How can we grow the nurse supply in underserved areas?

Challenge

The Health Resources and Services Administration (HRSA) established the Nurse Corps program to address the uneven distribution of the nation’s nurses and the growing need for nursing professionals in rural and underserved areas.

The Nurse Corp program aims to lessen the financial burden of those pursuing nursing careers and incentivize nurses to work in underserved areas. To this end, the program provides repayment of loans or scholarships for nursing education in exchange for service in critical shortage facilities in health professional shortage areas and schools of nursing.

The COVID-19 pandemic increased demand for nursing care while exacerbating issues in nurse workforce distribution and retention. Westat is leading a 3-year mixed-methods evaluation to understand the impact of additional funding for the Nurse Corps program from the American Rescue Plan (ARP) Act of 2021, a one-time investment to support the COVID-19 emergency response and enhance the reach of the program.

Solutions

This project leverages Westat’s extensive experience in mixed-method evaluation design and data analysis along with our best-in-class survey research capabilities. We conducted secondary data analysis of program administrative data, examining Nurse Corps applications, awards, and distribution across 2 cohorts from 2017 to 2023. As part of this analysis, Westat harmonized data across several sources, including the Uniform Data System (UDS) and American Hospital Association (AHA).

Westat also designed and fielded a web-based national survey of Nurse Corps program participants and alumni to better understand participant experiences with the Nurse Corps program and long-term employment decisions. The survey administration included nonresponse telephone follow-up and achieved a 52% response rate.

We subsequently conducted in-depth follow-up interviews with a subset of program participants and alumni to enable a richer understanding of program experience.

Results

Findings from the evaluation will help HRSA to hone its strategic investments in the nation’s nursing workforce, particularly for increasing the supply of nurses in rural and underserved areas. In the first year of the evaluation, Westat found that additional funding for Nurse Corps greatly expanded the program’s reach. There was a nearly threefold increase in the number of Nurse Corps awards after the additional funding and a 76% increase in the number of counties with a Nurse Corps participant following additional funding.

Westat is preparing reports based on year 2 findings, focusing on participants’ experience with the program and on the retention of Nurse Corps participants in underserved areas and schools of nursing after they complete their service commitment to the program.

In the third year of the evaluation, Westat will conduct a cost-benefit analysis of the program to assess the value the Nurse Corps program brings to rural or medically underserved communities, schools of nursing, and public health and health care overall.

Report Findings

Year 1: Nurse Corps’ impact on increasing registered nurse staffing in critical shortage areas and facilities, 2017 to 2022