2006
State Reports
Updated
6/6/06
Projects/Issues Addressed This Year:
Documentation of Population/Community and Systems Focused PHN Activities: Up to this point all of our PHN services data has focused on individual client care services. This year we have developed a database and are just now beginning statewide use of a population-based services information management system to collect information about the type of activities and time PHNs are investing in population based service delivery. Activities are categorized according to program, and the PHN intervention/activity as categorized by the Minnesota Wheel, and PHNs asked to make note of the process and outcome objectives for the activity. We are hopeful this will add significant new information and data which will be useful in looking at PHN services and reporting the impact of PHN activities.Public Health Emergency Preparedness: PHNs continue to work actively on public health emergency preparedness and most recently pandemic influenza planning and preparations. PHNs are active on each Local Emergency Planning Committee in the state and numerous communities have already held or planning upcoming mass immunization/mass prophylaxis exercises. A respiratory protection plan has been completed for PHN staff and training and community planning and coordination work continues actively statewide. A contract was awarded to the Alaska Nurses Association to hire a coordinator for the Alaska Nurse Alert System. We were able to test the Alaska Nurse Alert System as we prepared to assist the Southeast as needed in response to Hurricane Katrina; we had more than 80 Nurse Alert volunteers ready to respond if called upon for assistance.
New Quality Assurance/Quality Improvement Position: We have reclassified a vacant Nurse Consultant position into a Nurse Consultant who will focus on developing and instituting a comprehensive QA/QI program for the Section of PH Nursing. We hope to fill this position within the next few months.
Statewide PHN Conference: Alaska is holding its first Statewide Public Health Nursing Conference in four years on April 18 – 20. The theme of the conference is “Partnering for Healthy Communities” and Linda Olson Keller will be our keynote speaker. The major focus of many of the presentations will be provision of population based public health nursing services.
Projects/Issues Pending:
Funding: After suffering a $1.2 million reduction and loss of 16.5 positions in FY 2005, and stable funding at that level in FY 2006, it is looking hopeful for a modest General Fund increase of $750,000 for public health nursing in FY 07. This is part of a public health preparedness and infectious disease GF request to increase public health capacity in the areas of public health nursing, epidemiology and labs. (This is half of the $1.5 million put forth for public health nursing in the Governor’s proposed budget).PHN Practice Guidelines: Work on revising and updating PHN Practice Guidelines (in process since 2004) continues with a real possibility of completion by the end of the summer. Our goal is to make our guidelines consistent with the Scope and Standards of Public Health Nursing, the Core Functions, the Ten Essential Services, the Minnesota PHN Interventions Wheel, and the PHN Competencies. It has been a long, but very worthwhile process as we have worked to include PHNs from across the state in developing, researching, writing, and reviewing the guidelines. We believe the finished product will serve as a valuable guide for PHN practice and decision-making for experienced Alaska PHNs as well as new graduates and nurses new to the field. Work has also begun on updating our Charting Manual to provide better instruction and to coincide with the Practice Guidelines.
Issues and Special Concerns for Public Health Nursing:
Recruitment and Retention: We continue to see departure of our most experienced PHN staff, primarily due to retirement. We have been experiencing a consistent 16% vacancy level despite our efforts to fill positions. We have been fairly successful in hiring PHN I level staff, but have it extremely difficult to find applicants for positions requiring PHN experience, particularly PHN III and PHN management level positions. The Division will be working together to encourage and assist staff in learning leadership and management skills so we can better grow our own new public health leaders for the future.Medicaid Funding: Medicaid has been funding approximately 35%-39% of the Alaska PHN budget based on a time study that determines the percentage of time spent by Alaska public health nurses providing services to Medicaid eligible clients. We are now being required to revise our time study methodology for PHN staff and have had to begin daily documentation of time devoted to Skilled Professional Medical Personnel (SPMP) activities by PHN management staff. Previously the Medicaid funding percentage was determined for a one year period based on time study results for the previous six quarters. The new time study which will begin July 2006, will result in a new Medicaid percentage each quarter based on the previous quarter time study results. This will result in much more volatility in our budget and we anticipate that these changes will have a significant impact on our total annual budget, though it is impossible to predict what that impact will be at this point in time.
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Projects/Issues Addressed This Year:
Since 2003, the Arizona Department of Health Services (ADHS), in cooperation with Knowledge Capital Alliance and the W. P. Carey School of Business at Arizona State University, has offered the Accelerated Leadership Academy (ALA) to ADHS staff and other public health partners. Per the ALA, it is “a customized leadership development program designed to assist public health organizations to clarify, communicate and execute their vision, mission, goals and strategic initiatives.”By the end of 2004, three cohorts (~200) had completed the ALA. The fourth cohort (80) began the course in May 2005. As part of Cohort 4, registered nurse members of the Arizona County Directors of Nursing Association (ACDONA) were invited to participate. The ADHS Preparedness and Response Bureau underwrote the cost and requested that the group’s ALA project be a Mass Vaccination Clinic Plan template that could be adapted by all county health department preparedness and response programs for use in their individual counties.
Registered nurses from 11 of the 15 Arizona county health departments participated; four counties were unable to attend due to staff and time constraints. The nurses (15) who participated manage or directly provide immunization services in their counties. They each have extensive knowledge and expertise in providing immunization services in different environments, serving small to very large numbers of individuals in a variety of locations.
A “gap analysis” was developed to identify what should be included in a mass vaccination clinic plan and evaluate the completeness of each county’s preparedness and response plans. Eleven criteria were identified as requirements for a quality, efficient, safe vaccination clinic process for staff and the public. The criteria included 8 nursing essentials and 3 preparedness and response contract deliverables. The Mass Vaccination Plan was distributed to the county health department preparedness and response program managers and to the Health Officers at their monthly meeting in March, 2006, where it was unanimously approved as the universal plan to be used by all counties. ACDONA will review the plan periodically (approximately every 6-12 months) and update as needed. Any changes will be posted on SIREN (Secure Integrated Response Electronic Notification), a web based secure information system accessible to state and county health department staff.The Mass Vaccination Plan was an overwhelmingly successful project due to the individuals who developed it – public health nurses.
Projects/Issues Pending:
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Issues and Special Concerns for Public Health Nursing:
Continued depletion of public health nurses primarily due to retirement. Informal canvassing of the three state colleges of nursing indicate declining enrollment in community health nursing leading to a lack of nurses to fill vacant positions at the state and county levels.
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Projects/Issues Addressed This Year:
Re-classification of Advanced Practice Nurses/Registered Nurse Practitioners within Arkansas Department of health for recruitment and retention purposes.
Arkansas Nurses provided essential public health services to many of the estimated 75,00 evacuees that sought safety and shelter immediately after Hurricanes Katrina and Rita. Nine thousand evacuees from Katrina and 1,5000 arrived via FEMA busses and Airplanes to the initial staging site at Fort Chaffee. Public Health Nurses along wit other providers and volunteers provided basic health service, needs assessments, immunizations, acute and maintenance prescriptions. Over 100 shelters were up and running with the help of faith-based camp. Public Health Nurses across the state staffed church camp shelters providing screenings, basic first aid, physical and mental health referrals. Public Health Nurses worked directly with state epidemiologists. We were fortunate to have a team of U.S. Public Service Nurses from CDC who worked with us in shelters and church camps to develop systems and individual care plans.
Arkansas Department of Health and Arkansas Department of Human Services merges to form the Arkansas Department of Health and Human Services. The Health Department became the Division of Health under the new agency. Dr. Paul Halverson became the new Division Director. Organizational changes resulted in the appointment of a State Director of Nursing in the Center for Local Public Health Services. This change has lead to many new opportunities for nursing to be involved at the state level in program planning.
The Arkansas Diabetes Prevention and Control Program at the Arkansas Department of Health and Human Services, Division of Health, was recognized by the Centers for Disease Control and Prevention (CDC) at the Program Director’s meeting in Atlanta for achieving a Healthy People 2010 objective for diabetes. – The Healthy People 2010 objective was to increase the percentage of persons with diabetes who receive two or more glycosylated hemoglobin (A1c) measures in a year to 65 percent. On a mid-period evaluation of the states conducted by the CDC, Arkansas’ rate was found to be 67.4 percent, surpassing the Healthy People 2010 objective. The CDC presented a ‘Certificate of Recognition’ to the Arkansas Diabetes Prevention and Control Program at the Program Directors meeting in Atlanta on March 1, 2006 for this accomplishment.
Boxing champion Jermain “Bad Intentions” Taylor – Arkansas resident partnered with Division of Health and Stamp Out Smoking Campaign to reach the youth. Made a music video and several commercials of this topic.
Projects/Issues Pending:
- We are currently working with the Arkansas State Board of Nursing (ASBON) to develop a link form their website to the Division of Health webpage, where we currently have a database of over 2000 nurse volunteers registered.
- We currently have a task force of Emergency Preparedness Communicable Disease Nurse Specialists working on emergency preparedness nursing protocols and policies.
- The development and implementing ongoing Emergency Preparedness Inservice and training to volunteer nurses throughout the state is an ongoing concern.
Issues and Special Concerns for Public Health Nursing:
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Projects/Issues Addressed This Year:
The California Conference of local Health Department Nursing Directors took on 2 major projects over the last year.
A copy will be available to view at the meeting.
A copy will be available at the meeting to be viewed.Projects/Issues Pending:
The organization is currently working on its 3 year Strategic Plan, goals address:
· Increasing the memberships understanding of the NACCHO Accreditation Standards
· Active participation in initiatives aimed at development of a Date level department dedicated solely to public health
· Advocacy for a State Level Public Health nursing director
· Standardization of PHN competencies and the role of unlicensed personnel statewide
· Increased use of information technology
· Increasing the number of BSN prepared nursing available to fill public hralth nursing positionsIssues and Special Concerns for Public Health Nursing:
For the local health jurisdictions’ public health nursing directors, the major concerns include the shortage of qualified nurses applying for employment, continued struggles between categorically funded staff and the needs related to addressing broader public health issues, our lack of a State Department of Public Health including the fact that there is no position for a State Director of public Health Nursing.The shortage of nurses has been exacerbated by California’s initiation of staffing standards for inpatient hospitals. To avoid significant fines hospital are paying premium salaries and signing bonuses, something that most public agencies cannot do.
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Download CT PDF
Projects/Issues Addressed This Year
The Office of Public Health Nursing (OPHN) mission is to enhance the state’s public health nursing practice through education, research and evaluation. Public Health Nursing is in part responsible for the health and safety of all Florida citizens and visitors to the state, and is a critical component of the health care delivery system.
The Office provides leadership, technical assistance, consultation and support to public health nurses, administrators, educators, and our community and agency partners. Some of the issues addressed this year are:
Workforce Development
The Florida Department of Health, like many other agencies, faces a challenge of maintaining a highly skilled and qualified workforce. There are many challenges related to enumerating our workforce, recruiting and retaining health professionals in a competitive environment and maintaining the skills and knowledge needed when we face new and emerging issues, diseases, and technology on a daily basis.
· Recruitment statewide and at national meetings, marketing and promotion of the Department’s Educational Leave With Pay Program, tuition waiver, flexed work schedules and other benefits of DOH employment
· Use of Behavioral Event Interviewing techniques to assist in selection of candidates and training for nurse leaders statewide in the use of these techniques
· Development and pilot testing of several tools to promote the development of supervisor/manager and non-supervisor staff. The (insert name of form) has been modified for use with a range of nursing positions with in the DOH structure. The tools provide a frame work for assessing core competencies and range from novice to expert. The tools can be customized based on local and job specific responsibilities.
· In concert with the performance evaluation tool, we have designed system for incorporating Individual Development Plans (IDPs). Ideally the IDPs are developed within the first 30-60 days of employment and are based on assessment of the individual’s skill, required agency training, job specific responsibilities and professional development goals.
· Staff within the Office of Public Health Nursing and public health nurses in the field have been offered and completed a wide variety of all hazards preparedness training ranging form incident command training, preparedness training for nurses (awareness level, operations level, mitigation and recovery). Additional training related to asset typing, special needs shelter, behavioral health, risk communication and other related topics have also been completed by nearly 1000 of our nurses.
· Staff actively participates in our Distance Learning Program which offers over 225 programs per year. Topics include preparedness, communicable disease, chronic disease, HIV/AIDS, immunization programs as well as many other topics. All programs are recorded and available for use as needed. Continuing education credit is provided for approximately 75% of the programs.
· The OPHN maintains a provider number for CEUS for nurses and processed approximately 250 programs this year. Approval of qualified programs is offered as a service to the DOH divisions, bureaus, offices and the local county health departments who do not have provider numbers.Influenza Vaccine Shortage
· Due to delays in the distribution of flu vaccine many of the “Flu Clinics” were still operating in November and December. OPHN Staff worked with the Bureau of Immunization and served on the Influenza Incident Management Team to assist with planning distribution and monitoring the vaccine supply.
· Public health nurses statewide played a key role in planning, staffing and evaluating flu clinics.
· We do not anticipate a shortage for this year.Emergency and Disaster Response
· OPHN staff served as Patient-Care Team Leader in the State Emergency Operations Center. As team members of the Emergency Support Function 8 (Health and Medical), staff coordinated hurricane preparedness efforts for the 2005 hurricane season. As members of the Logistics Team, staff assisted with recruiting and building teams, preparing them for deployment and tracking the status of missions. During Hurricane Katrina teams with over 300 individuals were deployed to the five most severely impacted counties in southern Mississippi.
· Special needs shelters - During Hurricane Wilma, the office coordinated Special Needs Shelters in those areas affected by the storm. Using Regional Special Needs Shelter Coordinators, the office was able to synchronize the resources from local communities, partner with local medical facilities and federal government agencies to ensure the welfare of those using the shelters.
· A Shelter Management Course has been developed. We are using a “Train the Trainer” approach to deploy this training to the 7 regions in the state. OPHN has partnered with the Regional Special Needs Shelter Coordinators to assure that it meets their needs and to leverage resources.
· Review Comprehensive Emergency Management Plans from home health agencies, nurse registry agencies and hospice providers, with over 1,000 completed on an annual basis. The goal and purpose of the reviews is to assure that all of these providers have adequate plans to ensure that critical patient’s needs are met and the patients are provided health care pre/during/post events.Quality Improvement
· A comprehensive quality management tool, addressing public health nursing practice has been developed and tested in local county health departments. Office staff coordinate and conduct quality improvement peer reviews as requested. All of the 67 county health departments in Florida have access to technical assistance and consultation when requested. The Office provides statewide consultative services and training for nursing quality improvement including techniques for collecting and analyzing data and the dissemination of evaluation data. The Peer Review tool incorporates Sterling Quality Criteria. This approach encourages and supports data driven decision-making.
Promoting Political Awareness and Proposing Legislative Action
· OPHN staff work closely with the Department of Health’s Office of Legislative Planning. During the past year staff have reviewed approximately # bills and provided detailed analysis. Staff has assisted with review of draft legislation, provided fiscal impact analysis of a number of key bills this year. Currently there is a Special Needs Shelter Bill moving through the legislative process and OPHN has had lead on tracking the bill and providing data and information to legislative staff as requested.
· Monthly conference calls are used to assure that field staff are aware of bills that have an impact on the Department and the practice of nursing.Nurse Practice Council
· A Nurse Practice Council (NPC) has been established to promote the advancement of public health nursing through leadership, education, communication and support of public health nursing practice standards. Members of Council provide collaborative leadership and are representative of the diversity of the state and our practitioners.
· The NPC provides collaborative leadership in the provision of nurse practice standards and scope of care. The Council is comprised of Public Health Nurses serving as Registered Nurses (RN), Advanced Registered Nurse Practitioners (ARNPs), and Licensed Practical Nurses (LPNs), and is reflective of all levels and programs throughout the Florida Department of Health.
· The Council believes Public Health Nursing has a responsibility to participate, be creative, test new ideas, and keep abreast of actual and needed advances that may translate into action to improve the practice of nursing. It functions as a representative body to assist with the development of strategies to communicate and operationalize public health nursing standards of practice within the Department, and provide a network that maximizes communication and promotes interdisciplinary collaboration.
· The Council’s initial projects will focus on nurse practice issues, Advanced Registered Nurse Practitioner protocols, Licensed Practical Nurse standards of practice within county health departments, and Registered Nurses certifications.Public Health Nursing Strategic Plan
· In early 2005, the Strategic Planning process began for Florida’s Public Health Nurses and the Office of Public Health Nursing. The plan was formulated in the summer and continued into the fall of 2005 with group sessions.
· The Office of Public Health Nursing (OPHN) strategic challenges are to: a) unite, align, collaborate and ensure accountability for common outcomes and results; b) systematically manage workforce issues; c) develop our Organizational Profiles.
· The OPHN drafted a balanced scorecard specific to this office with indicators in six of the Sterling outcomes or results categories. Currently, the office is in the process of refining these and populating the fields with data to determine the next steps in our journey.
Projects/Issues PendingPreparedness
· Training and education related to all hazards preparedness and the role of public health nursing.
· Reconstructing the Special Needs Shelters Operation and Special Needs Shelter Awareness Courses to include updated information learned during Katrina and Wilma, and to incorporate current trends/aspects in an all-hazards approach.
· Basis Skills Refresher Course for staff in Special Needs Shelters. This training will provide didactic and practice training of basic skills not used routinely in the county health department. This project will partner with the local community colleges and university programs to offer classes using state of the art skill laboratories, simulators and faculty.
· Alternative Site Discharge Planning Resources Manual. This project with be led by the OPHN but will include our partners and stakeholders in assuring continuity of care for persons displaced due to an event. The deliverable of this project will be a comprehensive and current electronic resource that includes assessment tools, check lists, contact information and algorithms to be used in linking clients to critical services in an effective and efficient way.
· Mental health/behavioral health training for activated and deployed DOH staff. The goal of this project is to deliver behavioral health training that addresses resiliency and psychological first aide for staff in high stress situations such as deployment.
· We are about to pilot a community/neighborhood mobilization and self triage project that will enhance the operational readiness of residential enclaves in handling resources during a disaster situation. In addition, the Self-Triage project will focus on decision steps for residents seeking medical care information. It will assist individuals in answering the questions “Should I go?, When to go?, Where to go?, and How to go? This program will get the information to the resident and should help in the use of valuable medical resources during a major disaster event.Issues and Special Concerns for Public Health Nursing
· Workforce development of Public Health Nurses related to demands of day-to-day job description vs. Emergency Response job description.
· This year, we will be involved in salary negotiations to ensure all health care workers are entitled to an appropriate level of compensation, when deployed during a disaster situation, similar to those received by first responders.
· The OPHN has lead for the 13 member Workgroup on Mammography Accessibility. The charge of the Workgroup is to study the availability of mammogram services offered in the state, the accessibility of these services to the public and the quality of care given. In addition, the Workgroup will identify challenges in meeting the needs of the public for mammography services and recommend strategies to alleviate obstacles in order to meet those needs.Nursing Shortage
· Nursing shortage is among the most pressing issue facing most hospitals and health systems today. A large number of patient care and medical assistance is provided by Public Health Nurses; the decrease in nurse staffing in any institution can dramatically compromise the delivery and quality of health care.
· The National Center for Healthcare Workforce Analysis projects that by 2020, Florida will need 61,000 more nurses than are currently projected to be available. Specific concerns focus on two areas: shortages of faculty positions and training of specialized RNs.
· The Office of Public Health Nursing manages the Nurse Student Loan Forgiveness Program which offers financial assistance to help address the issues of nursing shortage in Florida. During the most recent fiscal year, this program has provided $500,000 of assistance to 172 nurses. In total, this program has provided over $3.3 million in assistance to over 500 nurses in this state.Public Health Nursing Strategic Plan
· The Public Health Nursing (PHN) profile was compiled based on input from three different groups: the Office of Public Health Nursing staff, County Health Departments / Children’s Medical Service Nursing Leadership and Central Office Nursing Leaders. Strategic PHN challenges were identified for FY 2005 - 2006 and workgroups and team members were selected for these groups.
· At this time, we are in the deployment stage of the plan and are sharing it with all our stakeholders - internal and external.
· The state working groups continue the development/implementation of the action plans, including the measures for each activity to ensure that the activity is moving toward the objective. Action plans are to be developed for these challenges / objectives in the areas of improve retention and recruitment; improve financial viability; and Improve technologies through reduction in paperwork and email volume. Our next step will be to report on the progress of the workgroups.
· The OPHN contracts with the Florida Center for Nursing, the Office of Public Health “develop a strategic statewide plan for nursing manpower in this state”. During the past year, the FCN Board of Directors completed a strategic plan in collaboration with 12 key stakeholder organizations / agencies through joint meetings and taskforces with wide representation. In addition, the FCN is writing a comprehensive plan to implement a nurse supply and demand forecasting model through collaboration with state agencies and professional groups.
· The OPHN has and continues to work in collaboration with all community stakeholders such as the Florida Nurses Associations, Florida Hospital Association, colleges and universities, and leaders of this state.
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Projects/Issues Addressed This Year:
Transformation of Public Health
In 2003, the Division of Public Health commissioned the Georgia Health Policy Center to study the role of public health in Georgia from the perspective of diverse stakeholders, including the private perspective, community partners and public health professionals. The recommendations from that study included reexamining the core business of public health. On November 29-30, 2005 the Division of Public Health convened the Summit for a Healthy Georgia with approximately 800 public health workers and community stakeholders. The summit produced seven areas of emphasis as a framework for achieving the vision of a safe and healthy Georgia. Action plans to follow the summit are underway and include producing an executive summary of the summit activities, the development of a strategic plan, collaboration with academic partners in compiling the success stories from the local communities to be used as best practices, completion of the Frequently Asked Questions, formation of an advisory group to assist and guide the journey to health and regular and frequent progress updates via the website (www.healthygeorgiasummit.org), the Video Interactive Conferencing System (VICS) and various meetings.
Office of Nursing Infrastructure
The Emergency Preparedness Nurse Consultant position was upgraded to Assistant Chief Nurse. A vacant Program Associate position was assigned to the Office and filled. A contract nurse was hired to focus on updating the Manual of Biological and Chemical Protocols. The Office staff is now comprised of 1 Chief Nurse, 3 Assistant Chief Nurses, 1 contract nurse, 1 full-time Program Associate and 1 part-time Program Associate.
Population Health Competency Development
In June 2005, the HRSA, Division of Nursing grant (#D11HP00368) to develop Population Health Competencies for public health nurses ended. During this 3-year program, the Office of Nursing collaborated with multiple schools of nursing in Georgia to provide a Population Health Online Course and a Population Health 3-day training for CE credit. The population health online course and CE program included several components to support learning and application of population health concepts including computer skills training from a distance-learning expert prior to the online course, Office of Nursing support during application, enrollment, and class participation by the Population Health Nurse Coordinator, mentors, communication with faculty and other students, and two scholars’ CE programs each year on population health related issues. The online course also included a required project implemented in the community/workplace that incorporated at least one of the priority population health competencies.
Evaluation results from participants, faculty, mentors, and supervisors were instrumental in shaping the program. Participant feedback regarding the value of population health, the online course, and CE program were strongly positive. The most frequent comments centered on participants’ broadened and enriched perspective of, and their role in, public health. Although supervisors often were unable to encourage PHNs to participate in the online course due to time, staffing, and budget shortages, they rated the course well and supported the more manageable three-day CE programs. A new online version of the population health course, adminstered through DHR, is currently being developed; a pilot of this course is scheduled to begin in June.
History of Georgia Public Health Nursing 1898 – 2002
The Division of Public Health recently unveiled its new publication, The History of Georgia Public Health Nursing 1898 – 2002 at the annual meeting of the Georgia Public Health Association on December 15, 2005. This important document showcases Georgia’s rich history and provides a strong platform for building the future practice within the context of the transformation journey. It will soon be posted on our Website.
Quality Assurance/Quality Improvement (QA/QI) Initiative
A statewide assessment of Phase III of the QA/QI Initiative has been completed and we are in the process of developing Phase IV using a framework that is more multidisciplinary and supportive of the transformation journey being led by the Division of Public Health. In the interim, other projects designed to enhance the practice and policies of public health nursing are underway, including the creation of a documentation training program and the revision of retention policies for clinical records.
Emergency Preparedness
Georgia Public Health was an integral and indispensable part of our state’s huge hurricane relief effort. Hospitals, nursing homes, the VA, EMS and EMA, law-enforcement, churches, local governments, faith-based organizations, American Red Cross, and other organizations and private individuals all pulled together to make those efforts successful. It truly takes a total community effort to respond to a major disaster.
Public Health nurses were involved with every aspect of operations including: support for airlift operations, shelter management, clinic management and staffing at mega service centers and shelters, and accompanying strike teams who targeted hotels to assess evacuee health needs. The Georgia Nurse Alert System (GNAS) was used by the Office of Nursing to obtain additional nursing resources. Within 72 hours of initiating the system there were 180 nurses on the roster of nursing volunteers. Over 35,000 displaced persons were received in Georgia, and support efforts continue. Public health nursing not only played a vital role in coordination of nursing resources, but was also responsible for coordinating the deployment of volunteer physicians to the mega centers.
One nurse who participated as a GNAS volunteer reported back to us about her experiences. She states: “It was my pleasure to work in the field under the guide of Georgia public health nurses who greatly impressed me with their organizational and professional skills, and collaborative sense of mission.” We are very proud of the effort, expertise, caring, and compassion shown by all who participated in this effort; and we support those who continue to work to meet the needs of those individuals and families who have lost so much. We are also working, through research, surveys of the emergency preparedness community, and the Developing a Curriculum (DACUM) process, to develop a set of competencies for the role of the public health nurse in emergency preparedness and response. Next steps include creating a curriculum to impart these competencies to the public health nursing workforce. Additionally, in light of the great importance that volunteer recruitment, training, mobilization, and deployment plays in many emergency situations: the Office of Nursing has developed a job description for a position that it proposes will support the nurse volunteer program and well as ensure that bio-chemical protocols are updated yearly.
A new MOU with the American Red Cross was finalized, signed and disseminated in August 2005. The MOU is a component of the new document, Guidelines for the Care of Populations with Special Needs during Disasters and Emergencies. A communication plan is in process to clarify the contents of the guidelines and the MOU and to promote successful implementation of the new guidelines and MOU at the various levels within the organization as well as with the various community partners and stakeholders.The Office of Nursing is involved in the development and exercise of all major emergency operations plans at the state level to include: the Georgia Emergency Operations Plan, Pandemic Influenza Plan and Standard Operating Guidelines, The Emergency Evaluation and Response Plan for Hartsfield-Jackson Atlanta International Airport, and others.
Medicaid Managed Care
Medicaid managed care has come to Georgia as a new initiative in 2006. The Office of Nursing is participating on a statewide workgroup that has developed manuals for local boards of health to use for contracting and credentialing. The workgroup is also meeting with all Care Management Organizations (CMOs) to discuss public health services, streamline billing and claims issues and to advocate for coverage of public health services in CMO contracts.
Projects/Issues Pending:
Legislative
The Future of Georgia Public Health Nursing Committee
This new committee is being formed for the purpose of developing strategies to enhance the
capacity and support the leadership and practice roles that Public Health Nurses need to assume in order to improve the health status of Georgians. Committee membership will include a mix of
stakeholders outside governmental public health who bring diverse perspectives on health and
leaders who represent local and state level public health. The work of this committee will be
preparatory for the Public Health Study Committee referred to in the above list of legislative
issues.Issues and Special Concerns for Public Health Nursing:
Download GA PDF
Projects/Issues Addressed This Year:
Legislative:
· Codification of public health nursing services program into the Hawaii Revised Statues was signed into law by Governor Linda Lingle. The statutes clarify the role and functions of public health nursing and establishes the statutory base for public health nursing services in Hawaii.
· State legislature appropriated Registered Professional Nurse V and three (3) clerical positions to support Public Health Nursing Branch in meeting all of the rules and regulations of IDEA, Part C, Early Intervention ServicesEmergency Preparedness:
· Skills and Competencies for Disaster Preparedness for Public Health Nurses completed. Plans are underway for training programs for PHNs.
· PHNB presented at the 3rd Annual Hawaii Bioterrorism Preparedness Conference on February 17, 2006 on the role of nurses in Bioterrorism Emergencies.
· PHNs were part of the Disaster Assistance and Recovery Center to providing assistance to families during the recent flooding on Oahu and Kauai.
· Involvement in developing guidelines for Emergency Shelters for the Special Needs PopulationOther Public Health Nursing activities:
· Development of Skills and Competencies for Diabetes Care Management, Immunization Services, Tuberculosis Nursing, and Disaster Preparedness. Skills checklist for validation of skills have been developed for all except for Tuberculosis Nursing and Disaster Preparedness, which are being worked on.
· Update on Tuberculosis Nursing Workshop was held on December 7, 2005 with Judy Gibson, Nurse Consultant at CDC, as guest speaker.
· Continue with the facilitation of the Hawaii American Academy of Pediatrics-PHNB-DOE Advisory Partnership related to school health practices. The following has been finalized.a.” Formulary of Medications”, which is a guide of list medications that are appropriate to be given during the school day.
b. Standardized Emergency Action Plans for Respiratory Difficulties, Severe Allergies; Convulsive Seizures, and Gastrostomy Tube Replacement· Continued reimbursement for Targeted Case Management for infants and Toddlers under Medicaid, and Carve Out reimbursement for Early Intervention Services
· Collaboration with Child Welfare System, Department of Human Services regarding coordinated services for children in the Child Protective Services system.
· Active involvement with the Medically Fragile Coordinating Council regarding services to medically fragile technology dependent children
· PHNB re-organization to add the Quality Assurance/Technical Assistance staffing within the Branch
· Collaboration with the HIPAA Office within Department of Health in developing and implementing HIPAA policies and procedures for covered entities (PHNB Is a covered HIPAA entity)Projects/Issues Pending:
· Collaboration with the State Medicaid Program to allow for direct billing for skilled nursing services in the public schools
· Chairperson of Confidentiality Work Group in the development of the Hawaii Immunization Registry
· Completion of Skills checklist and validation of skills for Tuberculosis Nursing, Disaster Preparedness, and Child Health
· Collaboration with the University of Hawaii School of Nursing addressing enhanced integration of education and practiceIssues and Special Concerns for Public Health Nursing:
· High cost of skilled nursing services in the public schools for identified eligible students under IDEA, Part B
· Challenges in recruitment of Licensed Practical Nurses for administration of skilled nursing procedures; shortage of qualified licensed nurses with pediatric experiences for provision of skilled nursing services in the public schools under PHNB
· Movement of School Health Services to the Department of Education effective July 1, 2007. The skilled nursing component of school health services will remain during the interim with PHNB, Department of Health
· Continued challenges in recruitment of qualified applicants for public health nursing positions on Oahu
· Increased workload for the PHNB staff in a generalized program, which includes school health services in the public schools..
Download HI PDF
Projects/Issues addressed this year:
· Role of public health nurses in emergency preparedness and response
· Workforce Development issues
· Public Health Nursing Competencies to include Advanced Practice Public Health Nurses
· Expansion of Special Need Sheltering Plans post Hurricane Katrina and Rita
· Establishment of a statewide nurse consultant for emergency preparedness and response.
· Institution of a continuing education web-based course (Strategic National Stockpile Awareness Course)
· Continuation of Public Health services post Hurricane Katrina and Rita.
· Continued collaboration with parish correctional facilities regarding tuberculosis and sexually transmitted disease screening programs
· Disease Surveillance Exercise targeting sexually transmitted diseases in two of the highest risk regions of the state
· Development of culturally appropriate consent forms for contraceptive methods in Family Planning
· Participation in the development of the Family Planning 1115 Waiver Demonstration Project; application submitted to CMS
· Interagency Collaborative Agreement between the Office of Public Health, Office of Community Services and Prevent Child Abuse Louisiana to provide appropriate intervention in cases of suspected child abuse/neglect. Public Health Nurses assist in investigations by providing home health assessment of children from 0-5 years of age.
· Louisiana Prenatal and Infant Risk Assessments implemented in targeted public health clinics
· Implementation of an annual Safe Haven Training
· Implementation of the Early Childhood Comprehensive Systems (ECSS) to address:o Access to health care and medical homes
o Mental health and social-emotional development
o Early care and education/child care
o Parenting education
o Family support· Revision of current Nursing Management Tool to a web-based application to include patients seen, services provided and nurse efficiency.
Projects/Issues Pending:
· Testing of statewide web-based applications in progress:
o electronic tuberculosis medical record system for patient management, and
o revised nurse management tool· Continuing Education website
· Coordination of a comprehensive continuous quality improvement plan for public health programs, primarily, family planning, maternal-child health, and sexually transmitted diseases
· Coordination of public health programs to have a seamless effort between them, particularly family planning and maternal-child health efforts
· Integration of the assessment tool for nurse home visits into a computer-based program, thus allowing nurses to work more efficiently by decreasing the time frame for the generation of summaries and referrals
· Development of common objectives for all of Chronic Disease Programs
· Development of a plan for community worksite wellness activities with major employers
· 100% trained public health nursing workforce in the National Incident Management System, Incident Command Structure, and the National Response Plan by September 9, 2006.Issues/Special Concerns for Public Health Nursing:
· Recruitment and retention issues; aging of the public health workforce
· Lack of Master’s and Baccalaureate prepared public health nurses in Louisiana to assume greater leadership roles and positions, especially as the PHN workforce ages and reaches retirement age/status
· Lower salaries (particularly entry-level) of Louisiana Public Health Nurses in comparison with other nursing specialties.
· Additional emergency preparedness education and training for public health nurses, and the public health workforce to address the emerging roles
· The need for increased collaboration of public health and primary health care entities for care of Louisiana citizens
· Provision of more autonomous services to clients utilizing public health nursing foundational skills
· Maintaining a visible role in the community and education and marketing of public health nursing
· Participation in policy development of emergency preparedness plans and health legislation is critical
· Challenge of meeting the needs of public health nursing’s ever-evolving roles
· Public health funding for public health nursing and public health as a whole
· Skilled PHN workforce as it relates to information technology systems
· Strategic plan needed for public health nurses on a national basis
· Additional credentialing/certifications necessary for public health nurses as they become proficient in bioterrorism, community wellness, etc.
· Connecting with academic nursing institutions as well as the private sector
· Mechanisms to increase efficiency of service delivery
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Projects/Issues Addressed This Year:
The State of Maine Public Health Nursing Program:
· Celebrated 85th Anniversary of Public Health Nursing in Maine- honoring the past, celebrating the present, and looking to the future with the 10 essential public health services
· Completed implementation of a Central Referral Process for all referrals for PHN services across the entire state
· Expanded the use of the Omaha System, a standardized nursing language, from individual clients to population focused clients
· Developed a volunteer nurse registry with over 320 participants with our supervisor in the Office of Emergency Preparedness
· Collaborated with the Department of Corrections to train all nursing staff at the state correctional facilities to administer and interpret TB skin tests accurately
· Collaborated with the Maine Farm Bureau and the University of Maine Cooperative Extension to provide educational materials on noise induced hearing loss to adolescents in an annual tractor safety certification course
· Provided an educational program to all PHN staff on perinatal substance abuse including the use of methadone
· Collaborated with the Division of Disease Control to provide education to county correctional facilities on MRSA and methods to control outbreaks
· Developed an interactive self-assessment program for PHN staff on blood borne pathogens and latex safety
· Transitioned to new leadership in director’s positionProjects/Issues Pending:
· In preparation of CHAP accreditation project, rollout of self study programs
· Revising Client satisfaction surveys
· On going challenge to fill vacancies in the organization
· Positioning for increased involvement in department and state IT initiatives towards public health surveillance and Maine health information networkIssues and Special Concerns for Public Health Nursing:
· Meeting the needs of our expanding refugee and 2nd migrant population
· Providing the training and drilling in Emergency Preparedness & Response
· Remaining competitive in attracting qualified staff in a climate of mounting workforce shortages and budget restraints resulting in less than competitive wages
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