PKG00245633-instructions.pdf

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Bureau of Health Workforce Division of Nursing and Public Health

Advanced Nursing Education Workforce (ANEW) Program

Funding Opportunity Number: HRSA-19-003

Funding Opportunity Type: New, Competing Continuation

Catalog of Federal Domestic Assistance (CFDA) Number 93.247

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date: January 8, 2019

Ensure your SAM.gov and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems, including SAM.gov and Grants.gov, may take up to 1 month to complete.

Issuance Date: October 19, 2018

Michael McCalla, MHSA Public Health Analyst Telephone: 301-443-0856 Fax: 301-443-0791 Email: MMcCalla@HRSA.GOV

Authority: Section 811 of the Public Health Service Act (42 U.S.C. 296j).

mailto:MMcCalla@HRSA.GOV

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for the fiscal year (FY) 2019 Advanced Nursing Education Workforce (ANEW) Program.

The purpose of this program is to support innovative academic-practice partnerships to prepare primary care advanced practice registered nursing students through academic and clinical training for practice with a focus on rural and underserved populations. The partnerships support traineeships as well as academic-practice program infrastructure for schools of nursing and their practice partners to deliver longitudinal primary care clinical training experiences with rural and/or underserved populations for selected advanced practice nurse practitioner (NP), clinical nurse specialist (CNS), and nurse-midwifery students in primary care programs. The partnerships will also help link program graduates to the HRSA Health Workforce Connector and other existing support resources so they can find employment in rural and underserved community-based settings.

Funding Opportunity Title: Advanced Nursing Education Workforce (ANEW) Program

Funding Opportunity Number: HRSA-19-003

Due Date for Applications: January 8, 2019

Anticipated Total Annual Available FY2019 Funding:

$37,250,000

Estimated Number and Type of Awards: Up to 53 awards

Estimated Award Amount: Up to $700,000 per year (includes up to $350,000 per year for traineeship funds) subject to availability of funds.

Cost Sharing/Match Required: No

Period of Performance: July 1, 2019 through June 30, 2023 (4 years)

Eligible Applicants: Eligible applicants are schools of nursing, nursing centers, academic health centers, state or local governments, HRSA supported health centers and other private or public nonprofit entities determined appropriate by the Secretary.

For profit entities are not eligible under this Notice of Funding Opportunity

(NOFO).

See Section III-1 of this notice of funding opportunity (NOFO) for complete eligibility information.

https://connector.hrsa.gov/connector/

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf, except where instructed in this NOFO to do otherwise.

Technical Assistance

HRSA will hold a pre-application technical assistance (TA) webinar(s) for applicants seeking funding through this opportunity. The webinar(s) will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions.

Visit the HRSA Bureau of Health Workforce’s open opportunities website at https://bhw.hrsa.gov/fundingopportunities/ to learn more about the resources available for this funding opportunity.

http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf https://bhw.hrsa.gov/fundingopportunities/

TABLE OF CONTENTS

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract

ii. Project Narrative

iii. Budget

iv. Budget Justification Narrative Program-Specific Forms, ANEW Tables

vi. Attachments

3. Dun and Bradstreet Data Universal Numbering System (DUNS) Number and System for Award Management

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

IX. TIPS FOR WRITING A STRONG APPLICATION

APPENDIX

HRSA-19-003 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for funding under the Advanced Nursing Education Workforce (ANEW) Program.

Program Purpose The ANEW program supports academic clinical partnerships to educate and graduate primary care Nurse Practitioners (NP), clinical nurse specialists (CNS) and nurse midwives (NM) who are academically and clinically prepared for the unique challenges of transitioning from nursing school to practice in rural and underserved communities, thereby increasing access to needed primary medical care for these populations.

Program Goals Awardees must develop and deliver longitudinal clinical training experiences to primary care Advanced Practice Registered Nursing (APRN) students (NP, CNS, and NM). This includes supporting traineeship in rural and underserved community-based settings.

A longitudinal clinical training experience is a long term (e.g., 3-6 months) clinical experience with a clinical partner, focusing on the care of rural and/or underserved populations, for nursing students enrolled in accredited primary care NP, primary care CNS, and/or nurse-midwife programs.

Program Objectives

1. Establish or enhance at least one innovative academic clinical partnership between one or more schools of nursing and one or more clinical practice partners.

2. Organize and implement longitudinal immersive clinical training experiences for Advanced Practice Registered Nursing students in community-based settings, including providing support to students through traineeships.

3. Recruit, train, develop, support, and evaluate preceptors as program partners to enhance community-based clinical and didactic nursing education

4. Connect NP, CNS and NM graduates with existing resources so they can find employment in rural and underserved areas.

5. Have the ability to follow-up on graduates’ career outcomes after graduation to determine retention in nursing practice and in rural/underserved communities for a period of at least 1 year post-graduation.

Statutory Funding Preference The ANEW program provides a funding preference for qualified applicants, authorized by Section 805 of the Public Health Service Act, for projects that will substantially benefit rural or underserved populations, or help meet public health nursing needs in state or local health departments.

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Program Priorities Applicants are encouraged to select and address one of the priorities below which include HHS’s and HRSA’s priority for combatting the opioid crisis and value based care as well as other HRSA priorities.

Combatting the opioid crisis*/Mental Health

Value-based care delivery and quality improvement initiatives

Transforming the workforce –targeting the need

Telehealth

Childhood obesity

Maternal Mortality

* If your application discusses opioids as a priority, please consider that HRSA has a number of investments targeting opioid use disorder and substance use disorder across its Bureaus and Offices that applicants may be able to leverage. For information on HRSA-supported resources, technical assistance, and training, visit https://www.hrsa.gov/opioids.

2. Background The ANEW Program is authorized by Section 811 of the Public Health Service Act (42 U.S.C. 296j).

The demand for primary care services has increased largely due to both a growing and aging population. HRSA’s National Center for Health Workforce Analysis projects the demand for primary care physicians will increase to 239,460 full time employees by the year 2025. This projected demand in primary care services is expected to result in a supply shortage of 23,640 primary care physicians.1 Advanced practice nurses will likely take on expanded roles to help meet this need for primary care services.

Access to primary care providers, like doctors and nurses, is especially challenging in rural and underserved areas. Yet, these areas often face significant health challenges and health disparities.2 Many factors contribute to the maldistribution of APRNs in rural and underserved areas, including limited didactic and clinical training on the health needs of rural and underserved populations, limited training to identify and develop quality preceptors, and limited collaboration between academia and clinical sites.

Additionally, schools report difficulty developing new partnerships with clinical sites, with the greatest challenges in securing primary care preceptors and sites.2 Effective

1 U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. 2016. National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013-2025. Rockville, Maryland.

2 Bolin, J. N., Bellamy, G. R., Ferdinand, A. O., Voong, A. M., Kasha, B. A., Schulze, A. and Held user, J. W. (2015), Rural Healthy People 2020: New Decade, Same Challenges. The Journal of Rural Health, 31: 326–333.

doi:10.1111/jrh.12116 https://www.hrsa.gov/opioids

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partnerships are mutually beneficial relationships where both the nursing school and the clinical partner(s) collaborate to ensure strong clinical experiences for the students.3

The ANEW program creates a pipeline from APRN student clinical experiences in rural and/or underserved areas to post-graduation employment in those same settings.

Research has shown that providing nursing students with longitudinal primary care clinical training experiences in rural and/or underserved areas can align their intentions for professional practice with their clinical experiences.4 With this training, the nursing students get experience with critical health issues in their communities and in the critical technology used in current practice. As a result, clinical practice facilities are more apt to hire these graduates who are familiar with their practice culture and processes.5

Program Definitions

A glossary containing general definitions for terms used throughout the Bureau of Health Workforce NOFOs is located at the Health Workforce Glossary. In addition, the following definitions apply to the ANEW Program for Fiscal Year 2019:

Accreditation of health care facilities – a process of review that healthcare organizations participate in to demonstrate the ability to meet predetermined criteria and standards of accreditation established by a professional accrediting agency.

Accreditation represents agencies as credible and reputable organizations dedicated to ongoing and continuous compliance with the highest standard of quality (http://www.achc.org/getting-started/what-is-accreditation).

Advanced Education Nurses – Individuals trained in advanced degree programs including individuals trained in combined Registered Nurse (RN) /Master’s degree programs, post-nursing master’s certificate programs, or, in the case of nurse midwives, in certificate programs in existence on November 13, 1998, as enacted by Pub.L. 105- 392, Title I, § 123(4) in the Health Professions Education Partnerships Act of 1998, to serve as nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators, or public health nurses, or in other nurse specialties determined by the Secretary to require advanced education.

Advanced Education Nursing Program – a program of study in a collegiate school of nursing or other eligible entity which leads to a master’s and/or doctoral degree and which prepares nurses to serve as nurse practitioners, clinical nurse specialists, nurse-midwives, nurse anesthetists, nurse educators, nurse administrators, or public health nurses, or in other nurse specialties determined by the Secretary to require advanced education.

4 Bowman, C., Wyte-Lake, t., Pearson, M.L., Dougherty, M.B., and Needleman, J. The critical elements of effective academic-practice partnerships: a framework derived from the Department of Veterans Affairs Nursing Academy.

BMC Nursing, 2014; 13(1): 1-31. Accessed on August 2, 2016 from http://www.biomedcentral.com/1472-6955/13/36.

4 Collins C., Challenges of Recruitment and Retention in Rural Areas. N C Med J. 2016 Mar-Apr;77(2):99-101.

5 Developing the Advanced Practice Recruitment Strategy at an Academic Medical Center: The APRN Pipeline.

Authors: Brillant, Maria T.; Glassman, Kimberly S.; Press, Robert, Nurse Leader (NURSE LEADER), Apr2015; 13(2):

39-49.

https://bhw.hrsa.gov/grants/resourcecenter/glossary http://www.achc.org/getting-started/what-is-accreditation

HRSA-19-003 4

Advanced Practice Registered Nurse (APRN) – defined as nurse practitioner, clinical nurse specialist and nurse anesthetist, and certified nurse midwifery disciplines that provide direct patient care as a family nurse practitioner, adult-gerontology primary care nurse practitioner, pediatric primary care nurse practitioner, psychiatric mental health nurse practitioner, neonatal nurse practitioner, women’s health care nurse practitioner, nurse midwife, or nurse anesthetist, and advanced public/community health nursing providers.

Approval (for substantive change) – a specific body, committee, Board, or Commission at the faculty, department, school, university, or state levels has formally voted in agreement for the initiation of or a substantive change in the program. This must be documented by evidence such as copies of meeting minutes, letter from the Faculty Senate, letter from the Board of Regents, letter from the State Finance Board, and/or letter from the State Board of Nursing. Each University/College has a unique process for gaining approval to start new programs, especially new masters and doctoral programs. Examples of steps in the approval process are the following:

nursing faculty curriculum committee, Faculty Senate, Board of Regents of the University, State Finance Board for Higher Education, State Board of Nursing.

Certification – a process by which an agency or organization validates, based upon predetermined standards, an individual nurse’s qualifications and knowledge for practice in a defined clinical area of nursing.

Clinical Nurse Specialist – a specific area of advanced clinical nursing theory and practice addressed through formal instruction to prepare advanced education nurses.

Clinical nursing specialties prepare the nurse to provide direct patient/client nursing care to individuals or to population groups. A nurse completing a course of study in a clinical nursing specialty is expected to be eligible for a national certification(s) or state certification(s), when available, following graduation or required experience.

Collegiate School of Nursing – a department, division, or other administrative unit in a college or university which provides primarily or exclusively a program of education in professional nursing and related subjects leading to the degree of bachelor of arts, bachelor of science, bachelor of nursing, or to an equivalent degree, or to a graduate degree in nursing, or to an equivalent degree, and including advanced training related to such program of education provided by such school, but only if such program, or such unit, college or university is accredited.

Combined RN/Master’s Degree Program – a program of instruction that when completed results in a master’s degree in nursing and licensure as an RN at or prior to the time of graduation.

Doctoral Program in Nursing – a program of instruction beyond the baccalaureate and master’s degrees in nursing (e.g., PhD, DNS, DSN, DNSc, DNP). Doctoral programs in nursing fall into two principal types: research-focused and practice-focused.

HRSA-19-003 5

Faculty Paid Release Time – Release time is administratively authorized time spent away from the employee’s normal job responsibilities to participate in University sponsored or sanctioned programs without loss of pay and without charge to paid time off (PTO) leave. Release time is considered work time; therefore, such time is counted when computing overtime.

Full-time Educational Program – an educational program that provides for a full-time program of study as defined by the institution. Students progressing through the program are able to enroll on a full-time basis to complete the program in a timely manner. Students in such a program may be part-time or full-time.

Nurse-Midwife – an RN educated in the two disciplines of nursing and midwifery that has successfully completed a nurse-midwifery education program accredited by Accreditation Commission on Midwifery Education (ACME) of the American College of Nurse- Midwives.

Nurse Practitioner – an RN who has successfully completed a nurse practitioner program, as defined below, who can deliver primary and acute care services but may have a primary focus on either primary or acute care in a variety of settings, such as homes, ambulatory care facilities, long-term care facilities, and acute care facilities, using independent and interdependent decision making with direct accountability for clinical judgment.

Program – a combination of identified courses and other educational or training experiences at a specified academic level, the sum of which provides the required competencies to practice.

School of Nursing – a collegiate, associate degree, or diploma school of nursing, as further defined in Section 801(2) of the PHS Act.

II. Award Information

1. Type of Application and Award

Types of applications sought: New, Competing Continuation.

HRSA will provide funding in the form of a grant.

2. Summary of Funding

HRSA expects approximately $37,250,000 to be available annually to fund approximately 53 recipients. You may apply for a ceiling amount of up to $700,000 total cost (includes both direct and indirect) per year, of which up to $350,000 may be used for student traineeships. In order to be eligible for an award, applicants must request both traineeships and academic-practice program infrastructure funds. HRSA award

HRSA-19-003 6

recipients may make traineeship awards of up to $22,000 per year per full-time student and $11,000 per year per part-time student. Further funding details are located in the Budget section. The period of performance is July 1, 2019 through June 30, 2023 (4 years). Funding beyond the first year is subject to the availability of appropriated funds for ANEW in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles and Audit Requirements at 45 CFR part 75.

Indirect costs under training awards to applicants other than State, local or Indian tribal governments will be budgeted and reimbursed at 8 percent of modified total direct costs rather than on the basis of a negotiated rate agreement, and are not subject to upward or downward adjustment. Direct cost amounts for equipment, tuition and fees, and sub-awards and subcontracts in excess of $25,000 are excluded from the direct cost base for purposes of this calculation.

III. Eligibility Information

1. Eligible Applicants

Eligible applicants include accredited schools of nursing, nursing centers, academic health centers, state or local governments, HRSA supported health centers, and other private or public nonprofit entities determined appropriate by the Secretary. See PHS Act Section 801(1) for definitions of these types of entities. Domestic faith-based and community-based organizations, tribes, and tribal organizations are also eligible to apply, if otherwise eligible.

In addition to the 50 states, only the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau may apply.

Individuals and for-profit entities are not eligible applicants under this NOFO.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75

HRSA-19-003 7

Eligible Students To be eligible for ANEW traineeship support, the student/trainee must meet all of the following requirements:

Be a licensed RN;

Be enrolled full- or part-time in an advanced nursing education program to become certified as primary care NP, primary care CNS, or nurse-midwife;

Be eligible to work in the United States;

Be a citizen of the United States, a foreign national having in his/her possession a visa permitting permanent residence in the United States, or a non-citizen national. Individuals on temporary or student visas are not eligible to receive ANEW support.

Maintain the predetermined academic standards of the recipient institution.

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

3. Other

Ceiling Amount HRSA will consider any application that exceeds the ceiling amount of $700,000 annually to be non-responsive and will not consider it for funding under this notice.

Deadline HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

Maintenance of Effort (MoE) The recipient must agree to maintain non-federal funding for award activities at a level that is not less than expenditures for such activities during the fiscal year prior to receiving the award, as required by Section 803(b) of the Public Health Service Act.

Complete the MOE information and submit as Attachment 5.

Multiple Applications Multiple applications from an organization are allowable. Eligible applicants can submit only one application per campus or clinical facility; multiple applications from a single campus or clinical facility are not allowable. A campus is defined as a division of a university that has its own grounds, buildings (e.g., school of nursing) and faculty. A clinical facility is defined as a healthcare facility, whether part of a system or not, which has its own grounds containing its own leadership (chief nursing officer, chief medical officer, chief executive officer, etc.). Independent organizations are those entities that have unique DUNS numbers.

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If for any reason (including submitting to the wrong funding opportunity number or making corrections/updates), an application is submitted more than once prior to the application due date, HRSA will only accept your last validated electronic submission, under the correct funding opportunity number, prior to the Grants.gov application due date as the final and only acceptable application.

Failure to include all required documents as part of the application may result in an application being considered incomplete or non-responsive. Applications received without the appropriate tables will be deemed non-responsive to the NOFO and will not be considered for funding under this notice.

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically. HRSA encourages you to apply through Grants.gov using the SF-424 Research and Related (R&R) workspace application package associated with this NOFO following the directions provided at https://www.grants.gov/applicants/apply-for-grants.html.

If you’re reading this notice of funding opportunity (NOFO) (also known as “Instructions” on Grants.gov) and reviewing or preparing the workspace application package, you will automatically be notified in the event HRSA changes and/or republishes the NOFO on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note, you are ultimately responsible for reviewing the For Applicants page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Section 4 of HRSA’s SF-424 R&R Application Guide provides instructions for the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the SF-424 R&R Application Guide in addition to the program specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 R&R Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in the English language and in terms of U.S. dollars (45 CFR § 75.111(a)).

See Section 8.5 of the SF-424 R&R Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 60 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, https://www.grants.gov/ https://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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attachments including biographical sketches (biosketches), and letters of commitment and support required in HRSA’s SF-424 R&R Application Guide and this NOFO.

Standard OMB-approved forms that are included in the workspace application package do NOT count in the page limit. Biographical Sketches do count in the page limit.

Indirect Cost Rate Agreement and proof of non-profit status (if applicable) do not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

Applications must be complete, within the specified page limit, and validated by Grants.gov under the correct funding opportunity number prior to the deadline to be considered under this notice.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) The prospective recipient certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. 3321).

3) Where the prospective recipient is unable to attest to any of the statements in this certification, an explanation shall be included in Attachment 9 Other Relevant Documents.

See Section 4.1 viii of HRSA’s SF-424 R&R Application Guide for additional information on all certifications.

Program-Specific Instructions

Program Requirements

In addition to application requirements and instructions in Section 4 of HRSA’s SF-424 R&R Application Guide (including the budget, budget justification, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

Establish or enhance at least one academic-practice partnership between at least one school of nursing and at least one community-based primary care practice site in a rural and/or underserved settings, and include an ongoing feedback mechanism. A signed Memorandum of Understanding (MOU) must outline aspects of the partnership agreement;

Recruit, train, develop, support, and evaluate preceptors as program partners to enhance community-based clinical and didactic nursing education;

Demonstrate successful recruitment and retention of a culturally competent student body that reflects the community being served and demonstrates a commitment to working with rural and or underserved populations;

Provide longitudinal, immersive, community-based clinical training experiences (e.g., 3-6 months) with rural and/or underserved populations for nursing http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424rrguidev2.pdf

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students enrolled in accredited primary care NP, primary care CNS, and/or nurse-midwifery programs, preferably in settings that incorporate interdisciplinary team based clinical practice training models;

Provide trainings on telehealth, and other health care technology (e.g., health informatics) that assures graduates are exposed to successful training models which may be used in the community health centers and other employment sites post-graduation.

Provide traineeship funds to nursing students enrolled in an accredited eligible nursing programs.

Connect program graduates with the HRSA Health Workforce Connector and other existing employment support resources so they can obtain primary care employment with rural and/or underserved populations, preferably community based clinical settings; and

Follow-up with graduates to collect post-graduation employment demographics for at least 1 year after graduation. As a best practice, awardees should also encourage nursing students to apply for a National Provider Identifier (NPI) number and collect the NPI numbers of nursing students who receive traineeship funds.

i. Project Abstract See Section 4.1.ix of HRSA’s SF-424 R&R Application Guide.

The Abstract must include:

A brief overview of the project as a whole;

Specific, measurable objectives that the project will accomplish;

The clinical priorities that the project will address, if applicable; and

How the proposed project will be accomplished, i.e., the "who, what, when, where, why and how" of the project.

ii. Project Narrative

This section provides a comprehensive framework and description of all aspects of the proposed project. It should be succinct, self-explanatory, consistent with forms and attachments, and well organized so that reviewers can understand the proposed project.

Successful applications will contain the information below. Please use the following section headers for the narrative:

PURPOSE AND NEED -- Corresponds to Section V’s Review Criterion #1

Briefly describe the purpose of the proposed project. Outline the needs of the training program or institution. You must describe and document the targeted discipline and its training needs. You should include a discussion of the target population served by this segment of the health workforce, as well as the socio-cultural determinants of health and health disparities impacting the population or communities served and/or unmet.

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Use and cite demographic data whenever possible to support the information provided.

This section will help reviewers understand the organization that would receive funding for training, as well as the needs of the communities that trainees would ultimately serve.

• You must:

Describe the need for primary care NPs, primary care CNSs, and nurse-midwives in the benefiting community.

Discuss any relevant barriers or gaps in the benefiting community that your proposed project intends to address.

Describe the community that will benefit from the increased distribution of primary care NPs, primary care CNSs, and nurse-midwives, to include the demographics of the population, the health status of the community, health literacy level, social determinants of health, rural and/or underserved status, and other elements in support of your proposal.

RESPONSE TO PROGRAM PURPOSE -- This section includes three sub-sections

— (a) Work Plan; (b) Methodology/Approach; and (c) Resolution of Challenges—all of which correspond to Section V’s Review Criteria #2 (a), (b), and (c).

(a) WORK PLAN -- Corresponds to Section V’s Review Criterion #2 (a).

You must provide a detailed work plan that demonstrates your experience implementing a project of the proposed scope (a sample work plan can be found here: http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx.).

You must:

Describe the activities or steps you will use to achieve each of the objectives proposed during the entire period of performance identified in the Methodology section.

Describe the timeframes, deliverables, and key partners required during the award period of performance to address each of the needs described in the Purpose and Need section.

Explain how the work plan is appropriate for the program design and how the targets fit into the overall timeline of award implementation.

Identify meaningful support and collaboration with key stakeholders in planning, designing, and implementing all activities, including development of the application and, further, the extent to which these contributors reflect the communities served.

Include formal mechanisms for feedback and evaluation, specifically related to preceptor-student progress, between the clinical practice sites and the academic institution through frequent communication to inform program development and curricular enhancements utilizing Rapid Cycle Quality Improvement (RCQI) methods. Describe how the partnerships will communicate and coordinate project planning, progress, evaluations, and resolutions.

http://bhw.hrsa.gov/grants/technicalassistance/workplantemplate.docx

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(b) METHODOLOGY/APPROACH -- Corresponds to Section V’s Review Criterion

#2 (b).

You must describe your objectives and proposed activities, and provide evidence for how they link to the project purpose and stated needs. Propose methods that you will use to address the stated needs and meet each of the previously described program requirements and expectations in this NOFO. As appropriate, include development of effective tools and strategies for ongoing staff training, outreach, collaborations, clear communication, and information sharing/dissemination with efforts to involve patients, families, and communities, if applicable. If applicable, include a plan to disseminate reports, products, and/or project outputs so project information is provided to key target audiences. Explain why your project is innovative and provide the context for why it is innovative.

Specifically, applicants must describe the following:

Discuss how the proposed project activities will strengthen the applicant’s ability to increase the distribution of primary care NPs, primary care CNSs, and nurse-midwives in rural and/or underserved settings.

Describe how training in telehealth and other health care technology (e.g., health informatics) assures graduates are exposed to successful health information technology models which may be used in community organizations, such as community health centers and other employment sites, post-graduation to support the provision of health care in the target community.

The academic-practice partnership between a school of nursing and one or more primary care practice site(s) in rural and/or underserved settings.

Mechanisms to identify, recruit, train, develop, support, evaluate, and compensate preceptors using evidence-based methods to enhance clinical and didactic nursing education.

A detailed plan to provide longitudinal clinical training experiences that prepares students for transition to practice with rural and underserved populations.

A description of how care for rural and/or underserved populations is incorporated throughout the curriculum and the training experiences.

Details of how the project will provide traineeship funds to primary care NPs, CNS, and Nurse Midwives, including a disbursement plan for provision of traineeship support to students who are placed into longitudinal primary care clinical experiences in rural and/or underserved settings.

A description of the feedback cycle (via flowchart or otherwise) illustrating communication and collaboration plans, checks, and balances between the school of nursing and clinical practice site(s), including the preceptor development component.

Plans to recruit student participants that reflect the population served.

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Mechanisms for recruiting and supporting primary care NP, primary care CNS, and nurse midwife students in both their clinical experiences and post-graduation employment.

Plans to improve training and practice by supporting modern health care practice technology tools including distance education and meaningful use of electronic health records.

How the applicant will use existing resources such as the HRSA Health Workforce Connector that can be provided to students who are graduating to help them find jobs in rural and/or underserved settings.

You must submit a logic model for designing and managing the project. A logic model is a one-page diagram that presents the conceptual framework for a proposed project and explains the links among program elements to achieve the relevant outcomes. While there are many versions of logic models, for the purposes of this notice the logic model should summarize the connections between the:

Goals of the project (e.g., objectives, reasons for proposing the intervention, if applicable);

Assumptions (e.g., beliefs about how the program will work and support resources. Base assumptions on research, best practices, and experience);

Inputs (e.g., organizational profile, collaborative partners, key staff, budget, other resources);

Target population (e.g., the individuals to be served);

Activities (e.g., approach, listing key intervention, if applicable);

Outputs (i.e., the direct products or deliverables of program activities); and

Outcomes (i.e., the results of a program, typically describing a change in people or systems).

Refer to Section VIII of this NOFO for further information.

(c) RESOLUTION OF CHALLENGES -- Corresponds to Section V’s Review Criterion

#2 (c) Applicants must discuss the following:

Plans to ensure that clinical placements and experiences support curricular and APRN competencies.

Plans to ensure the quality of clinical placements and experiences.

Plans for resolving challenges with preceptors and with academic-practice partnerships to ensure all students receive quality guidance.

Barriers to obtaining a culturally competent student/faculty population that reflects the community served.

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Barriers in the service area; challenges to implementing the work plan; or obstacles for implementing the program performance evaluation plan and the solutions to resolve these challenges.

IMPACT -- This section includes two sub-sections— (a) Evaluation and Technical

Support Capacity; and (b) Project Sustainability—both of which correspond to Section V’s Review Criteria #3 (a) and (b).HRSA provides funding to awardees in expectation that the awardee will both meet the goals of the program and provide written documentation explaining how their strategies succeeded or failed so that the field benefits and advances

(a) EVALUATION AND TECHNICAL SUPPORT CAPACITY -- Corresponds to

Section V’s Review Criterion #3 (a)

You must describe the plan for program performance evaluation that will contribute to continuous quality improvement. The program performance evaluation must monitor ongoing processes and progress toward meeting goals and objectives of the project. Include descriptions of the inputs (e.g., key evaluation staff and organizational support, collaborative partners, budget, and other resources); key processes; variables to be measured; expected outcomes of the funded activities;

and a description of how all key evaluative measures will be reported. In the Attachments section (IV. 2. v., Attachment 1), you must attach a complete staffing plan and job descriptions for key personnel. Bio sketches of Key Personnel should be uploaded in the SF-424 R&R Senior/Key Person Profile form. You must demonstrate evidence that the evaluative measures selected will be able to assess: 1) the extent to which the program objectives have been met, and 2) the extent to which these can be attributed to the project.

You must also:

Describe the systems and processes that will support your organization's collection of HRSA’s performance measurement requirements for this program. At the following link, you will find the required data forms for this program: http://bhw.hrsa.gov/grants/reporting/index.html.

Describe the data collection strategy to collect, manage, analyze and track data (e.g., assigned skilled staff, data management software) to measure process and impact/outcomes, and explain how the data will be used to inform program development and service delivery in a way that allows for accurate and timely reporting of performance outcomes.

Describe current experience, skills, and knowledge, including individuals on staff, materials published, and previous work of a similar nature.

Describe any potential obstacles for implementing the program performance evaluation and meeting HRSA’s performance measurement requirements and your plan to address those obstacles.

The evaluation and reporting plan also should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be national in scope, and the degree to which the project activities are replicable.

http://bhw.hrsa.gov/grants/reporting/index.html

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Describe your process to follow-up with students after graduation for up to 1 year, such as by collecting students’ National Provider Identifiers (NPI). (Note: Students who receive traineeship funds as a result of this award are encouraged to apply for an NPI for the purpose of collecting post-graduation employment demographics. HRSA anticipates being able to gather NPI data as part of regular performance reporting.).

You must include a plan for RCQI for the continuous monitoring of ongoing project processes, outcomes of implemented activities, and progress toward meeting goals and objectives and the implementation of necessary adjustments to planned activities to effect course corrections. Additional information on RCQI is available at the following website: http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/

Performance Evaluation Plan: You must describe your plan for a Program Performance Evaluation. This plan should monitor ongoing processes and progress toward meeting award goals and objectives. The Evaluation Plan should include descriptions of the inputs from your logic model (e.g., evaluation of key staff, organizational support, collaborative partners, budget, and other resources), key processes, variables to be measured; expected outcomes of the funded activities; and a description of how all key evaluative measures will be reported.

Key staff should be included in Attachment 3.

The Evaluation Plan must demonstrate evidence that the evaluative measures selected will be able to assess:

The extent to which program objectives have been met;

That these accomplishments can be attributed to the activities of the proposed project; and

Dissemination strategies for project outcome and/or outputs.

Performance Reporting Plan: All award recipients are required to collect and report the counts of individuals who have been directly and indirectly impacted by the award including, but not limited to: counts of currently enrolled individuals or participants, graduates/completers, and attrition; the gender, age, race, and ethnicity of all individuals; the disadvantaged background status of all individuals (using the low income guidelines found at:

https://www.healthcare.gov/glossary/federal-poverty-level-fpl/) and the rural residential background of all individuals.

Award recipients are required to track the number and profession/discipline of individuals who have participated in HRSA-sponsored curriculum, clinical or experiential training, faculty development, and/or continuing education as part of the award.

Award recipients are also required to provide additional information about individuals who receive direct financial support from this award, including http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/ http://www.healthworkforceta.org/resources/rapid-cycle-quality-improvement-resource-guide/ https://www.healthcare.gov/glossary/federal-poverty-level-fpl/

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individual-level funding and training data, and data for graduates on their intentions to practice in rural and/or underserved areas. You will also be required to report information about their actual practice setting(s) for a 1 year period starting the day after graduation. This information is collected through the HRSA Performance Measurement System.

You must describe your capacity to collect and report data including, but not limited to, the following on an annual basis:

The number and types of clinical sites (e.g., FQHCs, rural health clinics) and settings (e.g., HPSAs, rural, underserved, etc.);

The impact of your activities on the HHS/HRSA priorities that were outlined in Purpose and Need;

How mental health and substance use disorder treatment is taught and evaluated;

Students who live or practice in rural and underserved areas;

Community based longitudinal tracking;

Telehealth activities;

The number and characteristics of preceptors;

The number and characteristics of students (e.g., from disadvantaged backgrounds);

The number and percentage of graduates that work/practice in rural/underserved areas;

Training program characteristics;

The education level of the training program;

Characteristics of faculty development programs and activities;

Characteristics of curriculum development;

Characteristics of continuing education activities; and

Characteristics of preceptors.

You must describe any potential obstacles for the following and how those obstacles will be overcome:

Implementing the program performance evaluation;

Meeting HRSA’s performance measurement requirements; and

Participating in a HRSA-driven program evaluation

(b) PROJECT SUSTAINABILITY -- Corresponds to Section V’s Review Criterion #3 (b)

You must provide a clear plan for project sustainability after the period of federal funding ends, including a description of specific actions you will take to (a) highlight key elements of your award projects, e.g., training methods or strategies, which have been effective in improving practices; (b) obtain future sources of potential funding, as well as (c) provide a timetable for becoming self-sufficient.

Recipients are expected to sustain key elements of their projects, e.g., strategies or services and interventions, which have been effective in improving practices and those that have led to improved outcomes for the target population. You must

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discuss challenges that are likely to be encountered in sustaining the program and approaches that will be used to resolve such challenges.

Dissemination Plan: The Evaluation and Reporting Plan should indicate the feasibility and effectiveness of plans for dissemination of project results, the extent to which project results may be generalizable, and the degree to which the project activities are replicable. Dissemination plans should include academic-practice partners when possible, and may also include community based health centers such as HRSA supported Area Health Education Centers (AHECs) which enhance access to high quality, culturally competent health care through academic-community partnerships to improve the distribution, diversity, and supply of the primary care health professions workforce who serve in rural and underserved health care delivery sites.

ORGANIZATIONAL INFORMATION, RESOURCES AND CAPABILITIES --

Corresponds to Section V’s Review Criterion #4

Succinctly describe your capacity to effectively manage the programmatic, fiscal, and administrative aspects of the proposed project. Provide information on your organization’s current mission and structure, including an organizational chart, relevant experience, and scope of current activities, and describe how these elements all contribute to the organization’s ability to conduct the program requirements and meet program expectations. (A project organizational chart is requested in Section IV.2.v, Attachment 2.)

Discuss how the organization will follow the approved plan, as outlined in the application, properly account for the federal funds, and document all costs so as to avoid audit findings.

Describe how the unique needs of target populations of the communities served are routinely assessed and improved.

Consultant(s): In Attachment 3, provide the qualifications and nature/scope of the work to be provided by each consultant who has agreed to serve on the project. Include a biographical sketch (no more than 2 pages) for each consultant; upload in the SF-424 R&R Senior/Key Person Profile form. If consultant(s) are required but not yet identified, describe the vacant consultant position(s) by area of expertise and the scope of work, for at least the first project year, and provide a rationale for this need.

Community Support: Describe any community support or other resources involved in the proposed project, as applicable. Include significant letters of support via Attachment 4. Letters of support can be grouped and listed, with significant comments, if there is not space for the complete letter.

Linkages: Describe established and/or planned linkages with relevant educational and health care entities and inter-professional educational programs.

Provide a staffing plan and job descriptions for key faculty/staff must be…