IMPROVING RECRUITMENT AND RETENTION OF PUBLIC HEALTH NURSESM. Bane, A. Bernard, M. Hrezi, E. Lee, V. SimpsonGillings School of Global Public HealthUniversity of North Carolina at Chapel HillPrepared for NENC Partnership for Public Health

20 April, 2015

Agenda

About Our Client

Public Health Nursing in NENC

Program Selection Criteria

Recommendation: Public Health Nursing Pipeline

Questions

Agenda

• Northeastern North Carolina Partnership for Public Health

About Our Client

Public Health Nursing in NENC

Program Selection Criteria

Recommendation: Public Health Nursing Pipeline

Questions

Northeastern NC Partnership for Public Health

About our client

Mission “address common local public health needs through the sharing of resources and best practices regionally to achieve greater efficiency and effectiveness.”

Founded in 1999 Activities: disease surveillance, heart disease and

stroke prevention, and healthy weight promotion initiatives

Dependent on PHNs to deliver such services

Agenda

About Our Client

• Trends• Barriers to recruitment and retention• Consequences of an inadequate workforce

Public Health Nursing in NENC

Program Selection Criteria

Recommendation: Public Health Nursing Pipeline

Questions

TrendsFalling PHN Supply: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

Rising PHN demand:

Health RisksHIV/ AIDS rate in

NENC 75% higher than NC

Above average obesity rate in every

county in NENC

Demographics

38.3% Age 50+

16.2% Age 65+

AccessRural

location19.8%

Uninsured (2014)

Public Health Nursing in NENC

TrendsFalling PHN Supply: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

Rising PHN demand:

Health RisksHIV/ AIDS rate in

NENC 75% higher than NC

Above average obesity rate in every

county in NENC

Demographics

38.3% Age 50+

16.2% Age 65+

AccessRural

location19.8%

Uninsured (2014)

Public Health Nursing in NENC

Barriers to maintaining workforce Aging workforce Insufficient public health funding Lack of public health awareness Incongruity between education training

and job demands Rural location

Public Health Nursing in NENC

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

2000

2010

Age Distribution of Public Health

Registered Nurses in 2000 compared to 2010

Source: Characterization of the Public Health Nurse Workforce, Robert Wood Johnson Foundation. (2013)

Consequences of insufficient PHNs

Decreased preventative care & health promotion Increased burden on health system

Lack of emergency preparedness ex. Inadequate response to natural

disasters

Public Health Nursing in NENC

Agenda

About Our Client

Public Health Nursing in NENC

Program Selection Criteria

Recommendation: Public Health Nursing Pipeline

Questions

Program Selection Criteria

Cost effective

Local participation

Sustainable

Agenda

About Our Client

Public Health Nursing in NENC

Program Selection Criteria

• Mentorship• Employee Development• Internships

Recommendation: Public Health Nursing Pipeline

Questions

}Grow Your Own

MentorshipEmployee

Development

Internships

Grow Your Own

Public Health Nursing Pipeline

Recommendation

Immediate implementation to long-term planning

Short-term resources to long-term investment Relatively prompt results to fostering future

solutions

Mentorship• North Carolina

Accreditation Learning Collaborative

Employee Development Internships

Grow Your Own

Nursing Workforce Initiatives

Recommendation: Public Health Nursing Pipeline

MentorshipRecommendation: Public Health Nursing Pipeline

North Carolina Accreditation Learning Collaborative Outcomes (NCALC) 6-month pilot program in 2010 Target: new PHNs Problem: PHN retention-issues in PH departmentsOutcomes All mentees intended to stay in public health for at least

3 to 5 years 3 of 4 stated intention to stay for 6+ years

Perceived competence increase from 4.75 to 5.00 All mentees and 3 of 4 mentors willing be future

mentors Decreased job satisfaction from 4.63 to 4.35

Activities• Mentor-mentee

pairing• Training• Remote and face-

to-face communication requirements

• Mentor training for mentees

Recommendations• One year, one-

on-one mentorship, same activities

• Offer financial incentives (grant funded) or new title (ex. Senior PHN)

Recommendation: Public Health Nursing Pipeline

Mentorship

Benefits Shown to improve retention among new nurses Develop culture of support Foster non-financial reasons to stay Support integration of new graduates into work

environment

Limitations Relatively time and labor intensive Increases administrative costs Some financial resources required

Recommendation: Public Health Nursing Pipeline

Mentorship

MentorshipEmployee Development• Jewish Hospital Healthcare Services

Internships

Grow Your Own

Public Health Nursing Pipeline

Recommendation

Employee-Based ProgramRecommendation: Public Health Nursing Pipeline

Jewish Hospital Healthcare Services (JHHS) Started in 2002 Target: current employees Problem: insufficient nursing workforce

Outcomes 102 applicants; 32 accepted participants Average time at JHHS: 8.65 years Average age: 35.8 year old 90% program retention

Activities• Support employees

with full-time salary while attending nursing school part-time and working part-time

• Work one year per funded semester

Recommendations• Implement same

program activities• Survey for interest

within workforce• Establish strong

relationship with community college

• Apply for funding and/or analyze financial feasibility

• Integrate mentorship

Employee-Based ProgramRecommendation: Public Health Nursing Pipeline

Benefits Guaranteed workforce Community-based 90% retention

Limitations Financial resources needed Willing, young yet experienced participants Time

Recommendation: Public Health Nursing Pipeline

Employee-Based Program

Mentorship Employee Development

Internships• Vermont Nurse

Internship Program

Grow Your Own

Nursing Workforce Initiatives

Recommendation: Public Health Nursing Pipeline

Vermont Nurse Internship Program 10-week program Ongoing, started in 1999 Target: Nursing students and graduates Problem: inadequate clinical training

Recommendation: Public Health Nursing Pipeline

Outcome: Shown to improve retention among new

nurses One agency maintained a 0% vacancy

rate for over 3 years

Internships

Activities• Matches interns with

nurse preceptors• Additional clinical

training

Recommendations• Survey for interest • Open to non-nursing

majors and high school juniors and seniors

• Integrate community-oriented activities

• Form partnerships with local community college and high schools

Recommendation: Public Health Nursing Pipeline

Internships

Benefits Improved retention Community oriented

Limitations Increased administrative costs Time intensive

Recommendation: Public Health Nursing Pipeline

Internships

MentorshipEmployee

Development

Internships

Grow Your Own

Public Health Nursing Pipeline

Recommendation

Immediate implementation to long-term planning

Short-term resources to long-term investment Relatively prompt results to fostering future

solutions

Cost effective Local Participation Sustainable

Questions?

• Northeastern North Carolina Partnership for Public Health

About Our Client

• Trends: Falling Supply and Rising Demand• Barrier: Aging workforce, Insufficient funding, Lack of awareness, Education-work incongruity, Rural location

• Consequences of an inadequate workforce

Public Health Nursing in NENC

• Cost effective, Local participation, Sustainable

Program Selection Criteria

• Mentorship• Employee Development• Internships

Recommendation: Public Health Nursing Pipeline

}Grow Your Own

ReferencesSlide 4About The NENCPPH. (n.d.). Retrieved April 19, 2015, from http://www.nencpph.net/about/Slide 6The Northeastern North Carolina Partnership for Public Health. (2012). Health in Northeastern North Carolina: Regional Assessment of a 15-County Region, 1-94.Slide 7Washington State Nurses Association. (2011, June). Public Health and Public Health Nursing.Retrieved from http://www.wsna.org/practice/publications/documents/Position%20Paper%20on%20Public%20Health%20r2.pdfU.S. Bureau of Labor Statistics. (2014, January 8th). Registered Nurses: Occupational Outlook Handbook. Retrieved from http://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htmSlide 8Diana McLawhorn, personal communication, October 6, 2014). Robert Wood Johnson Foundation. (2008, September). Charting Nursing’s Future: Reports on Policies That Can Transform Patient Care. Retried from http://www.rwjf.org/content/dam/farm/reports/issue_briefs/208/rwjf32665Slide 14 & 15The North Carolina Institute for Public Health (Jan 2010). Public Health Nurse Mentoring Pilot Program: Mini-Collaborative. Retrieved from: http://nciph.sph.unc.edu/mlc/NurseMentoringPilotProgramManual.pdfSlide 16Davis, M.  (2013) Improve the Retention of Public Health Nurses Through a Mentoring Program. Public Health Quality Improvement Exchange. Retrieved from https://www.phqix.org/content/improve-retention-public-health-nurses-through-mentoring-program.Slide 18, 19 & 20Burge P., Dolan L., Price C., Kramer J., et al. (2004, June). ‘Grow Your Own’: A Responsible Approach to Addressing The Nursing Shortage. Nursing Economics: The Journal for Health Care Leaders, 22(3), pp. 155-6.Slide 22 & 23Intern and Preceptor Development - Vermont Nurses in Partnership. (2009). Retrieved March 15, 2015, fromhttp://www.vnip.org/preceptor.htmlCrimlisk, J., McNulty, M., & Fancione, D. (2002). New graduate RNs in a float pool. An inner-city hospital experience. Journal of Nursing Administration, 32(4), 211-217.

Appendix A: MentorshipThe NC Accreditation Learning Collaborative (NCALC)Statement of Need: Address retentionDesired Outcomes: Increase mentees who plan to remain in public health nursing; increase knowledge base, competence, job satisfaction, train future mentorsTargets: New PHNs (<2 years)Activities: 6-month pilot program with 4 NC health depts., establish mentor-mentee pairsOutcomes: All mentees intend to remain in PHN for 3-5 years, increased competence, all but one willing to serve as mentor in future, fall in job satisfactionStage of Development: 1 March 2010 to November 2010

Appendix

Appendix B: Grow Your OwnJewish Hospital Healthcare Services (JHHS)Statement of need: Address nursing retentionDesired outcome: Ensure retention and support Target: Current employees of JHHSActivities: Current employees work part-time, receiving full-time salary, and attend nursing school

Agree to work as RN for a year for each semester of nursing school tuition covered

Context: Depends on relatively young workforceOutcomes: 102 applicants, 38 enrolled, 89.47% retention rateStage of Development: Currently unavailable

Appendix

Appendix C: PartnershipsThe Vermont Nurse Internship Program (VNIP)Statement of need: Address recruitment and retentionDesired Outcomes: Provide a more effective transition from graduation into the workforceTarget: Undergraduate nursing and newly graduated studentsActivities: 10-week program that includes lessons in standards of care, managed care, cultural competenceOutcomes: One Vermont agency that implemented VNIP reduced its vacancy from 20 % to 0%, maintained this vacancy rate for over 3 yearsStage of Development: Ongoing since 1999

Appendix