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KRISP Project Related Studies: PHN Workforce in Stark Relief. L. Michele Issel , PhD, RN ACHNE Annual Meeting, Pre Conference Workshop on Workforce Chicago, IL June 8, 2010. KRISP : A Name and an Acronym. Funded by HRSA’s Bureau of Health Professions, Division of Nursing. Introduction. - PowerPoint PPT Presentation
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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
and
Michele Issel, PhD, RN
University of Illinois at Chicago
School of Public Health
312/355-1137
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