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Nursing Scholarship Program

Service Requirements and Eligible Sites

What are the service requirements after graduation?

1. Obtain a License
   Prior to commencing service at a Critical Shortage Facility (CSF), NSP participants must be permanently licensed within 6 months of graduation to practice as a registered nurse (or if appropriate, as an advanced practice nurse) in the State where they will be serving.
   1. Credit towards fulfillment of the scholarship service commitment will not be given in the absence of a current, unencumbered permanent license in the State of service.
   2. In addition, advanced practice nurses are expected to pass a national certification examination for their specialty (that is administered by a nationally recognized certifying body) prior to commencing service.
   3. Service credit will NOT be given until the NSP has received documentation that all licensure and certification requirements have been met. Documents should be uploaded to the Customer Service Portal.
   4. Responsibility for obtaining the required State license (and national certification exam, if applicable) prior to the service start date rests with the NSP participant.
   5. NSP participants are expected to take the appropriate licensure/certification exams at the earliest possible date.
   6. If the participant is unsuccessful in obtaining a license or passing the certification exam(s) within 6 months of his or her graduation date, the participant should immediately contact the NSP in writing at the address above to request a suspension. See the “Breaching the Contract, Suspension and Waiver” section in this Guidance.

2. Obtain a Position at a Critical Shortage Facility
   NSP participants will have up to 6 months from their date of graduation to (1) obtain a nursing license and (2) accept an offer of employment from an NSP-approved facility. Participants will have up to 3 months following the date of the acceptance of such job offer to commence full-time (or if approved by the Secretary, part-time) clinical services at the facility.
   Participants should contact the NSP prior to accepting employment to assure facility/position eligibility. The NSP reserves the right to grant final approval of all service locations in order to ensure a participant’s compliance with statutory requirements related to the service obligation (What are the types of sites where I can fulfill my service obligation?). Once employment begins, participants are required to submit an initial Employment Verification Form and a 6-Month Employment Verification Form thereafter until the service obligation is completed (See below).
   Participants may be recommended for default of their service obligation for failure to (1) accept an offer of employment from an NSP-approved facility within 6 months of their date of graduation or (2) commence full-time (or if approved by the Secretary, part-time) clinical services at the facility  within 3 months following the date of the acceptance of the job offer. Participants who default on their NSP service obligation incur the damages described in Breaching the Contract, Suspension, and Waiver.
3. Perform Full-Time or Part-Time Clinical Service
   Participants may satisfy their service obligations on either a full-time or, with written approval from the Secretary or his/her designee, a part-time basis.
   1. Full-Time clinical practice is defined as a minimum of 32 hours per week for a minimum of 45 weeks per year. At least 26 hours per week must be spent providing clinical services, or direct patient care, to patients. The remaining 6 hours may be spent on administrative or other non-clinical activities.
   2. Part-Time clinical practices defined as a minimum of 16 hours per week and up to a maximum of 31 hours per week. Participants wishing to serve part-time must first obtain approval from the Secretary or his/her designee and must extend their service obligation so that the aggregate amount of service performed will equal the amount of a full-time service obligation. At least 80% of the hours each week must be spent providing clinical services, or direct patient care, to patients. For example, a nurse scheduled to work 20 hours per week must spend at least 16 hours per week providing clinical services.
   3. Absences
      Please note that the information provided below pertains to compliance with the NSP service obligation and is not a guarantee that a service site will allow any particular amount of leave.
      No more than 35 work days per service year can be spent away from the approved NSP site for vacation, holidays, continuing professional education, illness, or any other reason. If a participant has circumstances due to a medical or personal emergency that will result in an extended period of absence, he/she will need to request a suspension of the NSP service commitment. The NSP cannot guarantee that a suspension request will be approved. If a suspension is requested and approved, the participant’s service commitment end date will be extended accordingly.

4. Verify Service. Every NSP participant who has completed school and is providing clinical nursing services must verify their service every six (6) months through the Customer Service Portal. In this process, an appropriate official at the NSP-approved CSF must certify the participant’s compliance or noncompliance with the full-time or part-time service requirement during each 6-month period. The service verification process will also record the time spent away from the CSF.
   Participants who fail to complete and submit their 6-month service verification through the Customer Service Portal on time may jeopardize receiving service credit and may also be recommended for default. Participants must download and submit the form via the Customer Service Portal. Any participant who cannot complete the form through the portal should contact the NSP immediately through the Customer Service Portal, by phone (1-800-221-9393), or email to GetHelp@hrsa.gov.

What are the types of sites where I can fulfill my service obligation?

NSP participants are required to serve for a minimum of 2 years at a health care facility with a critical shortage of nurses (Critical Shortage Facility) and will be expected to serve at a Tier 1 Critical Shortage Facility. A Critical Shortage Facility is defined to be:

Critical Shortage Facility (CSF) – a health care facility located in, designated as, or serving a primary medical care or mental health Health Professional Shortage Area (HPSA).

Health care facilities include the following types:

1. Critical Access Hospital (CAH). A facility that is (a) located in a State that has established with the Centers for Medicare and Medicaid Services (CMS) a Medicare rural hospital flexibility program; (b) designated by the State as a CAH; (c) certified by the CMS as a CAH; and (d) in compliance with all applicable CAH conditions of participation. For more information, please visit Critical Access Hospitals.
2. Disproportionate Share Hospital (DSH). A hospital that has a disproportionately large share of low-income patients and receives an augmented payment from the State under Medicaid or a payment adjustment from Medicare. Hospital-based outpatient services are included under this definition. For more information, please visit Disproportionate Share Hospitals.
3. Public Hospital. Any hospital that is owned by a government (Federal, State, or Local) and receives government funding and is primarily engaged in providing, by or under the supervision of physicians, to inpatients: (a) diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons; or (b) rehabilitation of injured, disabled, or sick persons. Hospital-based outpatient services are included under this definition.
4. Federally Qualified Health Center (FQHC). FQHCs include: (1) nonprofit entities that receive a grant, or funding from a grant, under section 330 of the Public Health Service Act to provide primary health services and other related services to a population that is medically underserved; (2) FQHC “Look-Alikes” which are nonprofit entities that are certified by the Secretary of HHS as meeting the requirements for receiving a grant under section 330 of the Public Health Service Act but are not grantees; and (3) outpatient health programs or facilities operated by a tribe or tribal organization under the Indian Self-Determination Act or by an urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act. FQHCs include Community Health Centers, Migrant Health Centers, Health Care for the Homeless Health Centers, and Public Housing Primary Care Health Centers. Find health centers listed by State.
5. Indian Health Service Health Center. A health care facility (whether operated directly by the Indian Health Service or by a tribe or tribal organization, contractor or grantee under the Indian Self-Determination Act, as described in 42 Code of Federal Regulations (CFR) Part 136, Subparts C and H, or by an urban Indian organization receiving funds under Title V of the Indian Heath Care Improvement Act) that is physically separated from a hospital, and which provides clinical treatment services on an outpatient basis to person of Indian or Alaskan Native descent as described in 42 CFR Section 136.12. For more information, please visit Indian Health Service.
6. Native Hawaiian Health Center. An entity: (a) which is organized under the laws of the State of Hawaii; (b) which provides or arranges for health care services through practitioners licensed by the State of Hawaii, where licensure requirements are applicable; (c) which is a public or nonprofit private entity; and (d) in which Native Hawaiian health practitioners significantly participate in the planning, management, monitoring, and evaluation of health services. For more information, please see the Native Hawaiian Health Care Act of 1988 (Public Law 100-579), as amended by Public Law 102-396.
7. Rural Health Clinic. An entity that the Centers for Medicare and Medicaid Services has certified as a rural health clinic under section 1861(aa)(2) of the Social Security Act. A rural health clinic provides outpatient services to a non-urban area with an insufficient number of health care practitioners. For more information, please visit Rural Health Clinics.
8. Skilled Nursing Facility (SNF). An institution (or a distinct part of an institution), certified under section 1819(a) of the Social Security Act, that is primarily engaged in providing skilled nursing care and related services to residents requiring medical, rehabilitation, or nursing care and is not primarily for the care and treatment of mental diseases. For more information, please visit Skilled Nursing Facilities.
9. State or Local Public Health or Human Services Department. The State, county, parish, or district entity in a State that is responsible for providing population-focused health services which include health promotion, disease prevention, and intervention services provided in clinics or other health care facilities that are operated by the Department.
10. Ambulatory Surgical Center. An entity in a State that provides surgical services to individuals on an outpatient basis and is not owned or operated by a hospital
11. Home Health Agency. An agency or organization, certified under section 1861(o) of the Social Security Act that is primarily engaged in providing skilled nursing care and other therapeutic services. For more information, please visit Home Health Agencies.
12. Hospice Program. An agency or organization, certified under section 1861(dd)(2) of the Social Security Act, that provides 24-hour care and treatment services (as needed) to terminally ill individuals and bereavement counseling for their immediate family members. This care is provided in individuals’ homes, on an outpatient basis, and on a short-term inpatient basis, directly or under arrangements made by the agency or organization.
13. Non-Disproportionate Share Hospital. An institution in a State that is primarily engaged in providing care, by or under the supervision of physicians, to inpatients: (a) diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, of (b) rehabilitation of injured, disabled, or sick persons. Hospital-based outpatient services are included under this definition.
14. Nursing Home. An institution (or a distinct part of an institution), certified under section 1919(a) of the Social Security Act, that is primarily engaged in providing, on a regular basis, health related care and service to individuals who because of their mental or physical condition require care and service (above the level of room and board) that can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases. For more information, please visit Nursing Homes.

Ineligible facilities include, but are not limited to:

1. Free-standing clinics that do not qualify as a facility above;
2. Renal dialysis centers;
3. Private practice offices;
4. Assisted living facilities; and
5. Clinics in prisons and correctional facilities.

If a participant is not sure whether a facility fits into one of the categories above, please contact the facility’s business office or human resources department.
NSP participants must provide full-time (or if approved, part-time) clinical service in a CSF. Participants are expected to serve in Tier 1 of the CSFs (see below). NSP participants who must relocate to accept a position in a different geographic area will not receive a relocation incentive or reimbursement.

What is a HPSA and how do I locate a facility’s HPSA score?

Health Professional Shortage Areas (HPSAs) are designated by the Health Resources and Services Administration (HRSA) as having shortages of primary medical care, dental or mental health providers and may be geographic, population, or institutional. NSP will only be using primary medical care and mental health HPSA designations and scores. For more information on HPSA designations, please visit Shortage Designation: HPSAs and MUAs.
Participants should consult the HPSA websites listed below: 

• Find HPSAs by Address: Enter the facility’s address to see if the facility is located in a HPSA. Please note that once the results are generated, the facility MUST be located in a primary medical care or mental health HPSA. More specifically, “Yes” must appear beside “In a Primary Care (or Mental Health) Health Professional Shortage Area”. The primary care/mental health HPSA score(s) will appear beneath the respective designation(s). 
• Find HPSAs by State and County: Find HPSAs by State, county, and discipline (select only primary medical care or mental health).

A HPSA score or HPSA designation status may change on the HPSA websites over time. A facility may be deemed as a Tier 1 CSF at the time the NSP participant begins nursing school but may become a Tier 3 CSF by the time the participant completes nursing school. If a facility has more than one designation with different scores, NSP will use the highest score.

Can I leave my NSP-approved Critical Shortage Facility prior to completion of service?

The NSP expects that a participant will fulfill his or her obligation at the NSP-approved CSF; however, the NSP does understand that circumstances may arise that require a participant to leave the initial facility and complete service at another NSP-approved CSF. If a participant feels he or she can no longer continue working at the approved facility, the participant should contact the NSP. All transfers must be approved by the NSP. A transfer request should be submitted before the participant leaves his or her site. Leaving the assigned site without prior written approval may result in a default recommendation.

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