Building Bridges & Creating Opportunities: Connecticut s Virtual Office of Public Health Nurses 2009 ASTDN Conference

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1 Building Bridges & Creating Opportunities: Connecticut s Virtual Office of Public Health Nurses 2009 ASTDN Conference Barbara Dingfelder, RN, BSN, MPH, PHCNS-BC, CHES May 6, 2009 Connecticut Department of Public Health Local Public Health Nurse Liaison

Barbara Dingfelder, RN, BSN, MPH, PHCNS-BC, CHES May 6, 2009

2 Consider Connecticut s s Landscape Source: and rural scenes taken by Carroll Foreman 2

3 Objectives By the conclusion, participants will be able to. Describe four strengths and challenges for public health nurses in CT Discuss CT s s public health infrastructure, mission, and historical influences Identify three strategies and interventions implemented by CT s s Department of Public Health to strengthen public health nursing 3

public health infrastructure, mission, and historical influences Identify three

4 Special thanks: Their generous support Norma Gyle,, RN, PhD Deputy Commissioner Pamela Kilbey-Fox, MPH Chief, Local Health Administration Branch Wendy Furniss,, RNC, MS Chief, Health Care Services Lisa Davis, RN, MSN Family Health Section Chief Mentors and Assistance Judy Sartucci, RN, MSN Ruth Knollmueller, EdD, MPH, RN Phil Greiner, DNSc, RN VOPHN Visionaries Andrea Lombard, RN, MPH Epidemiologist Debbye Rosen, RN Epidemiologist Kristin Sullivan, MPA DPH Workforce Development Section Chief VOPHN Core Team Members Local Health Administration Branch Staff Lora Shannon, Administrative Assistant Rebecca Foreman, Office Assistant CAPHN Executive Board 4

Phil Greiner, DNSc, RN VOPHN Visionaries Andrea Lombard, RN, MPH Epidemiologist Debbye Rosen, RN Epidemiologist Kristin Sullivan, MPA DPH Workforce Development

5 DPH s Mission is to protect the health and safety of the people of Connecticut and actively work to prevent disease and promote wellness through education and programs. 5

6 CT s s Virtual Office of Public Health Vision: To promote the health of populations in CT by supporting excellence in public health nursing practice Mission: To foster professional development through collaboration and education of nurses working in public health 6

health nursing practice Mission: To foster professional

7 Our Priorities Fostering a collective voice for public health nurses Promoting a public health workforce based on core competencies and integration of the Public Health Nursing Scope and Standards of Practice (2007, ANA) Identify and promulgating best, evidence based practices 7

integration of the Public Health Nursing Scope and Standards of

8 Our plan 8

9 9

10 How? Recognizing the nurses roles and distinguishing their contributions to improving the health of CT s s residents Enhancing peer support and information sharing Strengthening and building partnerships and collaborations between nursing organizations, schools, and related affiliates Working to assure a competent PHN workforce and network with a foundation based on core public health competencies 10

partnerships and collaborations between nursing organizations, schools, and related affiliates

11 Historical Influences for CT s s Public Health System CT State Board of Health established January 1898 American Public Health Association (APHA) 1940 Desirable Minimum Functions 1950 Basic Six Expanded and amplified local health department s s role National Public Health Performance Standards (CDC, 2001) 11

1940 Desirable Minimum Functions 1950 Basic Six Expanded and amplified local

12 Looking for Public Health Nursing Roots in CT First visiting nurse in Norwich, CT New Haven Health Department assigned a nurse to public schools in that community Census revealed 231 PHN agencies in CT employing 555 nurses CT became first state to pass legislation regulating home health care RNs employed full or part-time time for public health work in state and local agencies in CT Source: CT Health Bulletin vol. 100, Number

employing 555 nurses CT became first state to pass legislation regulating home health care RNs employed full or

13 Virtual Office of Public Health Nurse Links Across DPH 13

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15 Population and Town Distribution Served by Type of Local Health Department Full-Time Number of Towns 139 *Population 3,285,455 Proportion (% of pop.) 93% Municipal 32 1,699,216 48% Districts (20) Part Time ,586, ,332 45% 7% Total 169 3,510, % *2006 Population Estimates (Last updated June 17, 2008) 15

) 93% Municipal 32 1,699,216 48% Districts (20) Part Time 108 28 1,586,239

16 Authority CT Gen. Statutes 19a-2a Shall ensure the enforcement of the CT General Statutes and regulations of the Public Health Code by local health departments Approval for appointment May remove DOH from appointment 16

17 Basic Local Health Department Program CT s s Public Health Code Section 19a Public Public health statistics Health Health education Nutritional services Maternal Maternal and child health Communicable and chronic disease control Environmental services Community nursing services Emergency medical services 17

services Maternal Maternal and child health Communicable and chronic disease

18 Per Capita Funding To receive per capita funding the Part-Time municipality must have the equivalent of at least one full-time employee (FTE) [CGS 19a-202a 202a] CGS Regulations Section 19a Definitions: A maximum of three employees whose total work week consists of a minimum of 35 hours 18

(FTE) [CGS 19a-202a 202a] CGS Regulations Section 19a-76 76-1 Definitions:

19 Municipal Local Health Departments CGS 19a-245 District Health Departments Towns with population < 5000 receive $2.43 per person Towns with populations > 5000 receive $2.08 per person 19

20 Per Capita CGS 19a-202 Full-Time Health Departments receive $1.18 per person CGS 19a-202a Part Time Health Departments receive $0.49 per person 20

21 How many nurses are employed by CT s s health departments and where do they work? 21

22 DPH Staff Classified Under Nursing Source: DPH Human Resources (July 2005) 1% 2% 4% 27% 51% 2% 10% AIDS BHCS BPHS 2% 1% Child Lead Comm Base Reg Family/Prim Health Health Sys Reg LHA/Bioterr OEMS Based on 97 Nursing Positions ~ 12% DPH Workforce Local Public Health Nurse Liaison 9 22

23 LHD Nursing Staff Data Source: CT DPH, SFY 2005 Annual Reports for LHDs 31% 2% 3% DON N Sup School N NP 8% 6% 50% Other RNs PHN Based on 397 Nursing Personnel Aggregate Data for 105 LHDs Local Public Health Nurse Liaison 19 23

24 LHD Nursing Personnel Data by Staffing Source: CT DPH, SFY 2005 Annual Reports for LHDs LHD Nursing Personnel 100% 80% 60% 40% 20% 0% Health District Full Time HD Part Time HD Proportion of Services Contracted Part Time Full Time Nursing Staff Data for CT LHDs 8% 4% 88% PT FT Depts FT Districts Based on 397 Nursing Personnel Aggregate Data for 105 LHDs Local Public Health Nurse Liaison 20 24

25 Strengths Relatively small state with a large Brain Trust Timing (e.g., national efforts, public need, aligns with other state association initiatives) Leadership capacity Executive support Visionary Participatory Untapped opportunities by Pooling resources Partnering and collaborating 25

26 Challenges Diverse education and professional backgrounds Unions Limited: Understanding by workforce of the scope of PHN practice Awareness of models and evidence base for how nurses can impact and carry out the public health mission Orientation for transition to public health Coordination of State nursing leadership and support for local health nurses Incentives for nurses to pursue continued or advanced academic preparation or certification 26

27 Creating Opportunities To build on strengthens and mutual core knowledge base Fostering increased networking and information sharing between nurses Peer support Facilitating pooling of resources Participation in decision making Recognition of contributions Collective response 27

28 How VOPHN is Inter-Connected DPH Across Programs LHAB CNA CAPHN LHDs CPHA Academia CADH CEHA School Health Home Health DOE VOPHN Community Partners DMR DSS DCF Others? DMHAS 28

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30 Accomplishments Participation National organizations National surveys Formation of VOPHN Placed Foundations for Bridges Strengthening collaborations and partnerships Bi-Annual Meetings with community based nurses (e.g., local health partners, nurse educators, VNA, etc) Offering continuing education opportunities Developing Profile Baseline Assessment Defining criteria Data Collection Portfolio of CT s s Public Health Nurses in 30

31 On-going Activities Providing continuing education opportunities (CEUs( CEUs) Enhancement of an orientation and mentoring program for nurses new to public health Information sharing: Web-page link for the VOPHN in conjunction with the DPH homepage Distribution list for participants in conferences and meetings Collaborations Schools of Nurses Professional Associations 31

32 On-going Challenges include. Culture of change (and inherent challenges) Silo phenomenon Competing needs, demands, and limited resources Range of professional experience(s) and academic preparation Sustainability Lack of developed and organized infrastructure for nurses working in public health roles in CT 32

33 VOPHN Founding Team Norma Gyle,, Deputy Commissioner, DPH Pamela Kilbey-Fox, Chief, LHAB Barbara Dingfelder, Local PHN Liaison, LHAB Andrea Lombard, HIV/AIDS Surveillance Debby Rosen, Adult Immunizations Program Kristin Sullivan, Section Chief, Workforce & Professional Development Wendy Furniss,, Chief, Health Systems Branch Lora Shannon, Administrative Asst (LHAB) Eileen Boulay,, Supervisor, Asthma and Injury Prevention Programs Mary Emerling,, Office of Emergency Management Linda Bailey, Lead Program Linda Cooney, AIDS Health Care/Social Services Lisa Davis, Section Chief, Family Health Donna Heins,, School and Adolescent Health Coordinator 33

34 In conclusion Building bridges starts with a a Commitment of a dedicated team Needs assessment A strategic plan One step at a time 34

35 Thank you! Barbara Dingfelder, RN, BSN, MPH, PHCNS-BC,CHES Local Public Health Nurse Liaison Connecticut Department of Public Health Local Health Administration Branch via e at: barbara.dingfelder 35

36 For Additional Information. Connecticut Department of Public Health via and the Virtual Office of Public Health Nurses is listed under programs Connecticut Association of Public Health Nurses via caphn.org 36

A Profile of Nurses Working in Connecticut s Health Departments

A Profile of Nurses Working in Connecticut s Health Departments Barbara Dingfelder, APRN-BC, BSN, MPH, CHES Local Public Health Nurse Liaison Local Health Administration Branch November 2006 Keeping Connecticut