A scholarly concentration program to promote public health nursing for generalist Clinical Nurse Leader students

Abstract

Background

The number of public health nurses has decreased consistently and significantly since the 1920's. The recent COVID-19 pandemic has put a spotlight on the need for more public health nurses in the workforce. The number of novice nurses entering into public health roles is declining, demonstrating a clear need to mentor pre-licensure nursing students into the public health nursing workforce. Scholarly concentration (SC) programs are a method to explore specialty roles through in-depth scholarly activities, outside of core curriculum. However, SC programs have not been described in the nursing literature. The purpose of this paper is to describe the development of a SC program to engage pre-licensure Clinical Nurse Leader (CNL) students in scholarly activities related to public health nursing.

Program overview

This Public Health Nurse Scholars program was developed in 2014 with the goal of developing a cadre of generalist CNL students with experiences in public health nursing scholarly activities. The program aimed to increase awareness of career and scholarship opportunities through mentorship with public health nursing faculty. Students were encouraged to attend and present at professional conferences, participate in active scholarly projects and conduct quality improvement projects from a public health nursing perspective. The program was designed to foster students' public health nursing leadership and presentation skills and enhance their self-directed learning.

Results

To date, 46 pre-licensure nursing students were selected as Public Health Nurse Scholars. Sixty-seven percent (n = 31) have graduated as Public Health Nurse Scholars; 33% (n = 15) are current Public Health Nurse Scholars. Twelve public health nursing faculty have served as mentors. As a result of the program 15 scholars attended and 3 scholars presented respectively at community/public health nursing conferences, and several scholars had related professional development opportunities. A majority of Public Health Nurse Scholars have designed and implemented a capstone quality improvement project with a public health nursing perspective, 15 of which were completed at community-based sites.

Conclusions

In the face of our current global, public health crisis, there is a clear need to develop a cadre of novice nurses prepared to enter the public health nursing workforce. The Public Health Nurse Scholars program shows promise towards encouraging an interest in public health nursing scholarship. Schools of nursing may consider the implementation of similar SC programs as an approach to mentor pre-licensure nurses in other specialty areas such as gerontological and neonatal nursing.

Background

The United States is approaching a well-documented shortage of nurses with a projected one million additional nurses needed by 2024 (U.S. Department of Labor Bureau of Labor Statistics, 2017). The current nursing shortage impacts all areas of nursing, and public health nursing is no exception (Quad Council of Public Health Nursing Organizations, 2007). Retirement and attrition are some contributors to the nursing shortage, however, public health nursing may be at particular risk due to pay differential and underfunding (U.S. Bureau of Labor Statistics, 2020). The number of public health nurses has decreased consistently and significantly since the 1920's. In addition to low comparable wages, public health recently experienced a number of budget cuts causing considerable reductions in the healthcare workforce (Robert Wood Johnson Foundation, 2012; Centers for Disease Control and Prevention (CDC), 2020b; Edmonds et al., 2020; Keith, 2018). The National Association of County and City Health Officials (NACCHO) estimated that there are currently 10.75 public health nurses per 100,000 population (National Association of County & City Health Officials, 2011). This is just half of the estimated need of 20 per 100,000 population (National Association of County & City Health Officials, 2011) to meet the basic public health needs of the country and demonstrates the consistent shortage of public health nurses (Center for State and Local Government Excellence, 2020).

The reason for the shortage of public health nurses is multifaceted. Public health nurses are the largest group of public health professionals, however, the shrinking workforce and lack of budget to hire vacant positions leave up to 20% of preventive health service positions unfilled (Beck & Boulton, 2016; Center for State and Local Government Excellence, 2020). This is of considerable importance as public health nurses serve in key roles such as implementing evidence based and culturally competent prevention programs, home visiting programs, and primary roles in ambulatory/outpatient settings and local/state/federal health departments (Beck & Boulton, 2016). A recent statement from American Nursing Association stressed that now, more than ever, there is a need for public health nurses and called on government to increase the funding to further develop the public health nursing workforce (American Nurses Association Jun 24th, 2020). However, underfunded public health systems, the public health nursing shortage, and lack of public health integration in nursing curriculum serve as significant barriers to a representative number of public health nurses in the workforce (U.S. Department of Labor [DOL], 2017; BLS; Health Affairs).

Public health nurses are critical to our health care system and contribute to improved outcomes for communities with the highest rates of morbidity and mortality (Hassmiller, 2014; Kub et al., 2017). The COVID-19 pandemic immediately and simultaneously highlighted both gaps in healthcare services left by a diminished public health nursing workforce and existing health inequities due to structural racism (CDC, 2020b). Public health nurses are uniquely trained to work with populations to address both the social determinants of health that affect racial and ethnic minority groups while simultaneously addressing community spread of infectious diseases like COVID-19 (CDC, 2020a; Edmonds et al., 2020). New graduate nurses need to be prepared to fulfill these roles due to the public health nursing shortage, however, the lack of public health nursing content required in the curriculum challenges their ability to do so (Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, 2011).

In order to increase student awareness and desire to enter into public health as a specialty, nursing faculty are being called upon to develop opportunities to get students excited about public health nursing. There is conflicting evidence regarding the influence of course and clinical work on a nursing student's decision to enter into a particular specialty, with some studies documenting influence and others reporting none (Larsen et al., 2012). The Council of Public Health Nursing Organizations' Council on Linkages Between Academia and Public Health Practice recommends a variety of strategies, including but not limited to, developing innovative approaches to teaching students about and establishing leadership development programs for public health nursing (2011).

Scholarly concentration (SC) programs are defined as programs that encourage scholarly activities beyond the core curriculum (George et al., 2015). While programs that align with this definition can be found in undergraduate honors or mentorship programs, they are also commonly published in medical education (George et al., 2015). For example, medical schools have used SC programs as a method for medical students to explore specialty roles through in-depth scholarly activities (Bierer & Chen, 2010; Parsonnet et al., 2010). SC programs do not add to the length of a program, rather they are complimentary experiences, providing opportunities beyond standard curriculum to develop specialized expertise, scholarship and leadership (Burk-Rafel et al., 2016). In medical education SC programs have been shown to influence career decisions by providing students with co-curricular opportunities that expose them to specialty areas (DiBiase et al., 2020). Further, SC programs have demonstrated a positive impact on scholarship productivity, career development and the formation of a professional identity (Liu et al., 2018; Wolfson et al., 2017). However, SC programs have not been described in the nursing literature.

In alignment with the Council of Public Health Nursing Organizations call for nursing faculty to develop innovative approaches to expose nursing students to the public health specialty, a SC program was developed to engage Clinical Nurse Leader (CNL) pre-licensure nursing students in public health nursing. The purpose of this paper is to describe the development, implementation and evaluation of the Public Health Nurse (PHN) Scholars Program.

Methods

Setting

The College of Nursing is a part of a private, midwestern university in a large metropolitan area and offers a generalist entry masters (GEM), CNL program. The American Association of Colleges of Nursing introduced the role of the CNL in 2003 as a master's prepared nurse trained as a leader in managing patient care outcomes through the design, implementation and evaluation of evidenced based practice interventions (American Association of Colleges of Nursing, 2013). CNL certification can be obtained through master of science in nursing (MSN) degree preparation from five different pathways. The two pathways offered in the College of Nursing are referred to as models A and C, bachelor of science in nursing or bachelor in another discipline to MSN respectively (American Association of Colleges of Nursing, 2013). Model A is a 2-year, part-time program for current registered nurses. Model C, hereafter referred to as pre-licensure generalist entry masters (GEM), is a 2-year, full-time program. As the only group of non-nurses, model C students were the only participants of the SC program.

The College has 125 full-time faculty within three departments: Adult Health and Gerontological Nursing, Women, Children and Family Nursing, and Community, Systems and Mental Health Nursing. Nine of the faculty members in the department of Community, Systems and Mental Health Nursing are public health nurses. Each academic year, two cohorts of 75 students each, are admitted to the GEM program with a total student body of 300 students. During the program the GEM students complete 1100 total clinical hours required for graduation. One hundred of these 1100 h are dedicated to professional development hours. Professional development hours are designed to encourage students to engage in volunteer opportunities that align with the CNL role. Additionally, students are required to complete 100 of the 1100 h towards their capstone in which they are responsible for assessing, planning, implementing and evaluating a project in a microsystem following CNL competencies (American Association of Colleges of Nursing, 2013).

Public Health Nurse Scholars program development

The CNL role has been successful utilized in the public health nursing environment (Shipman et al., 2013). Public health nursing leaders within the college identified an opportunity to promote public health nursing in the GEM program by fulfilling the 100 h required professional development hours and 100 required capstone with public health nursing scholarly activities relevant to CNL essentials. To fulfill accreditation requirements, the CNL curriculum must include CNL Role Competencies and Clinical Expectations which are organized into nine CNL essentials. Of the nine essentials, Essential 3: Quality Improvement and Safety and Essential 8: Clinical Prevention and Population Health for Improving Health, are particularly relevant to the PHN Scholars Program. Essential 3 includes activities such as performing a microsystem assessment and implementing and evaluating quality improvement projects which align with capstone activities. Essential 8 includes activities such as engaging with community systems and designing and evaluating culturally appropriate health promotion programs which align with professional development hour activities (American Association of Colleges of Nursing, 2013).

The Dean and past president of a national public health nursing association met with public health faculty to encourage them to create a program for students to engage in public health nursing as a co-curricular activity. Next, through structured group meetings and one on one conversations, faculty began to document barriers to public health nursing engagement in the curriculum. Faculty found that although students were interested in public health nursing they did not feel supported in pursuing public health nursing professional development or capstone learning opportunities. Students did not feel supported because they felt in-patient, medical surgical clinical nursing opportunities and career advice were promoted more than public health nursing. In response to the dean and students, one public health nursing faculty member volunteered to direct a SC program, called the PHN Scholars program.

In 2013 the PHN Scholar faculty director applied for and was awarded a one-year internal planning pilot grant for $3000.00. In 2014, five of the public health nursing faculty joined the director to develop the specific objectives of the program (Table 1 ). These faculty comprised the PHN Scholar advisory group the inaugural year and also served as faculty mentors. The format and content of the PHN Scholar program was developed by the advisory group. The advisory group conducted listening sessions with students and reviewed student engagement initiatives at national conferences to assess current best practices and educational trends for engaging students in co-curricular activities. The program objectives, format and content were then submitted to the Master of Science in Nursing Curriculum Committee as a SC co-curricular activity to enhance the GEM CNL experience. The committee agreed the program outcomes such as professional development hours and capstone presentations aligned with CNL essentials, could be used to fulfill required clinical hours and therefore approved the PHN Scholar program.

Table 1.

PHN scholar objectives.

Term	Objective
Term 3	All scholars will identify a public health nursing area of interest.
Terms 3–6	All scholars will attend team building and leadership development events to allow for the identification of community partners or projects for the PHN Scholar experience.
Terms 5–6	All scholars will include a public health nursing focus in at least one scholarly presentation (capstone, professional podium or professional poster presentation).

Program overview

The goal of the PHN Scholar program was to provide GEM students with public health nursing opportunities and focused mentored experiences. As a part of the program, scholars receive mentorship by experienced public health nursing faculty for: 1) the identification of professional experiences and scholarship development 2) team building and leadership development, 3) capstone projects, 4) guidance to submit abstracts and present at professional conferences.

The program was initiated in 2014 and has provided an opportunity for 2–6 GEM CNL students per cohort to join as scholars. Students are eligible to enter the program in the second term. Each applicant submitted their resume and an essay describing their interest in the program and were interviewed by two faculty. Faculty completed a 10-item interview form which guided the interview questions. The form included a review of each applicants' experience and interest in research, practice, education, leadership, readiness for the program and professional demeanor. The guiding principles for selection were a participant's potential to expand their knowledge, experiences and skills in public health nursing. Faculty reviewed their assessments of applicants using the interview tool at a group meeting and made selections for the scholars from those interviewed based on 100% faculty agreement.

The faculty director reviewed the scholar resumes and essays and matched them to a faculty mentor with similar interests. An important aspect of the scholar/mentor match was that faculty were asked to identify professional development or capstone activities in which mentees may collaborate with them during the remainder of the GEM program. For example, faculty identified opportunities such as literature review assistance for integrative reviews, project recruitment initiatives, community engagement events or community partners with quality improvement project needs.

Selected scholars were notified of acceptance and invited to a PHN Scholars luncheon the following term. During the luncheon, scholars met their faculty mentor and the faculty director led a discussion of objectives, requirements and expectations of the program. Scholars were also asked to share their recent public health nursing activities so mentors could assess their area of interest. An important expectation of the program was attendance at mentoring events such as luncheons, coffee chats and one-on-one scholar and faculty meetings to discuss opportunities to attain public health nursing professional development hours and capstone experiences. For example, scholars were expected to attend the PHN Scholars luncheon each term until they graduated to share lessons learned and identify any barriers to engaging with communities. During national conferences such as American Public Health Association, scholars were invited to group team building events for coffee chats, team dinners or group walks on a nearby trail. During these social events mentors were able to identify scholar interest and make referrals to community partners and projects. In addition, scholars and their mentor were expected to meet at least once per term, outside of the group meeting for one on one professional and/or career conversations. Scholars worked with their mentor to identify opportunities to explore public health nursing scholarly interests for professional development hours such as poster or podium presentations at professional conferences. Even though not all capstone projects could be completed at a community-based site, scholars were asked to include a public health nursing perspective within their capstone project, regardless of the setting.

Budget

In 2014 the program received an internal alumni grant award in the amount of $9500.00 to pilot the PHN Scholar program for 15-months. After presenting preliminary findings, in 2016, the college made a commitment to maintain the structure of the program to support up to 8 scholars per fiscal year, at a cost of $576.00 per scholar for mentoring events, team building events and conference expenses. The faculty director worked with the colleges' finance department to establish a funding code and manage the spending and reimbursements. The College registered students for conferences; students were reimbursed for travel and lodging after the faculty director approved the travel. The PHN Scholar luncheons ranged in attendance from 2 to 10 students and 6–9 faculty members at each meeting. PHN Scholar group meetings were held once per term and lunch was provided at each. Additionally, each scholar was awarded up to $500.00 in travel reimbursements to attend or present at a professional conference.

Program recruitment

After the pilot year, the faculty director created a shared folder with photos of group events, student/faculty roster and highlights of scholar achievements. Images from the shared folder were displayed during in-person cohort meetings which took place in between classes a few weeks before a call for applicants was distributed. The colleges' marketing department created a Scholars website link on the college of nursing's intranet. The site included a program description and faculty director's contact information. The faculty director included the PHN Scholar program as an agenda item at faculty meetings to identify facilitators and barriers to engagement as well as gauge continued interest and commitment to mentor and interview students.

Data analysis

Evaluation of the program included analysis of the archival data maintained by the faculty director. Archival data from 2014 to 2020 included results of summative end of program exit interviews as well as information maintained in a program database. This information included student activities during their time as a PHN Scholar, such as professional development and scholarly activities, professional conferences attended, presentations, and the title of their capstone project. Faculty mentors were asked to validate all data collected.

Professional development and scholarship activities were reviewed and analyzed by activity type. The number of scholars who attended a professional public health-focused conference and presented at a conference were calculated. The name of each conference attended was also recorded. To analyze the capstone project information, the title of each scholar's project was reviewed separately by all three authors. Each author listed whether the project was based at a community site and the major theme/topic area the capstone project focused on. All three authors then met and discussed the capstone project sites and themes. Results were finalized once a majority (two or more) of the authors were in agreement on whether the capstone project was implemented at a community-based site and the major theme of the capstone project.

Results

Since the PHN Scholar Program started in 2015, 46 CNL nursing students in the GEM program have been accepted. Sixty-seven percent (n = 31) of the scholars have graduated, while 33% (n = 15) are still enrolled.

Mentorship

Twelve PHN faculty have participated in the program as mentors. The frequency of meetings and the nature of mentoring relationships varied, based on the unique needs and interests of each student. Topics discussed during mentor meetings included professional development, specifically the formation of a professional identity as a public health nurse, and exploration of public health nursing career opportunities. Mentors provided guidance on scholarly activities, often including PHN Scholars in faculty research projects while also assisting students in developing and disseminating their own student quality improvement, capstone projects. Mentors acted as content experts for PHN Scholar capstone projects. Mentors also engaged PHN Scholars in informal discussions about current public health events and other professional topics. For many, the mentoring relationship sustained well after scholars graduated from the program and entered into the nursing profession.

Teambuilding

PHN Scholars and mentors participated in a variety of teambuilding events outside of the required luncheons in an effort to promote a sense of community. The faculty director organized a weekend group walk for PHN Scholars and mentors on a newly developed urban walking trail. PHN Scholars also walked together each fall during the American Heart Association's Heart Walk. While at professional conferences, PHN Scholars were matched up with a faculty member who guided them in navigating the conference experience. PHN Scholars were invited to participate in dinners and social events that took place during professional conferences. Faculty also invited PHN Scholars to participate in informal “coffee-chats” after professional conferences to explore conference content in relation to their public health nursing interests and career development.

Outcomes

Professional development and scholarship opportunities

Throughout their time in the program, PHN Scholars participated in numerous scholarship and professional development opportunities. Three PHN Scholars have been Chicago Area Schweitzer Fellows. As part of this fellowship program for health professional students, fellows develop and implement projects to promote health and wellness in local, underserved communities in Chicago (Health and Medicine Policy Research Group, 2020). Other professional development opportunities have included assisting with public health services and projects at community-based sites such as local schools and school-based health centers, a women's treatment center, and an adolescent family center. Other students have served as research assistants for faculty-led public health nursing projects. Two PHN Scholars received awards from the College of Nursing's Alumni Association Golden Lamp Society; one for potential for future nursing leadership and the other for community involvement.

Programmatic outcomes

Capstone

As noted earlier, every GEM student designs, implements and evaluates a quality improvement capstone project during the final two terms of the program. As quality improvement projects with a health promotion component, completing the capstone project aligns with CNL Essentials 3 and 8. Students can complete the project individually or in pairs. Capstone projects are graded as pass/fail. All 31 PHN Scholars that have graduated passed and completed a total of 29 capstone projects since some scholars worked together on the same capstone project. Fifty-two percent (n = 15) of these capstone projects were completed at community-based sites. The capstone projects that the PHN Scholars developed focused on a variety of important public health topics. Thirty-one percent (n = 9) of the projects focused on topics related to maternal and child health, 17% (n = 5) on adolescent health, 10% (n = 3) for each mental health, end of life care, disease management, and professional nursing roles, and 3% (n = 1) on LGBTQ health. Some projects were developed to promote health and wellness among vulnerable populations within these topic areas including individuals with developmental disabilities, people experiencing homelessness, and individuals seeking asylum. A list of a sample of scholar capstone project titles is available in Table 2 .

Table 2.

A sample of completed PHN scholar capstone project titles.

Projecto Juventud Health Ambassadors: The Development of Peer Health Educators

Increasing Staff Knowledge and Skills of I-CARE to Accurately Depict Vaccination Rates

Addressing Medication Adherence Barriers in a Homeless Drop-in Center

Increasing Community Resource Utilization among Obstetric Patients with Elevated ACE Scores

Utilizing a Podcast as an Intervention to Improve Nursing Confidence in Advance Directives

Advance Care Planning for Spanish Speaking Residents

Assessing the Knowledge of Volunteers Helping Asylum Seekers Coming from U.S. Detention Centers with Symptoms of PTSD

Developing an E-Resource Database for a Drop-in Mental Health Community Center

Conference attendance/presentations

One of the overarching goals of the PHN Scholar program is to support public health nursing scholarship opportunities through conference attendance and submitting professional conference abstracts. Thirty-five percent (n = 16) of the PHN Scholars attended a professional public health-focused conference. Six percent (n = 3) of PHN Scholars presented a total of five presentations at professional public-health focused conferences. Some of the topics of student presentations included the development of a community partnership to create an after-school health ambassador program, integrating social determinants of health into a needs assessment for people experiencing homelessness who have diabetes, and lessons learned from their public health clinical about the importance of partnerships to build public health nursing leadership skills, The conferences students have attended and presented at most often include the American Public Health Association's Annual Meeting and Expo (n = 11) and the Association of Community Health Nursing Educators' Annual Institute (n = 2).

Discussion

The PHN Scholar program is a promising SC co-curricular model to engage pre-licensure CNL nursing students in public health nursing. Through team building, mentoring and financial support students successfully engaged in professional development opportunities and capstone projects. Students were mentored in scholarly activities to promote public health as an important specialty in nursing. Mentoring has been identified as a successful approach to improve student satisfaction and retention (Jones, 2017). Similar to recent literature, the PHN Scholar program utilized mentoring to increase the awareness and scholarly interest in public health nursing. Prior literature on successful faculty and undergraduate nursing student mentorship programs identified the following as important components of the successful faculty- student relationship: engagement, facilitation, accountability and collaboration (Nelson et al., 2018). The components of the PHN Scholar program were consistent with these approaches to mentorship. The PHN Scholar program adds to this literature by using a SC program that focuses on the public health specialty through a variety of scholarly activities.

The Institute of Medicine in the Future of Nursing calls for nursing schools to transition traditional acute-care education models to preventive models, such as care coordination, to address the public health nursing shortage (Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, 2011). Similarly, the American Academy of Ambulatory Care Nursing noted that healthcare reform, the Affordable Care Act, care coordination and the move to value-based, rather than volume-based care have increased the need for new-graduate nursing students prepared to work in ambulatory care settings (American Academy of Ambulatory Care Nursing, 2017). The curricula in many nursing programs focus on acute care content with a large number of clinical hours in acute-care settings and do not allow for these preventive-care model experiences that align with public health. With limited exposure to preventive-care model experiences students are not given the opportunity to explore their personal interest to public health nursing. An important component of the PHN Scholar program was that it was not prescriptive in assigning a scholarly public health topic to the student. The focus of the program was more on supporting the formation of the professional identity of each student in a number of public health nursing topics or settings. This approach is consistent with the individually tailored relationships that were identified as important characteristics of successful mentoring relationships in previous work (Nelson et al., 2018). For students interested in public health, a deliberate and intentional program such as PHN Scholar, should be explored to help to ensure exposure and experiences in preventive models, ambulatory and other related public health fields.

Implications

Prior to the implementation of the PHN Scholar program professional development hours and capstones did not regularly include community based settings. Prior to the PHN Scholar program, despite individual mentorship with faculty advisors, students did not feel supported in their desire for community based professional development and capstone activities. The PHN Scholar program was a strategic approach to organize a community of faculty mentors and cadre of students that could identify appropriate opportunities and advocate for the integration of public health in capstone experiences. Through mentoring and professional relationships developed during this co-curricular experience faculty and a cadre of students were able to establish public health opportunities within the required GEM curriculum.

The two other departments in our college of nursing, Adult Health and Gerontological Nursing & Women, Children and Family created respective scholar programs based on the PHN Scholar model. To date they've been successful in recruiting four cohorts of scholars into the programs with some preliminary success towards scholarly engagement. Important aspects of these programs are the identification of a program leader, several faculty in the specialty area to serve as mentors, and faculty identification of scholarly activities to engage the students for the duration of their program. These programs should continue to monitor the effectiveness of the SC model on engaging students in the specialty programs. Further study of the impact that SC programs have on new graduate nurses' decisions to choose careers in specialty areas such as public health, gerontological and neonatal nursing is needed. Future quality improvement projects should assess SC programs with larger sample sizes and track graduates to assess the career choices and decisions to enter specialty areas as a new graduate and early career nurse. As the program goal was to provide GEM students with public health nursing opportunities and focused mentored experiences future projects should include robust metrics to assess the impact of the program over time. Future projects should also assess graduates' interests and decisions as new nurses to transition to entry level positions in public health nursing; and their preparedness and satisfaction for entry level positions.

Limitations

Considering the results are based on a small sample size from a singular College of Nursing, these findings may not be generalizable to other nursing programs. It should also be noted that evaluation data was limited as it was difficult to obtain end of program data from students in their last term of the program. The limited evaluation data was supplemented by faculty input and validation. Therefore, some of the findings were based on public health nursing faculty recall, written documentation and email correspondence and may be incomplete or include errors. Further, there is limited information on scholar entry level career choice after graduation thus no correlation to participation in the PHN Scholar program and employment as a public health nurse can be made.

Conclusion

There is a national need to increase the number of public health nurses in the workforce. Mentoring has been a strategy used to promote recruitment and retention in nursing. Scholarly Concentration (SC) programs have been used to explore specialty areas through individualized scholarship experiences. This PHN Scholar program developed a SC based model to increase the co-curricular experiences and opportunities for public health for generalist entry masters CNL students thus creating a cadre of graduates interested in public health. To address the nursing shortage in specialty areas, future programs should explore the effectiveness of the PHN Scholar program to transition graduates into related entry level positions.