KRISP Project KRISP Project Related Studies: Related Studies: PHN Workforce PHN Workforce in Stark Reliefin Stark Relief

L. Michele Issel, PhD, RNACHNE Annual Meeting, Pre Conference Workshop on

Workforce

Chicago, IL June 8, 2010

1KRISP Project

KRISPKRISP: A Name and an : A Name and an AcronymAcronym

K Keeping Knowledge access

R RNs to Redesign job and work environment

I Improve Innovate to improve

S Strengthen

Scope and competency based practice

P Population Health

Population focused care

KRISP Project 2

Funded by HRSA’s Bureau of Health Professions, Division of Nursing

IntroductionIntroductionKRISP Project ~

◦Require to report outcomes related to PHN practice

◦Needed indicators for QI and for project evaluation

◦HRSA required 4 indicators

Population-patient ~ specific target or set of actual or potential recipients of PHN care, services or activities focused on or delivered to a population as the intended patient

KRISP Project 3

Benefits to Benefits to KRISP KRISP ParticipantsParticipants

To LHD as organization◦ Recruitment, Retention of RN improved◦ Increased readiness for PHAB accreditation

To DONs◦ Leadership and peer support◦ Ability to focus on RNs only

To PHNs◦ Enhanced professionalism◦ Skill at Quality Improvement ◦ Increased perceived appreciation for work done

To County Population◦ Appreciation of role of PHN◦ Improved outcomes related to QI projects of

PHNs

KRISPKRISP as PHN Workforce Intervention Research

2 years of experience ~Low survey response rates from PHNs in

LHDsExpectations of PHNs are changing very

rapidly making it difficult to anticipate appropriate measures of change

Turnover rates and program eliminations makes longitudinal studies of individual RNs questionable

Unions play a role in the PHN workforce

KRISP RELATED STUDIES:

* PHN JOB DESCRIPTIONS

* PHN-RN SALARIES

* PHN COMPETENCIES

KRISP Project 6

Job Descriptions -Their Job Descriptions -Their ValueValueHuman Resources Department

Uses:◦Recruit, place, and transfer of staff◦Share job expectations, standards, and

competencies with applicant◦Establish scope of practice per position

Job descriptions may be used to demonstrate compliance with standards to regulatory agencies

7

Presented at 2010 APHA Annual Meeting in Denver, CO.

MethodologyMethodology

Obtained 33 PHN job descriptions ◦3 IL LHDs and 3 WA LHDs◦ All 6 part of KRISP Project◦Provided by HR or Nursing Director◦All PHN job descriptions per LHD

PHN job descriptions (n=18)◦Deleted duplicates, outdated, clinical

only (ie, NP)  

MethodologyMethodology1. Ignored statements of job specification

e.g., Licensure, driving, lifting, etc

2. Cross-walk ANA PHN Scope and Standards Quad Council Competencies

~ Done to assure consistency in our coding of statements.

3. Statements categorizing into the 20 ANA PHN Scope and Standards (and sub-standards)

4. Coding ReliabilityUsed iterative process for initial codingUsed other researchers for reliability check

Description by LHD Description by LHD (April 2010)(April 2010)

  A B C D E F

% of ANA PHN Standards used in Job Description(s)

75%

90%

40%

100%

65%

100%

PHN FTEs 31.0

29.1

19.6

23.4 6.324.3

PHN Positions 35 31 21 26 8 25

PHN Job Descriptions

1 1 1 5 1 9

1: Assessment 94%2: Population Diagnosis and Priorities 78%3: Outcomes Identification 22%4: Planning 94%5: Implementation 100%

5a: Coordination of Services 94% 5b: Health Education/Health Promotion 94% 5c: Consultation 56% 5d: Regulatory Activities 44%6: Evaluation 83%7: Quality of Practice 83%8: Education 83%

9: Professional Practice Evaluation 89%10: Collegiality, Professional Relationships 78%11: Collaboration 94%12: Ethics 89%13: Research 50%14: Resource Utilization 50%

15: Leadership 89%16: Advocacy 72%

Percent of Job Descriptions with the Percent of Job Descriptions with the Standard Standard

ConclusionsConclusionsPopulation-focused PHN standards are

used, but not universally included across Standards.

Need attention to ANA Standards regarding: Outcome identification Regulatory activities Research Resource utilization

Gaps in application of ANA PHN Standards to PHN job descriptions exist.

Job Description related Job Description related referencesreferencesFried BJ, Fottler MD. Human Resources in

Healthcare: Managing for Success. 3rd ed. Chicago, IL: Health Administration Press; 2008.

Fallon LF, Zgodzinski EJ. Essentials of Public Health Management. 2nd ed. Sudbury, MA: Jones & Bartlett Publishers; 2009.

Kalb KB, Cherry NM, Kauzloric J, et al. A competency-based approach to public health nursing performance appraisal. Public Health Nursing. 2006;23(1): 115-138.

KRISP Project 13

Salary Survey-BackgroundSalary Survey-Background

General wisdom: Lower compensation paid by local health departments (LHDs) for public health nurses (PHNs) compared to hospital nurse contributes to the difficulty in recruiting registered nurses (RNs) in to PHN positions.

No studies appear to have substantiated this belief.

Anecdotally, LHDs benchmark PHN salaries against other LHDs, rather than the local market for RNs.

KRISP Project 14

Presented at 2010 APHA Annual Meeting in Denver, CO.

SampleSample10 Hospitals & 6 LHDs in 6 KRISP

Counties (IL & WA) One LHD per KRISP County 0-4 hospitals included per KRISP

Co.◦One Co. had no comparable hospital

data◦Overall hospital participation rate

58.8% (n=10) Participation rate for IL = 40% Participation rate for WA = 85.7%

RN Hourly Wage by LocationRN Hourly Wage by Location

RN Differentials by LocationRN Differentials by Location

Findings Findings

No differences found among benefits offered by LHDs & Hospitals.

Some differences exist among education packages ◦100% of LHDs provide CE

reimbursement compared to 70% hospitals.

◦LHDs provided on average 11% more ($2,924) tuition reimbursement compared to hospitals ($2,639)

Salary Study related Salary Study related References References

American Nurses Credentialing Center [ANCC]. (2008). ANCC Magnet Recognition Program. Accessed October 12, 2008 from http://www.nursecredentialing.org/Magnet.aspx

Bacon, D. (2009). Results of the 2009 AORN Salary Survey. AORN Journal, 90(6), 829-844.

Brewer, C., Kovner, C., Greene, W., & Cheng, Y. (2009). Predictors of RNs' intent to work and work decisions 1 year later in a U.S. national sample. International Journal of Nursing Studies, 46(7), 940-956.

Ericksen, A. (2007). To your benefit. RN, 70(11), 42. NACCHO, (2005). Resolution to Support the Education and

Recruitment of Public Health Nurses. Accessed September 28, 2008 from http://www.naccho.org/advocacy/positions/

Quad Council. (2006). The Public Health Nursing Shortage: A Threat to the Public’s Health. Accessed October 10, 2008 from http://www.astdn.org/downloadablefiles/Final%20Nursing%20Shortage%20Paper.pdf

Serow, W., Cowart, M., Chen, Y., & Speake, D. (1993). Health care corporatization and the employment conditions of nurses. Nursing Economic$, 11(5), 279-291.

PHN Competency PHN Competency AssessmentAssessment

Purpose

Assess current competencies of KRISP PHN workforce

PUBLIC HEALTH NURSING SURVEY

 Advancing Public Health Nursing Education Grant

 Kathleen Baldwin, PhD, RN

University of Illinois at Peoria

College of Nursing

309/671-8467

kbaldwin@uic.edu

 and

Michele Issel, PhD, RN

University of Illinois at Chicago

School of Public Health

312/355-1137

issel@uic.edu 

 November 2, 2002

 Funded by HRSA Division of Nursing 

Please Note: Answer both front and back of all pages.

Competency Scales for Competency Scales for PHNsPHNs

Competency Domains (10 EPHS) # items

Link people to services 4

Mobilize community partnerships 13

Assure competent public health workforce 8

Enforce laws and regulations 4

Diagnose health problems 5

Inform, educate, and empower 4

Monitor community health status 13

Evaluate health services 8

Policy and planning skills 6

Research innovative solutions 6

Competency Scores per DomainCompetency Scores per Domain

KRISP(n =81)

IL 2007(n = 177)

Mean (SD)   Mean (SD)

Link people to services 3.3 (1.2)   3.3 (0.9)

Mobilize community partnerships

2.4 (1.1)   3.0 (0.8)

Assure competent PH workforce

2.1 (1.1)   3.0 (0.9)

Enforce laws and regulations

2.1 (1.1)   2.9 (1.0)

Diagnose health problems 2.0 (1.2)   2.8 (1.0)

Competency Scores per DomainCompetency Scores per Domain

   KRISP(n =81)

2007(n = 177)

Mean (SD)   Mean (SD)

Monitor community health status

2.0 (1.1)   2.7 (0.9)

Inform, educate, empower 2.2 (1.1)   2.7 (1.0)

Evaluate health services 1.9 (1.0)   2.7 (1.0)

Research innovative solutions

2.2 (1.1)   2.6 (0.9)

Policy & planning skills 1.1 (1.0)   2.5 (0. 9)

PHN competencies related PHN competencies related referencesreferences

Quad Council of Public Health Nursing Organizations.(2004). Public health nursing competencies. Public Health Nursing, 21, 443–452.

Epstein, R. M., & Hundert, E. M. (2002). Defining and assessing professional competence. JAMA, 287,226–235.

Issel, L.M., Baldwin, K. A., Lyons, R., Madamala, K. (2006). Self-reported competency of public health nurses and faculty in Illinois. Public Health Nursing, 23: 168–177.

KRISP Project 24

What I’ve heard PHNs What I’ve heard PHNs say…say…What is the social-ecological model?How we supposed to add QI activities

to our real work?What is PHAB?What is going to happen to my

program with all the county cuts?Evaluation is a managers job, not ours.What’s a logic model?I worry about my clients.

KRISP Project 25

On the other side, I’ve On the other side, I’ve heard…heard…

I like learning something new.We do want to make improvements.

It’s beginning to make sense.

KRISP Project 26

WHAT DOES IT WHAT DOES IT MEAN?MEAN?

KRISP Project 27

My Soap Boxes ~My Soap Boxes ~

Access to full-text online scientific journals for ALL LDH employees.◦What’s the reality where you live?

Collaborate with unions to have PROFESSIONAL job descriptions

Nursing faculty attitudes need to reflect a value for PHNs

KRISP Project 28

PHN as advanced practice◦Requires population focus◦Requires analytic skills

PHN wages◦Alignment with skill (not)◦Alignment with breadth of practice

(not)

Job description as one route toward improvements for PHN as a job

Advocating for PHN Advocating for PHN PracticePractice

Opportunities for Opportunities for Educ/TrainingEduc/TrainingIntegrate quality improvement

techniques into courseworkCreate more and more frequent

opportunities for education of public health nursing along with other disciplines in public health

Create coursework specific to the management of population-focused practice

Etc…..KRISP Project 30

Opportunities for Opportunities for ResearchResearch

PBRNs◦Collaboration as an opportunity

RWJF’s PHSSR grants◦Workforce as a focus

Topics (from the list of infinite needs)◦Databases needed for real-time QI ◦Leadership

KRISP Project 31

KRISP Related PublicationsKRISP Related Publications

Issel, L. M, Ashley, M., Kirk, H. & Bekemeir, B. (2011, in press). Public Health Nursing Job Descriptions: Are they Aligned with Professional Standards? Journal of Public Health Management and Practice.

Issel, L. M., Bekemeier, B., Baldwin, K. (2011). Three population patient indicators for public health nursing: Results of a consensus project. Public Health Nursing, 28: 24-34.

Issel, L. M., Bekemeier, B. (2010). Safe practice of population-focused nursing care: Development of a public health nursing concept. Nursing Outlook. 58, 226-232.

KRISP Project 32

Thank You!Thank You!

http://krispproject.wordpress.com/

Funded by HRSA Bureau of Health Profession, Division of Nursing, under the Nurse Education, Practice and Retention Program, grant number D11HP14605