1. Addressing implicit bias in dnp admissions
Roberta P Lavin, FNP-BC, PhD, FAAN
This work was partially funded by HRSA Award DO9HP28669

2. Learner objectives
Learner Objective 1. The learner will be able to identify admission processes that may be vulnerable to implicit bias.
Learner Objective 2. The learner will be able to implement a blinded admissions process for Doctorate of Nursing Practice program that reduces the risk of implicit bias.

3. Purpose
The goal was to address the impact of implicit bias in the application process and increase diversity in the Doctorate of Nursing Practice program.

4. Saint Louis Demographics
Missouri’s proportion of African Americans is similar to that of the U.S. (13.6%), and the majority is concentrated in urban areas of St. Louis City or in rural areas
The St. Louis region ranks as the 6th most segregated, having a wide gap between Blacks and Caucasians on a range of social, economic and health indicators.
The African American population is distributed unevenly throughout the state; the largest concentrations (78%) in St. Louis and Kansas City. Only 14% of graduate students and 19% of MSN NP students were from minority groups. A recruitment plan was developed to target underrepresented minorities. In the first year of the BSN-DNP the admission resulted in 87.5% Caucasians, 8.3% Hispanics, 4.2% that identified as mixed race, 0% African American.

5. What we found and what worked
The holistic admission process included
GPA
Essay
Letters of Reference
Years of Experience
What you need to know about St. Louis
High School
Zip Code
Parish
As part of a plan-do-study-act rapid cycle quality improvement the faculty identified to assess the status of integration of state and local-level recruitment activities. Data were synthesized key informant interview, review of relevant documents, and review of core data on admissions. We questioned whether implicit bias was at issue.
The holistic admission process was blinded for race, gender, years of experience, zip code, and prior educational institutions.

6. Blinded The holistic admission process was blinded for: race, gender,
years of experience,
zip code, and
prior educational institutions
The faculty saw the letters of reference and the essay and used a rubric to evaluate them. Each applicant was reviewed by two faculty members. The GPA and years of experience were assigned a number value. All values were compiled by the academic advisor and only after the cut point had been set were the applicants reidentifed.

7. DNP Admissions 2015 Cohort 1 2016 cohort 2 African American 4%
Asian 0%
Caucasian 87%
Hispanic 8%
Other 0%
African American 16%
Asian 12%
Caucasian 76%
Hispanic 2%
Other 2%
In the first year of the BSN-DNP the admission resulted in 87.5% Caucasians, 8.3% Hispanics, 4.2% that identified as mixed race, 0% African American.

8. DNP Admissions by population density
2015 Cohort 1
2016 cohort 2
Urban 17%
Suburban 54%
Rural 25%
Urban 14%
Suburban 50%
Rural 36%

9. Major outcomes
The blinded process resulted in 12% Asian, 16% African American, 2% other, and 76% Caucasian.
In one year the program saw a significant increase in diversity both based on race and ethnicity and urban and rural.
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This wasn’t done without challenges. Multiple faculty members said we were accusing them of racism. Explaining that we all have some implicit bias whether it be related to race, gender, socioeconomic status, or other attributes. The goal is to make our processes fair.
And there is no question that this is a more labor intensive process, but in the end the results in only one year were significant.

10. Next steps Holistic admissions mission statement
New admission criteria
Criteria based on leadership,
Understanding and commitment to learning,
Involvement in activities that give meaning to life, and Experience with diversity
Created new criteria for admission starting in Fall 2017

12. Conclusions
Holistic admission are not enough to make a significant change without addressing implicit bias among those making admission decisions.
Our faculty took a hard look at ourselves and made changes that attempted to eliminate implicit bias.