Managing Human Resources for Sustaining TB Control in Massachusetts

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1 Managing Human Resources for Sustaining TB Control in Massachusetts Sue Etkind, R.N., MS Director, Division of TB Prevention and Control Massachusetts Department of Public Health

2 Skilled people are at the heart of our public health infrastructure. Without an adequate supply of competent workers, almost nothing else matters. Emergency protocols and policies can t protect us without trained people to implement them and a state-of-the-art laboratory system can t run itself no matter how much money you have.

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4 Managing Human Resources for Sustaining TB Control in Massachusetts 1. Background: Massachusetts Public health infrastructure (local/state) Bureau of Communicable Disease Control: nursing/tb TB problem 2. Role of public health nurses 3. HR Problems: Local/State/National 4. Strategies for sustaining TB control

5 Massachusetts

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7 351 autonomous cities and towns ranging from the City of Boston with more than a half million population, to small towns with persons in the Berkshires.

8 Managing Human Resources for Sustaining TB Control in Massachusetts 1. Background: Massachusetts Public health infrastructure (local/state) Bureau of Communicable Disease Control: nursing/tb TB problem 2. Role of public health nurses 3. HR Problems: Local/State/National 4. Strategies for sustaining TB control

9 Massachusetts Public Health: A Shared Responsibility 351 Local Boards of Health Disease Control State Health Dept

10 Massachusetts Public Health: A Shared Responsibility 351 Local Boards of Health: nursing capacity Public health nurses 2. VNAs 3. none Disease Control TB State Health Department Communicable Disease Bureau Division of TB Prevention and Control: nursing capacity Central Office Regional nurses Nursing case management model

11 CD Bureau Nursing Immunization Nurses TB Nurses Preparedness Nurses STD Nurses

12 Managing Human Resources for Sustaining TB Control in Massachusetts 1. Background: Massachusetts Public health infrastructure (local/state) Bureau of Communicable Disease Control: nursing/tb TB problem 2. Role of public health nurses 3. HR Problems: Local/State/National 4. Strategies for sustaining TB control

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14 Massachusetts Tuberculosis Case Rates Per 100, Projected TB cases Year MDPH/DIVISION OF TB 2,716 TB cases Between ,787 excess TB cases MA Projected Decline TB Elimination Goal

15 Managing Human Resources for Sustaining TB Control in Massachusetts 1. Background: Massachusetts Public health infrastructure (local/state) Bureau of Communicable Disease Control: nursing/tb TB problem 2. Role of public health nurses 3. HR Problems: Local/State/National 4. Strategies for sustaining TB control

16 Public Health Nurse The title public health nurse designates a nursing professional with educational preparation in both public health and nursing sciences APHA Public Health Nursing Section

17 John Adams, 2 nd President, signed into law The Act for the Relief of Sick and Disabled Seaman (first Public Health Service) 7/16/1798

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21 Nurses, yellow fever hospital, Louisiana 1891 PH nurse 1924, formula preparation

22 Cadet Nurse Corps 1944 PH Nurse 1920

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27 Managing Human Resources for Sustaining TB Control in Massachusetts 1. Background: Massachusetts Public health infrastructure (local/state) Bureau of Communicable Disease Control: nursing/tb TB problem 2. Role of public health nurses 3. HR Problems: Local/State/National 4. Strategies for sustaining TB control

28 Massachusetts Public Health Nurse Survey Public Health Nurses making a difference protecting and improving the health of communities

29 Introduction Why have data? Nurses are the largest segment of the public health workforce Data about public health nurses serving Massachusetts cities and towns is key to documenting the future of public health The nursing shortage continues to grow nationally and in Massachusetts

30 Response 225 PHNs 237 Municipalities Some cities have more than one PHN and some nurses provide service to 5 or more towns 237 municipalities = 83% of the population

31 Survey Contents Background and Methods Education and Experience Scope of Practice and PH Interventions Preparedness Populations Served Compensation Age Trends and National Trends Summary of Findings Recommendations

32 Educational Level 51% surveyed have a BSN or higher 50% nationally have a BSN or higher Quad Council of Public Health Nursing Organizations The Impact of the Nursing Shortage on Public Health Nursing

33 PHN Age Cohorts <

34 National Findings Average age of the workforce is 40 Average age of a PH worker 46.6 Average age of a nurse 46.8 Average age PHN survey (N=215) is % of women work 73% of men 83% of nurses

35 Age Trends Approximately 10% of the PHN workforce will be eligible to retire each year beginning in 2007 predicted to continue through 2020 Massachusetts PHN Survey

36 Scope of Practice 58% reported that they had this document in hand 70% or above in some regions

37 Purpose of PHN Leadership Guide Assist in orientation of new PHNs Guide PHNs established in practice Inform Boards of Health on PHN role Link PHN practice and education Institute standards of practice

38 Public Health Intervention Model

39 Practice Model 72% Surveillance Disease and Health Event Investigation Outreach Screening Case Finding 64% Referrals and Follow-up Case Management Delegated Functions 73% Health Teaching Counseling Consultation

40 Practice Model 59% Collaboration Coalition Building Community Organizing 46% Advocacy Social Marketing Policy Development & Enforcement

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44 PHN Survey Findings Preparedness: participation of PHNs in specific trainings, LEPC meetings and exercises needs to increase Populations Served: there are residents of the Commonwealth who do not have access to public health nursing services Compensation: average PHN salary is $27/hr, range <$15 to >$35/hour

45 Populations Served # of PHNs per population varied greatly across the state # of PHNs was not proportional to health indicators some towns reported having less than $1000/year budgeted for nursing services

46 Nursing Shortage The nursing shortage is evident in the hospital setting and equally if not more so impacting public health

47 Projections

48 National Nursing Shortage Without measures to reverse the trends the nation is in danger of experiencing serious breakdowns in the health care system Strategies to Reverse the New Nursing Shortage AACN Position Statement 2001

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50 National Public Health Shortage If current public health workforce trends are not reversed, a major shortage is imminent The size of the public health workforce will be cut in half over the next 5 years The Public Health Workforce Shortage: Lift Unchecked, Will We Be Protected? APHA, Issue Brief, September 2006

51 Nursing Faculty Shortage The shortage of nursing faculty continues to be a serious contributor to the worsening national nursing shortage About 33,000 qualified applications to nursing programs were turned down in 2004, primarily because of the shortage of nursing faculty The Nursing Faculty Shortage: A Crisis in Health Care Karl Yordy Association of Academic Health Centers

52 Those that cannot remember the past are doomed to repeat it George Sanatayana extreme Budget Reductions PH infrastructure erosion Multi-state TB Outbreaks Global Pandemic XDR TB I never thought it would fill again MDR TB

53 Managing Human Resources for Sustaining TB Control in Massachusetts 1. Background: Massachusetts Public health infrastructure (local/state) Bureau of Communicable Disease Control: nursing/tb TB problem 2. Role of public health nurses 3. HR Problems: Local/State/National 4. Strategies for sustaining TB control

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55 Recommendations Lead in Workforce Development Assure Competency and Preparedness Recruit and Retain Nurses

56 Lead in Workforce Development Engage policy makers in improving public health competency at all levels Conduct a PHN Survey in Support collection of workforce data Maintain local and national alliances to advance public health nursing practice

57 Education Recommendation PHNs often are the only nurse for the municipality and do not have ready access to a public health nursing advisor Increase PHN attendance at educational, skill building and networking sessions

58 Compensation Recommendation Align PHN compensation with education experience competency

59 Assure Competency and Preparedness Utilize technologies to document outcomes Increase PHN participation in trainings Strongly advocate for educational funds Link practice and education

60 Recruit and Retain Nurses Aggressively market careers in nursing and public health to diverse groups Align PHN compensation with education, experience and competency Support organizations working to ensure the health of the public through nursing practice

61 Partnership expansion leads to resource maximization The ion words

62 What can regionalization do for TB resources? Expand experts Build on diversity of experiences and practices Increase ability to affect health Improve nursing efficiencies Stronger nursing advocacy

63 Northeastern National TB Center New England Region Regional Training and Medical Consultation Centers (RTMCCs) Areas of Coverage AK WA OR NV CA ID UT AZ MT WY CO NM ND SD NE KS OK TX MN IA MO AR LA WI IL IN MI TN KY OH MS AL GA WV SC PA VA NC NH VT NY ME MA RI CT NJ DE DC MD FL PR HI Area of Coverage Region 1 Region 2 Region 3 Region 4 Legend Center Location San Francisco, CA San Antonio, TX Newark, NJ Gainesville, FL Erin Howe

64 Interactive Web Presentation Wednesday, January 18, :00 Noon Eliminating TB Case by Case A TB Case Series for Providers and Clinicians Presenter: C. Fordhamvon Reyn, MD Chair, Infectious Diseases and International Health Dartmouth-Hitchcock Medical Center The New England TB Control Programs invite you to participate in an interactive case presentation on the diagnosis, treatment, and case management of tuberculosis patients. The TB Case Series will be held quarterly. Access the TB Case Series at Toll free audio access: Password = 2006 # Accreditation: CME, CNE, CHES. This activity has been designated by CDC for 1.0 Category 1 hours toward the AMA physician's recognition award, 1.2 hours toward the ANCCCA nurse s recognition award and 1.0 hours accreditation by the NCHEC for health educators.

65 Public Home Page

66 What can integration do for TB resources?

67 CD Bureau Nursing NOW Immunization Nurses TB Nurses Preparedness Nurses STD Nurses

68 CD Bureau Nursing The FUTURE Immunization Nurses TB Nurses Large vaccination clinic in western MA Mass antibiotic dispensing clinic (anthrax) TB cases in prison Mass vaccination (smallpox) Measles clinic in a daycare center Preparedness Nurses STD Nurses

69 Advocacy & Marketing Efforts joint press releases joint press conferences mailings posting of survey on MAPHN web site promotional displays at conferences presentations

70 Social Marketing Audiences local boards of health selectmen (elected officials) regional public health coalitions regional MAPHN chapters (local PHN) state representatives and senators faculty and students in PH & nursing

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73 Public Health Nurses do make a difference protecting and improving the health of communities and the lives of our TB patients

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