Welcome to “Seeking to Understand: Public Health Nursing Recruitment and Retention in North Carolina”

We will start the webinar at 12 pm

This is a webinar with no phone call in number

All questions will be through the “CHAT BOX”

This webinar will be archived, and the location will be emailed out later today

Everyone attending will be muted

Please “sign in” with your name and organization

Thank you for attending – NCPD survey, evaluation and certificate link with be provided at the end of the presentation!

Disclosures

• 1.0 NCPD contact hours and up to 1.0 CPH Recertification Credits may be earned upon successful completion.

• For successful completion, participants must attend 100% of educational activity and complete the online course evaluation. There will be no partial credit awarded.

• No conflict of interest exists for anyone in the position to control content for this activity.

• No commercial support has been received for this activity.

The Public Health Nursing Institute for Continuing Excellence is approved as a provider of nursing continuing professional development by the North Carolina Nurses Association, an accredited approver by

the American Nurses Credentialing Center’s Commission on Accreditation.

Going to the source:North Carolina public health nurses’ perspective on job retention & job satisfaction

FacilitatorEllis Vaughan Matheson DNP, RNPresidentNorth Carolina Association of Public Health Nurse Administrators

The ultimatealliance

Presenters

Jaimee Watts Isley DNP, RN, AGNP-BCAssistant ProfessorUNC Chapel Hill School of Nursing

Claire Stuart, RN, DNP candidateUNC Greensboro School of Nursing

BIG THANKS to NC Public Health Nurses!

We would not have had the success we have

had in the first two phases of this project if it

weren’t for the input from YOU!

Agenda

1. Introduction (Ellis Vaughan)

2. Phase I; NC PHN Recruitment & Retention Study: RETENTION (Jaimee Watts Isley)

3. Phase 2; NC PHN Recruitment & Retention Study: RECRUITMENT (Claire Okeeffe)

4. Phase 3; NC PHN Recruitment & Retention : Translation of Research into Practice

5. Q & A Session

Learner outcomes

• Increase knowledge regarding N.C. public health nursing recruitment and retention (study, survey) to engage local public health professionals in educated decision making for staffing solutions.

• Identify recruitment barriers and facilitators identified by PHN leaders, supervisors and managers in NC

Phase I PAC

Practice Advisory Committee of state & local PHN leaders Ellis Vaughan DNP, RN

Director of Nursing, Buncombe County Health and Human Services

Olatubosun Aloba, PhD, WHNP Program Manager, Durham County Department of

Public Health

Phyllis Rocco, MPH, RN Chief Nursing Officer, NC Division of Public Health

Susan Haynes Little, DNP, RN, PHNA-BC, CPH, CPM Manager, Public Health Nursing, NC Division of Public Health

Public HealthNursing

Public Health Nurses make up 20% of the nation’s public health workforce (Beck & Boulton, 2016)Over 60% of staffing for state and

local health departments across the nation (Beck & Boulton, 2016)Nearly one quarter of NC LHD

staffing (NC DPH, 2012; NC DPH, 2017).

Houston, we have aproblem…

2016 study determined that 27 states in the U.S. would experience a shortage of Public Health Nurses by 2017 (Beck & Boulton)

NC experienced a decline of nearly nine percent of their public health nursing workforce in recent years (NC DPH, 2012; NC DPH, 2017).

So begins phase I of our #NCPHNRecruitRetainStudy Phase II: Recruitment Phase III: Change implementation

Revised Casey- Fink Nurse Retention Survey

Developed by Kathryn Casey, PhD RN-BC and Regina Fink PhD, APRN, FAAN University of Colorado College of Nursing & School of Medicine

* More details included on this survey tool at the end of my slides for later review * All changes made to the survey (related to PHN population)

were approved by Dr. Casey & Dr. Fink prior to use

We asked,they answered!

We reached out to 1900 public health nurses from across the state and received 672 responses back. A whopping 35% response rate!

We did this by having NC DPH leadership reach out to LHD nursing management directly Online survey (Qualtrics) Introduction video to PI Small ($25 gift card) incentive

optional

NC PHN response &demographics

612 usable for data analysis 672 responses received 1900 surveys sent to 84 LHDs across

the state

Sample characteristics

Female (98.3%, n= 562)

Age 45-54yo (27.8%, n= 158)

20+ years nursing experience (47.9%, n= 270)

3 years or less public health experience (35.5%, n=201)

BSN level (55.2%, n= 311)

The Good Place

90% believed that they were making a difference in their communities (n=540)

86.24% reported feeling ‘challenged’ by their work (n=514)

79.76% were satisfied in their role (n=473)

The number one reason NC PHNs stay in their current position is the people their work impacts (16.86%, n= 419)

Only 7% reported daily occurrence of work-related stress (n=42)

Retention, rhymes with intention

Nearly 1/3 reported that they were leaving (or thinking about leaving) their current job within

the next three years (35.31%, n= 203)

Add in those leaving due to retirement, that is nearly half (47.83%, n= 275)

WE SEE YOU: Work Environment/ Support/ Encouragement

The Work Environment/Support/Encouragement section includes 26 items related to: Rewards and Recognition Professional Nursing Role Mentoring

Likert-response style:

(1=strongly disagree, 2= disagree, 3= agree, and 4= strongly agree)

Perception matters

Those who didperceive a problem with PHN retention within their health

departments

VS

Those who did not perceive a problem with PHN retention within their health

departments

Those who wereleaving (or thinking about leaving) their

job in the next three years

Those who were not leaving (or thinking about leaving) their job in the next three

years

VS

WESE Subscale: Rewards & Recognition

• 77. 51% felt supported in work area (n= 462)

• Fewer felt their efforts were acknowledged (62.08%, n= 370).

Direct supervisors were found to be*• Supportive (78.02%, n= 465) • Approachable (85%, n= 492)• Responsive (76.84%, n=458) • Committed (72.65%, n= 433) • Valued/Appreciate PHN

(72.99%, n=435; 72.82%, n=434)

*Raw data provided in a later slide

WESE Subscale: Professional Nursing Role/ Stress/ Workload

Overall, PHNs:

Agreed that job expectations were realistic (69.13%, n= 412) Did not agree that they had adequate opportunities

for career advancement (38.48%, n=229)

Most frequently reported work-related stress occurrence was 1-2 days a week (41.11%, n= 245) 63.26% indicated their workload had increased in

the past 3 years (n= 377)

WESE Subscale: Mentorship

Overall, PHNs: 86.24% felt challenged by their work

(n=514) 73.66% agreed they had positive role

models at work (n= 439) 54.12% identified having a

professional mentor (n=322)

WESE Subscale: Job Satisfaction

Top areas for job satisfaction: Scheduling; getting out on time (78.79%, n= 468); flexibility

(76.94%, n= 457)

Low areas for job satisfaction: Salary (43.1%, n=256) Clinic Flow (49.58% , n=292) Encouragement from management (64.31%, n= 382)

FIVE key areas to address for improving NC PHN retention

Acknowledging PHN Contr ibut ions

Increas ing opportunit ies for career advancement

Support ing workload expectat ions

Compensat ion

Communicat ion

Implications: Acknowledging public health nurses’ contributions

• More towards a more authentic form of recognizing accomplishments and away from standardized employee recognition programs

• Understanding factors that drive individual employees’ motivation & sense of recognition

(Mann & Dvorak, 2016; Mamiseishvili & Lee, 2018).

This Photo by Unknown Author is licensed under CC BY-SA-NC

Implications: Opportunities for career advancement

Investing in educational grants and mentorship opportunities for staff to grow into leadership roles within their organization- especially in rural areas (Johnson, 2017; Daye, 2015; Bogaert et al., 2019).

Increasing academic-practice partnerships to increase opportunities for teaching, service, and research and to increase competencies for PHNs (Erwin, 2016).

Implication: Workload and Support

Implementing regular staff ‘stay interviews’ (Robeano,2017).

Delegating non-clinical activities to support staff (Tourangeau et al., 2017; Wisniewski et al., 2019).

Recognizing and promoting creativity and innovation are also highly correlated with the intention to stay (Locke, 2019).

Implications: Compensation

Competitive Pay Frameworks that recognize career progression and increased role & responsibilities (Ashwood et al., 2018).

Think ‘clinical nursing ladder’ in the hospital setting

Pay frameworks reduce the need of individuals having to negotiate their terms and conditions (Ashwood et al., 2018; Yeager & Leider, 2019).

Implications: Communication

Promote team-building & collaborative skills (Mylonaet al., 2016).

Promoting opportunities for multiple work areas to come together to solve common challenges (Locke, 2019).

Implement simulation training of interprofessional teams as a first step in establishing improved communication skills within practicing clinical teams (Vermeir et al., 2017).

Phase II: Recruitment

Purpose: To investigate PHN recruitment barriers and facilitators

from the perspective of PHN leadership in NC

Phase IIPAC

Practice Advisory Committee of state & local PHN leaders• Ellis Vaughan DNP, RN

• Director of Nursing, Buncombe County Health and Human Services

• Kimberly Hardy, DNP, APRN, FNP-BC, NEA-BC• Personal Health Division Director, DON Pitt County

• Mona Cooper, MSN, RN• Deputy Division Director II of School Health

Mecklenburg County• Olatubosun Aloba, PhD, WHNP

• Program Manager, Durham County Department of Public Health

• Susan Haynes Little, DNP, RN, PHNA-BC, CPH, CPM• Chief Nursing Officer, NC Division of Public Health

Revised Survey

The Enumeration and Characterization of the Public Health Workforce form the 2012 Public Health Nurse Workforce Surveys

Reversing the Decline of Public Health Nurse Retention and Recruitment in California –Director’s Survey

Director’s Assessment of Workforce Needs Survey (DAWNS)

The 2018 Employer Needs Survey

Population

We reached out to 398 PHN leaders, managers, and supervisors across the state and received 109 responses back. 27% response rate

This was accomplished through NC DPH leadership reaching out to population of interest via e-mailOnline survey (Qualtrics) Introduction video to PIOptional incentive

Sample Demographics

PHN Experience 14.7% 8-12 years

(n=16) 64.2% >13 years

(n=70)

RN Experience <12 - blue 24.8% 13-19 years (n=27)

- yellow 63.3% >20 years (n=69) -

green

RN Experience

PHN Experience

Sample Demographics

45-54 & 54-64 age mostly represented

Mostly Bachelor’s and Master’s Degrees

Recruitment

75% report current vacancies in their HD

52% more difficult to fill positions

63.3% difficulty hiring or retaining PHNs

90.4% anticipate shortage of PHNs

Identified Barriers

Leading factors contributing to shortage

of PHNS

• Non-competitive wages

• Worker retirements• Budget reductions

Barriers to recruitment

• Low wages & salaries • Competition from

private sector• Insufficient funding

Biggest workforce challenge

• Non-competitive wages

• Finding qualified candidates

• Turnover

Budget 39.4% believed the budget for their HD would

remain the same in next fiscal yearMore recognized a decrease(45%) than an

increase (15%)

68.8% reported insufficient funding as a barrier to some degree in recruitment

81% reported county budget policies as a barrier to some degree in recruitment

Cause of Nursing Vacancies and Time to Fill

71% reported making offers that were not accepted

85.7% reported long hiring times as a barrier to some degree to recruitment

43% agreed policies and procedures for hiring staff are cumbersome (n=43)

Time to fill• 29.9% 5-8 weeks • 26.2% 9-12

weeks • 22,4 >16 weeks

Vacancies• Left for different health care setting • Retirements • ResignedThis Photo by Unknown Author is

licensed under CC BY-NC-NDThis Photo by Unknown Author is licensed under CC BY-NC

Competition for Recruitment

Hospitals were identified as largest competitor for recruitment with 84% ranking as their number one competitor

Private healthcare providers

Outpatient clinics

Qualification and Experience of Candidates

78.1% rated candidates not being fully qualified for position as a barrier to some degree to recruitment

87.2% rated too few candidates as a barrier to some degree to recruitment

75.6% reporting finding qualified candidates as one of the biggest workforce challenges ranked it in their top three challenges

54.2% agreed that candidates applying for PHN positions have insufficient experience

Resources Used for Recruitment

Utilized & Effective Word of Mouth Internet Post Job Boards

Social Media Mostly N/A

Newspaper Community college & universities Recruitment agencies Tuition assistance Relocation reimbursement

66.1% of respondents believe too few benefits was not a barrier Respondents also agreed that their job benefits were competitive in another

similar survey question with 69.7% agreeing or strongly agreeing that they are competitive 67.0% reported hiring freezes are not a barrier to recruitment 59.6% reported geographic location is not a barrier to recruitment 78.9% reported agreeing to some degree than their HD provides adequate

training and professional development Inflexible schedules were recognized mostly as a small barrier (33%) or not a

barrier at all (35.8%)

Facilitators

Where to Focus to Improve

Compensation

Budget

Qualification of candidates

Process and timeline for hiring PHNs

Turnover

Resources utilized

Phase III:Implementation

• Phase 3 will take the data and evidence gathered during Phases 1 & 2, will translate it into practice, and will result in the creation of an evidence-informed toolbox for Local health department PHN leaders to use to positively impact recruitment and retention practices.

• This toolbox will help get new public health nurses in the door and provide evidence-informed practices to keep them engaged and in their positions longer.

A strong and satisfied public health nursing workforce is core to

effective public health and promoting and

protecting health for all.

THANK YOU

References

Ashwood, L., Macrae, A. & Marsden, P. (2018). Recruitment and retention in general practice nursing: What about pay? Practice Nursing 29(2). doi.org/10.12968/pnur.2018.29.2.83

Beck, A.J., & Boulton, M.L. (2016). The Public Health Nurse Workforce in U.S. State and Local Health Departments, 2012. Public Health Reports 131(1), 145-152.10.1177/003335491613100121

Bogaert, K., Leider, J.P., Castrucci, B.C., Sellers, K. &amp; Whang, C. (2019). Considering Leaving, But Deciding to Stay: A Longitudinal Analysis of Intent to Leave in Public Health. Journal of Public Health Management and Practice 25(2), s78-s86.10.1097/PHH.0000000000000928

Daye, D., Patel, C.B, Ahn, J &amp; Nguyen, F.T. (2015). Challenges and opportunities for reinvigorating the physician-scientist pipeline. Journal of Clinical Investigation 125(3), 883-887. 10.1172/JCI80933

Erwin, P.C., Barlow, P., Brownson, R.C., Amos, K. &amp; Keck, C.W. (2016). Characteristics of Academic Health Departments: Initial Findings from a Cross-Sectional Survey. Journal of Public Health Management and Practice 22(2), 190-193. 10.1097/PHH.0000000000000237

References

Johnson, I. (2017). Rural “Grow your Own” Strategy: Building Providers from the Local Workforce. Nursing Administration Quarterly 41(4), 346-352.10.1097/NAQ.0000000000000259

Leider, J. P., Coronado, F., Bogaert, K., & Gould, E. (2019). Public health workforce development needs: a national assessment of executives’ perspectives. American Journal of Preventive Medicine, 56(5), e153-e161.

Locke R, Castrucci BC, Gambatese M, Sellers K, Fraser M. (2019). Unleashing the creativity and innovation of our greatest resource – the governmental public health workforce. J Public Health Mang Pract. 25(2), S96-S101.

Mamiseishvili, K. &amp; Lee, D. (2018). International faculty perceptions of departmental climate and workplace satisfaction. Innov High Educ 43(5), 323–338.

Mann, A. &amp; Dvorak, N. (2016). Employee recognition: low cost, high impact. Bus Jour. To Stay or Leave. https://www.gallup.com/workplace/236441/employee-recognition-low-cost-high- impact.aspx

References

Mylona, E., Brubaker, L., Williams, V.N., Novielli, K.D., Lyness, J.M, Pollart, S.M., Dandar, V. &amp; Bunton, S.A. (2016) Does formal mentoring for faculty members matter? A survey of clinical faculty members. Medical Education 50(6), 670-681. https://doi.org/10.1111/medu.12972

North Carolina Department of Commerce (2018). 2018 employer needs survey. https://www.nccommerce.com/nc-workforce-development/workforce/commission--workforce/2018employerneedssurvey.pdf

North Carolina Department of Health & Human Services, Division of Public Health [NC DPH]. (2012). Local Health Departments Staffing and Services Summary: Fiscal Year 2012. https://schs.dph.ncdhhs.gov/data/other/lhd/2011/FacStaff.pdf

NC DPH. (2017). Local Health Departments Staffing and Services Summary: Fiscal Year 2017. https://schs.dph.ncdhhs.gov/schs/pdf/LHD_2017_FIN_20171120.pdf

Robeano, K. (2017). “Stay Interviews” to improve retention. Nursing Management 48(9), 7-8. DOI-10.1097/01.NUMA.0000522179.30887.38

References

Tourangeau, A.E., Patterson, E., Saari, M., Thomson, H. &amp; Cranley, L. (2017). Work- related factors influencing home care nurse intent to remain employed. Health Care Manage Review 42(1), 87-97. 10.1097/HMR.0000000000000093

Vermeir, P., Degroote, S., Vandijck, D., Mariman, A., Deveugele, M., Peleman, R., Verhaeghe, R., Cambre, D. & Vogelaers, D. (2017). Job Satisfaction in Relation to Communication in Health Care Among Nurses: A Narrative Review and Practical Recommendaitons. Sage Journal 7(2). doi.org/10.1177/2158244017711486

Wisniewski, J.M, Jacinto, C., Yeager, V.A., Castrucci, B., Chapple-McGruder, T., & Gould, E. (2019). Opportunities to Improve Employee Satisfaction Within State and Local Health Agencies. Journal of Public Health Management and Practice 0(0), 1-8. 10.1097/PHH.0000000000000857