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THE CURRENT AND FUTURE ADEQUACY OF THE PUBLIC HEALTH NURSING WORKFORCE M. BANE, A. BERNARD, E. LEE, M. HREZI & V. SIMPSON 13 TH NOVEMBER, 2014 NORTHEASTERN NORTH CAROLINA PARTNERSHIP FOR PUBLIC HEALTH

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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

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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

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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

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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?

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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?

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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

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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

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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

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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

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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).

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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

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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

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RECRUITMENT AND RETENTION

CHALLENGES OF MAINTAINING AN ADEQUATE OF WORKFORCE

Recruitment Retention

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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

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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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

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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

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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.