Post on 13-Apr-2017
THE CURRENT AND FUTURE ADEQUACY OF THE PUBLIC HEALTH NURSING WORKFORCEM. BANE, A. BERNARD, E. LEE, M. HREZI & V. SIMPSON 13TH NOVEMBER, 2014
NORTHEASTERN NORTH CAROLINA PARTNERSHIP FOR PUBLIC HEALTH
PRESENTATION AGENDA
What is Public Health Nursing?
Current Adequacy of Public Health Nursing Workforce
Challenges to Maintaining an Adequate Workforce
Consequences of an Inadequate Workforce
Summary
PRESENTATION AGENDA
• Public Health Nursing defined• Comparison of Public Health and Non-Public Health Nursing
What is Public Health Nursing?
Current Adequacy of Public Health Nursing Workforce
Challenges to Maintaining an Adequate Workforce
Consequences of an Inadequate Workforce
Summary
PUBLIC HEALTH NURSING DEFINED
Source 1: Characterization of the Public Health Nurse Workforce, Robert Wood Johnson Foundation. (2013, June 26). http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/06/enumeration-and-characterization-of-the-public-health-nurse-work.html
Public Health Nursing is the practice of promoting and protecting the health of populations in addition to providing clinical services.
Public health nurses comprise 25% of the national public health workforce, making them the largest branch.
WHAT IS PUBLIC HEALTH NURSING?
THE ROLE OF PUBLIC HEALTH NURSES VS. NON-PUBLIC HEALTH NURSES
Non-Public Health Nurses Public Health Nurses
Goal Direct patient careHealth education, prevention efforts, in addition to patient care
Primary Audience Individuals Populations
Setting of Work Hospitals and health clinicsSchools, community and senior centers, health departments
Examples
Observe, assess, and record symptoms, reactions, and progress, which provides the basis for care planning and intervention
Design and implement health education campaigns and disease prevention activities, including: • Immunization programs• STD screenings and basic treatment• Educating communities and schools
on nutrition and healthy lifestyles
Source 2: Public Health Nursing. NC Public Health Careers, http://www.ncpublichealthcareers.com/images/Nursing.pdf
WHAT IS PUBLIC HEALTH NURSING?
PRESENTATION AGENDA
What is Public Health Nursing?
• National• North Carolina• Northeast North Carolina• Demand• Supply
Current Adequacy of Public Health Nursing Workforce
Challenges to Maintaining an Adequate Workforce
Consequences of an Inadequate Workforce
Summary
NATIONAL SHORTAGE OF PUBLIC HEALTH NURSES
219 public health nurses per
100,000 people1980
158 public health nurses per
100,000 people2000
27 state health departments
anticipate severe shortage
2013
Source:. Robert Wood Johnson Foundation. Enumeration and Characterization of the Public Health Nurse Workforce. (2013).Source: U.S. Department of Health and Human Services Human Resources and Service Administration Bureau of Health Professionals. NCHWA’s Nursing Workforce Research Activities and Findings. (2013).
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
NORTH CAROLINA PUBLIC HEALTH WORKFORCE
Source: North Carolina Association of Local Health Directors Public Health Task Force. (2013).
Public health nurses are: • the primary deliverers of
clinical care in the local public health workforce;
• the first responders in times of emergencies.
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
NORTHEASTERN NORTH CAROLINA
The Northeastern North Carolina Partnership for Public Health. Health in Northeastern North Carolina: Regional Assessment of a 15-County Region. (2012).
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
NORTHEASTERN NORTH CAROLINA: INCREASING DEMAND
Health Risk Factors
HIV/ AIDS rate in Northeastern NC is
75% higher than NC
Above average obesity rate in every county in
Northeastern NC
Age
38.3% Age 50+
16.2% Age 65+
Access
Rural location
19.8% Uninsured (2014)
“When the need for public health increases, a need for Public Health Nursing increases”
- Susan Little, Nurse Consultant for Department of Human and Health Services
Demand for public health nurses is linked to population factors such as:
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
The Northeastern North Carolina Partnership for Public Health. Health in Northeastern North Carolina: Regional Assessment of a 15-County Region. (2012).
NORTHEASTERN NORTH CAROLINA: FALLING SUPPLY
http://www.shepscenter.unc.edu/hp/longitudinal.htmhttp://www.census.gov/popest/data/historical/index.html
The supply of public health nurses is declining:
General nursing
shortage
Fewer nurses in Northeastern
NC vs NC
Slow and unsteady growth of supply in Northeastern
NC
Nurses not entering the public health
workforce
0
100
200
300
400
500
600
700
800
900
1,000
Resistered Nurses per 100,000 (2000-2010)
North Carolina
NE North Carolina
0
5
10
15
20
25
30
35
40
45
2000 2002 2004 2006 2008 2010
Nurse Practitioners per 100,000 (2000-2010)
North Carolina
NE North Carolina
CURRENT ADEQUACY OF PUBLIC HEALTH NURSING WORKFORCE
PRESENTATION AGENDA
What is Public Health Nursing?
Current Adequacy of Public Health Nursing
• Aging workforce• Lack of financial resources• Education requirements• Exposure to public health settings• Regional factors
Challenges to Maintaining an Adequate Workforce
Consequences of an Inadequate Workforce
Summary
RECRUITMENT AND RETENTION
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
Recruitment Retention
AGING WORKFORCE
Retiring faster than hiring
40% of workforce age 50+ Shortage will worsen over next
decade as baby boomers retire
Age Distribution of Public Health Registered Nurses in 2000 compared to 2012
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
2000
2010
CHALLENGE: LACK OF FINANCIAL RESOURCES
Public Health Nurse (Local-level)
Non-Public Health Nurse
Difference
Nurse Practitioner 70,160 96,460 37%
Registered Nurse 49,246 65,470 33%
http://www.bls.gov/ooh/healthcare/registered-nurses.htmhttp://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htmhttp://www.rwjf.org/content/dam/farm/reports/reports/2013/rwjf406659http://healthyamericans.org/states/?stateid=NC#section=3,year=2014,code=undefinedhttp://healthyamericans.org/assets/files/TFAH2013InvstgAmrcsHlth05%20FINAL.pdf
Median Salary ($) for Nurse Positions (2013)
Severe lack of financial resources for public health programs North Carolina health funding per capita (2012-13 FY): $12.51
Ranked 47th nationwide
Cannot afford to compete with non-public health employers
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
CHANGING EDUCATION REQUIREMENTS
There are not enough students graduating from Bachelor nursing programs In Northeastern NC, most public health nurses have Associate degrees (2 years)
Shift in requirements towards Bachelor prepared nurses (4 years)
• Registered Nurse or nursing degree with enhanced trainingRequirement
Source ###: North Carolina Association of Local Health Directors Public Health Task Force. (2013, June). A Blueprint of the Future for Local Public Health Departments in North Carolina: 2013 Statewide Public Health Incubator Summary Report and Recommendations.Source ###:Zahner, S. J., & Henriques, J. B. (2013). Interest in Public Health Careers Among Undergraduate Student Nurses. Journal of Public Health Management and Practice,19(1), 62-69Source ###: The Quad Council of Public Health Nursing Organizations (November 2006) The Public Health Nursing Shortage: A Threat to the Public’s Health
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
EXPOSURE TO PUBLIC HEALTH SETTINGS
The only experience that increases interest in Public Health Nursing is having community health exposure prior to graduation
Many nursing programs in Northeastern NC do not incorporate community health engagement and experiential learning
Students in community colleges do not have community health rotation Less awareness and interest
Unprepared upon graduation
• Experience in school, local health department or community centerRequirement
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
Please cite UWM (2013)
UNATTRACTIVE WORK ENVIRONMENT
It is difficult to recruit and retain nurses to rural communities Small, non-diverse population
Few amenities Restaurants, movie theaters, arts
Few social events
Worn-out facilities
Source ###: (personal communication, September 24, 2014)
Source ###: Dingley J. and Yoder L. (2013). The public health nursing work environment: review of the research literature. Journal of Public Health Management and Practice. 19(4) 308-321. doi: 10.1097/PHH.0b013e31825ceadc
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
RECRUITMENT AND RETENTION
CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE
RECRUITMENT RETENTION
• Education requirements
• Exposure to public health settings
• Lack of financial resources
• Unattractive work environment
• Aging, retiring workforce
PRESENTATION AGENDA
What is Public Health Nursing?
Current Adequacy of Public Health Nursing
Challenges to Maintaining an Adequate Workforce
• Poor emergency preparedness• Heavy burden on vulnerable population• Reduced preventative care and health promotion
Consequences of an Inadequate Workforce
DECREASED PREVENTATIVE CARE AND HEALTH EDUCATION
Public Health Nurse Roles
• Health planning• Home health
visits• Vaccinations• Sexual &
Reproductive Health Education
Affected Populations
• Low income• First-time
mothers• Youth
Example: Nurse Family Partnership
• In home consultations
• Encourages father participation
Outcomes of Nurse Family Partnership
• 46% increase in father’s presence in household
• 79% reduction in pre-term delivery for women who smoke
Decrease preventative care Increase demand of health care services
CONSEQUENCES OF AN INADEQUATE OF WORKFORCE
LACK OF EMERGENCY PREPARATION
Public Health Nurse Roles
• Assess community needs
• Operate command center
Affected Populations
• Everyone within an afflicted area during a disaster• Vulnerable
populations
Hertford County Department of Social
Services
• Staff shelters at local high schools in cases of emergency
Consequence
• Poor response in times of crisis• Increased wait time
for medical treatment
• Insufficient staff to distribute supplies
• Limited facility capacity
Lack of emergency preparation Negative impact on population health
CONSEQUENCES OF AN INADEQUATE OF WORKFORCE
HEAVY BURDEN ON VULNERABLE POPULATION
Public Health Nurse Roles
• STD management, including screening and treatments
• Vaccinations• Acute condition
treatment• Physicals
Affected Populations
• Uninsured and Medicaid patients
Enhanced Nursing Program
• Advanced training program
• Funded by local health department
• Equips nurses with skills needed for physical assessments and disease treatment
Outcomes of Enhanced Nursing
Program
• Increased access to care for vulnerable populations
• Better prevention of and care for infectious diseases
• Decreased burden on clinicians and emergency departments
Few Public Health Nursing services Heavy health and financial burden on vulnerable populations
CONSEQUENCES OF AN INADEQUATE OF WORKFORCE
SUMMARY
• The practice of promoting and protecting the health of populations in addition to providing clinical services
What is Public Health Nursing?
• Increasing in demand and decreasing in supply in Northeastern North Carolina
Current Adequacy of Public Health Nursing Workforce
• Aging workforce• Lack of financial resources• Changing education requirements• Lack of exposure to public health settings• Unattractive work environment
Challenges to Maintaining an Adequate Workforce
• Lack of emergency preparation• Heavy burden on vulnerable populations• Reduced preventative care and education
Consequences of an Inadequate Workforce
ACKNOWLEDGEMENTS
Susan Little Nurse Consultant for the NC Department of Health and Health and Human Services
Diane McLawhornDirector of Nursing, Hertford County
Julie TunneyCoordinator of the Northeastern North Carolina Partnership for Public Health
Melanie StuderProgram Director, Course Instructor
REFERENCES
1. Robert Wood Johnson Foundation. (2013, June 26). Characterization of the Public Health Nurse Workforce. Retrieved from http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/06/enumeration-and-characterization-of-the-public-health-nurse-work.html
2. Public Health Nursing. NC Public Health Careers. Retrieved September 30, 2014, from http://www.ncpublichealthcareers.com/images/Nursing.pdf
3. Boulton, M., & Beck, A. (2013). Enumeration and Characterization of the Public Health Nurse Workforce. Robert Wood Johnson Foundation, 63-63. Retrieved October 5, 2014
4. Nooney, J. (2013, May). NCHWA’s Nursing Workforce Research Activities and Findings. U.S. Department of Health and Human Services Human Resources and Service Administration Bureau of Health Professionals, 1-30
5. The Northeastern North Carolina Partnership for Public Health. (2012). Health in Northeastern North Carolina: Regional Assessment of a 15-County Region, 1-94.