nursing by wuxiangyu

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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
Public Health Occupations Most Needed in Next Five Years



             13%


                                        28%                All Other Professionals


                                                           Environmental Health


                                                           Epidemiologists

 28%
                                                           IT Professionals


                                                           PH Nurses

                                      21%

              5%                                           Health Educators
                     5%



   Source: The Future of Public Health in the 21st Century, 2002
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.
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?
Assumptions to be Tested

• LHD require a year’s 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
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.
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.
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.
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?
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?
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
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
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
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 RN’s 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
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.
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
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.
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
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
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.

								
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