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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