CMS-10467 Consent Form for Student Focus Groups

Evaluation of the Graduate Nurse Education Demonstration Project
Consent Form for Student Focus Groups
Purpose
This evaluation is sponsored by the Centers for Medicaid & Medicare Services (CMS) and
conducted by Optimal Solutions Group and the American Institutes for Research (AIR). The
purpose of this research study is to evaluate the Graduate Nurse Education (GNE) demonstration,
identify the challenges and monitor its implementation, assess outcomes, and assess the potential
for sustainability, improvement and replication of key outcomes.
This interview is intended to gather information about challenges encountered and strategies
utilized to overcome them during the demonstration implementation and to gather information on
strategies that may potentially increase the number of Advanced Practice Registered Nurses
(APRNs).
Participation
Your participation in this focus group is voluntary. If, at any time, you wish to discontinue
participation, you may do so without penalty.
Procedures
The focus group will last 90 minutes and will be audio-taped for our records. Only Optimal/AIR
will have access to the tapes and that they will be destroyed upon the completion of the
evaluation.
Risks and Discomfort
There are no anticipated or known risks in participating in this study. As explained below in the
section on confidentiality, you should be aware that we will be submitting reports that may
identify organizations by name. Your identifying information will not be published.
Benefits
Your participation in the evaluation will contribute to an understanding of how to expand the
number of clinical training opportunities for APRN students, and ultimately the number of
practicing APRNs. You will receive $25 as a thank you for participating in this study.
Confidentiality
We will treat the information you supply in a confidential manner. Only selected staff from the
evaluation team will have access to your actual focus group participation responses. You will
not be identified by name in any report to the public or the funder.
As part of the evaluation, we will share our findings with CMS. The results of the evaluation will
describe strengths as well as areas for improvement. Findings will describe the progress made
and difficulties encountered in achieving project goals.
After the interview is completed, we will ask you to identify any information which you would
NOT want presented in any form that might be linked with your personally. We will comply
with your request by being especially careful to not present such information in any way that
would enable it to be linked to you.

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More Information
For more information about this evaluation, please contact Julie Jacobson Vann at
[email protected] or (919) 918-4503 or Brandy Farrar at [email protected] or (202) 403-5416.
For questions regarding your rights as a human subject participating in this research, please contact
AIR’s Institutional Review Board (IRB) Chair, at [email protected]; 800.634.0797.
Documented Consent
By signing this form you are indicating that you have read and understood the information
provided to you and agree to participate in the focus group.

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Organization

Signature

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