Clinician Recruitment and Service

Nursing Loan Repayment and Scholarship Programs

Notes:
* This long-term measure does not have annual targets.
a DNA = Data not available.  Data were not collected for FY 2005, FY 2006, and FY 2007.

INTRODUCTION

The Nurse Education Loan Repayment Program (NELRP) and the Nursing Scholarship Program (NSP) are authorized under Section 846 of the Public Health Service Act [42 USC 297n] to work in partnership with other HHS programs to encourage more people to consider nursing careers and motivate them to serve in areas of critical shortage.  The performance measures gauge these programs’ contribution to the HRSA strategic goals of improving access to health care and improving the health care systems through the recruitment and retention of nurses working in Critical Shortage Facilities.
A major challenge facing NELRP is ensuring placements in facilities with the greatest need.  As one strategy to assure better targeting of program resources to areas and facilities of greatest need, the Program is testing a methodology for identifying Critical Shortage Facilities for nurses.

Another major challenge for the Program is the current difficulty with data collection and analysis.  The Program had been using a Nursing Information System which was deactivated in anticipation of another system being brought online.  This has not yet occurred.  Both NSP and NELRP will participate in the new information management system of the Bureau of Clinician Recruitment and Service, which is scheduled to be operational at the end of FY 2009.  The Program anticipates reporting on FY 2009 performance data in 2010.

DISCUSSION OF RESULTS AND T ARGETS

Long-Term Objective:  Improve the distribution of health professionals in underserved areas.

5.1.  Increase the number of individuals enrolled in professional nursing education programs.

The NSP is expected to attract more students into nursing education by providing financial support during the training years. 

5.I.C.1.  Increase the proportion of nursing scholarship recipients working in a facility with a critical shortage of nurses within 4 months of graduation.

In FY 2004 the proportion was 43%.  Data is unavailable for this measure for FY 2005 through FY 2007 due to the lack of an information system.  The program expects to report on FY 2009 data in 2010. The FY 2009 target is 85%.

5.I.C.2.  Increase the proportion of NELRP participants working in shortage facilities such as:  Disproportionate Share Hospitals for Medicare and Medicaid; nursing homes, public health departments (State and local) and public health clinics contained in these departments.

Data for this measure is obtained by monitoring automated data on NELRP contracts.  NELRP applicants working in shortage facilities, such as Disproportionate Share Hospitals for Medicare and Medicaid; nursing homes, public health departments (State and local) and public health clinics contained in these departments are in the first preference category for awards.

These data indicate the degree to which NELRP resources are being successfully targeted to facilities experiencing the most critical shortages of nurses.  All available funds for initial awards were expended to nurses working in those facility types in FY 2004 through FY 2006.  The proportion in FY 2007 was 97%, exceeding the target by 8%. The target for FY 2009 is 90%, and reflects the requirement in the law (effective in 2009) that program participants may only be placed in entities that are non-profit (42 USC 297n(b)(3)), which is anticipated to disqualify some facilities such as nursing homes.

5.I.C.4.  Reduce Federal investment per year of direct support by increasing the proportion of program participants who extend their service contracts and commit to work at a critical shortage facility for an additional year.

NELRP initial contracts are for two years of service.  This indicator will provide a measure of the degree to which registered nurses participating in NELRP are willing to serve in a critical shortage facility for at least one additional year.  The proportions in FY 2005 and FY 2006 were 38% and 45%, respectively.  The target of 45% for FY 2007 was met.  The target for FY 2009 is 45%, reflecting the program’s expectation that third-year participation will continue at this current level.

5.I.C.3.  Increase the percent of States in which NELRP contract recipients work. 

Prior to FY 2002, information about this program was not widely distributed and contract recipients were limited to a small number of States.  Increased funding and marketing strategies in FY 2002 resulted in broader distribution of contract awards in more States. 

In FY 2007 NELRP participants were working in 94 percent of the States, which was 1 percent over the target, and 2% over the FY 2006 level.   Some fluctuation from year to year is expected because awards are based on financial need and type of facility rather than the State in which the recipient plans to work.  The target for FY 2009 is 93 percent.

5.E. Increase the proportion of NELRP participants who remain employed at a critical shortage facility for at least one year beyond the termination of their NELRP service.

This indicator will address the issue of retention by providing a measure of the degree to which trained nurses participating in NELRP are willing to serve in a critical shortage facility for at least one additional year beyond the termination of their NELRP service.  The FY 2004 result was an estimated 90 percent.  Data were not collected in FY 2005 through FY 2007 due to the lack of an information management system.  The target for FY 2009 is 50 percent.