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
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.
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
Massachusetts
351 autonomous cities and towns ranging from the City of Boston with more than a half million population, to small towns with 50-100 persons in the Berkshires.
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
Massachusetts Public Health: A Shared Responsibility 351 Local Boards of Health Disease Control State Health Dept
Massachusetts Public Health: A Shared Responsibility 351 Local Boards of Health: nursing capacity --------------------- 1. 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
CD Bureau Nursing Immunization Nurses TB Nurses Preparedness Nurses STD Nurses
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
Massachusetts Tuberculosis Case Rates 1992-2005 10 9 8 7 6 5 4 3 2 1 0 Per 100, 000 667 Projected TB cases 1997-2005 92 93 94 95 96 97 98 99 00 01 02 03 04 5 Year MDPH/DIVISION OF TB 2,716 TB cases Between 1996-2005 1,787 excess TB cases MA Projected Decline TB Elimination Goal
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
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
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
Nurses, yellow fever hospital, Louisiana 1891 PH nurse 1924, formula preparation
Cadet Nurse Corps 1944 PH Nurse 1920
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
Massachusetts Public Health Nurse Survey 2005-2006 Public Health Nurses making a difference protecting and improving the health of communities
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
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
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
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
PHN Age Cohorts 90 80 70 60 50 40 30 20 10 0 <30 30-39 40-49 50-59 60-69 70+
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 51.7 60% of women work 73% of men 83% of nurses
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 2005-2006
Scope of Practice 58% reported that they had this document in hand 70% or above in some regions
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
Public Health Intervention Model
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
Practice Model 59% Collaboration Coalition Building Community Organizing 46% Advocacy Social Marketing Policy Development & Enforcement
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
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
Nursing Shortage The nursing shortage is evident in the hospital setting and equally if not more so impacting public health
Projections
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
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
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
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
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
Recommendations Lead in Workforce Development Assure Competency and Preparedness Recruit and Retain Nurses
Lead in Workforce Development Engage policy makers in improving public health competency at all levels Conduct a PHN Survey in 2009-2010 Support collection of workforce data Maintain local and national alliances to advance public health nursing practice
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
Compensation Recommendation Align PHN compensation with education experience competency
Assure Competency and Preparedness Utilize technologies to document outcomes Increase PHN participation in trainings Strongly advocate for educational funds Link practice and education
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
Partnership expansion leads to resource maximization The ion words
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
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
Interactive Web Presentation Wednesday, January 18, 2006 12:00 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 www.mymeetings.com/nc/join.php?i=pg6855503&p=2006&t=c Toll free audio access: 888-282-8357 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.
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What can integration do for TB resources?
CD Bureau Nursing NOW Immunization Nurses TB Nurses Preparedness Nurses STD Nurses
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
Advocacy & Marketing Efforts joint press releases joint press conferences mailings posting of survey on MAPHN web site promotional displays at conferences presentations
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
Public Health Nurses do make a difference protecting and improving the health of communities and the lives of our TB patients