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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