam scores, GRE scores, time required to complete the nursing program and school-developed surveys
• Data regarding institutional mission-related attributes including information from nursing applications, school-developed surveys, focus groups or individual interviews.

3. When should a program conduct an evaluation?

Determining when an evaluation plan should be implemented is a fundamental question that should be answered as early in the process as possible. An ongoing recommendation highlighted by the AAMC (2013) is to start with the end in mind. When making a final determination about when to engage in an evaluation, it is important to remember that you are assessing the entire process, not just student selection. While selection is important, it is critical that data be reviewed throughout the entirety of the process (from application through graduation and on to practice).  Both formative and summative evaluation data should be obtained for each area identified by an institution such as application/screening, key progression points, graduation, and practice.

4. Who is responsible for evaluating HRA?

Who is responsible for evaluation of HRA process should be determined at the onset and involve the entire team including stakeholders, administration, faculty, students, and community partners. An evaluation team approach for collection, analysis, and interpretation of data is recommended.  Assessing the current data collection methods at each institution is a valuable strategy to tap into the available resources and identify additional data points that could be added to HRA.

5. How should the evaluation be carried out?

How to evaluate relates back to the purpose of moving to HRA. Understanding the goal of HRA helps to determine the data needed to review to determine success of the process.

See Holistic Review for Admissions Toolkit PDF for more information on evaluation

See Holistic Review for Admissions Toolkit PDF for references

See Holistic Review for Admissions Toolkit PDF for examples 

Holistic Review for Admissions Toolkit PDF

The Mentoring Toolkit, developed by the Indiana NEEDS Initiative Mentorship Subcommittee, offers nursing programs tools and resources for implementing a Peer-To-Peer Mentoring Program during prelicensure nursing education.

Mentoring has been found to have a positive impact on student outcomes including integration and transition, academic support, guidance and advice, future preparation, and emotional, social, and personal support (Miller et al., 2019). This toolkit builds on the Robert Wood Johnson Foundation and the American Association of Colleges of Nursing’s [AACN](2012) New Careers in Nursing Mentorship Program Toolkit. The three critical aspects of a formal mentoring program include the matching process, training and orientation, and interaction frequency (Cornelius et al., 2016). 

What is Mentoring?
Mentoring is defined as “a reciprocal learning relationship in which a mentor and mentee agree to a partnership where they work collaboratively toward achievement of mutually defined goals to develop a mentee’s skills, abilities, knowledge, and or thinking” (Fain & Zachary, 2020, p. 6-7).

• Mentoring is reciprocal–Mentor and mentee fully engage in the relationship.
• Mentoring involves learning–Mentees must go into the relationship as a learner and the mentor must come into the relationship as both a learner and learning facilitator.
• Mentoring requires a strong relationship between mentoring partners–Building a collaborative relationship that is open and trusting and honors each other’s uniqueness is essential to a successful mentorship. Mentors must create a safe and trusting space; a place for mentees to take risks, engage with a mentor, and ask for what they need.

Toolkit Components
Existing resources, grounded in research and best practice, are included in this toolkit to assist nursing programs in developing and implementing a Peer-To-Peer Mentorship Program that best fits their school’s individual needs. The four modules of this toolkit include Recruiting and Screening, Matching and Training, Monitoring and Support, and Closure and Evaluation. Each module contains tools and resources.

Recruiting
Nurses are continually growing and mentoring their peers through informal mentoring in a preceptorship or through more formalized mentoring programs and nurse residency programs. Therefore, student-to-student peer mentoring offers an opportunity to begin learning this professional skill. Tying peer mentoring to the profession of nursing is an important recruitment strategy. Additionally, connecting peer mentoring to clinical leadership hours could incentivize students to participate. When recruiting peer mentors, it is essential that a clear understanding of the mentor role is explained.

Screening 
Peer mentor screening should be directly related to the institution’s policy on nursing student background checks, academic, and student life policies. Mentoring should always occur in public settings and all participants should be comfortable with the pairing. Peer mentoring can also transpire in a group format which may create an additional layer of safety to your program.

Michigan State University. (n.d.). Peer Mentor Program Guide

In a peer-to-peer mentoring program, both mentors and mentees will need early clarification of the program’s expectations and responsibilities. They will also need guidance on the logistical and interpersonal components of their participation. Participants may be hesitant to sign on without a clear idea of the time commitment. Appropriate timing of training activities supports engagement, eases the assessment process, and improves the participant experience. This section includes research findings pertinent to developing peer-to-peer mentor training and examples of mentoring program training timelines.

Training Timelines
Your program’s needs and goals will be central to developing your timeline. To plan when you are going to take each step in the process, you need to know the intended outcome. It may be helpful to work backward by addressing the following questions. When do you hope to implement your program? What structures and processes need to be in place from the beginning and what can be developed as you go? Who will be responsible for carrying out the required tasks? How will you be assessing your program? These questions uncover the what, who, and when for your program. First, you will need to know what you want to happen and how you will assess when and how well it happened. Then you will need to coordinate with the people who will be responsible for making it happen. They are your collaborators in setting up a timeline that works and drive the when, allowing you to develop a realistic timeline for training your mentors.

As you are collaborating with mentors, consider the following factors in your timeline:

• Mentor schedules
  As you are developing mentor training schedules, consider what timing would be most open for them. In a peer based, or even a faculty based, mentoring program, the calendar of the academic year could impact the availability and engagement of your mentors.
• Modality
  Determining whether your training will be online, hybrid, or in-person should be very intentional. An online modality is very convenient but gives less control over the training environment. Hybrid or in-person training provides program staff with more direct engagement with the mentors and greater control over the learning environment. However, hybrid and in-person training may be less convenient for the mentors and require an increased flexibility from the trainers.
• Marketing and Recruiting
  How you choose to train your mentors should be directly linked to the intended outcomes of the training and likewise to the program’s intended outcomes. The selected method to train mentors should be a key marketing and recruiting strategy for obtaining mentors. Communicating how you will prepare mentors to have fulfilling experiences can be a powerful recruiting tool. Good mentors want to know that they will have the tools they need to be successful. However, you should be deliberate about deciding the best timeframe to deliver that information in a reasonable way. A yearlong training commitment is likely to dissuade some high-quality mentors, especially if they do not see the extended training value. Similarly, if all training is held in person and during business hours only, mentors in certain life situations will self-select out, even if the training can be completed in a short timeframe. As you develop your training timeline, consider who your processes will attract and who they will dissuade. Securing a diverse, well-qualified mentor pool without early attention to how to market the mentor experience to the candidates you hope to attract may be challenging.

Execution of the Timeline
Identifying a designated point person for your mentoring program will benefit the execution of the training timelines. When one person or a small team is actively engaged in maintaining the program’s momentum, mentors will be more engaged, and actions and details will be prevented from falling through the cracks. You may also consider the use of technology to manage your timeline. Using learning management systems, task centers, dashboards, and other technology driven organizational strategies may keep the project on track. Technology can also create a history of the project, allowing it to continue with minimal disruption if the person coordinating the process is no longer available to you. The use of technology may also aid in creating data sources for future evaluation.

Continued Training
In general, a short-term initial training schedule is recommended to support effective, marketable training requirements, but you must also consider your mentors’ long-term needs. In a peer mentoring program, there should be a distinct benefit to the mentor and the mentee. As you consider the goals of your program, you should build objectives related to the mentors’ development. Then integrate check-ins, communication points, workshops, or other activities that support the intended goals for mentors in your long-term training plan.

Related Research
Frank, B. H. (2018). Implementation of a peer mentoring program for undergraduate student nurses. [Doctoral dissertation, North Dakota State University]. North Dakota State University Repository

(The author describes implementation of a peer-to-peer mentoring program for pre-licensure nursing students at an urban university school of nursing. Discussion of the training procedure begins on page 30.)

Resources
Queens University. (2016). M² Peer Mentoring Program Training Manual. M. Dineen & M. Condra (Eds.)
Wayne State University. (2019).  Peer Mentor Training

Cultural Intelligence (CQ)
CQ is more than cultural competence. It is the capability to function and relate effectively in culturally diverse situations. Cultural diversity includes: Race, ethnicity, socioeconomic status, gender, sexual orientation/sexual preference, life experiences, age, educational access, and other personal characteristics. CQ builds on IQ and Emotional Intelligence (EQ). Before one can understand other cultural values, they must understand their own values. Developing CQ will help students and nursing professionals to work effectively across cultures. CQ predicts personal adjustment and adaptability, judgment and decision-making, and leadership effectiveness as well as trust, idea sharing, and innovation (Cultural Intelligence, 2020).

As described in Livermore’s research (2015), there are four components to CQ: drive, knowledge, strategy, and action. Drive, or motivation, involves having interest, confidence, and determination to adapt cross-culturally. Knowledge, or cognition, is the understanding of intercultural norms and differences. Strategy, or metacognition, is making sense of culturally diverse experiences and planning accordingly. Action, or behavior, involves changing verbal and nonverbal actions appropriately when interacting cross-culturally.

Livermore, D. (2015). Leading with cultural intelligence: The real secret to success [Video]. YouTube.

Cultural Intelligence in Mentor Matching
Cultural intelligence (CQ) is an essential factor to consider when designing and implementing mentoring training for administrators and participants. By incorporating CQ principles into mentor training, both mentors and mentees are introduced to this valuable concept and learn how CQ principles can enrich the mentoring relationship. To support diverse student groups, administrators must consider the contexts and prior experiences that participants bring to practice. Likewise, participants may still be learning what it means to incorporate various worldviews into their perspective. They will need guidance on utilizing differences to build positive momentum in mentoring relationships. This section includes scholarly articles on the cultural components of mentoring training and examples of CQ training for mentoring program participants.

Importance of CQ in Matching
The concept of cultural intelligence is interwoven throughout our discussion of how to build an effective mentoring program. Matching is an area where CQ is a necessary skill for everyone involved, including the mentors and mentees and the staff and faculty working with mentors and mentees throughout the program. It is not possible to know whether a pair will “hit it off” in advance. There is no reasonable way to predict a perfect personality match, even between people you know well. Capitalizing on CQ strategies during matching increases the odds of a successful match by infusing a positive perspective on differences from the beginning.

Ways to Infuse CQ
One of the best ways to learn about your participants’ cultural needs is to ask them. The Robert Wood Johnson Foundation and the AACN’s Mentoring Toolkit (2012) recommends having participants meet and provide input into their matches. Participants who feel that they had a say in their match tend to be more satisfied with the match and with the program overall (Packard, 2003.) If a meeting isn’t possible, you can gather information about participant’s perspectives and values through surveys.

Another critical factor in engaging CQ in matching is to bring a diverse range of participants to the table. Marketing and recruiting strategies should involve attracting people from a broad range of experiences and backgrounds, both as mentors and mentees. The more experiences are represented, the more those experiences can be leveraged to foster culturally engaging, mutually beneficial relationships among your participants. This is especially true if your participants will be engaging with the larger group rather than just their mentor or mentee. While a mentee may prefer a mentor with a similar background, they could benefit from engaging with other participants with different perspectives in other settings, such as meetups or training events.

Managing Assumptions in CQ Focused Matching
A holistic perspective to matching, including the application of CQ, is supported by research. There is some evidence that matches based on similarity aren’t necessarily more successful than matches between people who are demographically different. Yet when a pair is demographically different, the relationship may take longer to build trust (Johnson-Bailey & Cervero, 2002). As you are creating a pairing mechanism, you must balance these considerations. Even demographically similar students will need to engage in culturally intelligent approaches to get the maximum benefit from mentoring relationships. Pairing demographically similar students does not absolve the responsibility to ensure that participants have the tools they need to navigate cultural and personal differences. Likewise, pairing demographically dissimilar participants may require more attention to building rapport and cultural knowledge development, yet it still allows participants to have helpful and meaningful interactions.

Related Research
Packard, B.W. (2003). Student Training Promotes Mentoring Awareness and Action. The Career Development Quarterly, 51(4), 335-345.
(This article describes qualitative student outcomes in a composite mentoring program that established mentor pairings with multiple people and was designed to engage students with a strategically diverse mentor pool.)

Johnson-Bailey, J., & Cervero, R.M. (2002). Cross-cultural mentoring as a context for learning. New Directions for Adult and Continuing Education, 96.
(This article qualitatively discusses various aspects of cross-cultural mentoring relationships, specifically across race, and describes some of the potential benefits and challenges for the mentor and mentee.)

Coordination of Training and Matching
Training and matching are some of the more labor-intensive portions of coordinating a mentorship program. The coordination responsibility falls to the participants during active mentoring, while the program bears the responsibility for preparing them for the mentoring phase of the process. Training for both mentors and mentees sets the tone for the mentoring relationship and prepares participants for their roles, expectations, and challenges. Matching is also an essential part of setting the tone. Effective coordination of the matching activities can significantly improve the experience for mentors and mentees.

If you have the option to do so, designate a single person or office to be the point of contact for training and match coordination. While many people can, and often should, share in the decision making and execution of a successful mentoring program, coordinating the logistics through a central source will avoid misunderstandings and create consistency for participants as they onboard into the program.

Coordination of Training
Training should be intentionally designed to facilitate engagement with the most critical takeaway points. Those points should be communicated to the participants frequently. Consider your program’s priorities and how you can embed those priorities into the training structure. Then, identify multiple communication methods for sharing those priorities. For instance, consider if there are opportunities to convey critical points in person and in writing, or if on-demand videos would be a good resource for your population. Also, you will need to identify the follow-up needs of your participants.

Important takeaway points for a nursing undergraduate mentoring program may include:

• Basic understanding of the purpose and process of mentoring
• Expected commitment for the program
• Ethical expectations
• Cultural intelligence considerations
• Resources available to participants

In addition to the overall main takeaway points that you choose to emphasize during training, you will want to ensure that the program’s goals are transparent. Mentors and mentees should have a clear idea of the expected outcomes and their role in achieving them. Furthermore, keeping participants involved in the program’s mission encourages them to fully engage in its success.

Coordination of Matching
Coordination of matching should also be intentionally linked to the goals and mission of the program. For example, suppose one of the goals of your program is to help students in a particular ethnic or cultural group meet successful peers who are also members of those groups. In that case, your recruitment and matching strategies should reflect that goal. Thereby, assessment of your program’s success will be connected to your goals. It may not be feasible for every pair to be matched in a way that reflects each goal, but each match should be set up for success as measured by the program assessment strategies.

As you are constructing the matching process, select tools that will best reflect your desired outcomes for the pairs. First you will need to determine if you are aiming to match participants who are demographically similar or different. A survey tool may be an effective way to compare demographic characteristics. If continuing friendships are a desirable outcome, then face to face matching strategies may help to gauge chemistry. No matter what strategies you use, matches tend to be more successful when the participants feel that they have a say in the match. While easy for the coordinator, random pairing does not contribute to a feeling of connection between participants. Whether or not the participants meet prior to matching, matching should include elements specific to the participants’ personalities and goals. Also, you should ensure that the participants are aware of how their information is used in the matching process.

Fostering Engagement During Training
Engagement of mentors and mentees during training sets a positive tone for the entire program. By facilitating strong participant buy-in early on, you encourage the participants to engage with the program and their mentoring partners. Engaged mentors and mentees develop skill and efficiency in their role. As they gain confidence and begin to see the effectiveness of the program, they may become strong advocates for the program. Training is not one-and-done; it is a powerful support and engagement tool that evolves throughout the mentoring program experience.

According to Comer (1980), people are generally motivated to learn by connection to a significant person, connection to the material, or connection to their sense of purpose. Mentoring is, at its core, a relationship-based learning experience for both mentor and mentee. In theory, the participants will develop a connection to a person in the mentoring relationship. However, that connection is not automatic. By reinforcing the connection to the tasks, the experience of mentoring, and the participant’s personal mission during training, the mentor can facilitate an experience that will support the development of the personal connection that pushes the participant to learn about themselves and their role within the profession of nursing.

Sharing the program’s goals, purpose, and benefits early on supports engagement of the participant’s sense of purpose. Participants need to know how the program will support their personal objectives. Participants who feel that their goals are aligned with those of the program are more likely to remain fully engaged. For example, suppose one of your program goals is to support leadership development. In that case, your training materials might include information on using the leadership experience they have gained in the program to market themselves to employers. By sharing your objectives early and reinforcing how those objectives are being addressed, your participants can see what they are getting from the experience in real time.

Connecting to the material manifests in two ways for program participants: engagement with the skills of mentoring and engagement with the relationship. The training coordinator’s role is linked to mentoring skills which allow participants to effectively engage with their partner and learn and grow from the relationship. As the participants move through the program, consider:

• How much guidance do participants want and need?
• What training needs will be different between mentors and mentees?
• Where are opportunities for fun and relationship building?
• What drew your participants to the mentoring program?
• How can you ensure they are getting what they wanted out from this experience?

Related Research
Comer, J. P. (1980). School power: Implications of an intervention project. New York: Free Press.

Althoff, S. E., Linde, K. J., Mason, J. D, Nagel, N. M, & O’Reilly, K. A. (2007) Learning objectives: Posting and communicating daily learning objectives to increase student achievement and motivation. Saint Xavier University & Pearson Achievement Solutions.

Modulating Unconscious Bias
Bias, although inherent, can be managed. Affinity bias is the tendency to gravitate or give preference to people in our in-group or people like us. Having self-awareness of how we think and act can help to prevent harmful actions, thoughts, and feelings. Most people function with a fast-thinking brain which involves intuitive thinking. Fast thinking is characterized as unconscious, automatic, emotional, fast, and effortless. On the other hand, a slow thinking brain lends to rational thinking which is conscious, deliberate, systematic, slow, and effortful (Kahneman, 2013).

Resources
Kahneman, D. (2013). Thinking fast vs thinking slow [Video]. YouTube.

Harvard University. (2011). Project Implicit.

Minority Nurse. (2018). Recognizing Implicit Bias in Health Care Setting.

Madva, A. (2014, May 6). Understanding Implicit Bias in Higher Education.

Support resources for mentors and mentees are available in section three of the AACN New Careers in Nursing Mentorship Program Toolkit. It provides definitions and discusses how to prepare, set goals, and build rapport as well as how to support and empower. The toolkit discusses the stages of learning and the levels of confidence that a mentor can apply to help the student succeed. It also includes information on how to evaluate feedback and maintain relationships.

Monitoring is also an essential component of mentoring and should include accountability for both mentor and mentee. Regular feedback and surveys that gather qualitative data surrounding the relationship for both individuals may also provide a means to monitor the process.

Resources

Academic Persistence

• How to Reduce Test Anxiety for College Students
  
• Test Anxiety: Crash Course Study Skills #8
• 12 Hacks that will Improve Your Studying
• Information Processing Model: Sensory, Working, and Long-term Memory
• How to Stay Motivated and Prevent Burnout in Nursing School
• Finding the Main Idea
• Main Ideas
• Test Taking Strategies for Nursing Students
• Test Taking Tips for Nursing Students
• One Thing I Wish I Would Have Known about Nursing School Before I Started
• Med Math for Nurses
• 4 Tips for Setting Powerful Goals
• Smart Goals

Professional Identity

• Reconciling professional identity:  A grounded theory of nurse academics’ role modeling for undergraduate students
• An exploration of role model influence on adult nursing student’s professional development:  A phenomenological research study

Self-Care

• The College Student’s Guide to Stress Management
  
• Nurses and Health-Promoting Behaviors: Knowledge May not translate into Self-Care
  
• Practicing Self-Care for Nurses: A Nursing Program Initiative
  
• Healthy Nurse Healthy Nation

Sense of Belonging

• How to Overcome Stereotype Threat: Looking Beyond Society’s Expectations
• Stereotype Threat
• Nursing Student Support Group Eases Stress
• Nurse Keith: Nursing School Study Groups are Always in Style
  
• The Power of Peer Mentoring. Peer Mentoring Resource Booklet
• Mentors: Cultivation phase Resources
• Exploring the student peer mentor’s experience in a nursing peer mentorship program

Networking

• National Student Nurses Association
• American Nurses Association. Welcome to the Profession Kit 
• Nurse Buff. 30 Social Networking Sites for Nurses

The peer-to-peer mentoring relationship is built upon open communication, transparency, trust, and mutual support. The closure of the formal relationship is an influential part of the mentoring process and requires an intentional process that frames the closure in a manner that supports the ongoing success of both the mentee and mentor, recognizes the issues of loss that may be experienced by both, and proactively identifies future goals for the mentee that sustains their academic socialization, campus engagement, and sense of belonging. As the mentoring relationship comes to a formal conclusion it is important that both the mentor and mentee communicate and recognize key constructs and outcomes of their mentoring relationship including but not limited to:

• Acknowledge the areas of progress and growth experienced by both the mentor and mentee.
• Reflect on mentoring relationship’s success and challenges.
• Revisit the goals of the mentee and recognize the skills and strategies they have developed to be successful.
• Identify systems and resources that provide support and validation, as well as, practical strategies for the academic and personal success of the mentee.

 See Peer-to-Peer Mentoring Toolkit PDF for mentor and mentee survey examples

 See Peer-to-Peer Mentoring Toolkit PDF for references

Peer-to-Peer Mentoring Toolkit PDF