The National Academy of Medicine report The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity calls for nursing programs to dismantle practices undermining efforts to create a more equitable society. To support this goal, nursing programs should limit their participation in current college ranking systems based on reputational-based surveys that rank institutions on the basis of subjective data rather than on measures of schools' efforts to advance health equity. The current ranking systems could lead students to mistake a high-ranking school for one that best meets their needs or prepares them with the skills to advance health equity.
In January, 13 of the top medical schools dropped out of the U.S. News and World Report (USNWR) rankings. The boycotting institutions cited concerns about emphasizing prestige over public and student interests. Should nursing schools take similar action to encourage USNWR to use new methods to evaluate quality that incorporate core values supporting health equity? Although the current ranking system is touted as an "objective guide for students and parents," subjective peer assessments contribute to 25% of a master's level nursing school score and 100% of a baccalaureate nursing program's score. Peer assessments rest on the assumption that nursing school deans and clinical directors can judge the quality of other institutions accurately. In 1988, USNWR revised its undergraduate rankings after some university presidents refused to respond to the survey, claiming that neither they nor other university presidents could assess the quality of any other institution. In 2022, U.S. Secretary of Education Miguel Cardona observed that prestigious institutions "seek favor with [their] peers from other elite schools with expensive dinners and lavish events, because their opinions carry clout in surveys."
"Selectivity" of the institution contributes to an additional 15% of the score for a master's level nursing program and is calculated according to undergraduate grade point average, acceptance rate, number of degrees awarded, and percentage of enrollees in the program. Many have argued that the outsized focus on selectivity favors schools that admit students of high opportunity (higher socioeconomic status and resource rich) rather than high aptitude. The remainder of USNWR rankings for master's nursing programs focus on an institution's research activity (30%) and faculty resources (30%), neither of which reflects a student's likely educational experience at that institution.
The quality of a nursing program includes its ability to advance equity and prepare graduate students to improve health care outcomes. Discrepancies between a learner's needs and the support a school provides can result in high dropout rates, delayed graduation, substantial financial debt, stigma, and burnout.
A more appropriate ranking methodology would factor in schools' contributions to improving community and societal health and the readiness of graduates to advance health equity. Such an evaluation would include measuring student and faculty diversity, integration of health equity concepts throughout the curriculum, community-related school activities, and whether a school's mission guides those priorities.
Batra and colleagues (Academic Medicine, 2020) developed a tool to measure six core domains for what constitutes a strong health professions school with a social mission dedicated to health equity: educational program, community engagement, governance, diversity and inclusion, institutional culture and climate, and research focus. Those domains could be part of the metrics used to evaluate and rate schools and reduce disparities created by a system focused largely on academic scores. More importantly, it would allow students to weigh schools using criteria they may value in their potential educational experience.
Nurses should consider a systems-level change to address inequities in health care outcomes. We will get there by recruiting and graduating a diverse body of nurses educated to do this from within the health system, and our current rankings system needs to do more to address the inequities built into the nursing profession. Creating a rating system is an essential first step to ensuring a future where success and quality are measured by positive impact instead of prestige.