From Barriers to Opportunities: Increasing the Training and Employment Opportunities in Public Healt

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From Barriers to Opportunities Increasing the
Training and Employment Opportunities in Public
Health Nursing in North Carolina

• Beth Lamanna, WHNP, MPH, RN, School of Nursing,
  UNC-Chapel Hill
• Janet L. Place, MPH, School of Public Health,
  UNC-Chapel Hill
• Jayne Y. Lutz, MS, RN, BC, School of Nursing,
  UNC-Greensboro

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Public Health Occupations Most Needed in Next
Five Years
Source The Future of Public Health in the 21st
Century, 2002
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Public Health Nursing in North Carolina

• 1995 3200 Public Health Nurses in NC (30 BSN)
• 2002-- 2500 Public Health Nurses (48 BSN)
• NC has large number of PHNs delivering clinical
  care in addition to the essential services
• Enhanced RN role enables PHN to perform Category
  II functions and bill independently
• North Carolina is in the middle third of states
  in ratio of public health workers to population,
  with a large majority at the local level.

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Research Questions

• What are the challenges and opportunities that
  university nursing instructors and practicing
  public health nurses have with recruiting and
  preparing BSN students to enter the public health
  workforce well prepared?
• What are the myths and assumptions and what are
  the realities?

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Assumptions to be Tested

• LHD require a years experience prior to
  employment with a health department
• LHD are not interested in recruiting new
  graduates
• Faculty lack skills in population based health
  assessment and in NC public health
• Faculty do not value dialog/partnership with
  practice

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Study Design

• Key informant interviews with leaders in PH
  nursing practice and academia revealed a
  collective memory of a strong past mutually
  beneficial dialogue between practice and academia
  including the Committee on Practice in Education
  (COPE) and an annual statewide PHN practice and
  academic conference. COPE is currently dormant
  and it has been ten years since last statewide
  conference.

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Committee on Practice and Education

• The duties of this committee include
• Actively monitoring the Nurse Practice Act and
  all other rules and prohibitions affecting
  nursing practice in NC
• Assessing PH nursing practice needed in LHDs and
  determining the extent to which PHN practice
  fulfills legal mandates and assures efficient,
  effective delivery if services
• Determining the basic educational preparation
  required to assure safe, legal and desirable
  public health practice.

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Focus Groups

• Practicing public health nurse administrators
  from LHDs located near BSN programs and who had
  past involvement with COPE
• Undergraduate faculty teaching Community Health
  in public and private NC BSN programs, including
  those within Historically Black Colleges.

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Questions Asked

• What are the challenges and barriers that you
  face as a PHN instructor to foster meaningful
  clinical experiences for BSN students?
• What are the challenges and barriers faced by new
  BSN graduates who chose to work in public health
  settings?
• What hands on clinical experiences do you offer
  that help BSN students enter the public health
  workforce prepared?
• What are the major gaps in undergraduate
  preparation from the point of view of public
  health agencies?
• What kinds of clinical experiences would help
  fill these gaps?

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Questions Asked

• What orientation does your community health
  nursing faculty have to public health in NC in
  particular and the US in general?
• What would help attract BSN nursing graduates
  into public health settings?
• What would help keep BSN nurses practicing in
  public health settings?
• Do you know of good models for educational
  preparation in PHN and what makes them good?

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Subjective Data Analysis of Focus Groups
Faculty

• Many clinical experiences in community health too
  short to learn PH skills
• There are not enough good opportunities available
  in some areas (Nurse Run clinics at
  UNC-Greensboro excellent solution)
• Good for faculty to be involved on site
• Important for student to identify
  preceptor/mentor on site
• Need for competitive salaries in public health
• Need for paid internships / externship programs

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Faculty Continued

• Public Health Nursing Awareness Campaign
• Need for bilingual skills
• Need to share best practice models through
  ongoing statewide faculty dialog
• Faculty and practicing PHNs need to be
  educational team
• Public health nursing is undervalued by nursing
  schools which impacts both students and faculty

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Subjective Data Analysis of Calls
PHN Directors

• Ideal if all students can experience LHD
• Need to find good clinical placements of at least
  a semester long
• Need to have more than observational experience
• Need for internship/externships and orientation
  opportunities
• Need for competitive salaries
• Need for real collaboration between faculty and
  preceptor

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PHN Directors Continued

• Clinical faculty need orientation to PH in NC and
  population based skills they may not have
  received in their Community Health graduate
  courses
• Some small LHD need experienced RNs with
  clinical skills. Some can orient and train new
  graduates
• Students need to be confident with independent
  PHN demands
• Need bilingual graduates
• Students need a sound grasp of cultural
  competencies
• Students need appreciation for population health
  practice

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Overlapping Challenges

• Public health and community health are not the
  same thing and thus community health curricula
  often does not adequately prepare PHNs
• Many clinical opportunities in community health
  too short to learn PH skills. Students need to
  spend at least a semester at site.
• Need for competitive salaries in public health
• Need for paid internships / externship programs
• Need for real collaboration between faculty and
  preceptor
• Need Public Health Nursing Awareness campaign for
  both students and nursing school administrators.

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Assumptions Revisited

• LHD require experience and are not interested in
  recruiting new graduates
• No policy exists, size and resources of LHD
  determining factor
• Once again, some LHD recruit/partner/dialog and
  some do not
• Faculty lack skills and devalue partnerships with
  LHD PHNs
• Faculty meeting revealed genuine interest in
  gaining skills and knowledge
• Faculty enthusiastic about revitalization of
  COPE, attendance at summit, and annual faculty
  meeting

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Strategies in North Carolina

• Revive COPE in order to provide a dynamic dialog
  between baccalaureate nursing education and
  public health nursing practice
• Revive Annual Summit for Academic/Practice dialog
• Provide Community Health faculty with orientation
  to public health in North Carolina
• Provide continuing education for faculty on
  public health competencies
• Provide BSN students dynamic public health
  experiences and internships, so that they can
  enter PH departments.

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Activities Already Underway

• September 2003 meeting of statewide BSN faculty
  tested the waters for further work
• Enthusiasm high for ongoing annual meetings and
  COPE
• Creation of statewide network of faculty.
• December 2003 summit to revitalize COPE and
  annual conference

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Partnership is Key in Answering the Need

• Southeast Public Health Training Center, NC
  Institute for Public Health, UNC School of Public
  Health
• UNC-Chapel Hill and UNC-Greensboro Schools of
  Nursing
• NC Public Health Nurse Administrator's
  Association
• Committee on Practice and Education
• Public health nursing faculty in NC baccalaureate
  programs
• PH Nurse Continuing Education Council
• NCCDD
• Local health departments
• The BSN programs of NC

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Recommendations

• Public health nursing needs to reclaim its once
  appreciated subspecialty status and both
  curriculum in BSN programs and work opportunities
  in public health need to require core
  competencies in public health nursing practice
• The future public health infrastructure MUST
  contain a place for well prepared BSN graduates
  and opportunities for advanced degrees
• Schools of nursing must collaborate with public
  health schools and programs to strengthen public
  heath content in nursing programs.