Being Interviewed for Admission to a BSN Program : A Qualitative Inquiry

Nursing schools want to choose candidates most likely to successfully finish the program andmany include interview as part of the admission process. Research on interviews as a component of admission has yet to address the students’ experience. The purpose of this study was to examine students’ lived experience of being interviewed for admission into a BSN program, with application of findings tomore holistically examine the interview process.Three themes resulted from grounded theory analysis of 25 transcribedverbatim interviews of nursing students. Seeing Me describes how the interview was a positive way of showing a side that was not represented on paper. Participants shared an awareness that qualities needed in a nurse (The Right Stuff ) are better assessed with interview. The interview marked when the Beginning of the Nursing Journey felt real. This paper considers the student’s experience and helps us more holistically examine effective processes for admission to a nursing program.


Introduction
The nursing shortage continues [1].With a mean age of 46, the nursing workforce will be retiring, and the number of new nurses being produced will not fill the resulting gap.The aging North American people are living longer with chronic disease and will require even more health care services.As health care reforms change the availability of services, even more Americans will seek needed nursing care [1].
Schools of nursing across North America are challenged with finding ways to increase retention and graduation without compromising the expected high standards of their institutions.Trends show that funding for academia is often awarded through retention and graduation of admitted students [2].Interviewing applicants is one more way to filter the pool for those students who are most likely to excel and complete their program.Structured and consistent interview processes are effective in obtaining reliable information [3].Some empirical data is available to guide admission committees on effective and proven processes.The literature does not, however, reflect what the experience of an interview has on the student.The purpose of this study was to examine students' lived experience of being interviewed and accepted into a BSN program.The application of findings towards improving the interview process will be considered.

Review of Literature
Historically, medical schools have interviewed candidates for admission to their programs, but nursing schools have not.The reasoning behind the interview is to assess interpersonal and communication skills which cannot be evaluated from applicants admission paperwork including grade point average (GPA) and entrance exams [4].In the healthcare professions, it is valuable for schools to evaluate students' motivation, knowledge of the profession, expectations, and fit for their chosen career.Including an interview as part of the admission process allows the faculty to examine students' fit within the program and the school.Multiple articles have been published regarding the process of admission interviews in various health professional programs [4][5][6][7][8][9][10][11][12][13][14][15][16].Admission processes are created with the intention of admitting candidates with the greatest possibility of success.Structured interviews have been found to have strong internal validity and reliability [4,5], but no recommended standards for 2 Advances in Nursing interviewing exist within or among programs.Some programs have implemented the admission interview to decrease attrition and increase diversity with some positive results [7,13,16,17].Prior to the admission interview, attrition rates were higher and diversity rates lower compared with those cohorts interviewed.This research has certainly informed our understanding, but holistic knowledge is incomplete without a view that includes the student's experience.
Minimal literature exists regarding the admission process which included interviews in generic Bachelor of Science in Nursing (B.S.N.) programs [7] and few in accelerated B.S.N. programs [14,16].This may be the case due to the issues of subjectivity and bias that the interview can evoke.McNelis et al. [13] revised the admission process at the Indiana University School of Nursing program from GPA only to include interviews as a way of evaluating the applicants' knowledge of nursing, community service, and diversity issues.No followup has been published as to the success of the change in student attrition or success.The added value of interviewing balanced against the required time commitment has also been questioned.Our experience shows the task is time consuming for faculty and there is a need for continual monitoring and adjustment to ensure interrater reliability, yet it is still seen as valuable.
In the fall of 2010 a large undergraduate university in the southeast United States began implementing interviews as part of the admission process to assist in increasing retention and improve quality of the candidates.This study sought to discover and describe the experience of being interviewed for admittance into nursing school and what lasting influence the interview left.

Research Design
Guiding theories in this study were drawn from the fields of social psychology and nursing.Social influence theory proposes that interpersonal relationships, such as structured interviews for job or student placement, involve social influence which is interactive and creates a cycle of information relevant to all involved [18].Human Becoming Theory is Parse's nursing theory which values the perception of the experience of all involved [19,20].The phenomenological approach is congruent with nursing education because of the holistic focus on the human experience [20].Meaning making arises from the exchange of the human and the surroundings and Parse's theory in research examines a phenomenon to better understand life as lived by that person.
This qualitative study used open-ended questions to guide the participants through describing their experiences of being interviewed for admission.Institutional IRB approval and informed consent from participants were obtained and participants were informed they could withdraw from the study at any time.Twenty-five participants were randomly invited from the 5th and 1st semester of a five-semester BSN nursing program.All participants had been interviewed as part of the admission process.

Data Collection and Analysis
Data was collected and analyzed in spring 2013.Audio-taped interviews were transcribed verbatim using Dragon: Naturally Speaking Software (Nuance Communications, Inc.) and double-checked for accuracy by listening to the interviews in their entirety once again.Researcher notes and observations were included and the interviews were discussed throughout the data collection process to hermeneutically improve the quality of future interviews.Grounded theory was used to analyze data as it was collected, and the research team together assigned codes into concepts and then categories, and resultant themes emerged from patterns.Analysis began after the first interview was transcribed and continued until all interviews were coded into data sets of similar meaning to best enhance the hermeneutical process.Transcripts and data analysis will be kept for five years and password protected to protect participants.Validity of findings was assured when five participants were examined and concurred with the themes discovered.A second literature review sought validation of qualitative findings.

Limitations
Subjects to interview for study included only those who were interviewed and accepted into the BSN program.The data was obtained from those whose outcome was positive, missing potentially valuable lived experiences of students who were not accepted.Interviews and data analysis were conducted by faculty and staff at the School of Nursing, giving some bias related to perceived and actual power to data collected.However, personal experience of researchers also added to the understanding of the qualitative data analyzed.

Population
A total of 25 participants were interviewed.The mean average age of respondents was 28, with a median of 24, and an age range of 20 to 55 years.Eighteen respondents were female (72%) and 7 were male (28%).Twenty were white (80%), four were African-American (16%), and one was Asian (4%), reflecting a common demographic in this school of nursing.Fifteen 1st semester students (first semester sophomores) were interviewed and 10 5th semester students (final semester seniors).

Findings
Admission to nursing schools is becoming more and more competitive due to universities' expectations for recruitment, retention, and graduation.The student interview as part of the admission process has allowed for a more holistic view of the applicants in hopes of retaining, graduating, and placing them in an entry level position [16].Students described the interview process for admission as a positive step in presenting themselves in expressing why becoming a nurse was so important to them.In retrospect, the students found value in the interview process and professed they may not have been accepted if it were not for the interview.This was especially true for the nontraditional students and those who had difficulties in some of their liberal arts courses thus decreasing their GPA.Students found the interview to be very stressful as they understood their performance could solidify or hinder their changes of being accepted.They also realized the importance of it.Having some prior experience in healthcare and specifically in nursing was also voiced as an asset for the student.Some discussion has been contemplated about adding healthcare experience as part of the admission criteria, but it is still just that discussion (J.Sauls, personal communication, May 16, 2014).The study subjects made several suggestions that could assist future students when they are interviewed for admission into a BSN program.Suggestions included being prepared, confident, and selfassured as well as understanding the role of the professional nurse and being able to articulate reasons why they want to become nurses.
Three themes emerged from this study which examined the lived experience of being interviewed for admission to a BSN program including Seeing Me, The Right Stuff, and The Beginning of the Journey to be a Nurse.It was not surprising that 1st semester students had richer memories of the interview experience when compared to fifth semester, but these three themes were common experiences to both groups.

Seeing Me.
The interview was seen by the students as an opportunity to show who they really were beyond their numbers of GPA and entrance exam score.Structured interview improves reliability and predictive validity of information obtained [3] and gathering more information certainly provides a more thorough and whole view of the candidate.Participants seen as who they were at the moment of the interview was more reflective of their potential.A lower GPA may reflect what has resulted in a maturing and more serious student, so the interview really shows more of who you are now, and the interview process is important in that way, that they see me.
Holistic approaches to interviewing are not new [21] and measure the bigger picture of the candidate to look for fit.

To actually see the person behind grades says a lot more; get a visual of what a person is says a lot more than just grades on paper. . . you can get a better picture what that person is all about.
Nursing faculty interviewing is well familiar with blending science with art and our students felt connections.Reiter [22] discussed human resources departments finding the right candidate in corporations was "both a science and an art" and warmly engaging the students helped them open up to sharing their real self.

. . . truly show what kind of person you are and sit down with someone face-to-face and they can see who I am and understand why I'm doing this then
I have a better chance than just looking at me on paper.

The Right Stuff.
Participants noted that the interview gave the school a chance to choose those who had intrinsic qualities needed to be a good nurse.There was an understanding that not all applicants would have the right stuff to be successful in nursing.
You have to be the right fit for nursing.
Most nurses are called to it, so they have a sense of caring.
Students thought the interview process would be useful in filtering out those candidates who had the qualities expected in a nurse.

It cannot be just because of your grades. Anyone can ace a test not everyone can be that comfortable with a patient.
Students thought that only using GPA and test scores to assess for nursing school can be detrimental.

[The faculty] cannot figure out what the person is like or if they can be an effective nurse. It seems like they would really miss a lot of good people.
Described as "work engagement" of nurses in some literature, ways of behaving and being are antecedents for safe nursing [23].These qualities, the Right Stuff, include caring, compassion, commitment, and connectedness and other orientations.Magno [24] commented that these qualities directly affect aptitude and academic achievement.Successful nurses integrate these characteristics with knowledge, skills, and behaviors taught to them in school.

The Beginning of the
Journey to Be a Nurse.Students saw the interview as part of their learning and the beginning of their journey to become a registered nurse.

It made me think how hard it really is to get in and I'm fortunate to be in this position.
The process of being socialized as a nurse involves a clear understanding that nursing is a profession [25].The faculty modeled professionalism which helped the students see the interview as the beginning of their journey.

I came in knowing how serious everybody took their job, knowing how formal everybody was, how important this interview was.
When you finally do get to the interview and you get accepted this makes you have a little more pride, to be a part of the program such as this one.

Discussion
The purpose of this study was to examine students' lived experience of being interviewed for admission into a BSN program, with application of findings to more holistically examine the interview process.Nursing educators motivation for including an interview as part of the admission process is to ensure schools of nursing are selecting students who will complete the program and pass the state licensing board examination [7,13,16,17].Ehrenfeld and Tabak [7] discuss using the interview to decrease attrition and improve the selection process.They found that including an interview somewhat predicts lower attrition rates but was not definitive [7].Historically programs of nursing have used objective criteria like GPA and entrance exams as inclusion which has led to higher than desired attrition rates [13].Including a subjective component in the interview allows students to present themselves as highly qualified candidates who will be successful in the program.More than one student experienced the admission process with and without the interview.They felt the interview added a dimension that was positive for the student and as a result of the interview were accepted into the program.As previously stated students viewed the interview as having value for those whose objective components of the admission criteria were less than stellar.The subjective interview gave those students an added element to the process which they felt was an advantage for them.

Application for Educators
Lessons learnt include the added value the interview has in the admission process stated by the students and interviewers.Prior to the inclusion of the interview schools of nursing have increasing rates of attrition and a lack of diversity.Once the interview was included, diversity increased and attrition decreased based on continued evaluation of the interview process [7,13,16,17].Assuring internal reliability and validity of the process is ongoing.
Faculty and admission committees balancing choices related to admission processes would benefit from an understanding that the students (retrospectively) perceived the interview as a positive experience.The experience gave an opportunity to been seen and thus considered more fully.The experience helped them gain confidence in their innate ability to be a nurse and was seen as the beginning of their entry into nursing.
Limited resources, competition for clinical sites, and expectations of high retention rates drive schools of nursing to carefully choose candidates for their programs.A consistent and structured interview that considers the student's experience helps us to more holistically examine effective processes for admission to a nursing program.Finally, we are reminded how important the work that we as nurse educators do and how big a ripple we make.I'm glad I got into nursing school because it's the best thing that's happened to me in my life so far.
Further research in both qualitative and quantitative methods can be beneficial in determining the best practices in using the interview as part of the admission process.Interviewers and interviewees thoughts and feelings about the interview process are also an important issue.This study touched the surface of students' reaction to the interview, but interviewers' reactions have not been studied.Establishing the effectiveness of the interviewer(s), as well as the questions to include in the interview, is also needed.The reliability and validity of the process need to be continually evaluated as to ensure an unbiased approach.Using standardized questions asked for each candidate is also imperative in the decision making process.Utilizing multiple faculty in the process will ensure an added layer of unbiasedness.