Document Type



A study of Public Law 94-437 Scholarship Program for nurses was conducted in the following states: Iowa, Kansas, Michigan, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota, and Wisconsin. The IHS conducted the study to improve the understanding of the P.L. 94-437 Scholarship Program for nurses. The results of the study will be used to guide IHS policy and programs for the recruitment of students into the Scholarship Program, recruitment and retention of nurses in the IHS, and the education of nurses. The study examined the education, goals, needs, perceptions, and problems encountered, and work experience of a sample of recipients of ""437 nursing scholarships."" The characteristics of ""437"" scholarship recipients were contrasted with those of a sample of nurses employed by the IHS who had not received a ""437"" nursing scholarship. The objectives of the study were to determine: 1) how many nurses have been produced by the ""437"" Scholarship Program; 2) the pattern of career development of ""437"" nurses; 3) the factors that prevent, impede or facilitate American Indians and Alaska Natives from entering nursing and from greater assumption of leadership positions; 4) how recruitment of Indian nursing students can be improved; 5) the major sources of funding for nursing scholarships in the midwest; 6) the feasibility of developing long term linkages among the IHS, tribes, and nursing education institutions in the areas of education, research, and practice; and 7) the changes in the ""437"" Scholarship Program suggested by recipients of the ""437"" nursing scholarships.The study included a survey of recipients of the ""437"" nursing scholarships and a comparison group of nurses employed by IHS that had not received ""437"" nursing scholarships. The survey included current and retrospective data for each person interviewed. Additional information about the Scholarship Program in general was derived from records maintained by the IHS Headquarters Scholarship Program Branch of the Division of Health Professions, Recruitment and Training, and the Division of Nursing. Stratified random samples of 200 persons were drawn from lists of ""437"" scholarship recipients and from personnel listings of the IHS nurses for the comparison group. The two samples were stratified by state and year of scholarship award for the ""437"" group and by year of employment for the control group, beginning in 1978 (the first year ""437"" scholarships were granted) to 1989. The sample size of 200 was based on an expected response rate of 50 percent to yield 100 respondents in each group. This size would provide a 90 percent level of confidence and a +/- 10 percent level of precision. The actual response rate for the ""437"" sample (24%) was significantly lower that of the non-""437"" sample (56%). In order to increase the number of ""437"" respondents, the ""437"" group was repeatedly resampled until all of the ""437"" scholarship recipients from the midwest (449) were included in the sample frame. A 58-item questionnaire was developed to obtain information about each respondent\'s training, education, current position, nursing activities, career progression, and other relevant data. Both open-ended and closed-ended questions were used. The data were analyzed using frequency distributions, and cross-tabulations. Chi square tests of independence and associated probabilities were computed. Multiple regression analyses were used to determine the factors influencing measures of career advancement.Since 1978, 1,714 nursing scholarships have been awarded nationally by the ""437"" scholarship program. In the last 5 years (1986-1990), an average of 141 scholarships have been awarded each year. A student receives awards annually; therefore, the number of scholarships exceeds the total number of recipients. Since 1978, 553 recipients have graduated with nursing degrees nationally. Over the last 5 years, an average of 64 recipients have graduated each year. A total of 330 ""437"" nurses have been employed nationally by the IHS since the beginning of the ""437"" Scholarship Program. Over the last 5 years, an average of 37 recipients have been hired each year by the IHS with a great variation from year to year. Forty-nine percent of the ""437"" group reported they would not have become nurses without the assistance of the ""437"" Scholarship Program. The majority (75%) of the graduates of the ""437"" program stated that they were working for the IHS and all continued to work in the area of nursing. None of the ""437"" reported a job series other than nursing and none with a GS rate higher than 12. Twelve percent of the ""437"" group reported they worked for tribes or Indian organizations. None reported working in an urban Indian health programs. Approximately 25% of the ""437"" group learned about the ""437"" scholarship program after starting nursing school. Only 24% learned about the program from the IHS. The respondents recommended an increase in the number of Indian instructors and counselors in nursing schools, more practical experience in nursing education, increased recruiting efforts, establishment of an ""800 hotline,"" and creation of a national Indian nurses association. Primary recommendations of the study included: 1) evaluate the effectiveness, process, and outcomes of the ""437"" Scholarship Programs in relation to program costs; 2) evaluate administration of the ""437"" Scholarship Programs; and 3) determine factors associated with successful completion of the programs. IHS should track ""437"" scholarship recipients using a database system to report career changes and status of ""437"" recipients before and after graduation from the nursing programs. IHS should increase recruitment efforts and urge ""437"" scholarship recipients to obtain baccalaureate and higher degrees. IHS should encourage participation of nurses in national organizations and require tribal involvement in recruitment and planning for employment of nurses. IHS should expand placement of ""437"" scholarship recipients in IHS facilities as part of the training using internships and externships. IHS should assist in the development of an alumni association for ""437"" scholarship recipients as a means to increase dissemination about the program to potential nursing students.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation, and Research, Rockville, MD 20857 (E-113).