OMB Memo

Generic Information Collection Request

Cognitive Testing of National Sample Survey of Registered Nurses

Request: The U.S. Census Bureau plans to conduct additional research under the generic clearance for questionnaire pretesting research (OMB number 0607-0725). We propose to conduct cognitive interviews to pretest new and revised content for the 2026 National Sample Survey of Registered Nurses (NSSRN). We are seeking approval for this project.

Background: The National Sample Survey of Registered Nurses (NSSRN) is conducted by the Census Bureau and sponsored by the Health Resources and Services Administration (HRSA). The NSSRN is conducted using self-administered paper and web modes. The Census Bureau’s Demographic Statistical Methods Division (DSMD) Survey Methodology (SM) team was tasked with evaluating new and revised content for the questionnaire in preparation for the upcoming survey cycle. The SM team made recommendations to enhance the proposed new items and prepared a Qualtrics questionnaire for cognitive testing, as requested by HRSA. The next step is to conduct cognitive interviews to evaluate how well the new content performs and to identify improvements. The survey samples Registered Nurses (RNs) and Advance Practice Registered Nurses (APRNs).

Purpose: The purpose of this research is to interview current Registered Nurses and Advance Practice Registered Nurses (i.e. Nurse Practitioners, Clinical Nurse Specialists, Nurse Midwives, and/or Nurse Anesthetists) to explore multiple paths of the questionnaire. The research will assess their understanding of the new questions and response options. In the cognitive interviews, we will assess the clarity and potential effectiveness of the new items and identify respondent issues with comprehension or interpretation, with the goal of producing valid survey items that minimize the potential for measurement error attributable to the questions themselves. The results of the cognitive interviews will influence decisions about final content and wording of the survey questions for the 2026 NSSRN survey cycle.

Population of Interest: Participants will be screened during the study recruitment effort to ensure they are part of the relevant survey population. To maximize feedback across questions, we will focus our recruitment efforts on identifying participants who represent a variety of nursing positions. We will probe on up to 22 new/revised items with RNs and 18 new/revised items with APRNs. The topic areas covered by cognitive testing by participant type (RN or APRN), as well as the number of questions for each topic, are described below.

RNs (22 questions):

• Skill-based certification types (1)

• Type of first nursing degree (2)

• Awareness of HRSA funding opportunities (1)

• Hours worked during typical week and rate(s) (3)

• Percentage of time spent on specific activities (1)

• Whether primary care services were provided (1)

• Primary and secondary clinical specialties (2)

• Precepting students (6)

• Feelings of burnout (5)

APRNs (18 questions):

• NP Board certifications and types (2)

• RN transition-to-practice program (3)

• Ability to practice to full extent of state’s legal scope of practice (1)

• Workplace violence (2)

• Whether they have considered leaving their position (2)

• Working for pay in other nursing jobs (1)

• NPI billing (1)

• How much did education prepare them for their job (1)

• Type of relationship with physicians they work with (1)

• Prescriptive authority (1)

• Prescription of buprenorphine (1)

• Participation on peer review panel (2)

Language: The interviews will be conducted in English.

Timeline: Cognitive interviews are planned for November 2024.

Project scope: The cognitive testing of the proposed revisions to the NSSRN questionnaire will be carried out according to the schedule described in Table 1.

Table 1. Estimated Project Schedule

Activity	Dates
Recruiting (Ongoing)	10/28/24 – 11/21/24
Conduct Cognitive Interviews	10/30/24 – 11/22/24
Develop Draft Recommendations	11/25/24 – 12/13/24
Deliver Final Recommendations	1/15/25

General Protocol: DSMD will conduct this research remotely, via Microsoft Teams. Teams is a Census Bureau approved platform and allows for secure video conferencing capabilities and screen-sharing to maximize both the respondent and interviewer experience. The interviews will be conducted in accordance with guidelines and policies outlined in the internal Census Bureau policy memo Use of Microsoft Teams for Conducting Title 13 Qualitative Research Remotely.

At the start of the interview, the participant will electronically sign an online consent form via Qualtrics that references the OMB approval for the study, the confidentiality of the session, the voluntary nature of the study, and acknowledges that the session will be recorded.

Once the consent form has been signed, any participant questions will be answered, and audio recording will begin. The participant will complete the relevant survey questions in Qualtrics (based on whether they are a Nurse Practitioner or Registered Nurse). The researcher will walk the participant through the questions using a think aloud technique, verbally expressing their thoughts to allow researchers to gain insight into how they interpret and respond to questions. The cognitive interviewer will administer both concurrent and retrospective probes to gain a full understanding of respondent perceptions of specific elements of the survey.

Sample: Up to 15 participants will be interviewed throughout the U.S. Participants will be screened during the study recruitment to ensure they meet the relevant recruitment criteria.

Recruitment: We will use a multi-pronged strategy to recruit participants, such as posting ads on internet and social media platforms (e.g., Facebook) and using personal networks. While not intended to be nationally representative, an attempt will be made to recruit participants with varying demographic characteristics (e.g., sex, education, age, race and ethnicity).

Use of Incentive:

For this research, we request an increase in the typical incentive. The Census Bureau typically uses an incentive of $40-$50 per one-hour interview. Because we expect the NSSRN target population to be highly educated and highly paid, and therefore may be hard to recruit for a research study, we propose offering $100 for their participation. There is precedence for giving a $100 incentive for past NSSRN cognitive interview studies at the Census Bureau in 2017¹ and 2021².

The materials to be used in this research, entitled “Selected 2026 NSSRN Content and Probes” is included as an attachment.

Length of interview: Based on past experience with similar pretesting efforts, it will require approximately 2 minutes for potential participants to complete the online cognitive interviewing screener questionnaire. We estimate up to 60 screener completions to result in 15 participants. Therefore, total recruitment burden is 2 hours. We estimate it will take 1 hour per participant to complete the cognitive interview. For 15 participants, the estimated burden for the interviews is therefore 15 hours, bringing the total burden to no more than 17 hours with recruitment.

In order for us to meet our project deadlines for this work, we request OMB approval no later than October 24, 2024.

The contact person for questions regarding data collection and statistical aspects of the design of this research is listed below:

Courtney N. Reiser

Demographic Statistical Methods Division

U.S. Census Bureau

Washington, D.C. 20233

Courtney.n.reiser@census.gov

1 "NSSRN Cognitive Testing", under OMB Control No 0607-0725 approved on 01/10/2017.

2 "2022 NSSRN Cog Testing", under OMB Control No 0607-0725 approved on 05/27/2021.

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