Upstream gatekeeping in pre-nursing pathways: An institutional analysis of racialized attrition

Efforts to diversify the nursing workforce have emphasized recruitment and retention; however, persistent disparities suggest inequities may originate earlier in the pipeline. The pre-nursing phase, where prerequisite coursework and GPA thresholds determine eligibility, remains underexamined.

To examine racialized attrition in pre-nursing pathways as an institutionally produced outcome shaped by curricular design and progression requirements.

A retrospective institutional analysis was conducted using over a decade of academic records from a Midwestern public university. The sample included students who declared pre-nursing upon entry. Data included demographics, prerequisite course outcomes, progression to application eligibility, and degree attainment. Descriptive and comparative analyses examined disparities between racially and ethnically minoritized students and non-minoritized peers.

Attrition was concentrated at early progression points, particularly in foundational science courses and GPA thresholds. Minoritized students experienced consistently higher failure and withdrawal rates, contributing to cumulative "fail-any" patterns that limited progression to eligibility. These losses occurred prior to admission review and are not reflected in traditional retention metrics, indicating structural inequities in pathway design.

Pre-nursing pathways are a critical site of inequity in nursing education. Equity-oriented reform requires redesign of prerequisite structures, instructional practices, and progression policies, along with incorporation of upstream attrition into institutional accountability systems.