Supporting Statement
SECTION A
Initial
Submission: December 14, 2010; Revision: October 25, 2011
Prepared
for
Office of Management and Budget
Prepared by
Mongan Institute for Health Policy,
Massachusetts General Hospital
Boston MA
On behalf of
Uniformed Services University of the Health Sciences, Graduate School of Nursing
Department of Defense
TABLE OF CONTENTS
A. Justification and Background 2
Circumstances Making the Collection of Information Necessary 2
Purpose and Use of Information Collection 2
Use of Improved Information Technology and Burden Reduction 3
Efforts to Identify Duplication and Use of Similar Information 3
Impact on Small Business or Other Small Entities 3
Consequence to Federal Program of Not Collecting This Information 3
Special Circumstances 3
Federal Register Publication 3
Payments or Gifts to Respondents 3
Assurance of Confidentiality and Data Security 4
Justification for Questions of a Sensitive Nature 5
Estimates of Hour Burden of the Collection of Information 5
Estimates of Annualized Cost to the Respondent for Record Keeping 6
Estimated Annualized Costs to the Federal Government 6
Reasons for any Program Changes or Adjustments 6
Plans for Tabulation and Publication 6
Reason for Not Displaying Expiration Date for OMB Approval 6
Exceptions with “Certification for Paperwork Reduction Submissions” 6
A. JUSTIFICATION AND BACKGROUND
1. Circumstances Making the Collection of Information Necessary
The US healthcare system is facing an acute nursing shortage of unprecedented magnitude. This shortage is also affecting the Nursing Corps of the three military services. In this environment of a short supply of nurses, several initiatives are being explored to increase the number of nurses recruited annually by the military services. In order to achieve the level of recruitment required by the military to maintain desired end-strength, a more thorough assessment of barriers and incentives to pursuing military nursing careers is required.
The National Defense Authorization Act (NDAA) for 2010 requested a plan to establish an “undergraduate nurse training program” through which participants would earn a baccalaureate nursing degree and serve as a member of the armed forces. The NDAA provided two options: establish a Department of Defense (DoD) School of Nursing or enter into agreement with one or more academic institutions to establish and operate a program under which individuals will earn a Bachelor of Science degree in nursing. The Nursing Corp Chiefs of the Army, Navy and Air Force, who lead this initiative, chose the second option and developed the Tri-Service Nursing Academic Partnership (TSNAP) program. There are several components involved with the NDAA request. One, is creating academic partnerships with Schools of Nursing that are within a reasonable distance of major military facilities with military medical centers or the equivalent and two, providing an assessment of individuals who would be interested in such an educational nursing program; i.e., the Military Nurse Recruitment Survey. In March of 2009, a meeting was held with a number of Dean’s of Schools of Nursing to determine their interest in a possible academic partnership with the military nursing corps; Army, Navy and Air Force. Since then, the number of locations for the academic partnerships has been narrowed by the House and Senate Armed Services Committees (HASC, SASC) to those Schools of Nursing relatively close to military bases with medical centers or the equivalent. The plan for TSNAP has been provided by the Assistant Secretary of Defense for Health Affairs office to the following Congressional Committees; Senate Committee on Armed Services and its’ Subcommittee on Personnel, the Senate Committee on Appropriations and its’ Subcommittee on Defense, the House of Representatives Committee on Armed Services and its’ Subcommittee on Military Personnel, the Committee on Appropriations in the House of Representatives and its’ Subcommittee on Defense. Once the survey data are collected and analyzed, the information will be provided to the Corp Chiefs of the three Armed Services and to the HASC and SASC for further policy consideration on the use of TSNAP to educate baccalaureate nurses for the services.
The primary purpose of this study is to develop and deploy surveys to assess the knowledge, attitudes, barriers and incentives perceived by potential student populations to consider accepting an undergraduate nursing education in return for a commission as a nurse officer in the Armed Forces with a required service obligation. Targeted populations for this study will include students who are enrolled in university-based nursing schools offering BSN (Bachelor of Science in Nursing) degrees that, per the policy guidelines noted above, are located within close proximity to major military bases in the US. We also plan an exploratory online survey of young adults in the general public and in similar geographical regions to major military bases in order to understand barriers and incentives for this population. The data from the student survey will be collected by the researchers to explore the factors related to recruitment of Army, Navy and Air Force Nurses and development of the Tri Service Nursing Research Program. The data from the online survey will be used as pilot, qualitative data and may inform the development of recruitment messages about military nursing that may be used in broader recruitment efforts. Data will be reported simultaneously with a survey being conducted with active duty and reserve military personnel (DMDC reviewed and approved) that includes similar questions. Findings will be used in reports and testimony provided to Congress.
The Dean and faculty of the Graduate School of Nursing at the Uniformed Services University of the Health Sciences (USUHS-GSN) requested this study after finding that existing data resources were not sufficient for an assessment of the effectiveness of outreach to target populations. While data exist on the interest in military careers or nursing careers, respectively, no data currently exist to help a) assess interest in military nursing careers, b) explore incentives and barriers to the pursuit of these careers among the interested public; c) assess interest in training and education placed in existing nursing schools; and d) assess whether recruitment strategies should be differently focused within the military, within the nursing student population and/or within the general public.
2. Purpose and Use of Information Collection
The information collected will be used to assist in formulating policy to increase recruitment of military nurses. The Dean and faculty of the Graduate School of Nursing at the Uniformed Services University of the Health Sciences will collaborate with the researchers to make the data available to Active Duty Army, Navy and Air Force Nurses as well as to inform the development of the Tri Service Nursing Research Program. Findings will be used in peer-reviewed publications as well as in reports and testimony provided to members of Congress.
The survey would provide needed data for policymakers in the following domains:
Perception and awareness of nurse shortages in the public and in the military
Barriers and incentives to pursuing and financing nursing education
Barriers and incentives to pursuing military career
Perceptions of military and nursing careers and characteristics of those professionals
Interest in service branches and in key specialty areas where there exist current and/or expected future personnel shortages
Impact of sources of career guidance and information on career decisions
Personal and family characteristics
3. Use of Improved Information Technology and Burden Reduction
The data collection protocol reflects our objective to gather accurate information efficiently while minimizing respondent burden. We have selected online surveys for several reasons. For both nursing student and military personnel surveys, email recruitment and online data collection are preferred by the leadership who will facilitate access to those populations. The online survey of young adults in the general public is planned to gather preliminary information on barriers and incentives to pursuit of military, nursing, and military nursing careers. Research among young adults in the US, and among young adults in the geographic areas of the nursing schools, is practically both expensive and difficult to accomplish and achieve adequate population level estimates. It may well not be possible to conduct online surveys in a general population of young adults that would provide probability estimates with high response rates of an acceptable level for policy. USUHS is satisfied that for the general public young adult sample, an exploratory qualitative study will meet their needs for testing messages about incentives and barriers to pursuit of a career. Since other data are being collected online, we will use a consistent mode of data collection. Online surveys also protect the privacy of the responses from the researchers—individual names and contact information are not collected and are known only to the authorized personnel in the organizations and institutions of interest.
Efforts to Identify Duplication and Use of Similar Information
Our review of the literature finds survey data on young adult interest in military careers, young adult interest in nursing careers, and surveys of active duty military nurses about retention and promotion. We do not find any surveys on interest in military nursing careers among nursing students, enlisted military personnel or the young adult online public. No other government agency is responsible for this program. The Graduate School of Nursing does not have any forms or information collection that duplicates the information to be collected. There has not been another study conducted for the above targeted populations (i.e., nursing students and the general public). Similar information will be collected from military personnel in another phase of this project to be reviewed by the Department of Defense.
Impact on Small Business or Other Small Entities
The survey of young adults in the general public should have no impact on small businesses. This survey will be of individuals who have previously consented to be a part of a national panel of survey respondents. The survey of nursing school students will be conducted with the collaboration of several educational institutions, specifically, the schools of nursing. All entities involved do not meet the definition of a small entity.
Consequence to Federal Program of Not Collecting This Information
The survey would effectively serve as a way of improving the ability of USUHS-GSN to inform planning for military nurse education and recruitment in the United States. Failure to collect these data would diminish the ability of USUHS-GSN to create the knowledge base essential to understanding factors that drive military nurse recruitment in different audiences (military, nursing student, public). Further, the data collected are key to the ability of federal agencies to develop partnerships with nursing schools that will be training the nurses of the future. Only by correctly identifying barriers to recruitment can effective strategies be developed to overcome those barriers, and sufficient resources made available to fulfill the obligation to assure adequate personnel.
Special Circumstances
For our purposes, we see no circumstances in which respondents would have to a) report this data more than once; b) prepare written responses; c) submit more than one response to the survey; d) keep records which they do not already keep; e) classify data in a way unusual to OMB; f) require a pledge of confidentiality that is not supported by statute or regulations; or g) divulge proprietary or trade secrets.
Federal Register Publication
In the Federal Register of September 30, 2010, Volume 75, No. 189, Docket ID DoD-2010-HA-0134, notice was made of our intent to conduct this study. No comments or questions were received.
Payments or Gifts to Respondents
This data collection plan includes offering incentives valued at approximately $5-$10 to nursing student and public respondents. For these samples, such a sum is viewed as a token of appreciation, rather than compensation. For nursing students, incentives will be delivered in the form of online gift cards. For the public Harris online panel (HPOL), participants will be paid in HI POINTS, a program that allows them to accumulate points to be redeemed for gifts. HPOL participants may also be eligible for periodic sweepstakes drawings. The initial incentive will be $5 per respondent. If additional response incentives are required to enhance our response rate, some respondents may be paid as much as $10 per subject.
Assurance of Confidentiality and Data Security
This study is being conducted in accordance with all relevant regulations and requirements of federal law, including the Privacy Act of 1974 (5 U.S.C. § 552a), the Privacy Act Regulations (34 C.F.R. pt 5b), and the Freedom of Information Act (5 C.F.R. 552) and related regulations (41 C.F.R. pt 1-1, 45 C.F.R. pt 5b, and 40 C.F.R. 44502). Harris Interactive will withdraw any personally identifying data before any draft or final data set is submitted to MGH or USUHS-GSN and no information capable of personally identifying any respondent will be included in any data set submitted to these same groups. Data on subjects interviewed for this study will be published in aggregate statistical form only.
TMA Privacy Advisory language will be included in the recruitment materials and at the landing page of the website. The required language is as follows:
“The information collected by this survey will be used to evaluate factors, which influence decisions to become a nurse and receive a commission as a military officer. The information collected will be used to assist in formulating policy to increase the recruitment of active duty nurses. The survey responses are anonymous, and all identifiable information will be protected and not used to identify you. Data will be analyzed in aggregate form, and there will be no retrieval capability or intent in the collection of your responses.”
This statement will be repeated in subsequent mailings and in telephone prompting. This statement also will appear on the Web site. This letter will also provide assurances that the protocol was approved by appropriate Institutional Review Boards (IRB) and will provide a toll-free phone number for respondents to use to report any perceived violation of confidentiality.
10.1 Confidentiality Procedures.
Harris Interactive is a licensee of the TRUSTe Privacy Program. Harris Interactive and its subsidiaries, abide by the principles set forth in the Safe Harbor framework as set forth by the U.S. Department of Commerce regarding the collection, use, and retention of data from the European Union. Information about the U.S. Department of Commerce Safe Harbor certification can be found at www.export.gov/safeharbor.
Harris Interactive strives to conform to the Council of American Survey Research Organizations (CASRO) Code of Standards and Ethics for Survey Research, the European Society of Opinion and Marketing Research (ESOMAR) Codes and Guidelines for Survey Research, the European Commission Directive on Data Protection, SNYTEC in France, the French law on "Informatique et Libertés", CNIL, the American Association for Public Opinion Research (AAPOR) Code of Professional Ethics and Practices, the Federal Trade Commission (FTC) Fair Information Practice Principles, the FTC’s Children’s Online Privacy Protection Act (COPPA) Final Rule, the Children’s Advertising Review Unit (CARU) Guidelines for Advertising on the Internet and Online Services, the Health Insurance Portability and Accountability Act (HIPAA), the Graham-Leach Bliley Act (GLB), the CAN-SPAM Act, and other privacy regulations and guidelines in the U.S. and abroad.
Harris Interactive safeguards all information it collects through its websites from unauthorized access. Only authorized Harris Interactive employees or agents carrying out permitted business functions are allowed to access this information. In addition, each employee of Harris Interactive is required to sign a confidentiality agreement requiring him or her to keep confidential all personal information of panel members. Employees who violate the confidentiality agreement are subject to disciplinary actions, including termination when appropriate. In the unlikely event that Harris Interactive suffers a breach of its security systems and an individual or entity gains unauthorized access to any information stored on Harris Interactive servers, Harris Interactive will immediately investigate such security breach, and will provide prompt notice to any individual whose information was affected.
For this project, Harris Interactive will build proprietary panels (database of survey participants). With respect to Proprietary Panels, de-identified data from the resulting database of respondents may also be made available for use by the client who commissioned the research. Such information will only be made available to the client pursuant to an agreement with Harris Interactive that the information will be kept confidential and will be used exclusively for research purposes. The sample lists (with respondent names and contact information) will be available only to authorized personnel at Harris Interactive.
Any links that show respondent ID numbers and identifying information will be kept separate, and linked data will also be viewed only on a need to know basis. The need to know is determined by the Harris project director. Data will be stored in a password protected network environment. Multiple electronic gateways require the use of passwords in order to access the data. Buildings are protected by a security force and locked entryways. Any ID number assigned to a respondent will be de-linked from personally identifying information at the end of data collection. Any files linking identifiable information and an ID will be stored in a secure environment. After data collection, electronic files with names and address information will be destroyed. No hard-copy forms of the list will be produced.
Justification for Questions of a Sensitive Nature
The information collected in this study is not sensitive, unless respondents perceive questions about their attitudes and perceptions about nursing and the military to be sensitive. Respondents can refuse to answer the survey, or can decline to answer certain questions in the survey.
Estimates of Hour Burden of the Collection of Information
12.1 Estimates for Hour Burden in the Survey.
The total reporting hours of burden associated with the data collection for are approximately 1,000. Exhibit A- 12.1 displays respondent burden time estimates for this study, and provides a summary by respondent type of the sample size, estimated response time per respondent, and total response time. Each completed interview will take, on average, 15 minutes or about 0.25 hours to administer. This includes reading the email invitation and instructions. This estimate is based upon experience with studies of similar length.
Exhibit A-12.1. Estimated Burden for Military Nurse Recruitment Surveys
Survey |
Number of respondents |
Response per respondent |
Individual response burden (hours) |
Annual burden (hours) |
General public |
2,000 |
1 |
.25 hours |
500 |
Nursing student |
2,000 |
1 |
.25 hours |
500 |
Total |
4,000 |
|
|
12.3 Estimated Annualized Cost to Respondents for the Hour Burden.
There is no cost to respondents for participating in the survey, except for the respondent burden identified in heading 12.1. They will not be asked to keep any records. The estimates of annualized cost are displayed in Exhibit A 12.3 below.
Exhibit A 12.3: Estimated Annual Costs to Respondents:
*Based on US Census Bureau estimate of mean income for US adults aged 18 and older. **Based on US Census Bureau estimate of mean income for US population aged 15 – 24.
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Estimates of Annualized Cost to the Respondent for Record-Keeping
This is currently planned as a one-time survey and there are no associated costs of ongoing record-keeping. There is no expectation that respondents will acquire or use any equipment not already in respondents’ possession.
Estimated Annualized Costs to the Federal Government
The total cost to DoD of conducting this study is $346,500, which includes development of scientific procedures for data collection, the data collection, and analysis and reporting of the resulting data. These funds are paid to MGH under subcontract from the Henry Jackson Foundation Award HU0001-05-D-0005 Task Order 0051.
Reasons for Any Program Changes or Adjustments
Not applicable.
Plans for Tabulation and Publication
It is expected thatmanuscript will be prepared for publication, using the estimates from the student (and military personnel) surveys. Several additional conference reports could also result. Data from the surveys of nursing school students will be aggregated with weighting proportional to the size of the eligible student population at each school. We expect to use descriptive analyses of the nursing school data, summarizing responses using population means, bivariate and multivariate analyses of student characteristics, expressed preference for military careers, barriers and incentives to career choices. We expect to use confirmatory factor analyses to test the instrument predicting interest in military nursing careers. The form of the exploratory responses generated from the online survey of young adults in the general public will allow for tabulation of the responses, albeit not for the purpose of reporting point estimates or statistics. Reason for Not Displaying Expiration Date for OMB Approval
The OMB number and expiration date will be displayed on the cover of the data collection instruments and advance letters.
Exceptions with “Certification for Paperwork Reduction Submissions” Not applicable
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Supporting Statement |
| Author | Partners Information Systems |
| File Modified | 0000-00-00 |
| File Created | 2021-01-31 |