Alaska 2006 State Report...

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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Arizona 2006 State Report...

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:

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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Arkansas 2006 State Report...

Projects/Issues Addressed This Year:

Projects/Issues Pending:

Issues and Special Concerns for Public Health Nursing:

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California 2006 State Report...

Projects/Issues Addressed This Year:
The California Conference of local Health Department Nursing Directors took on 2 major projects over the last year.

1. Nursing Directors Manual- the members of the organization had reviewed our previous members manual and felt there was a need for an update- the directors from our southern region developed a new version, with an eye towards it being particularly useful to newly appointed public health nursing directors in our local jurisdictions. A copy will be available to view at the meeting.

2. Public Health Nurse Disaster Field Manual- the members of the organization reviewed our older Disaster Manual and determined that it was a valuable and still up-to-date document for use by management level Public Health Nursing staff, but that there was a need for a uniform body of information usable for field staff functioning in disaster situations. The Central Area directors, with input from the entire membership, developed the Disaster Handbook. It includes everything from model mass vaccination site layouts and supply lists, to water purification methods to disease investigation templates. 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:

Issues 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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Connecticut 2006 State Report...

Projects/Issues Addressed This Year:

Connecticut State Department of Public Health (DPH) Nursing Activities

• The State of Connecticut has rejoined the ASTDN in 2005 after more than eight years absence. Deputy Commissioner Norm Gyle, RN, PhD, is the state's represenative with the addition of an associate member, Barbara Digfelder, APRN, MPH, CHES, BC, with the Local Health Administration Branch.
• Although DPH does not have a seperate or distinct Nursing Section, DPH nurses continue to participate in, facilitate, coordinate and / or lead various advisory groups and statewide task forces to include (but not limited to):
  - DPH Executive Leadership Team
  -
• DPH

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Florida 2006 State Report...

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.

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 Pending

Preparedness

• 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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Georgia 2006 State Report...

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

1. The legislation passed by the 2006 Georgia General Assembly that gives Prescriptive Authority to Advanced Practice Registered Nurses awaits the pen of Governor Perdue. Plans are underway to develop guidelines for implementation of the new legislation in public health by July 1, 2006.

2. A resolution was approved by the Georgia General Assembly to appoint a Public Health Study Committee is expected to produce a report on the role of public health and a study of salaries of public health workers, including salaries of public health nurses, due by December 31, 2006.

3. A resolution was approved by the Georgia General Assembly to commend the Public Health Nurses of Georgia for their vital role as an integral part of the health system in Georgia.

4. Legislation was passed expanding the scope of newborn metabolic screening by increasing the number of screening tests performed from 13 to 29.

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

Issues and Special Concerns for Public Health Nursing:

1. Uncertainty regarding the scope of public health services that will be covered by Care Management Organizations.

2. The loss of 215 Public Health Nurses during the past 2 years due to budget cuts and retirements and the need to significantly alter the compensation structure.

3. The increasing demand to devote nursing resources to Emergency Preparedness without any additional funding for nursing positions at the local level.

4. The challenge of balancing the transformation process with the need to generate new revenue.

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Hawaii 2006 State Report...

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 DEA, Part C, Early Intervention Services

Emergency 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 Population

Other 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:

Issues 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 PHN

• Movement of School Health Services to the Department of Education effective July 1, 2007. The skilled nursing component ofschool 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.

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Louisiana 2006 State Report...

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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Maine 2006 State Report...

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 position

Projects/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 network

Issues 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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Mississippi 2006 State Report...

Projects/Issues Addressed This Year:

Mississippi Department of Health (MDH) Launches “Healthy • Secure • Mississippi” Campaign

MDH Launches Aggressive Preventive Health Program

Tomorrow’s Smiles Healthier and Brighter Thanks to MDH

MDH Automatic External Defibrillator (AED) Initiative a Lifesaver for Rural Communities

Hurricane Katrina

Projects/Issues Pending:

Due to the large mobilized population, the MDH has realized the need to develop a set of tools to assess the reproductive health needs of women affected by Hurricane Katrina and other natural disasters. The goal is to use the data to promote and enhance evidence-based local programs and services to improve the reproductive health of women and their families during the critical periods following a natural disaster when resources are most difficult to access. Topic areas for the women include, but are not limited to, safe motherhood, family planning, HIV/STDs, gender-based violence, perceived family mental health issues, and observed trauma-reactive behaviors and symptoms among their children. The MDH is developing tools in collaboration with the School of Nursing, the University of Mississippi Medical Center utilizing technical assistance from the Division of Reproductive Health, Centers for Disease Control and Prevention (CDC). The most devastated areas including Hancock, Harrison and Pearl River Counties, are chosen as geographic areas of interest. The target population includes women of reproductive age (15-44 years) who have been permanently or temporarily displaced by Hurricane Katrina. Cluster sampling in the areas with the most significant population changes are planned. Convenience sampling opportunities such as pick up sites for food and supplies are also being considered. The MDH is in the stage of testing the survey tool and finalizing the research study design. Once completed, the questionnaires and sampling procedure will be modified /adjusted as needed. The trained staff will start data collection in May 2006. Preliminary survey results will be available in August 2006. Anticipated outcomes include data for evidence-based program planning, monitoring, evaluation, advocacy, and program funding requests.

Some PHN training on Special Needs Shelters was conducted last summer, just one month prior to Katrina. A follow up to this training which will include “lessons learned” from last year’s experiences, will be conducted in early summer of this year. Basic Disaster Life Support and Advanced Disaster Life Support courses have also been scheduled.

Issues and Special Concerns for Public Health Nursing:

The Mississippi State Medical Association estimates that about half of the 700 physicians practicing in Mississippi’s coastal counties have been impacted. Mississippi’s Dental Director estimates that over 80 dental offices were partially or completely destroyed. Based on our work with Mississippi’s emergency response teams, we anticipate a critical shortage of primary health resources for at least 12-24 months following Katrina.

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Missouri 2006 State Report...

Projects/Issues Addressed This Year:

Introduction to Public Health Nursing CD

Working with the University of Missouri-Columbia, Sinclair School of Nursing to implement a grant from the National Library of Medicine. This grant will teach public health nurses in local agencies how to access consumer and professional literature on the internet.

Issues and Special Concerns for Public Health Nursing:

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New Mexico 2006 State Report...

Projects/Issues Addressed This Year

1. The intranet between all Public Health Offices and Santa Fe was added to the Department of Health (DOH) intranet. This service allows all 52 health offices and the Barbara Richardson Mobile Van to link to the Director’s Office and Programs in Santa Fe. Breaking news, protocols (eliminating huge notebooks and piles of paper in every office), and lists of resources and supplies are available 24/7.

2. The Barbara Richardson Mobile Van is a product of the division’s partnership with Blue Cross/Blue Shield. The van visits rural sites without health offices, community gatherings, public schools, and a myriad of other public sites to offer dental and public health services such as immunizations, family planning, and health screenings.

3. The position of chief nurse is now one year old. I have been busier than I could ever have imagined and loved/loving every minute of it. I have been fortunate to have an extremely educated and motivated team that assures I am always up-to-date on regional and local issues. My accomplishment s include the re-organization and improved efforts of a number of standing committees: credential verification, safety, clinical records, information management, health office data collection, and quality improvement.

Projects/Issues Pending:

The biggest and most exciting pending project is Nurse Advice Line (NAL) NM. This effort is an example of a successful public/private partnership. A community group of primary care clinics, MCOs, UNM/School of Medicine, DOH, and other social service agencies started meeting over 5 years ago and the result is NAL. The NAL will have 5 essential functions once it “Goes Live” on June 1:

1. Primary care dispatch (appointment scheduling for insured clients in their medical home, and uninsured to a primary care center with sliding scale).

2. Linkage to the statewide pharmacy and medical supply database.

3. Linkage to the statewide Resource Directory that list services by county.

4. Linkages to statewide and local crisis lines.

5. Sentinel Surveillance Site for local and regional epi surveillance and emergency preparedness.

Issues and Special Concerns for Public Health Nursing:

The major issue and concern for every part of NM and probably every state, is emergency preparedness. Conferences and planning sessions are in full swing to mobilize and organize state resources to assure best practices.

Clinical Staffing is an ongoing concern especially considering the nursing shortage.

Financial resources are extremely limited as NM is one of the poorest states in the country and is designated as frontier.

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New York 2006 State Report...

Projects/Issues Addressed This Year:

• NYSDOH continues to work to finalize with proposed changes to the NYS Sanitary Code to add training requirements (15 hours in the 1st year of service) for the Public Health Nurse 2 title. Currently the department is meeting with stakeholders, including the unions, about the requirement. NYSDOH and NYSACHO are looking for curricula and online content that would satisfy this requirement.

• The New Jersey New York Public Health Training Center (NJNYPHTC) convened a series of nursing summits bringing together leaders in public health nursing and nursing education across NYS. Workgroups have been formed: 1.) Assurance of preceptor quality; 2.) Issues from the practice setting related to BSN education; 3.) Quad Council competencies crosswalked with what is being taught in the Schools of Nursing; and 4.) new graduate mentorship. The next meeting is June 7th.

• Research America conducted a poll of 800 New Yorkers and found them to be supportive of public health. The survey results are available at www.researchamerica.org. The material was used to launch Public Health Works!, a campaign to improve understanding about what public health is and who does the work. A poster featuring local public health nurses will be developed for this campaign.

• Emergency preparedness continues as a major issue for PHNs. The Department’s pandemic flu plan is posted on our website (www.nyhealth.gov). Nurses continue to drill with POD and influenza exercises. NYS has enhanced syndromic surveillance. County Attorneys attended an PH Law Emergency Seminar, cosponsored by NYSDOH and the State Emergency Management Office. Local Health Department BT coordinators meet on a regular basis.

Projects/Issues Pending:

• Dr. Ed Thompson (CDC) spoke with local Commissioners and Public Health Directors about accreditation. Local agencies are looking forward to the national blueprint to be released July 06.

• A workgroup has been convened to examine more universal models for MCH homevisiting and their financing. As more county health departments drop their CHHA designation, there are more issues with financing home visits to pregnant and parenting women and their infants.

• NYSDOH is exploring formation of a NYSDOH Nursing Practice Group, which will link and support State level PHNs across the various public health programs. The group will serve as a focus for public health nursing issues in the NYSDOH.

• There is legislation pending that would allow the Commissioner to authorize the training of civilians to deliver immunizations and other medical care in the event of public health emergency. Emergency powers also allow for additional disease reporting and submission of clinical specimens.

• There is legislation pending in NY that would allow future RN applicants to complete an Associate Degree or diploma in nursing, but would require the Baccalaureate degree within 5 years of initial licensure. The bill “grandfathers” all currently licensed RNs from ever having to meet the requirements and gives a 4-year lead in time from the passage of the bill to permit students currently in Associate and diploma programs to complete their program and be grandfathered. The RN’s license would go on “hold” if the 10-year requirement is not met, similar to action taken when an applicant does not meet continuing education requirements. There is also an opportunity for extension beyond the 10 years for extenuating circumstances, as determined by the licensing agency (State Education Department).

Issues and Special Concerns for Public Health Nursing:· Workforce Issues

Disaster Preparedness

o There is concern that pediatric and other special populations may not be well served in the current plan.
o PHNs are now being asked to work with emergency managers in their localities.

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North Carolina 2006 State Report...

Projects/Issues Addressed This Year:

“Effective Utilization of PHNs” – developed this document at the request of local health directors who wanted a document covering what must be done by PHNs as positions get harder to fill due to the increasing shortage. Although it does provide a limited list of tasks, the committee which developed it felt it was more important to provide a framework for making decisions about effective utilization of PHNs in a local health department (e.g., primary focus of activities and ability to have surge capacity.)

Updated Problem-Oriented Health Record Manual and Forms – includes a new form, “Patient Visit Record,” which combines the elements of three previous forms (Adult Health History, Adult Health Basic History, Adult Health Systems Review and Adult Health Flow Sheet.)

Reclassification of all positions in the PHN series – a market analysis conducted by the Office of State Personnel resulted in each position in the series being increased two salary grades.

Projects/Issues Pending:

The Committee on Practice and Education is continuing to use the PHN Competencies to revise job descriptions, orientation for PHNs and BSN curricula.

Issues and Special Concerns for Public Health Nursing:

The North Carolina General Assembly passed legislation during the 2005 session implementing a mandatory system for accreditation of local health departments. The legislation includes on-going funding and provides an eight-year timeframe for all local health departments to become accredited. The funding includes money for administration of the process, additional technical assistance from DPH and $25,000 in one-time money for each local health department during the year that they are seeking initial accreditation. DPH Lead on this project is the ASTDN representative and each site visit team includes a PHN Supervisor/Director.

NC Division of Public Health and local health departments have been seeking a new Information System to replace the antiquated mainframe system that has been in use since the early 1980’s. An RFP for a COTS product to meet the defined business needs of public health agencies in NC resulted in 3 proposals. This process is still in the evaluation phase. DPH Lead is the ASTDN representative since many of the clinical and other services to be captured are provided by PHNs.

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Ohio 2006 State Report...

Projects/Issues Addressed This Year:

Public health preparedness and the public health nurse role in response to public health emergencies.

Establishing Volunteer Nurses Registry and training (in process)

Partnership between the Ohio Department of Health (ODH), the Directors of Nursing Section of the Ohio Public Health Association (OPHA) and faculty of Ohio Schools of Nursing to revise the state-wide Public Health Nurse orientation. In 2005, the curriculum, faculty and scheduling of the new orientation course were established.

Statewide meetings to improve communication and collaboration between Schools of Nursing and Directors of Nursing from local Public Health districts to enhance preparation of nursing students for public health.

The OPHA DON section utilized bimonthly meetings to convene local DONs to improve communication with ODH and across health districts.

Projects/Issues Pending:

Continuing to strengthen ties between local jurisdictions and nurse leaders at the state level.

Need to establish support for Public Health Nursing practice beyond program-specific support

Delivery and Evaluation of the Public Health Nursing Orientation revision

Plan to work to develop competency-based position descriptions and performance standards for Public Health Nurses.

Regional Planning related to emergency preparedness

Pandemic planning, alternative emergency responses by the medical community and the role of public health nurses related to pandemic or public health emergencies.

Communications, support and training for all levels of public health nursing including DON’s from the state level.

Issues and Special Concerns for Public Health Nursing:

The challenge of managed Medicaid / finding providers for Medicaid eligible clients, which is especially a challenge in a fairly affluent county where providers are already busy and don’t need to see Medicaid clients to survive

The seeming lack of cultural sensitivity towards the Amish in recent changes in Ohio law- ie. Registration of home birth requirements and mandate that Amish apply for Healthy Start, which is against their religious belief, before they can receive BCMH funding.

Many new vaccine recommendations with a 2 tiered system of accessibility in Ohio. While Medicaid eligible clients have access to all, the working poor, whose children are perhaps most vulnerable to disease exposure in day care settings, are often not eligible for vaccines unless families pay privately for them.

Meeting the challenge of many new mandates in preparedness, infectious disease surveillance, etc in the small rural health department with limited staff.

ODH is organized and structured based on programs, local health district organization is by specialty and program. This provides a challenge for state and local public health nurses alike. Senior ODH nursing staff from a variety of programs are collaborating to respond to the identified need for public health nursing presence and support at the state level.

Working in a system that is home rule and the challenges and benefits this brings to public health nursing practice.

Lack of orientation and support for Nursing Directors.

Need for standardized orientation manuals for public health nurses and Nursing Directors.

After the community assessment and needs are established the state determines that philosophically they do not support the local assessment and will not provide funds unless the state philosophy is accepted versus the local assessment. This is particularly noticeable in areas where access to care is the most prevalent community problem.

Dwindling resources to support public health nurses.

Lack of sites for preparation of the next generation of PHNS

An aging workforce

Needing to re-tool beyond direct care

Educational preparation and differentiated practice

Creating visibility for the specialty of public health nursing within the general and nursing community

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Oklahoma 2006 State Report...

Oregon 2006 State Report..

 

• The Oregon Public Nursing Leadership Institute has started its 5th year. The OPHNLI was designed to build and improve leadership skills of public health nurse scholars through a yearlong experiential and learning program for emerging public health nursing leaders. It is based on three central components: a mentoring relationship, a leadership learning project, and public health and leadership content areas. Evaluation validated that those components were important motivators for nurses as they considered applying to the Institute and for supervisors as they released nurses to participate.

• PH Nurses and Oregon Health Sciences University in collaboration with PH Nurses developed a resource web site:
  http://www.ohsu.edu/library/publichealth/

• Continued work about emergency preparedness including Strategic National Stockpile exercise and Pandemic Influenza planning.

• A number of field nursing services are working to understand impacts that might be coming if there are changes in Medicaid targeted case management.

• A number of county health departments have become or planning to become an FQHC or a look alike.

• The Oregon Consortium for Nursing Education partners community colleges, and public and private university schools of nursing to address nursing shortage by a shared curriculum culminating in a bachelor’s degree. Nine of the fourteen community colleges are participating.

• We are exploring the use of video conferencing to assure nurse participation across the state in training and networking activities.

• We hope to begin soon creation of a public health nurse database.

• The Oregon Public Health Association came close to folding, but a number of public health nurses stepped up to save the organization.

• Association of Oregon Public Health Nursing Supervisors has begun a supervisory forum at the monthly meetings.

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Tennessee 2006 State Report...

Projects/Issues Addressed This Year:

• PHN Salary Increase
• Nursing Assistant Salary Increase
• Changing Nursing Personnel Classification from PHN to RN
• Implementation of Primary Care in over 40 of the 95 Public Health Departments in TN.
• Hired Primary Care staff including physicians, NPs and RNs.
• Pandemic Influenza Planning
• Emergency Response and Preparadness

Projects/Issues Pending:

• Nursing Salary Increase
• Nursing Assistant Salary Increase
• Recruitment and retention of nurses in Public Health
• Implementation of Primary Care in over 40 of the 95 Public Health Departments in TN.
• Continue to hire physicians, NPs and RNs for Primary Care.
• Investigation of Public Health electronic medical.
• Pandemic Influenza planning.
• Emergency Response and Preparadness

Issues and Special Concerns for Public Health Nursing:

• Increase in PHN salaries for all classifications of nursing.
• Management training for Nursing Supervisors and other administrative staff.
• Recruitment and retention of nurses in Public Health.
• Implementation of an electronic medical record for Public Health.
• Emergency Response and Preparadness

Download TN PDF

Texas 2006 State Report...

Projects/Issues Addressed This Year:

• Along with several of the other Gulf States, Texas was actively involved in providing assistance and care for evacuees from Hurricane Katrina. Shortly thereafter, in October, Hurricane Rita hit the eastern Texas Gulf Coast and we became an affected area as well as a responder. For the first time, the Department of State Health Services assumed its new role as the coordinator for Special Needs Populations.

Projects/Issues Pending:

• There has been a workgroup formed, involving all agencies of the Health and Human Services Commission, which is exploring the problem of nurse recruitment and retention faced by all of the agencies under the commission. The workgroup is looking at salaries, career ladders and various other strategies that could have a positive impact on the situation. Workgroup members from the Department of State Health Services include a nurse from the Central Office and one of the Regional Nursing Directors.

• Department nurses once again sponsored a Nursing Leadership Conference which was held March 2-3, 2006 the after a 3-year absence. The conference was the first major collaboration between nurses from the newly formed Department of State Health Services, which consolidated both public health and mental health into one agency. The conference was a huge success featuring Dr. Tim Porter-O’Grady as the keynote speaker. Approximately 150 nurses attended coming from public health, mental health, community mental health, academia, and DSHS contractors

• Nurses, along with other DSHS employees will be participating in a statewide hurricane preparedness exercise on May 1-5.

Issues and Special Concerns for Public Health Nursing:

• There continues to be a void in nursing leadership within the department at the central office level since there is no longer a Division of Public Health Nursing. Previous functions of the Division have been reassigned to other areas but there is no oversight to assure that these functions are carried out. The situation has created some unique challenges for nursing within the agency. Much of the continuity within the Nursing arena has been maintained by a core group of nursing leaders in the department, especially the nurses in leadership roles in the regions.

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Vermont 2006 State Report...

Projects/Issues Addressed This Year:

1. Recruitment and Retention of PHNs and PHN Supervisors – developed a professional display board for conferences and job fairs

2. Collaboration with the Vt Office of Nursing Workforce, Research and Planning to conduct a survey of PHNs state wide and the development of a proactive recruitment plan.

3. PHN mentoring Program – through a HRSA grant to the Vermont Nurse internship Program we (VDH) developed a comprehensive orientation/educational program for new PHNs. This is designed on Carrie Lunberg’s competency based COPA model, the ANA PH standards and the Public Health essential services and core competencies. It this focuses on what Public Health is. It is interactive in having staff learn what the work of public health is. We have also have adapted the curriculum for one hour presentations at staff meetings and lastly the content will be adapted to the competencies of new PHN Supervisors.

4. Other major projects - Emergency Preparedness, Refugee Health and Coordinated School Health and the rewriting of the SIDS program.

5. Educating current PHN Supervisors in the 12 District Offices on the challenges of supervision/management in a very complex time for Public Health.

Projects/Issues Pending:

The above to varying degrees. Hiring into vacant positions.

Issues and Special Concerns for Public Health Nursing:

1. The aging workforce

2. Recruitment strategies of qualified staff and supervisors

3. Defining what population based public health nursing really is and being able to communicate to staff, partners, legislators and the public what nurses ‘do’ in the population based model.

4. Salary constraints .

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Washington 2006 State Report...

Projects/Issues Addressed This Year:

• Began work to develop a logic model and performance measures for statewide public health child and family health programs. Project is in collaboration with state and local public health. This is a project of the Washington Public Health Nursing Directors with initial funding from this group. Funds for current phase from Public Health Improvement Partnership and a Robert Wood Johnson Foundation grant.

• Continued development of a documentation system for maternity support services that integrates Omaha Language System. Currently, forms are in draft form and are hard copy. The plan is to move to electronic data entry in the near future.

• Public Health Nursing Directors received Collaborative Leadership training as a component of each of their meetings in 2005. Training was provided by the Turning Point Program.

Projects/Issues Pending:

• Later this year we will have performance measures identified for child and family health programs. We will need to develop data collection tools and methods.

• Currently, there is a legislative committee in place that is looking at a stable source of funding for public health.

• Omaha Language will be utilized for some of our public health programs. We will have data to see if we are tracking outcomes at the level of detail we need for our programs. Government accountability requires us to have outcome-based performance measurements for programs.