SUCCESSION PLAN FOR PUBLIC HEALTH NURSING. Applicant: Wyoming Public Health Nursing. Community and Public Health Division

Transcription

1 SUCCESSION PLAN FOR PUBLIC HEALTH NURSING Applicant: Wyoming Public Health Nursing Community and Public Health Division Wyoming Department of Health 6101 Yellowstone Road Cheyenne, WY Project Director: Student Experience/Preceptor Development Karen Ouzts, RN, PhD, State Supervisor, Public Health Nursing (PHN) Administrator Support: Donna Griffin, RN, MS, Chief Nurse Executive, PHN Section Chief Molly M. Bruner, MSN, RNC, Community and Public Health Division Administrator 1

2 ORGANIZATION OVERVIEW Wyoming Public Health Nursing (PHN) is a section of the Community and Public Health Division of the Wyoming Department of Health (WDH). It is a unique partnership between the state and county government for the provision of PHN Offices in each of the 23 counties in Wyoming. A memorandum of understanding (MOU) allows each county to provide funding for support services, office space, county employees, and a percentage of the state employee salaries. The state provides a percentage of state employee salaries and provides nursing supervision, program consultation, and oversight. Each County PHN Office is staffed by a Nurse Manager who is responsible for program administration with local oversight by the Board of County Commissioners, and in some counties, a local board of health. The State PHN Section provides nursing oversight, supervision, and consultation from the chief nurse executive, three state public Health nursing supervisors, and three program consultants. Additional program funding is provided through state and federal grants including Public Health Emergency Preparedness, Maternal Child Health, Community Block Grants, and Wyoming Health Council. Total State Employees (includes registered nurses & nurse practitioners): Total county employees (includes registered nurses, home health aides, public health response coordinators, and clerical staff): 224 Total number of RNs: 180 Average number of PHN to population for state nurses only: 1 to 4370 Average number of PHN to population for state and county nurses: 1 to 2223 Recommended number of PHNs/population: 1 to 2500 (Personal communication, Donna Griffin RN, 2008) Each county has mandated state programs along with optional local county programs. Population focused care is provided in a variety of settings including home, office, and other community locations. Number of Contacts/People served: a total of 85,908 PHN contacts were made to 20,709 individuals of all ages in Wyoming during 7/1/07 through 6/30/08. Mandated Programs: 1. Preventive Health: Child and adult immunizations Tuberculosis testing and follow-up Disease prevention, surveillance, and outbreak follow-up 2. Maternal Child Health Programs Home Visiting programs for normal & high risk mothers, infants, & children Child Protection Team member 3. Public Health Emergency Preparedness 4. Community Planning Community Assessments Public Information/education 5. Adult Care Medicaid Waiver and Long term care nursing home preadmission screening Adult Protection Team Chronic Disease Prevention and Management 2

3 Background In general PHNs tend to either stay in their positions for a number of years or are promoted to new ones within the agency. Turnover and vacancies are similar from year to year. In 2007, the percentages for turnover and vacancies were 16% and 7% respectively. Turnover frequently relates to promotions from within the organization. According to a recent survey conducted by the Department of Employment (DOE, 2008) PHNs reported high job satisfaction in Wyoming PHN, and they also reported within the next decade over 50% of PHNs in Wyoming plan to retire. Of the 134 respondents who answered the retirement question on the DOE survey, 104 reported they will retire within 5 years. (See Table 1) Considering Wyoming presently has 180 RNs, this will account for half of the current workforce. Table 1 When Do You Plan to Retire from PHN? In more than 1 year but less than 3 years % In more than 3 years but less than 5 years % In more than 5 years % Don't Know % Skip 8 6.0% No answer 1 0.7% Total % A Bachelors Degree in Nursing (BSN) is the minimum expected level of education for PHN practice, yet PHN has needed to employ nurses with Associate Degrees (AD) due to a lack of BSNs in the state. Table 2 shows that approximately 56% of the nurses hold a BSN or higher degree. In addition, Table 3 demonstrates that 57 of the 125 respondents who plan to retire within five years have BSN or higher degrees. Without a solid pool of BSNs in the state to replace them the likelihood of employing nurses with ADs to replaces nurses with BSN is high. Employing more ADs can lead to a less educated, less competent workforce in PHN which directly impacts the ability to provide evidenced-based, populationfocused care. (See Table 2 and 3) Table 2 What is the Highest Level Of Education You Have Completed in Nursing? Diploma Program % Associate's Degree % Bachelor's Degree % Graduate or Professional Degree 8 6.0% Other 4 3.0% Total % 3

4 Table 3 Level of Nursing Education by Anticipated Time Before Retirement 1-3 Years 3-5 Years 5+ Years Don't Know Diploma Program % % % 2 9.5% Associate's Degree % % % % Bachelor's Degree % % % % Graduate or Professional Degree 1 7.1% % 3 4.0% 1 4.8% Other 0.0% 0.0% 2 2.7% 1 4.8% Total % % % % SUCCESSION PLAN FOR PUBLIC HEALTH NURSING Plan for proposed work place improvement project Considering the large number of nurses who will be retiring from PHN within the next three to five years a specific recruitment, retention, and succession plan needs to be developed for Wyoming PHN. This plan is imperative in order to have a competent PHN workforce in place to promote and protect the health of Wyoming citizens. (Robert Woods Johnson Foundation [RWJF], 2008) The project involves two separate but related activities. The first activity, a recruitment and retention strategy, focuses on the student experience and the development of expert preceptors. The second activity, a retention strategy, focuses on succession planning. Recruitment - The Student Experience Preceptor Development Student Experiences Student clinical experiences will be the focus of PHN s recruitment plan. A positive clinical experience that highlights autonomy, high level critical thinking, leadership, and importance to the health of the community will be emphasized because these are some of the reasons Wyoming PHNs love their work and stay in their positions (DOE, 2008.) At this time PHN preceptors welcome students, yet they are unsure about what the experience needs to be. Nurse preceptors in PHN offices often teach students from various nursing programs such as AD, basic BSN, accelerated BSN, and RN-BSN students. In order to address the needs of this diverse group of students and provide the best experience a continuum of experiences will be planned. The experience of AD students will focus on community-based services for individual clients. The experience of BSN students will focus on population focused public health nursing according to the Minnesota PHN Intervention Wheel. (Frank et al, 2005; Minnesota PHN) AD student experience. The experience of AD students will focus on community-based services for the individual clients. Typically the amount of time AD students spend in the agency is short and will focus on the individual client and on care that is moving out of the hospital and into the community. Course outcomes will also guide the experience. (Frank et al, 2005) 4

5 BSN student experience. The experience of BSN students will focus on PHN concepts such as population-focused care, PHN Seattle/Kincaid competencies, American Nurses Association PHN Scope of Practice, and PHN Intervention Wheel. (Minnesota PHN, 2001; Kalb et all, 2003). The following experiences will be provided depending on the individual student s course objectives: take a PH issue from assessment to program development; take a specific clinical experience and determine how it could be population-based; interact with a family over time to learn how to care for family as client... (Minnesota PHN, pg 3.) Collaboration with nursing programs The project manager will ask to meet with educators to discuss and collaborate about PHN practice and the student experience. The Project Manager will contact the Nurse Educators of Wyoming to initiate this discussion and collaborative effort. Retention Preceptor Development Development and recognition of nurses as expert preceptors will promote retention. Recent surveys of Wyoming PHNs revealed the high level of satisfaction of nurses who intend to stay (DOE, 2008.) Ability to learn new things, to grow, and use their education promoted their satisfaction. Preceptors will solidify their knowledge about population based care, core functions, essential services, and other core PHN concepts. Developing and recognizing their expertise as a preceptor will strengthen their leadership skills and will become part of a succession plan presented next. Succession Plan Because many critical managers and expert nurses are retiring within five years and taking their education and experience with them, PHN needs to develop a specific succession plan. This plan will be formed with the help of a national expert in succession planning. PHN competencies developed specifically for different levels of nursing practice will be used to inform the plan (Kalb et all, 2003.) Competencies specific to the supervisor/leadership levels will be used to develop a plan for staff nurse development. Nurses who choose to master these competencies will be officially recognized as part of their performance. A national consultant will work with state nursing and county mangers to draft a plan and pilot it within two to three smaller agencies and one to two larger local agencies. This same consultant will present at the Spring Nurse Managers Meeting in May. Time Table Preceptor/student experience February May 2009 Draft of student experience plan (plan meeting with educators) February March 2009 Draft of preceptor development plan April August 2009 Pilot preceptor training (plan all day event with10 preceptors) May July 2009 Review of student experience plans by work group members Fall semester 2009 Pilot student experience plan with newly trained preceptors December 2009 Evaluate student experience/preceptor development and revise Spring Semester 2010 Use revised student experience April 2010 Evaluate Spring semester experience 5

6 Succession Planning February April 2009 Meet with consultant and develop succession plan May 2009 Consultant presents plan information on succession planning June 2009 Managers develop local succession plan July- March 2009/2010 State supervisor review plans with managers who begin to Implement plans as part of performance plans and evaluations Spring 2010 Consultant presentation at Spring PHN Managers Meeting April 2009 Seek feedback from mangers and staff on succession plan Budget Preceptor/student experience $ 1,500 Travel costs for preceptors Use of statewide compressed video system for monthly calls with preceptors PHN Textbooks, printed materials, and postage for preceptors Succession Planning $ 5,400 Consulting fees to design succession planning and training and to design development programs Consulting/presentation fees for Spring 2010 Manager s Meeting WDH Indirect Costs $ 2,100 Total $10,000 Evaluation Preceptor and student experience will be evaluated by students, faculty, and preceptors following fall and spring semesters according to competencies, population-focused care, and enjoyment. PHN supervisors will evaluate number and types of succession plans developed locally by county managers. The consultant s presentation will be evaluated by participants. References RWJF - Charting Nursing's Future: September 2008-Part 1. Strengthening Public Health Nursing Part I: Policies and Programs that Recognize Nursing's Role in Assuring the Public's Health. (September, 2008) Retrieved from on December 12, 2008 DOE presentation (2008) Preliminary data PHN workforce survey. Frank, B., Adams, M., Edelstein, J., Speakman, E. & Shelton. (2005) Nursing Education Perspectives, 25 (6), pp Minnesota PHN (2001) Highlights of the Key Informant Survey for Linking PHN Practice & Education to Promote Population Health Grant. The PHN Clinical Experience, Conducted Retrieved from December 12, 2008) Kalb, K., Cherry, N., Kauzloric, J., Brender, A., Green, K, Miyagawa, L., & Shinoda-Mettler. (2006) A competency-base approach to public health nursing performance appraisal. Journal of Public Health Nursing, 23 (2), pp