Admission Criteria for Undergraduate Nursing Programs: A Narrative Literature Review

Abstract

Introduction

Admission criteria for selecting the undergraduate nursing candidates have been a major concern in many countries over the past few decades. The quality of graduate nursing professionals appears to be associated with the effectiveness of undergraduate student selection processes.

Aim

This literature review aimed to assess and summarize the existing research evidence regarding undergraduate nursing program admission criteria.

Methods

Twenty-two eligible studies were selected for full review from PubMed, Cochrane Library, ScienceDirect, Scopus, ERIC, Medline, and CINAHL databases.

Results

The following themes were identified using thematic analysis: grade point average, traditional interviews, and multiple mini-interviews as admission criteria. Studies on commonly used admission criteria, examining their effectiveness and limitations, were reviewed and analyzed.

Conclusion

The continuous development of admission criteria for undergraduate nursing education has both opportunities and challenges. To choose the best applicants for nursing programs, a thorough evaluation was required by using a multifaceted selection process that equally considers caring values, academic ability, and overall potential. This can significantly contribute to the progress of the nursing profession and, more importantly, the safety and quality of care that patients and local communities will receive.

Background

Criteria for admission to undergraduate nursing programs were a fundamental determinant of the quality of entry students and the holistic development of the nursing profession. The success of any higher education institution depends on its undergraduate selection (Capponi & Mason Barber, 2020). Therefore, admission criteria for selecting the undergraduate nursing candidates have been a major concern in many countries over the past few decades (Shulruf et al., 2011; Zamanzadeh et al., 2020).

The nursing profession requires a high level of commitment, intense academic preparation, and emotional fortitude (Yousafzai & Jamil, 2019). Its rigorous requirements make it important to carefully evaluate entrance requirements to ensure that prospective nurses have the knowledge and skills needed to excel in their coursework and, eventually, deliver top-notch patient care (Tamimi et al., 2023). Therefore, the selection of capable students for health professional schools was a critical starting step that facilitated the cultivation of competent and compassionate health professionals (Yousafzai & Jamil, 2019). Generally, admission criteria were set by educational institutions, such as ministries of education, while universities largely determine their specific requirements (Griffin, 2025).

Universities use a variety of methods to choose applicants, frequently including grade point average (GPA), admissions tests, interviews, letters of recommendation, personal statements, and previous healthcare experience to assess both academic cognitive and non-cognitive abilities (Yousafzai & Jamil, 2019). Hence, it was concluded that the responsibility to select and admit students to undergraduate nurse education programs often falls with university admission teams and nurse educators. Consequently, nursing schools were responsible for implementing valid and reliable admission criteria to select the most qualified applicants (Vierula et al., 2024).

The nursing profession is known as one of the most difficult and stressful professions (Ibrahim et al., 2024; Nabizadeh-Gharghozar et al., 2021). It covers significant challenges and rewards, which require emotional and physical resilience. Consequently, nurses need to be in good health based on valid occupational health standards to take responsibility for nursing work (Gallagher & Timmins, 2022). For this reason, occupational health screening was common for students entering nurse education programs (Gallagher & Timmins, 2022).

Studies suggest a possible association between recruitment mechanisms and the clinical competence and compassion levels of newly graduated nurses (Vierula et al., 2024). Furthermore, there was a lack of attention to the psychological and mental capacities of students admitted to nursing programs (Vierula et al., 2024). Despite the necessity to attract and select a professional workforce, nursing, unlike other healthcare occupations, does not have a comprehensive analysis of the selection criteria and recruitment tactics employed (Zamanzadeh et al., 2020). Therefore, the implications of current admission trends require attention that will not only enhance the admission process but also contribute to the development of a nursing workforce better equipped to meet the demands of healthcare. A conceptual framework representing the nursing admission criteria was originally developed to support the study (Figure 1). This conceptual framework embodies a comprehensive nursing admissions model that amalgamates academic credentials, personal characteristics, environmental influences, and several assessment instruments. It focuses on both cognitive factors like GPA and test scores, and non-cognitive traits, like empathy, resilience, and drive. The framework encourages fairness and inclusion by taking into account candidates’ socioeconomic background, cultural diversity, and life experiences. The main goal is to improve the success of the program, the readiness of nurses to work, the number of nurses who stay in the field, and the diversity of the nursing workforce.

Figure 1.

A conceptual framework about holistic nursing admission criteria.

In this framework, GPA is classified as an academic qualification, whereas interviews and multiple mini-interviews (MMIs) are designated as both personal attributes and evaluative instruments, illustrating how each criterion enhances a thorough and equal admissions process.

Methods

This narrative review seeks to evaluate and assess the current research findings about the admission criteria for undergraduate nursing programs. A narrative approach was chosen since the study designs, populations, and outcomes measured were too different from each other to be able to combine them into one number. However, systematic components like explicit inclusion and exclusion criteria and a PRISMA flow diagram were added to make sure that the methods were strict and clear.

The PICO framework was adapted to direct the research focus as follows: Population (P): Individuals applying to nursing programs as undergraduates Intervention/Exposure (I): Criteria for admission and selection (e.g., GPA, interviews, several mini-interviews) Comparison (C): Different ways of letting people in or not having certain conditions Outcome (O): Student academic performance, program completion, clinical competence, and preparedness for practice

Selection of Studies

Studies were included if they primarily targeted undergraduate nursing students and analyzed admission factors pertinent to this demographic. Eligible studies employed quantitative (e.g., cross-sectional, correlational, cohort), qualitative (e.g., grounded theory, descriptive), or review-based methodologies (systematic or scoping reviews). Only peer-reviewed, full-text articles published in English from 2005 to 2024 were included. Studies from many nations and contexts were incorporated to facilitate international comparison, as long as they concentrated on tertiary-level undergraduate nursing education rather than secondary school pre-nursing programs. Editorials, opinion articles, student dissertations, and gray literature were omitted. Secondary sources were excluded from the synthesis unless utilized contextually. This review employed a narrative methodology owing to the variability in study design, population attributes, institutional contexts, and outcome metrics among the included literature, rendering a meta-analysis or systematic synthesis approach inappropriate.

Search Strategy

A thorough literature search was performed in the following health-related databases: PubMed, CINAHL, Scopus, Cochrane Library, ERIC, Medline, and ScienceDirect. These databases were chosen because they jointly index the majority of pertinent health, nursing, and education journals where relevant papers are expected to be published. The search approach integrated free-text phrases and subject titles where necessary. The principal search terms encompassed (“admission criteria” OR “admission prerequisites” OR “student selection” OR “undergraduate nursing admission” OR “nursing program admission”) AND (“nursing students” OR “undergraduate nursing” OR “bachelor of nursing” OR “student nurse”) AND (“interviews” OR “multiple mini-interviews” OR “MMI” OR “grade point average” OR “GPA” OR “academic performance” OR “selection methods”).

Medical Subject Headings (MeSH) and database-specific indexing phrases were utilized when accessible (e.g., Students, Nursing [MeSH] in PubMed; Education, Nursing, Baccalaureate [MeSH]). For Scopus, supplementary non-MeSH keywords were incorporated to encompass a wider range of terminological variations. To augment the thoroughness of the search, backward citation tracking was conducted by examining the reference lists of all included research to locate other eligible papers. Figure 2 presents a PRISMA flowchart that encapsulates the search approach.

Figure 2.

PRISMA flow diagram of the literature review process.

We rigorously put the data from the 22 studies into a structured datasheet (Table 1). The categories for extraction were the author(s), year, country, title, study design, setting and sample, objectives, important findings, and suggestions. Two independent reviewers did the data abstraction procedure to make sure it was accurate and to reduce bias. We talked about any disagreements and came to an agreement.

Table 1.

Summary of Studies Datasheet (n = 22 Studies).

No.	(Author, Year), and country	Title	Journal name	Objective	Study design	Setting and sample	Findings	Recommendations
1	(Gallagher & Timmins, 2022) United Kingdom	Admission to undergraduate nurse education programs: Who should be selected?	Nursing Ethics	to reflect on how processes and criteria for admission has evolved and how these continue to be contentious.	Editorial	Interview with male and female students	The nursing profession had a shortfall of over six million nurses globally and has evidence of the impact on the nurse workforce during the pandemic.	Balancing requirements to support equality, diversity, and inclusion in nurse education with the need for patient safety and quality care.
2	(Finch et al., 2014). United States of America	Being Interviewed for Admission to a BSN Program: A Qualitative Inquiry	Advances in Nursing	was to examine students’ lived experience of being interviewed for admission into a BSN program, with the application of findings to more holistically examine the interview process.	Qualitative study (grounded theory)	25 nursing students	Three themes were extracted: (1) Seeing Me and (2) The Right Stuff is better assessed with interviews.	This study adds value to the admissions process, as both the interviewers and the students have stated. This is one of the lessons learned. Before the interview was added, nursing schools possessed declining attrition rates and a dearth of variety.
3	(Callwood et al., 2020) United Kingdom	The predictive validity of Multiple Mini Interviews (MMIs) in nursing and midwifery programmes: Year three findings from a cross-discipline cohort study	Nurse Education Today	To examine the reliability and predictive validity of MMIs using end-of-year-one practice outcomes of undergraduate pre-registration adult, child, mental health nursing, midwifery, and paramedic practice students.	Cross-sectional cohort study. Conducted in One university in the United Kingdom.	180 adults, 33 children 34 mental health nursing, and 34 paramedic practice students	Evidence of the reliability of MMIs across multi-professional groups. Insight into the significance of the number of stations about predictive validity. Age and academic entry level do not appear to influence MMI scores.	The results support MMIs as a valid measure of the future performance of students in practice when a 7-station model is employed. MMIs were also found to be objective and not influenced by age or academic entry level. These outcomes have generic relevance in informing the national and international use of MMIs in healthcare professional selection processes.
4	(Capponi & Mason Barber, 2020) United States of America	Undergraduate nursing program admission criteria: A scoping review of the literature	Nurse Education Today	To provide a broad overview of literature related to undergraduate nursing program admission criteria used by faculty and administrators in the United States to predict student program success.	Scoping review	35 relevant articles were selected for review	3 themes emerged in the charted literature representing criteria used to predict student program success: academic program admission criteria, nonacademic program admission criteria, and admission criteria formulas or scoring systems.	Significant gaps in the literature exist regarding standards or benchmarks for determining program admission criteria, including nonacademic criteria.
5	(Negarandeh et al., 2021). Iran	Exploring the Reasons for the Inadequate Clinical Competency in the Newly Graduated Nurses: A Qualitative Study	International Journal of Ayurvedic Medicine	To explore the reasons for the inadequate competence of newly graduated nurses.	Qualitative study	30 individuals, including nursing students, newly graduated nurses, nursing faculties, clinical nurses, nursing managers, and deputies for the education of nursing schools.	3 main categories emerged as reasons for inadequate clinical competency in the newly graduated nurses such as the inefficient mechanism of student recruitment, ineffective education, and a gloomy outlook for the nursing profession.	The process of training certified clinical nurses is dynamic and involves recruiting the right people, setting up a training infrastructure that works, teaching them well, giving them in-service training, and giving them the drive to pursue their careers.
6	(Crawford et al., 2021). United Kingdom	An exploration of the predictive validity of selection criteria on progress outcomes for pre-registration nursing programmes-A systematic review	Journal of Clinical Nursing	To determine which selection techniques are currently employed in pre-registration nursing programs and to evaluate the degree to which these techniques can predict students’ performance.	A systematic review	25 studies met the criteria for inclusion.	A significant aspect of nurse educators’ work is choosing students who possess the knowledge, interpersonal skills, and character traits necessary to finish undergraduate nursing programs. This analysis demonstrates the great range of selection techniques employed by various institutions, some of which are superior at forecasting student outcomes to others.	To support the sustained use of some popular selection techniques for undergraduate nursing programs, more research is needed. The likelihood of choosing students who will succeed appears to be increased by selection models that incorporate different kinds of selection factors with predictive value.
7	(Crouch, 2015) United States of America	Predicting Success In Nursing Programs	Journal of College Teaching & Learning	To evaluate the value of the National League of Nursing pre-admission exam and the college requirement grade point average as commonly used entrance criteria, as well as the Watson-Glaser Critical Thinking Appraisal.	A discriminant analysis	Data were collected from 192 first-year nursing students	The identification and validation of applicant selection criteria that predict success in the nursing programs will continue to be of significant importance because of the emphasis on the importance of fostering critical thinking in nursing education	Studies to determine how nursing educators score on the Watson-Glaser Critical Thinking Appraisal would provide data regarding the critical thinking abilities of educators
8	(Gale et al., 2016) United Kingdom	Student nurse selection and predictability of academic success: The Multiple Mini Interview project	Nurse Education Today	To evaluate the degree to which the MMI is predictive of nursing school achievement and to look for signs of bias in the MMIs (gender, age, nationality, and secondary school location).	A longitudinal retrospective analysis of student demographics, MMI data, and the assessment marks for years 1, 2, and 3.	One university in southwest London uses one cohort of students who commenced their program in September 2011, including students in all four fields of nursing.	When combined with the MMI reading and numeracy tests, MMI reveals minimal to no prejudice for age, gender, nationality, or secondary school location. MMI is only marginally predictive of academic success when combined with literacy and numeracy tests.	The MMI seems to be a useful tool for nursing candidate selection when combined with literacy and numeracy assessments. The degree to which selection techniques are indicative of nursing students’ academic success, however, may be increased by additional techniques like psychological profiling or emotional intelligence testing.
9	(Griffin, 2025). Australia	Exploring the Effectiveness of a Prenursing Introductory Course: Experiences of Culturally Diverse Nursing Students	Nursing Education Perspectives	To ascertain if MMIs are multidimensional or unidimensional, and whether MMIs conducted at different institutions assess the same or different constructs to each other or panel interviews.	Cross-sectional	Participants were candidates for medical degrees who were selected for interviews in 2013 (n = 165) and 2014 (n = 128) at three separate institutions. A panel interview was employed by the third institution, whereas two institutions used custom MMIs that were created apart from one another.	Similar findings from exploratory principle components analysis and confirmatory factor analysis were found in the data from both years, indicating the validity of a unidimensional model. The correlation between the two overall MMI scores was higher in 2013 and 2014 (r = .56 and.64, respectively) than it was in 2013 and 2014 (r = .07 and.15, 2013; r = .39 and.48, 2014) with the panel interview scores.	It seems that one latent construct—though not the same construct—is tapped by the panel interviews conducted by MMI. It is proposed that the MMI approach might make it possible to measure an emergent concept like adaptability.
10	(Herrera, 2019). United States of America	Quantitative analysis of variables affecting nursing program completion at Arizona State University	Research in Higher Education	To understand the patterns of selection, preparation, retention, and graduation of undergraduate pre-licensure clinical nursing students in the College of Nursing and Health Innovation at Arizona State University enrolled in 2007 and 2008.	Cross-sectional correlational analysis	523 students were examined using several independent variables were examined including GPA earned in prerequisite courses; replacement course frequency; scores earned on the Nurse Entrance Test (NET); the number of prerequisite courses taken at four-year institutions; race/ethnicity; and gender.	Specific prerequisite courses—Human Nutrition, Clinical Healthcare Ethics, and Human Pathophysiology—as well as race/ethnicity, and gender are predictive of completing this program in the prescribed four terms.	-
11	(Yousafzai & Jamil, 2019) Pakistan	Relationship between admission criteria and academic performance: A correlational study in nursing students	Pakistan Journal of Medical Sciences	To determine the relationship between various variables in the existing admission criteria and academic performance.	Cross-sectional design	Data (2009–2017) was gathered from the records of the Institute of Nursing Science, Khyber Medical University.	A substantial correlation between nursing students’ academic achievement and the entrance requirements. Academic performance is significantly correlated with several admission criteria variables, including SSC marks (r = 0.32, p=>0.001), prior diploma-level academic scores (r = 0.48, p=>0.001), and entrance exam scores (r = 0.26, p=>0.001). Nonetheless, prior diploma-level academic performance was a greater indicator of academic achievement.	Use integrated admission criteria for the selection of students and bring changes in the traditional admission process.
12	(Perkins et al., 2013). United Kingdom	Evaluation of a multiple-mini-interview protocol used as a selection tool for entry to an undergraduate nursing programme	Nurse Education Today	To assess whether standard interviewing techniques used for the final selection are sufficient in revealing critical competencies.	Managing evaluation toll using interviews	890 candidates and 82 interviewers completed a short questionnaire to gauge their reaction to the concept	Candidates responded well, with 65% saying that it was “a better experience” than traditional interviews. It was discovered that most uninvited comments alluded to limitations on chances to share one's passion for nursing. Positive feedback was also received from interviewers, with 71% mentioning “a better experience.” According to uninvited feedback, some would have preferred to have had more time to talk with their interviewees about nursing-related issues.	It has been agreed that the MMI system of interviewing will be retained and further work will include the tracking of students through and into the workplace.
13	(Schmidt & MacWilliams, 2011) United States of America	Admission criteria for undergraduate nursing programs: a systematic review	Nurse Educaator	To offer an evidence-based examination of the academic and nonacademic entrance requirements for undergraduate nursing programs to those who are involved in the admissions process.	Systematic review	50 studies were reviewed	In the face of nursing shortages, shrinking resources, and rising NCLEX passing scores, it is critical that nursing programs admit applicants who are most likely to succeed.	Nursing programs must admit candidates who are most likely to succeed in light of the scarcity of nurses, the reduction of resources, and the rise in NCLEX passing scores.
14	(Shulruf et al., 2011) New Zealand	Rethinking the admission criteria to nursing school	Nurse Education Today	to identify the best predictors for student achievements (Undergraduate Grade Point Average (UGPA)) in their first year in an undergraduate nursing program	Quantitative linear regression model	Tracking Project database which is held by the Faculty of Medical and Health Sciences at the University of Auckland. The data (n = 134) student's information.	The regression models suggest that the best predictor for the first-year GPA is the NCEAGPA (beta = .488; R2(for the entire model) = .53), followed by the admission ranking scores (beta = .308; R2=.40).	It is suggested that a Dual Admission Model (DAM) be utilized whereby students could be admitted either by the current university admission criteria or by an alternative model, which is purely based on the predictability of achievement within the nursing program. Application of the DAM to other institutions/countries was discussed.
15	(Ali et al., 2019) Pakistan	Multiple Mini-Interviews: Current Perspectives on Utility and Limitations	Advances in Medical Education and Practice	To review the available evidence to establish the utility of MMI.	Review paper	This literature search contains 74 publications	MMI scores have both a negative and a positive connection with assessment instruments that measure the same characteristics. With examinations gauging various qualities. There is a plethora of literature supporting its acceptability, but less supports its viability.	The following factors should be taken into account when calculating the cost: creating the interview materials; using human resources, training the interviewers, and the infrastructure and support staff needs. To address the constraints of linguistic barriers, cultural variety, and raters’ type influence, more research is needed.
16	(Talman et al., 2018). Finland	The predictive value of two on-site selection methods of undergraduate nursing students: A cohort study	Journal of Nursing Education and Practice	To compare the predictive value of two on-site selection methods used in nursing student selection.	Cohort study	Students admitted to 4 undergraduate BSc nursing programs at one Finnish nursing school between 2002 and 2004 (N = 626) were allocated into two cohorts based on the on-site selection method. Follow-up data was collected at two measurement points (2004–2009).	Two on-site selection methods produced very similar results regarding their predictive value. Both of the on-site selection methods predicted the knowledge skills, and study success of nursing students to some extent, but only explained a small proportion of variance.	It is not advisable to rely solely on the two on-site selection techniques to assess nursing students’ knowledge, abilities, or academic performance.
17	(Vierula et al., 2020). Finland	Identifying reasoning skills for the selection of undergraduate nursing students: a focus group study	Contemporary Nurse	To determine which thinking abilities should be evaluated when choosing candidates for undergraduate nursing programs.	Qualitative descriptive design	Four focus group interviews (n = 25) were undertaken with nursing students (n = 16) and experts (n = 9).	Deductive reasoning was used to identify all eight steps of the clinical reasoning process, which included 15 subcategories that represented reasoning skills in the selection phase. These processes were: Consider the situation, gather signals and data, analyze data, Determine the issue, set objectives, act, assess results, and reflect on the course of action and new knowledge. The most attention was placed on the start of the clinical reasoning process.	This study identifies reasoning skills that should be considered in the assessment of nursing applicants.
18	(Wagner et al., 2020) United States of America	Maximizing Effectiveness of the Holistic Admission Process: Implementing the Multiple Mini Interview Model	Nurse Educator	To describe the planning and implementation process for incorporating the MMI model into an existing holistic nursing program admission process	MMI model implementation	The design and execution approach for integrating the Multiple Mini-Interview (MMI) model into an already-existing holistic nursing program admissions process is covered in this article.	MMI model implementation resulted in more congruency in student attributes with the college vision, mission, and values and increased diversity.	The adoption of an effective, well-structured MMI interview methodology made it possible to meet admissions objectives overall and guaranteed that candidates who were chosen would exhibit qualities consistent with the college's mission and values as well as greater diversity.
19	(Wambuguh et al., 2016). United States of America	Examining the Importance of Admissions Criteria in Predicting Nursing Program Success	International Journal of Nursing Education Scholarship	To assess 5 criteria: pre-admit science GPA, TEAS score, healthcare experience, previous baccalaureate degree and pre-admission university enrollment vs. college transfer as predictors of 3 desired outcomes: graduation, nursing program GPA, and passing NCLEX-RN.	Cross-sectional	The study's student data came from our nursing program during the four years 2009–2014. Between 2009 and 2011, there were 130 students annually, and in 2012, there were 124 students, for a total sample size of 513 students in the study.	Nursing program outcomes were predicted by TEAS and pre-admit science GPA. In comparison to students with TEAS < 82, those with TEAS ≥ 82 had an 8% higher chance of graduating, a 13% higher chance of having a GPA ≥ 3.25, and a 9% higher chance of passing the NCLEX-RN. Comparatively speaking, students with pre-admit science GPAs > 3.8 had a 14% higher chance of a GPA ≥ 3.25 and an 11% higher chance of passing the NCLEX-RN.	It would be better to understand effective nursing education if measures for non-academic elements in nursing education and the nursing workforce were developed. In light of these findings, an empirical study is required to examine the effects of incorporating holistic admission standards.
20	(Wilson et al., 2008). Australia	Being an interviewer in a structured oral assessment process for selection of undergraduate nursing students: motivations, expectations and reflections of the experience	International Journal of Nursing Practice	To seek the perspectives of the assessors about the process of selecting undergraduate nursing students.	Cross-sectional	A semi-structured questionnaire was used with 45 assessors of nursing students at the University of Adelaide.	The most often stated reasons were wanting to influence who becomes a nurse (76.9%), knowing what it takes to be a registered nurse (76.9%), wanting to contribute to the advancement of the nursing profession (94.9% of respondents), and understanding what it takes to be a registered nurse (79.5%). The assessors considered the event pleasurable overall and expressed great praise for it.	To find out how well the method finds individuals who embody the attributes appraised for during the selection interviews—including the traits of the oral assessors who scored these qualities—longitudinal research is necessary.
21	(Zamanzadeh et al., 2020) Iran	A scoping review of admission criteria and selection methods in nursing education	BMC Nursing	To explore and synthesize the existing evidence regarding admission criteria and selection methods of nursing students and to identify an agenda for future research.	Scoping review	44 studies met the inclusion criteria.	Cognitive-academic abilities and non-cognitive abilities are the two main characteristics used to choose nursing students.	Results can be used to inform nursing education policymakers and institutions in the design of their selection practices.
22	(Vierula et al., 2024) United States of America	Applicants' success in the ethics entrance exam: A cross-sectional study’	Nursing Ethics	to assess social and healthcare applicants’ success and related factors in the ethics section of the universities of applied sciences digital entrance examination (UAS Exam) to undergraduate degree programmes.	A cross-sectional study	8972 participants from 20 universities		Students may need support in identifying ethical situations in practice and in further developing their ethical competence.

GPA, grade point average; MMI, multiple mini-interview.

A thematic analysis was conducted utilizing Braun and Clarke's six-phase framework: (1) familiarization with the data, (2) generation of initial codes, (3) formation of themes, (4) review of themes, (5) definition and naming of themes, and (6) selection of exemplar data to demonstrate conclusions. This strategy enabled the recognition of persistent trends across research while recognizing differences in context and methodology. The review process was also driven by the best practice criteria for evidence synthesis found in the JBI Manual for Evidence Synthesis (Aromataris et al., 2024). This manual gave a structure for making sure that narrative reviews were methodologically sound, open, and consistent.

Results

A total of 45 articles published between 2005 and 2024 were retrieved. After the removal of duplicates, 38 articles were screened for titles and abstracts. Twenty-nine relevant articles underwent full-text screening, of which 22 were found eligible to be included in the review (Figure 2). The studies’ information was extracted and organized in an electronic and paper datasheet (Table 1) by two authors (EA & SBH) to facilitate the review and interpretation of findings. The datasheet was divided into eight sections, which include author(s)/year/country, title, Journal name, purpose of study, study design, setting/sample, findings, and recommendations.

This review yielded 22 articles, eight of which were conducted in the United States of America (USA), five in the United Kingdom (UK), two in each of the following countries: Australia, Iran, Pakistan, and Finland, and one study in New Zealand. The majority of the studies were of a quantitative approach (n = 14, 64%), followed by the qualitative approach (n = 4, 18%), then two studies (9%) were a scoping review, and two studies (9%) were a systematic review.

Thematic analysis utilizes the method of following six processes that make up the iterative process: (1) familiarizing oneself with the data; (2) creating codes; (3) generating themes; (4) reviewing themes; (5) defining and labeling themes; and (6) identifying exemplars (Braun & Clarke, 2012). Firstly, relevant data from the chosen articles were collected, such as admission criteria and application forms for undergraduate nursing students. By reviewing the collected data, the authors become familiar with the information related to undergraduate nursing students using the key information, including eligibility requirements, academic criteria, personal statements, letters of recommendation, interviews, and any other factors considered in the admission process. Open coding, identifying concepts from the data, was started, and then descriptive codes were used to capture the essence of the admission criteria mentioned in the documents or interviews that took place. Related codes into preliminary themes were extracted by looking at their patterns, connections, or similarities. Naming themes as follows: (1) the GPA, (2) traditional interviews, and (3) MMIs as admission criteria.

Grade Point Average Pre-Admission Criteria

GPA was one of the primary academic program admission criteria. It remains a cornerstone of admission criteria, serving as a quantifiable indicator of academic performance. The majority of studies that were reviewed demonstrated that high school GPA was one of the best indicators of nursing student success, achievement, and program completion (Crouch, 2015; Schmidt & MacWilliams, 2011; Shulruf et al., 2011)

The predominant belief was that candidates with high GPAs and standardized test scores were generally believed to demonstrate stronger academic skills, which may be associated with future success in healthcare professions. However, although the GPA offers a valuable measure of academic capacity, it does not cover the multifaceted skills necessary for effective nursing practice. Tamimi et al., 2023 demonstrated that non-cognitive abilities, such as ethical judgment and empathy, were qualities required in those applying to join healthcare professions. These qualities cannot be measured by quantifiable measurements alone, such as GPA (Wagner et al., 2020). Moreover, interpersonal and communication skills cannot be evaluated by GPA (Finch et al., 2014). These limitations have led some institutions to incorporate additional evaluative components such as interviews.

Interviews

The face-to-face interviews provide a qualitative complement to the GPA, evaluating interpersonal skills, critical thinking, and the ability to empathize with patients, crucial attributes in the nursing profession (Capponi & Mason Barber, 2020). It was a non-academic program admission criterion that comprised two to three interviewers and one applicant who answered a series of preset questions and was scored according to the answers they provided (Crawford et al., 2021). The reason behind the interview was to evaluate the interpersonal and communication skills and the interest and aptitude that cannot be evaluated through the GPA and entrance exams (Mabope et al., 2022). Additionally, according to the evidence, morals and empathy were largely determined before students undergo professional training, making it essential to assess these qualities as part of the application and selection process (Ward et al., 2012).

A structured interview was intended to assess key professional competencies, including communication skills, teamwork skills, decision-making, and insight into self (Finch et al., 2014; Yousafzai & Jamil, 2019). Further, once the interview was included, attrition decreased, diversity increased (Talman et al., 2018), and cost decreased (Schmidt & MacWilliams, 2011).

A significant challenge that has emerged in this context was the subjective nature of the interview process, which was often a determining factor in the selection of candidates. Interviewer biases, such as the halo/horn effect, implicit bias, explicit bias, and extraneous characteristics, have contributed to reduced validity and reliability (Herrera, 2019; Wagner et al., 2020). In addition, the lack of consistency in interview practices in different institutions exacerbates these concerns even more. Therefore, the implementation of structured interview formats, training for interviewers, and continual monitoring and adjustment to ensure inter-rater reliability can mitigate bias and increase the reliability of the evaluation process (Finch et al., 2014; Wilson et al., 2008).

The Multiple Mini-Interview

MMI was one of the non-academic program admission criteria, which was originally used solely for medical school admission; nevertheless, increasing psychometrics have led to its adoption in other schools, like nursing schools (Calma et al., 2019).

Gale et al., 2016 suggested that future recruitments need a combination of intellectual and social skills, as well as characteristics such as honesty, empathy, and integrity. Such qualities were often not effectively captured through traditional interviews, highlighting the need for the implementation of MMI that could be feasible and successfully implemented (Ali et al., 2019).

Through a circuit interview structure, candidates in MMI spend 8–10 minutes at each of six to eight stations, with a different assessor at each station (Gale et al., 2016). It was intended to assess many of the personal characteristics, like critical thinking, communication skills, ethical decision-making, and knowledge of the healthcare system, which were previously insufficiently assessed by traditional interviews (Herrera, 2019). Additionally, the MMI has stronger psychometrics (reliability and validity) for selecting nursing students than traditional interviews (Ali et al., 2019; Gale et al., 2016; Perkins et al., 2013), with robust internal consistency (Callwood et al., 2020). Therefore, MMIs were considered an alternative to traditional interviews (Crawford et al., 2021).

MMI aims to recruit students who demonstrate the values and attitudes essential for healthcare professionals, including caring, compassion, honesty, leadership, and sound decision-making, ultimately fostering the development of compassionate individuals with strong communication skills (Gale et al., 2016). Interestingly, an efficient, well-structured MMI interview will allow achievement of overall admission goals and ensure selected applicants display traits aligned with the college vision and values and enhanced diversity (Wagner et al., 2020), along with the prediction of academic performance (Yousafzai & Jamil, 2019).

On the other hand, candidates who were interviewed using MMI argued that it limited the opportunity for applicants to discuss their past achievements and experiences and instead compelled them to perform rather than respond naturally and authentically (Yousafzai & Jamil, 2019). Furthermore, the MMI demands more time and effort than regular interviews because it needs participants to organize, carry out, and enter data, as well as the right infrastructure (Griffin, 2025; Yousafzai & Jamil, 2019).

It is noteworthy that, despite the common use of standardized test scores in admission criteria across numerous academic institutions, none of the 22 studies reviewed specifically investigated or highlighted standardized testing as a principal selection instrument for undergraduate nursing programs. This highlights a gap in the literature regarding how standardized test results may influence the selection process for nursing students.

Discussion

The objective of the current study was to review and analyze the existing research evidence regarding undergraduate nursing program admission criteria. In summary, a variety of admission criteria have historically and currently been used to assess undergraduate nursing students’ values and potential to become competent and compassionate nurses. Results of the current review showed that GPA, traditional interviews, and MMI were the main admission criteria in selecting undergraduate nursing students.

Nursing schools were mandated (by policies, individuals, local practices, etc.) to choose and instruct candidates who possess the right qualities to provide high-quality healthcare (Zamanzadeh et al., 2020). Selecting the right candidates for the nursing profession was essential to ensuring job compatibility, enhancing future workforce performance, and, perhaps most importantly, safeguarding patient safety (Chai et al., 2019). In addition, the continuous nursing shortage, the reduction of resources (Finch et al., 2014) (Schmidt & MacWilliams, 2011), and program attrition (Finch et al., 2014; Schmidt & MacWilliams, 2011) make it crucial to select applicants who will succeed (Schmidt & MacWilliams, 2011). According to the World Health Organization (WHO), a shortage of 11 million health workers (including nursing) was expected by 2030, primarily in low- and lower-middle-income nations (WHO, 2025).

Crouch (2015) found that assessing nursing students’ critical thinking abilities was especially important as professional nurses encounter more acutely ill patients, navigate developing technologies, and face complex ethical challenges (Crouch, 2015). Ethical competence was widely regarded as essential in health science professions, as it was linked with professionals acting with integrity and compassion. Therefore, selecting candidates who demonstrate potential for developing strong ethical judgment may support the cultivation of these attributes (Vierula et al., 2024). However, a review of the literature reveals that there remains a lack of consensus on the most effective criteria for admission into the nursing profession (Griffin, 2025; Talman et al., 2018). Besides, there was currently no standardized method available to reliably predict a student's success in completing a nursing program (Crouch, 2015).

Although GPA, interviews, and MMIs were the predominant admission criteria analyzed in the reviewed papers, the lack of emphasis on standardized test scores is significant. The infrequent focus on standardized exams in the examined literature may indicate a wider trend in nursing education that favors holistic and competency-based evaluations over standardized measures, given their prevalent role in higher education admissions processes (Yousafzai & Jamil, 2019). This underscores a domain for future investigation to assess the predictive validity and suitability of standardized test scores in nursing admissions, particularly. Finch et al. found in their qualitative study that including an interview as part of the admission process, alongside GPA, enables the faculty of nursing to assess a student's fit within the program. Additionally, students often perceive the interview as a positive experience and a valuable opportunity to present themselves beyond academic metrics (Finch et al., 2014).

In their cross-sectional study, they examined the reliability and predictive validity of MMI evaluation based on the practice outcomes of undergraduate nursing students (Callwood et al., 2020). The study found that using MMIs revealed a significant predictive validity of nursing outcomes among nursing students, noting that the academic entry level and age do not appear to affect MMI scores. Similarly, a study by Gale et al., 2016 found that MMI shows little to no bias based on age, gender, nationality, or secondary school location. These outcomes hold broad relevance in guiding both national and international implementation of MMIs as part of the selection criteria for healthcare professionals. Therefore, Schmidt & MacWilliams, 2011 suggested that a combination of admission criteria was more effective than relying on any single variable alone.

One point that was valid to discuss here was that many nursing programs were linked by regulatory and accreditation requirements, which emphasize traditional evaluation methods, which can hinder the exploration of alternative approaches. Therefore, there was a palpable need for institutions to balance innovation with rigor, ensuring that all the newly adopted admission criteria maintain the integrity and competence standards required for nurse accreditation. Meaning that meeting regulatory requirements while also pursuing best practices may increase the likelihood of recruiting and retaining student nurses who become proficient, competent, and compassionate professionals with passion and ambition to deliver excellent care to all they serve. The selection of undergraduate nursing students was a fundamental starting point; it was equally crucial to consider the ongoing support, training, and professional development opportunities provided to these students throughout their education and their graduate roles (Negarandeh et al., 2021).

It was essential to acknowledge the contextual disparities among the nations featured in the analyzed studies. Diverse healthcare systems, educational structures, and cultural norms can profoundly affect the formulation, execution, and results of nurse admission standards. What was productive or possible in one country setting may not immediately apply to another due to varying institutional priorities, resource availability, or societal values. Recognizing these contextual differences was crucial for accurately understanding the results and for informing the adaptation of best practices to local environments.

While the evaluated admission criteria, such as GPA, traditional interviews, and MMIs, exhibited predictive validity in many contexts, their relevance across international educational and cultural environments may necessitate careful modification. Resource-intensive procedures such as MMIs may be more feasible in high-income nations with adequate infrastructure, skilled evaluators, and institutional backing. Conversely, institutions in low- and middle-income contexts may depend more significantly on academic indicators like GPA due to limitations in staff or resources. Cultural norms pertaining to communication, decision-making, and professionalism may impact the assessment of attributes such as empathy and ethical judgment during interviews or MMIs. Consequently, although the evaluated criteria provide a solid basis, their application must be tailored to fit local settings, guaranteeing both practicality and cultural significance. Recognizing these differences can facilitate the wider applicability of the findings and augment the significance of nursing admission procedures worldwide.

This review has identified numerous significant deficiencies in the existing literature concerning undergraduate nursing admission criteria. Currently, there is no globally recognized or defined method for the selection of nursing students, resulting in variance among schools and regions. Secondly, while standardized test scores were frequently utilized in various higher education contexts, none of the 22 studies examined directly assessed their predictive validity or efficacy in nursing education, highlighting a notable gap in the literature. Third, there was an absence of longitudinal data connecting diverse selection methods, such as GPA, conventional interviews, and MMIs, to long-term outcomes, including program completion, clinical competency, and professional practice.

Although this research focuses on admissions criteria as predictors of academic and professional success, it was critical to recognize that these variables were part of a larger educational environment. Once admitted, students’ outcomes were influenced by institutional resources, mentorship availability, professional socialization opportunities, teacher participation, and the general learning environment. These factors have a substantial impact on students’ growth, retention, and preparation for practice. Thus, any examination of admissions processes should be contextualized within a broader perspective of the entire student journey through nursing education.

Implications

This review of the requirements for undergraduate nursing students to be admitted can be a useful instrument for guiding practice and policy. The findings of the current review may guide nursing schools to improve their selection processes to ensure that candidates possess not only high academic talents but also the emotional intelligence and communication skills required for effective patient care. Furthermore, establishing consistent admission criteria was essential to ensure that all nursing graduates attain a fundamental pattern of knowledge and skills, thus promoting public trust in the profession.

Furthermore, it can serve as the foundation for future research studies (especially longitudinal studies) to explore whether a strong correlation exists between admission criteria and student success, ultimately aiming to produce competent and compassionate nurses by the end of the program. Nursing education was a constantly evolving field, particularly with the rise of artificial intelligence (AI). As AI continues to advance, it is crucial to consider its impact on future nursing admission criteria.

At Fatima College of Health Sciences, a higher education institution based in the United Arab Emirates, we believe the findings will contribute to the development of best practice policies and procedures for selecting students based on their potential to become competent and compassionate healthcare professionals. This will help address the United Arab Emirates’ growing need for skilled healthcare professionals, particularly in the nursing field. Additionally, the results emphasize the importance of involving faculty and industry partners in the student selection process, as these students represent the future workforce. This was particularly crucial, given that many universities were assessed based on their success in helping graduates secure employment within 9 to 12 months of completing their programs.

Recommendations

In light of these shortcomings, future research should focus on developing standardized, evidence-based frameworks for evaluating candidate potential. Longitudinal studies must be undertaken to evaluate the correlation between diverse selection instruments (e.g., GPA, MMI, interviews) and student success indicators, including retention, academic performance, and post-graduation clinical competency. Additionally, emerging methods like artificial intelligence-assisted screening and virtual assessments must be assessed for their reliability, potential to mitigate bias, and feasibility. Institutions must also investigate how to synchronize these improvements with accrediting standards and regulatory requirements, ensuring rigorous and justifiable selection processes.

Conclusions

The continuous development of admission criteria for undergraduate nursing education has both opportunities and challenges. To choose the best applicants for nursing programs, a thorough evaluation was required by using a multifaceted selection process that equally considers caring values, academic ability, and overall potential. Institutions must evaluate not only prevailing best practices but also endeavor to address gaps in data, especially with standardized testing and longitudinal outcomes. A cohesive, research-based methodology for application selection will improve the capacity to attract students who are both academically proficient and personally aligned with the requirements of the nursing profession. Ultimately, enhancing admission criteria grounded on substantial data can result in superior student outcomes and elevated quality of patient care within healthcare systems. This can significantly contribute to the progress of the nursing profession and, more importantly, the safety and quality of care that patients and local communities will receive. Future studies should focus on assessing and improving student selection methods to ensure the identification of candidates who are best suited for success in their healthcare careers.