State Sanitary Code Changes affecting Public Health Nursing

1. State Sanitary Code Changes affecting Public Health Nursing Sylvia Pirani, MPH, MS Director, Office of Public Health Practice New York State Department of Health

2. Presentation Outline Background: Public Health Workforce Task Force Nurses in the Public Health Workforce Changes to the State Sanitary Code Developing Continuing Education Opportunities

3. Background 2001: NYS Public Health Council appoints Public Health Infrastructure Workgroup to assess state�s public health system 2003: Workgroup releases report on Strengthening New York�s Public Health System for the 21st Century Focuses on workforce, organizations and systems and Information Technology Recommends that �a statewide public health training task force be convened�

4. Background 2005: NYS Public Health Workforce Task Force formed to focus on four issues: Recruitment Retention Education and Training Leadership Development 2006: Task Force releases Roadmap and establishes nine key strategy areas

5. Task Force Key Strategy Areas Strengthen academic/practice partnerships Strengthen workplace policies and procedures Assess leadership skills Define workforce competencies and gaps Market public health careers to college age students Market public health careers to adults and mid- career professionals Locate and advocate for new resources Hire staff with right skills and provide career development opportunities Implement workforce development programs

6. Enumeration of Public Health Workforce Conducted by Center for Health Workforce Studies in collaboration with NYS DOH and NYSACHO in 2006 32/58 local health departments participated 18 full service, 14 without environmental health N = 2078 In efforts to strengthen the public health workforce, the New York State Public Health Council appointed the Public Health Infrastructure Work Group in 2002, and then the Public Health Workforce Task Force in 2005 to identify strategies to fortify the system. Since its inception, the Workforce Task Force has been working to address recruitment, retention, training education and leadership. In 2006 A Statewide enumeration of all Local Health Departments was conducted by the Center for Health Workforce Studies, in collaboration with the New York State Department of Health (DOH) and the New York State Association of County Health Officials (NYSACHO). Goal of the enumeration was to produce a detailed description of local public health workers and to understand how health workers� composition, roles, educational backgrounds, and training needs affect the organizational capacity of Local Health Departments in New York to perform essential public health services. In efforts to strengthen the public health workforce, the New York State Public Health Council appointed the Public Health Infrastructure Work Group in 2002, and then the Public Health Workforce Task Force in 2005 to identify strategies to fortify the system. Since its inception, the Workforce Task Force has been working to address recruitment, retention, training education and leadership. In 2006 A Statewide enumeration of all Local Health Departments was conducted by the Center for Health Workforce Studies, in collaboration with the New York State Department of Health (DOH) and the New York State Association of County Health Officials (NYSACHO). Goal of the enumeration was to produce a detailed description of local public health workers and to understand how health workers� composition, roles, educational backgrounds, and training needs affect the organizational capacity of Local Health Departments in New York to perform essential public health services.

7. Formal Job Titles of LHD Employees (n=1930) Source: University at Albany School of Public Health Center for Workforce Studies Enumeration of the Local Public Health Workforce in New York: 2006; N = 1930 Nursing = 24% Support Personnel = 25% Administration = 16% Other = 7% Scientific Investigation = 14% Education/Outreach = 9% Other clinical (incl. MD) = 4 Epi/disease control = 2%Source: University at Albany School of Public Health Center for Workforce Studies Enumeration of the Local Public Health Workforce in New York: 2006; N = 1930 Nursing = 24% Support Personnel = 25% Administration = 16% Other = 7% Scientific Investigation = 14% Education/Outreach = 9% Other clinical (incl. MD) = 4 Epi/disease control = 2%

8. Formal Job Titles of LHD Employees Group While Nurses represent 24% of all local health department employees, the represent almost half of all employees in �part service� LHDs and less than 20% in full service. While Nurses represent 24% of all local health department employees, the represent almost half of all employees in �part service� LHDs and less than 20% in full service.

9. Specific Job Titles of LHD Employees in Nursing Jobs Employees in Nursing job titles most commonly described themselves as public health nurses (29%), while relatively few described themselves as community health nurses (9%). Twenty five percent responded their specific title as other registered nurse, and a small number reported they were nurse practionners Employees in Nursing job titles most commonly described themselves as public health nurses (29%), while relatively few described themselves as community health nurses (9%). Twenty five percent responded their specific title as other registered nurse, and a small number reported they were nurse practionners

10. Recruitment 2007 survey of county civil service agencies found that 23 of 30 agencies responding reported recruitment challenges related to public health personnel Agencies expressed difficulty recruiting for 25% of their positions. Highest concentration of recruiting difficulties found in nursing professions, esp. in four titles: Registered professional nurse Public Health Nurse Community Health Nurse Supervising Public Health Nurse Municipal Service Division of the NYS Department of Civil Service conducted email survey in 2007, at our request. Recruitment difficulty for 599 positions out of 2260 total positions reported as existing in their agencies Municipal Service Division of the NYS Department of Civil Service conducted email survey in 2007, at our request. Recruitment difficulty for 599 positions out of 2260 total positions reported as existing in their agencies

11. Recruitment Only 9 of 23 agencies provided reasons for recruitment difficulties. These are: Salary Educational Requirements for Position Other Job Criteria including Experience requirement Location of Agency

12. Retention Median age of local public health worker is 49, compared to median age of U.S. civilian worker of 40. Public Health Nurses have median age of 50. 62% of local public health workers are between the ages of 45 and 64 Almost 20% of local public health workers report plans to retire within next five years. Source: Center for Health Workforce Studies. 2007. New York State Public Health Workforce Enumeration Survey

13. Marketing Strategies Establish comprehensive web-based clearinghouse on public health careers http://www.nyhealth.gov/prevention/public_health_works Conduct survey of public health students to guide future strategies in supporting the public health pipeline Conduct survey of recently hiring SDOH employees to guide future marketing efforts

14. Public Health Works! Website

17. Task Force Key Strategy Areas Strengthen academic/practice partnerships Strengthen workplace policies and procedures Assess leadership skills Define workforce competencies and gaps Market public health careers to college age students Market public health careers to adults and mid- career professionals Locate and advocate for new resources Hire staff with right skills and provide career development opportunities Implement workforce development programs

18. State Sanitary Code Changes NYS DOH revised definitions and minimum qualifications for key public health professionals to ensure they: Reflect up to date professional job descriptions and qualifications Address training needs Support career ladders

19. SSC Code Changes Revise definition of Public Health Nurse and Supervising Public Health Nurse to reflect role in population health as well as individual patient care Maintain requirement for public health nurses to have BSN LHDs benefit from having Bachelor�s prepared nurses because the BSN provides training in population and community health, and the training to work independently, while an RN degree does not.LHDs benefit from having Bachelor�s prepared nurses because the BSN provides training in population and community health, and the training to work independently, while an RN degree does not.

20. SSC Code Changes �The term public health nurse 1 shall mean a nurse who plans, provides, directs and evaluates nursing care in a variety of settings with the goal of improved health outcomes and [offers instruction and guidance in health practices for] is actively involved in the planning, development, provision and evaluation of public health programs designed to prevent disease and improve the health of individuals, [and] families, specific populations, high risk groups and/or communities.� LHDs benefit from having Bachelor�s prepared nurses because the BSN provides training in population and community health, and the training to work independently, while an RN degree does not.LHDs benefit from having Bachelor�s prepared nurses because the BSN provides training in population and community health, and the training to work independently, while an RN degree does not.

21. SSC Code Changes Add new job definition: Public Health Nurse 2 In addition to working with individuals, groups and families to improve health in the community, a public health nurse 2 will administer programs, develop program budgets, and lead monitoring and/or quality care initiatives Provides career ladder to retain public health nurses with experience in LHDs LHDs benefit from having Bachelor�s prepared nurses because the BSN provides training in population and community health, and the training to work independently, while an RN degree does not.LHDs benefit from having Bachelor�s prepared nurses because the BSN provides training in population and community health, and the training to work independently, while an RN degree does not.

22. SSC Code Changes �The term public health nurse 2 shall mean a nurse who plans, provides, directs and evaluates nursing care in a variety of settings with the goal of improving health outcomes and is actively involved in the planning, development, provision and evaluation of public health programs designed to prevent disease and improve the health of individuals, families, specific populations, high-risk groups and/or communities. The public health nurse 2 is also involved in program administration and/or program budget development and monitoring and/or quality improvement initiatives, and/or acting as advocate and liaison for constituents.� LHDs benefit from having Bachelor�s prepared nurses because the BSN provides training in population and community health, and the training to work independently, while an RN degree does not.LHDs benefit from having Bachelor�s prepared nurses because the BSN provides training in population and community health, and the training to work independently, while an RN degree does not.

23. SSC Code Changes Require Public Health Nurse 2 and Supervising Public Health Nurse to complete 15 hours of continuing education in public health topics approved by the DOH within their first year of employment in each position. Topics can include education about supervision At a focus group meeting with over two-thirds of the LHDs represented, public health nurse managers voiced their overwhelming support for a continuing education requirement to ensure nurses obtain additional public health nursing training, including training for supervisors, when they are on the job. On-the-job training can improve employee satisfaction and assist in retention of staff. At a focus group meeting with over two-thirds of the LHDs represented, public health nurse managers voiced their overwhelming support for a continuing education requirement to ensure nurses obtain additional public health nursing training, including training for supervisors, when they are on the job. On-the-job training can improve employee satisfaction and assist in retention of staff.

24. Developing CE Program for PHNs Discuss typical work activities for each PH Nurse title Identify most important core competencies for public health nurses in these titles Identify on-line and in person courses related to those competencies that public health nurses could complete to comply with this requirement. Create new programming to address gaps

25. Quad Council Competencies 8 Domains Analytic Assessment Skills Policy Development/Program Planning Skills Communication Skills Cultural Competency Community Dimensions of Practice Skills Basic Public Health Science Skills Leadership and Systems Thinking Financial Planning and Management Skills 3 Levels Awareness Knowledge Proficient At previous summit, a workgroup took on the task of examining the Quad Council competencies Obtained information via survey to identify those competencies that should be taught in Schools of Nursing versus those that could be learned on the job. At previous summit, a workgroup took on the task of examining the Quad Council competencies Obtained information via survey to identify those competencies that should be taught in Schools of Nursing versus those that could be learned on the job.

26. Typical Job Duties � PHN 1 Assesses health status, resources and risk factors of community/population to determine priorities for targeted interventions Works with communities to develop/deliver targeted health promotion and disease prevention activities Participates in assessing and evaluating health care services to ensure people are informed of programs and assisted in utilization of services Provides health education, care management and primary care to individuals and families

27. Add�l Typical Job Duties � PHN 2 Assists in development of policy and programs to address health concerns in community Recommends strategies to meet identified community needs Assists in preparation of program budgets Conducts studies and or evaluation of qualify of health department programs Acts as liaison with community groups

28. Typical Job DutiesSupervising PHN PHN 1 or 2 duties, plus supervisory responsibilities

29. How Well Prepared are BSN Nurses? Workgroup #2 examined issues related to public health practice setting and links to BSN Education. Obtained information via survey to identify those competencies that should be taught in Schools of Nursing versus those that could be learned on the job. Question #3: Competencies were assessed within the context of population focused practice. Analysis revealed the following: LHD BSN new hires are not proficient in any competency LHD BSN new hires have knowledge in the following three areas Thinking: 67% Cultural competency: 64% Communication: 60% LHD BSN new hires have no knowledge for 2 competencies: Policy Development and Financial Planning LHD were almost evenly divided on BSN new hires having between no knowledge and knowledge for 3 competencies: Planning, Management and Leadership. Question #4: When asked to rate the importance of these competencies for the practice setting, the LHD rated the highlighted areas in order of importance. The top 4 are: Thinking abilities Communication skills Cultural Competency and Community Dimensions tied for third place and Analytic Assessment & Planning skills tied for 4th place.Workgroup #2 examined issues related to public health practice setting and links to BSN Education. Obtained information via survey to identify those competencies that should be taught in Schools of Nursing versus those that could be learned on the job. Question #3: Competencies were assessed within the context of population focused practice. Analysis revealed the following: LHD BSN new hires are not proficient in any competency LHD BSN new hires have knowledge in the following three areas Thinking: 67% Cultural competency: 64% Communication: 60% LHD BSN new hires have no knowledge for 2 competencies: Policy Development and Financial Planning LHD were almost evenly divided on BSN new hires having between no knowledge and knowledge for 3 competencies: Planning, Management and Leadership. Question #4: When asked to rate the importance of these competencies for the practice setting, the LHD rated the highlighted areas in order of importance. The top 4 are: Thinking abilities Communication skills Cultural Competency and Community Dimensions tied for third place and Analytic Assessment & Planning skills tied for 4th place.

30. How Important are These Competencies? Preliminary data indicate that there are essential skills for public health nursing practice which BSN graduates are not well prepared and skills which can be learned on the job. Of the competencies that BSN New Hires were judged to be knowledgeable about, THINKING SKILLS and COMMUNICATION, the LHD thought these skills were of high importance and essential to the job. One Competency, CULTURAL COMPETENCY that BSN new Hires were judged to be knowledgeable about, the LHD PHNs were evenly divided on whether they thought this skill was of medium importance and could be learned on the job or it was of high importance and essential to the job. The other five competencies (PLANNING, MGMT SKILLS and LEADERSHIP, ANALYTIC ASSESSMENT, and COMMUNITY DIMENSIONS OF PRACTICE) were all judged to be of medium importance and could be learned on the job. Of the 2 competencies that BSN New Hires were judged to have no knowledge in FINANCIAL PLANNING and POLICY DEVELOP, the LHD PHNs thought these skills were of medium importance and could be learned on the job.Preliminary data indicate that there are essential skills for public health nursing practice which BSN graduates are not well prepared and skills which can be learned on the job. Of the competencies that BSN New Hires were judged to be knowledgeable about, THINKING SKILLS and COMMUNICATION, the LHD thought these skills were of high importance and essential to the job. One Competency, CULTURAL COMPETENCY that BSN new Hires were judged to be knowledgeable about, the LHD PHNs were evenly divided on whether they thought this skill was of medium importance and could be learned on the job or it was of high importance and essential to the job. The other five competencies (PLANNING, MGMT SKILLS and LEADERSHIP, ANALYTIC ASSESSMENT, and COMMUNITY DIMENSIONS OF PRACTICE) were all judged to be of medium importance and could be learned on the job. Of the 2 competencies that BSN New Hires were judged to have no knowledge in FINANCIAL PLANNING and POLICY DEVELOP, the LHD PHNs thought these skills were of medium importance and could be learned on the job.

31. Top Three Recommendations From Practice to Academia Increase the amount of time students spend in the public health clinical arena 2. Stress with students the distinct difference between community health and public health nursing 3. Develop an educational component to the community health course that focuses on population-based practice and public health nursing in the LHDs Approximately 37 recommendations were received from 21 responders. The top three recommendations were: Increase the amount of time students spend in the public health practicum � 24% The distinct difference between community health and public health nursing should be stresses � 16% Develop a cognate to the community health course that focuses on public health nursing in LHDs � 11% Although not an overwhelming voice for change, these recommendations serve as a jumping off point for further discussion. (#3 will change color after clicking�this is to provide a sag way into to development of training) So you can say something like�..which bieng us to the next steps relating to this topicApproximately 37 recommendations were received from 21 responders. The top three recommendations were: Increase the amount of time students spend in the public health practicum � 24% The distinct difference between community health and public health nursing should be stresses � 16% Develop a cognate to the community health course that focuses on public health nursing in LHDs � 11% Although not an overwhelming voice for change, these recommendations serve as a jumping off point for further discussion. (#3 will change color after clicking�this is to provide a sag way into to development of training) So you can say something like�..which bieng us to the next steps relating to this topic

32. Next Steps Identify already existing courses or on-line training that could be used to provide these 15 hours Identify gaps Who can volunteer to review existing training? Who can volunteer to conduct new training? Let�s discuss: typical work activites for each title PHN1, PHN2, and Supervisor The most important core competencies for 15 hours (You can refer back to slide looking describing the importance of the competencies) What courses or online training could be used to provide these 15 hours Who can help volunteer to do the training? Let�s discuss: typical work activites for each title PHN1, PHN2, and Supervisor The most important core competencies for 15 hours (You can refer back to slide looking describing the importance of the competencies) What courses or online training could be used to provide these 15 hours Who can help volunteer to do the training?

33. Contact Information Sylvia Pirani Director, Office of Public Health Practice New York State Department of Health Corning Tower, Empire State Plaza Albany, NY 12237 sjp03@health.state.ny.us phworks@health.state.ny.us