Maryland s PHN workforce:

Transcription

1 Enumerating and Characterizing Maryland s PHN workforce: Impact on Population Health, Well-being, and Health Equity Carolyn Nganga-Good, MS, RN Pat McLaine, DrPH, MPH, RN Maryland s Robert Wood Johnson Assistant Professor, Foundation Public Health Nurse University of Maryland School of Leader Nursing Maryland Nurses Association Annual Convention October 5,

2 Activity Outcomes Recognize the distribution of PHNs in Maryland local health departments and local public schools. Identify two barriers to PHN practice and two suggestions to improve PHN practice in Maryland. 2

3 Outline Background Methods Results Next Steps Local Culture of Health Example Q & A 3

4 Institute of Medicine Future of Nursing Report tkey Messages Practice Education Leadership Data Diversity & Inter-Professional Collaboration 4

5 Nurses are educated to consider the social determinants of health alongside patients medical concerns. This perspective informs the work they do in homes, schools, and other community-based settings to improve health across the lifespan. This concept drove the development of the Public Health Nurse Leaders Program and work with state action coalitions. 5

6 Background Historical role of public health nurses (PHN): delivering comprehensive, population-focused, and coordinated care to communities Evolving healthcare landscape Significant ifi changes in how health services are delivered and the role of PHNs Comprehensive and reliable workforce data are needed to adequately plan the delivery of care The longstanding PHN workforce and infrastructure is aging and diminishing An adequate & competent workforce = quality care 6

7 Background: Maryland s PHN Workforce No reliable or comprehensive PHN workforce data for Maryland No Nursing Workforce Data Center No statewide Chief Nurse/ Director of Nursing RWJF Public Health Nurse Leader Project Purpose WHO are the PHNs? WHERE are they working? WHAT are they doing to promote a culture of health? 7

8 Data Collection Methods Study reviewed and exempted by the Institutional Review Board at University i of Maryland, Baltimore Interviews with PHN leaders from local health departments and school health Online survey for Maryland PHNs working in local health departments and/or public schools 8

9 Methods Interview PHN workforce and program trends Barriers to PHN practice Efforts to promote PHN Description of Culture of Health Initiatives Future of Nursing (FON) Campaign Initiatives Online Survey Demographic data Level of education Licensure and certification Primary and secondary practice roles and settings Salary range Barriers to PHN practice and Facilitators FON Campaign Initiatives 9

10 Results Participation ii i Interviews PHN leaders from 19 of the 24 local health departments (79%) School health nurse leaders from two county school districts Online Survey Respondents 541(Estimated 37% response rate*) 490 eligible for data analysis** * Based on the numbers of nurses reported from the interviews ** Data from respondents who responded but declined to answer questions (n=51) were excluded from the data analysis 10

11 Interview Findings Summary 10 of the 19 (53%) local health departments had a PHN Director position; in 9 of the 10 PHN Director positions were filled Many did not have historic workforce data Estimated number of PHNs 1446 nurses (based on interview results) Estimated number of SHNs FTEs (based on the MDSE SHN survey data) Overall decreases in number of nursing positions and programs led/staffed by PHNs A slight increase in the number of SHNs possibly as a result of new schools and implementation of the one nurse per school policy in some jurisdictions 11

12 Survey Results Participant Regional Representation Overall Regional Representation 4% 12% 35% 21% 28% Capital Central Eastern Shore Southern Western 12

13 Results Work Setting & Number of Years Worked kd Work Setting n = 490 2% Overall number of years worked as a nurse Average: 27 years Range: 2 56 years 37% PHN SHN Other 61% Overall number of years worked as a public health nurse Average: 25 years Range: 1-55 years 13

14 Results Race/Ethnicity Overall Race/Ethnicity n = 472, DA = 18 White/Caucasian Hispanic 1% 82% PHN American Indian or Alaska Native 0% Asian 3% Black/African American 12% Hispanic 0.7% White/Caucasian 83% Black/African American Asian American Indian or Alaska Native 14% 3% 0.21% 0% 20% 40% 60% 80% 100% SHN American Indian or Alaska Native 0.6% Asian 1% Black/African American 17% Hispanic 1% White/Caucasian 80% 14

15 Results - Gender Overall Gender n = 483, DA = 7 2% 98% Female Male PHN Female % Male 7 2% SHN Female % Male 3 2% 15

16 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Results Age Overall Age Overall Age in Years n = 477, DA = 13 Average age: 54 years 29% 42% Average age: 54 years Over 46 years: 80% Range: years PHN Age Average age: 55 years Over 46 years: 83% Range: years 13% 6% 9% 0.42% < >65 Over 46 years: 75% Range: years SHN Age Average age: 52 years 16

17 Results Type of License Type of License 93% 5% 3% Type of License PHN SHN APRN 5% 5% LPN 2% 4% RN 94% 89% APRN LPN RN 17

18 Results RN Qualifying i Degree RN Qualifying Degree Masters in Nursing 2% Bachelors in Nursing 45% Associates in Nursing 41% Diploma 12% 0% 10% 20% 30% 40% 50% 18

19 Results Education Highest Level of Education Doctoral Degree Other Masters Degree Masters Degree in Nursing Other Bachelors Degree Bachelors in Nursing Other Associate Degree Associate Degree in Nursing LPN 0.31% 4% 4% 7% 13% 13% 20% 40% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 19

20 Results Employment Status Employment Status 2% 10% Employment Status PHN SHN Full Time 91% 84% Part Time 9% 12% As Needed 0% 4% 88% Full time Part time As needed 20

21 Results Job Status Job Status 0.43% 14% 17% 69% Job Status PHN SHN Civil Servant/Merit 82% 47% Contractual 9% 23% Consultant 0.34% 1% Other 9% 29% Civil Service/Merit Contractual Consultant Other 21

22 Results Overall Salaries 30% 51% of the nurses including 26% 25% PHNs, SHNs, APRN, managers, 20% supervisors, and executives 18% earn $60,000 or less 15% 10% 12% 13% 11% 8% 8% 5% 0% 2% 0.22% 0.22% N = 454, DA = 36 22

23 Results Salaries, PHN versus SHN 35% 30% 25% 20% 15% 10% 5% 0% 6% 23% 12% 14% 30% 18% 18% 17% 15% 10% 10% 10% 5% 5% 48% of PHNs versus 55% of SHNs earn $60,000 or less PHN n = 284, DA = 16 SHN n = 132, DA = 47 3% 2% 0% 0% 0.00% 1% PHN Salaries SHN Salaries 23

24 Results Barriers to PHN Practice Financial (25%): over-all public health budget, sustainability of funding Salary (21%): I make less per hour than I did nine years ago in a hospital setting. Workload and staffing (19%) Access to resources (13%): transportation, supplies, educational material, housing, resources for youth in the schools and community Lack of opportunity for advancement (8%): fewer positions, reduced funding, inability to hire/retain Leadership (8%): non-clinical i l leadership, lack of consistency/coordination, no cross-training, no community awareness of public health, poor outreach, social marketing Access to health care for clients (7%): mental health services, pediatric dental care, specialty care, immunizations, health insurance. 24

25 Results Barriers to PHN Practice Poor communication (5%): with external partners, the community and staff. Poor record keeping systems (4%): out-of-date technology and equipment Recognition/respect/morale (4%): lack of recognition or management support, work not valued Education (4%): Lack of access to education and lack of incentives for advancing education Language barriers (3%): few PHNs speak Spanish, lack access to interpreters 25

26 Results Efforts to Promote PHN Practice Improve salary and employee benefits (23%) Ensure public health funding and resources (12%) Increase PH and PHN awareness (12%) Improve education and training opportunities (9%) Improve access and services (9%) 26

27 Results Efforts to Promote PHN Practice Streamlined and standardized policies (7%) Showcase PH and PHN value, improve nursing recognition and respect, and PHN engagement (4%) Leadership, advocacy for PH and PHN issues, and representation - a seat at the table (4%) Improve community/stakeholder engagement (3%) 27

28 Other Themes PHN is a fulfilling career (24%) Need to improve access to services and programs (11%) Need to value PHN, improve recognition and respect, and engage PHNs (11%) Need to improve access to funding and resources (10%) Need to improve salaries and benefits (8%) Need to improve staffing workload (7%) Need to address the shift in health department focus and privatization of services (5%) Need for PH and PHN advocacy and representation, leadership (5%) Need to increase awareness (5%) 28

29 Future of Nursing Campaign Awareness 55% were familiar with the term culture of health 31% were familiar with the culture of health framework 10% were familiar with the Nurses on Boards Campaign 17% served on a board of directors, advisory board, or appointed task force 29

30 Promoting a Culture of Health Where good health flourishes across geographic, demographic, and social sectors Where being healthy and staying healthy is an esteemed social value And everyone has access to affordable, quality health care 30

31 Culture of Health Framework 31

32 Strategies for Promoting a Culture of Health Provide education and training opportunities (35%) Increase awareness (12%): exposure during nursing school, continuing education opportunities, access to educational information, and policies that increase awareness Engage PHN in decision making, self-engagement and PHN engagement (7%) Staffing workload (7%): Allow time to promote it and incorporate it into PHN work Incentivize it and access to funding and resources (6%) Community/stakeholder engagement (3%) Advocacy and representation (3%) Already engaged (4%) 32

33 Nurses on Boards Campaign Be Counted! Mission: To improve the health of communities and the nation through the service of nurses on boards and other bodies Goal: 10,000 Nurses on Boards by 2020 If serving on a Board register your service If you would like to serve on a Board register your interests 33

34 Maryland Culture of Health Exemplars Community mobilization and coalition building Community engagement Cross-sector collaboration Integration of behavioral health programs schools, clinic Care coordination Telehealth and home visiting Access programs Workplace wellness programs Academic-Practice Partnerships 34

35 Next Steps dissemination at local, state, regional, and national meetings Summer/Fall 2017: Share data with PHN and SHN leaders Summer/Fall 2017: Regional Meetings with PHNs and SHNs to discuss findings, propose action steps, and prioritize action items Fall 2017: State-wide meetings with PHNs and SHNs to share findings and proposed recommendations Spring/Summer 2018: Publication of article/report summarizing findings of the study and actions to advance PHN in Maryland 35

36 Acknowledgements Maryland Action Coalition Maryland Public Health Nurse Directors Council Maryland Departments of School Education Maryland Association of School Health Nurses Maryland Higher Education Commission, Nurse Support Program II Robert Wood Johnson Foundation Center for Creative Leadership staff RWJF PHNL Cohort 36

37 Acknowledgements PHN Study Team Pat McLaine, DrPH, MPH, RN Co-Investigator Rashida Mohammed, MPH Research Consultant Lindsay Gray, MS, RN Research Intern Amy Nahley, RN, BSN, OCN Teaching Assistant Michelle Spencer, MS, RN Clinical Instructor, DNP Student 37

38 Contact Information: Carolyn Nganga-Good com Pat McLaine 38

39 Local Culture of Health Example Talbot County Health Department

40 A Regional Approach to Meet the Needs of Children/Youth with Special Needs Eastern Shore Mary E. O Brien R.N. CYSHCN program/tchd/eastern Shore Liaison and Coordinator of Special Projects-OGPSHCN 40

41 Background Created the CYSHCN program in 2001 with a desk, computer, telephone and one 3-ring binder. Slowly developed a case management, resource coordination, parent/caregiver support and education program. Average caseload-110 clients. Common theme for families-lack of local, regional resources, access to specialty care. 41

42 Clarifying Issues & Looking for Answers Lack of local & regional specialty physicians & support therapy providers. Uncoordinated or overlapping local services. Lack of medical home knowledge of what services do exist. Barriers to accessing specialty care in Baltimore, Washington, DC & Philadelphia- money for the trip, gasoline, toll, days lost wages, childcare, food and parking, lack of transportation. Participation in regional and statewide groups confirmed this was and issue for all rural areas of the state. 42

43 Addressing the Issues Development of a regional broad stakeholders group. Submitted a grant proposal to the State COC (Community of Care) to develop a pilot/prototype for the Eastern Shore Regiondeveloped a mini-coc. With the assistance of the Parent s Place of Maryland and the OGPSHCN a successful kickoff Regional Summit was held with 54 attendees. Workgroups focused on strategies for change in the following categories: family/professional partnerships, medical home, early/continuous screening, easy to use community services, adequate insurance and Transitional Youth. In the groups that followed priorities were established, projects were initiated and a speakers list was created to educate and inform participants about resources, highlight what is working in other areas and allow professionals and parents to meet and share with each other. 43

44 Outcomes of the Regional Consortium Benefits cited by the group participants (some of whom travel three hours round trip) include: Learning about local and regional resources they were unaware of. Face to face contacts with colleagues for collaboration and learning. Having input and participation p in deciding on projects/initiatives. Working creatively as partners to make effective changes for families. Identified Priorities: access to pediatric specialty care with a focus on the development of a pediatric specialty hub, planning for Transitional Youth issues, behavioral and mental health services for the very young and young children, lack of in home nursing options, lack of trained respite providers and the development of a sports mobility group. 44

45 Creation of Support and Ongoing Mentorship of Regional Local Health Department Nurses on the Eastern Shore Submitted a proposal to the OGPSHCN to formalize additional regional activities as a result of interactions with other LHD s who attended the COC-ES meetings, which was approved. Regional role includes meeting individually with nurses once per year, facilitating quarterly meetings to allow for group discussion, updates from the OGPSHCN, sharing resource information, and serving as a mentor and or consultant for difficult cases. Outcomes have been the development of a cohesive, collaborative group with increased two way communications with the OGPSHCN and the expansion of pilots/initiatives throughout the Eastern Shore. 45

46 Development of a Regional Pediatric Specialty Hub Renewed discussions with the OGPSHCN about the need for a pediatric specialty hub. Partnership with the Kinera Foundation was initiated as they also had a mission to access pediatric specialty care for families of children/youth with special needs on the ES. Grant funding from the OGPSHCN and the MCDD lead to the opening of the physical space in July of 2016-offering includes OT, PT, SLP, pediatric gastroenterology clinic, monthly HSC clinics and current planning for tele-medicine services 46

47 Conclusions The development of the broad stakeholder group (COC-ES), which includes parents, provided the opportunity for not only identification of priorities for families of CYSHCN but planning, development and implementation. Collaboration, new partnerships and resource education are routine by-products. Last fiscal year there were 126 attendees for the year. The regional LHD nurse group oversight and mentorship initiative iti has provided a sense of identity to the group, decreased isolation, increased resource awareness and education and resulted in improved care and resource coordination. The pediatric specialty hub is no longer an idea but a physical place where families can receive care in their region which minimizes barriers to care and continues to grow and gather momentum. Over 100 families are served there on a monthly basis. Savings in time :2 hour round trip from Tilghman Island versus 4 hour round trip to JHH and savings of over $40 for toll, gasoline, parking and food. 47

48 Final Thoughts Identifying needs, gaps and problems was the simple part of these initiatives. Gathering partners who shared the vision and were willing to work towards change was much more difficult than expected. Support from the OGPSHCN was essential for my role to change as was support from the Talbot County Health Department and the collaboration with the Kinera Foundation. Using a regional approach to improve outcomes for CYSHCN in rural areas is a way to bring people and entities together to work to activate/create needed services, to increase collaboration, decrease redundancies and reduce out of pocket costs for families who are better able to keep follow up appointments. GI clinic now has a three month wait list for services. 48

49 For more Information Mary E. OBrien O'Brien R.N. Director, Children/Youth with Special Health Care Needs Program Talbot County Health Department 100 South Hanson Street Easton, MD Coordinator-Eastern Shore Regional Projects/ Liaison-Office of Genetics and People with Special Health Care Needs-DHMH 49

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