Don't Rank Us, Thank Us

How ranking nursing programs perpetuates an ailing healthcare system.



I got a phone call from my nursing school's alumni office this week. A sweet first year asked me to donate to the scholarship fund. He sounded petrified. I made some small talk to put him at ease. How were his classes going? (German is hard.)


I mentioned I was returning to school in the Fall for my DNP. Apparently, I'd hit alumni office conversation gold. Before I knew it, he was telling me that my DNP program was Top 10 in the country! And wouldn't I like to be a generous contributor to the fund that would help future students like me be enriched by such a stellar program!?


This reminded me of the recent US News and World Report naming this year's Top Nursing Schools. Facebook friends in nursing schools all over the country proudly posted their school's ranking: "So blessed to be part of such an incredible nursing community!"


That same week we also learned about the indictment of certain big-name celebrities and CEOs who paid their kids' way into our nation's most elite universities. The timing was deliciously uncomfortable.


The landscape of nursing education is not an even playing field. Rankings don't encourage less prestigious nursing schools to up their game. Instead, they make it impossible by fostering increased competition among a small handful of already elite programs.


According to US News and World Report’s methodology, the rankings are determined using the following metrics (among others): “research activity”, “faculty credentials”, “faculty participation in nursing practice”, and “the percentage of faculty members with important achievements”. US News also cites mean undergraduate GPA and total research funding granted as ranking factors for graduate nursing programs.


I certainly don’t have anything against gathering data about institutions of learning. But what is the result of collecting this particular set of data? Acceptance rates shrink as  more students respond to the Pavlovian Bell apply to the #1 school. Grant money comes easily to the Top 10. School #110, not so much. Universities know this. Why else are they so quick to advertise their rankings to prospective students and faculty?

Rankings create a positive feedback loop encouraging prestige - among universities and students alike.

Rankings create a positive feedback loop encouraging prestige - among universities and students alike.


When we humble-brag on social media about our nursing school’s ranking, we try to signal something to the world. I am smart. I am successful. I am a hard worker. I see a different signal. I am privileged. I am unaware of this. My worldview is limited.


Rankings aren't meant for everyone. They only matter to a very specific population of prospective students: those with the means to afford these schools. Higher education is expensive, especially at a ‘top tier’ private university. I carry $76,000 of nursing school student loan debt. Of my five favorite universities, I picked by far the cheapest.


If you were one of those nursing students proudly posting your school's rankings last month, I get it. I’ve been there.


After being accepted to a competitive nursing program, I received from the admissions committee an apologetic email: "We are deeply sorry for our drop in the rankings from #1 to #2 Graduate Nursing School. We have plans to improve. We do hope you'll still consider us when making your selection."


This email impressed me then. Wow! Look how seriously they’re committed to excellence.


Now, I laugh. I laugh because I’m a nurse.


Nursing is not about brushing elbows with the 1%. Nursing is about holding an ashamed, terrified, injured woman in your arms as your colleague slides a bedpan underneath her. Nursing is about you, the manager, grasping for words to acknowledge a staff member's trauma after they've witnessed a horrific death. Nursing is about you, the politician, refusing campaign contributions from pharmaceutical companies who seek to buy your complicity in a devastatingly ill healthcare system.


As a nurse, you see people at their lowest: naked, broken, frightened, and filthy. In these moments, no one cares about prestige. You may not stay at the bedside, but you never forget the vulnerability of the patients you've cared for. You may one day run the hospital, and you will carry your stories of patient care for the rest of your life. Hopefully, they will inform your decisions.


I have been humbled by my entry into this nursing profession. Things that once mattered to me - like university rankings - don’t anymore.


Nursing schools, you’re missing the point. I’m not interested in an institution actively strategizing to fit into the cookie cutter description of “Best Nursing School”. Your current marketing strategy recruits nursing students who care about winning in our current, ailing system. The students you should really have your eye on are the disruptors.


The celebrity college bribery scandal is a perfect complement to our university rankings’ release. In each case, the privileged few gain more and more prestige. The celebrity scandal was alarming to so many because it punched a hole through the Veil of American Meritocracy that distorts our worldview. We say, “Rich people are successful because they’re smart and hardworking.” But what does this mean when Johnny’s mom is caught buying him a ticket to Harvard?


Future and current nursing students, I ask you, what is your school’s rank worth to you? Is your school advocating for structural change to the way we provide professional healthcare education? How is it addressing the ridiculous cost of attendance that limits the access of so many eager, qualified students? Is it complicit in an ailing system or is it working to change that system?

The top nursing schools may not be interested in changing the status quo because it serves them.

Systems are sustained, unless they are challenged. Be wary: the top nursing schools may not be interested in changing the status quo because it serves them.


If you're a person of privilege - perhaps a white upper-middle class guy or gal who wants to be a nurse practitioner one day - you have a choice to make. You can choose to benefit from this system, advancing your personal career and being honored by the people who are like you. Or, you can be a disruptor, working to heal this ailing system that fails to put people first.


The idea that you must go to a top-ranked school to have success as a nurse falsely represents reality. It may make it easier. But what matters most is your competence and your character. If you're a respectful, reliable, hard-working nurse, you will get hired.


The nursing school you choose is important - but not because of its rank. Your school matters because it will change you. You need to be connected with all kinds of students, with a diversity of experiences and ideas. Your peers must challenge you, make you uncomfortable, transform you.


Nursing students, look for a learning community more interested in putting their head down and doing the work, than making sure the world knows they're doing it.


Our healthcare system is sick. Health professional education is part of this ailing system. Broaden your view. Scan the horizon for a place that will provide you with the most meaningful challenge and the most transformative journey. That doesn’t mean the right school can’t be well-ranked. Know that if your school ranks highly, it may be complicit in a system that rewards the status quo. But also know that a high rank means your school has significant power to change it.


I did donate to my university's scholarship fund. Not because of our ranking, but because I know that my university is committed to innovation, justice, and the healing of our healthcare system. They are a disruptive force, but they are also a power center in the system. That is strategic alignment for a nurse planning to make some waves.

© 2020 by Nursing the System

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