Alaska 2007 State Report...

Projects/Issues Addressed This Year:

Documentation of Population/Community and Systems Focused PHN Activities: This past year we implemented use of a database to collect information about PHN involvement in population based service delivery. Activities are categorized according to program area, and the PHN intervention/activity as categorized by the Minnesota Wheel. PHNs are also asked to make note of process and outcome objectives for these population focused activities. This is part of our overall effort to better incorporate PHN interventions at the systems and community levels, along with the individual level. Initial data collection looks promising and we are hopeful this information, together with data we are currently collecting on individual client services, will add significantly to our ability to report on the impact of overall PHN services and interventions.

Public Health Emergency Preparedness: PHNs continue to work actively on public health emergency preparedness and pandemic influenza planning and preparations. This past year Mass Dispensing Exercises were successfully planned and carried out in ten communities across the state. Approximately 780 community volunteers were recruited and trained to take part in these exercises and 9.000 community participants were screened and/or vaccinated. As part of this effort Alaska EMTs were trained and certified to administer influenza vaccine, something that had not been within their job duties previously. We now have more than 300 Alaska licensed nurses registered as Alaska Nurse Alert System volunteers.

Market Based Pay Increase for State of Alaska Nurses: Alaska PHNs were included in a 15% pay increase for all nurses employed by the State. This market-based pay study was in large part due to the difficulty in hiring nurses for the 24 hour care facilities such as the Alaska Pioneer Homes, the Alaska Psychiatric Institute and Corrections facilities.

OSHA Compliant Safety Plans: A Section of Nursing Safety Plan was completed and training was provided to all staff using long-distance learning technology. Facility specific Safety Plans were completed and implementedfor each of the 21 State Public Health Centers.

Projects/Issues Pending:

New PHN Nurse Recruitment and Retention Position: We have recently created and filled a long-term, nonpermanent position focused entirely on recruitment and retention of public health nurses. We were lucky enough to engage Nancy Davis, our former PHN Chief, to fill this position. The time she has been able to devote to talking with potential candidates has already begun to pay off in terms of enlarging our pool of applicants.

Community Assessment: All State of Alaska PHNs received training on the use of the Mobilizing for Action through Planning and Partnership (MAPP) tool this past year. This is the first step in a longer term goal of engaging PHNs statewide in incorporating MAPP tools and processes into their ongoing community practice. Many local PHNs are conducting active outreach efforts to recruit community stakeholders to assist in community assessment and strategic planning related to public health needs.

Quality Assurance/Quality Improvement: Work is progressing well on the initiation of a systematic quality assurance/quality improvement program for the Section of Nursing. Audit tools have been completed and piloted in four program areas and work continues on other program areas. Routine client satisfaction surveys have been implemented and partner satisfaction surveys are being created. A QA/QI Manual is planned to bring all the program components together and assist in institutionalizing the process.

Issues and Special Concerns for Public Health Nursing:

PHN Recruitment and Retention: PHN recruitment and retention, particularly for expert and management level positions will continue to be an ongoing challenge. This is particularly true in the more rural and remote parts of the state.

PHN Competencies and Scope and Standards of PHN Practice: We are currently using a generic performance evaluation tool supplied by our Human Relations department. A goal for the coming year will be to develop a performance evaluation tool specifically for our staff that incorporates the PHN Competencies and the Scope and Standards of PHN Practice. I would very much like to see anything your agency may be using or working on in this same vein.

Arkansas 2007 State Report...

Projects/Issues Addressed This Year:

1. Continue to address Recruitment and Retention issues
   a. Lengthy process – trying to streamline the process
   b. Updated nursing starting salaries and implemented salary adjustments for a number of eligible nursing staff
   c. Agency hired a part-time Nurse Recruiter for the first time

2. Tornado Disaster Response in Dumas, Arkansas – no lives lost

3. Conducted Mass Flu Immunization Clinics in several (27) counties in the state, immunizing over 50,000 people.

Projects/Issues Pending:

1. Drafted a Position Statement on Role of the Public Health Nursing in Shelter Nursing – still awaiting approval at the Division Level
2. Drafted a PHN Guidebook to Emergency Response – still awaiting final approval.
3. Department of Health merged with the Department of Human Services two years ago; now facing the possibility of de-merging and creating new agency structure
4. Absence of Division of Public Health Nursing at the state level

Issues and Special Concerns for Public Health Nursing:

1. General nursing morale and feeling of “loss of identify” as public health nurses, nurse leaders in the community and within the agency due to loss of Division of Nursing and later merger with DHS.

2. Absence of nursing representation in the Office of Public Health Preparedness

3. Preparing a “deployable” and prepared nursing workforce in the event of a large scale emergency.

California 2007 State Report...

Projects/Issues Addressed This Year:

1. The California Conference of Local Health Department Nursing Directors (CCLHDND) have introduced legislation to appoint a State Public Health Nursing Director in the new California Department of Public Health. The California Department of Health Services is splitting into two departments as of July 1, 2007. The new departments will be the Department of Public Health and the Department of Health Care Services, which will be responsible for the administration of health care funding, including Medicaid. This is a great opportunity to again have a state nursing director.
2. Linda Olson Keller presented to our spring conference on the role of the public health nurse and the need for effective state leadership. County nursing directors were inspired by the work being done by ASTDN through cooperative grant agreement with CDC and the work being done by Ms. Keller.
3. 3000 copies of the public health nursing poster developed by the University of Illinois at Chicago were printed and distributed statewide.

Projects/Issues Pending:

1. CCLHDND is preparing a toolkit on best practices in California for PHN recruitment and retention.
2. CCLHDND is developing a plan to hire staff for our organization to implement conferences and training specific to the needs of public health nurses.
3. We are updating our PHN disaster manual. This manual is available on our website at
   http://phncalifornia.org/.
4. CCLHDND has surveyed county health departments to track the public health nursing workforce numbers and trends in hiring.

Issues and Special Concerns for Public Health Nursing:

1. The development of statewide record keeping and data collection systems for public health nursing for nursing documentation and outcome evaluation. The diversity of systems makes the documentation of PHN services and outcomes difficult to compare statewide, and to demonstrate the effectiveness of nursing interventions.
2. Recruitment and retention of a competent public health nursing workforce.
3. Public health certification and implications for the PHN workforce, practice, documentation and outcome evaluation.

Colorado 2007 State Report ...

Projects/Issues Addressed This Year:

Colorado Public Health Nursing Certificate

GOAL: To hold the title “Public Health Nurse” (PHN) in Colorado, a nurse shall have a BSN (or equivalent entry into nursing with completion of a public health nursing course). New public health nurses shall participate in an “Introduction to PHN in Colorado” class provided by the State Health Department Nurse Consultants, and be offered a twelve month formal mentor program and competency based orientation, when available. Resources such as educational scholarships and loans, and on-line educational programs will be communicated and promoted. Grandfathering of experienced public health nurses, with 3 or more years practice, will be eligible for the PHN Certificate.

STEPS:

• Research state models and requirements (Spring 07) Results posted www.cdphe.state.co.us/oll/
• Survey Colorado PHN population- update enumeration & educational status (Summer 07)
• Reassess PHN Competencies Survey (Summer 07)
• Provide an INTRO to PHN and formal Colorado Mentor program (ongoing)
• Competency-based 12 month orientation in local health agency’s (ongoing)

Projects/Issues Pending:

The Colorado PHN Academic/Practice Collaborative is assisting the state and local public health nurses through work groups in achieving the components for the Certificate program. In particular, members of the Collaborative are interested in exploring how to codify the requirements of the Certificate: state statute, addition to the Nurse Practice Act, or through the State Departments of Education or Public Health??

Issues and Special Concerns for Public Health Nursing:

Research is needed to provide evidence that a Public Health Nurse Certificate improves recruitment and retention of qualified public health nurses and improves public health outcomes within a population.

Florida 2007 State Report...

The Office of Public of Public Health Nursing (OPHN) is responsible for representing public health nurses throughout the state and nationally. The Office provides leadership, technical assistance, consultation and support to public health nurses, administrators, educators, community and agency partners. The office also facilitates central coordination, information sharing and research to more than 2500 public health nursing staff and other clinicians in 67 County Health Departments, 22 regional Children’s Medical Services Offices and one state hospital.

Vision: Champions for Healthy People in Healthy Communities – Public Health Nursing – the Ultimate Nurse Workforce

Priorities for the Office of Public Health Nursing include:

• Supporting public health nursing by rewarding and recognizing exemplary efforts
• Providing public health nurse workforce development using advanced technology, continuing education, conferences and training programs
• Mentoring the next generation of nurses through internships
• Providing resources that enhance the practice of public health nursing
• Enhancing recruitment and retention efforts to fulfill services
• Promoting partnerships with associations and communities for comprehensive public health initiatives.
• Coordinating the Special Needs Shelter Program for effective all hazards preparedness response

Projects/Issues Addressed This Year:

Public Health Nursing Leader’s Orientation – This one day program affords newly appointed Department of Health (DOH) Nursing Leaders an opportunity to be introduced to central office staff and to network with key program staff. It is also a way to assist them in accessing information and resources available to them at the state level. The agenda supports linkages to information and resources that can be used in their day to day operations, leadership and management roles. This new program has been well received and feedback from participants supports improved communication as well as a positive image of the Office of Public Health Nursing.
Nurse Practice Council – The Council is a professional body comprised of licensed public health nurses, reflective of all levels (RN, ARNP, and LPN) and programs throughout the Florida Department of Health. The mission of the council is to promote the advancement of public health nursing through leadership, education, communication, and support of public health nursing practice standards. The council believes that public health nurses have a responsibility to be active participants in promoting excellence in nursing, testing new ideas, keeping abreast of advances and translating research into action thereby improving the practice of public health nursing. The Office of Public Health Nursing provides consultation and facilitative leadership to support Council activities. The Nurse Practice Council held its inaugural face-to-face meeting on April 17, 2007 at the semi-annual statewide Nursing Leadership Conference. Standing committees identified priority areas to address over next twelve months, based on input received from DOH nursing leaders. These committees (Leadership, Practice, Education, and Research) will provide progress reports during quarterly council meetings.

Nurse Liaison and Consultant Services – As the world we work in becomes more complex with the information explosion, technologic advances, and change, the Office of Public Health Nursing (OPHN) in an effort to become more responsive to our nursing colleagues, established a nurse liaison for each county health department, Children’s Medical Services area offices, Central Office divisions, bureaus, and offices. The role of the liaison is to be a point of contact for technical assistance and consultation as needed. RN consultants cover counties within the seven regions of the state. To date, the majority of the requests for assistance and information have focused on practice issues, standard operating guidelines, training needs, and recruitment.

Leadership in Nursing Practicum - The Office of Public Health Nursing (OPHN) collaborates with Florida State University, School of Nursing to facilitate the assimilation of senior baccalaureate nursing students into leadership roles as registered professional nurses. The practicum provides the nursing student the opportunity to apply concepts, principles, and theories of leadership and management in a public health setting. Students have the opportunity to design, implement and evaluate a project that has a public health focus. OPHN nursing consultants serve as preceptors for the students throughout the semester. The practicum concludes with a presentation of project outcomes/deliverables to staff and university faculty.

Caring Hands Award – This recognition program provides an opportunity to recognize significant accomplishments, achievements, and contributions of public health nurses. Whether improving the health of the public, or the practice of public health, these exemplary nurses exhibit a commitment to public health nursing that inspires peers, clients and communities. Award categories include Leadership, Community Health & Safety, Education & Professional and Nursing Practice.
Continuing Education - The Office of Public Health Nursing is licensed as a Continuing Education Provider by the Florida Board of Nursing and allows use of the provider number, free of charge, to all work units of the department – Central Office, County Health Departments, and Children Medical Services throughout the state and to other state agencies. Many of the courses offered by the Department to public health nurses are certified through the Office of Public Health Nursing. Between 7/1/06 and 5/1/07, a total of 68 courses have been offered with 220 hours of continuing education granted to 1067 participants.

Nursing Student Loan Forgiveness Program – This program was established by the Florida Legislature to encourage qualified personnel (RN, LPN, or ARNP) to seek employment in areas of the state where critical nursing shortages existed. The program continues today and provides funds to assist in the repayment of nursing education loans. Nurses enrolled in the program are required to maintain full-time employment in designated sites such as teaching hospitals, children’s hospitals, birthing centers, county health departments, and community health centers. Currently, 250 qualified nurses are enrolled in the program. Between 7/1/06 and 3/20/07, a total of $490,000 in payments was disbursed by the Department for repayment of nursing student loans for 150 nurses.

Special Needs Shelter Program - The Department of Health, in coordination with the local county health departments and other partners, is responsible for operating and staffing the statewide network of 137 Special Needs Shelters (SpNS). The Office of Public Health Nursing (OPHN) provides leadership and support to the SpNS Program and the Regional Special Needs Shelter Coordinators (RSpNSC). The Office of Public Health Nursing coordinates all SpNS Program activities and maintains a comprehensive action plan. OPHN promotes quality services in the Program through a continuous cycle of planning, equipping, training, exercising, and evaluation that is designed to ensure prepared communities, a prepared workforce, and informed clients in the event that Special Needs Sheltering is required as part of the state’s response to a natural, man made or biological events. OPHN also staffs the Special Needs Shelter Interagency Committee consisting of more than 50 statewide special interest groups. The primary mission of the Interagency Committee is bring forward and try to resolve Special Needs Shelter issues not addressed through other venues. The Office of Public Health Nursing also serves in an advisory capacity by assisting with the development of recommendations to the Legislature and as a reviewer of proposed bills by the State Legislature.
Alternate Site Discharge Planning Resource Guide- This guide was developed and designed to assist state and local officials with the timely, efficient and effective placement of special needs shelter clients who are displaced due to a natural or manmade disaster. The guide contains technical information, procedures, resource listings and forms to assist shelter officials and discharge planning teams to expedite the process of moving persons back into the community in the least stressful manner to the least restrictive setting possible.

Florida Medical Reserve Corps - The mission of the Florida Medical Reserve Corps (MRC) is to augment local community and state-level health and medical services with pre-identified, trained and credentialed volunteers during emergency medical operations and vital public health activities. The Office of Public Health Nursing is responsible for developing a statewide system by coordinating statewide efforts, providing resources and technical assistance for the Florida Medical Reserve Corps. MRC volunteers supplement existing local emergency and public health resources. MRC volunteers include medical and public health professionals such as physicians, nurses, pharmacists, veterinarians, epidemiologists and support staff. Currently, there are 23 local Medical Reserve Corps Sites covering 39 of the 67 Florida counties.

Projects/Issues Pending:

In addition to ongoing projects, the Office of Public Health Nursing also supports the following:

Neighborhood Emergency and Preparedness Program (NEPP) - The purpose of NEPP is to organize and educate neighborhoods to increase their level of all hazards preparedness in managing emergency incidents. The project is designed to engage and mobilize small neighborhood teams to help foster self-sufficiency at the neighborhood residential level. Neighborhood health teams are prepared to collaborate in planning, communicating, and information sharing, and coordinating activities before, during, and after a biological, natural, or man-made emergency. NEPP utilizes personal and community empowerment strategies to mitigate the massive surge on medical resources that can be anticipated in a disaster situation. The anticipated outcome of NEPP will be to keep thousands of automobiles and residents off the roads and not contribute to the “worried well” surge on limited medical resources. NEPP utilizes a four step strategy in accomplishing this mission through education, planning, preparedness, and building capacity for distributing essential supplies and/or medications.

Home Care Curriculum - The Florida Department of Health is coordinating efforts to prepare citizens for a potential outbreak or event, in which, care in the home and the ability for people to take care of themselves and/or their family unit is compromised. The Office of Public Health Nursing has lead on development of a standardized curriculum, materials and resources to deliver this type of training. The training manual is intended to assist department of health staff and other community health care partners. The curriculum is designed to provide basic self care, home health assessment and in-home care information. This knowledge will be useful in the event of a pandemic or other emergency that encourages voluntary self isolation or requires persons to shelter at home. The curriculum and training materials can be modified for local use. The overall goal of this training project is to keep the worried well out of facilities that will be over burdened during an event and for consumers to know when they need to seek medical attention.

Disaster Skills Training Course - The curriculum is under development and is intended to provide a one day skills refresher training for the Department of Health public health nursing workforce to support the scope of nursing practice and services provided to the community related to all hazards events.

Public Health Nursing Orientation Program - Workforce development of public health nurses’ continues to be one of the Office’s main priorities. This past year OPHN completed an internet search and a telephone survey of members of the Association of State and Territorial Directors of Nursing of to determine the availability of existing orientation programs. The data revealed that 20 of 50 states have a Public Health Nursing Orientation Program. Many of the programs are accessible to interested parties outside of the state that developed the materials. Findings revealed a variety of delivery methods, options, provision of continuing education credit, program length, content, materials and time frames for program completion. It is anticipated that the Florida orientation modules will be revised, updated and improved based survey findings. The goal of our orientation program is to provide public health nurses with the most current information to support public health practice.

Issues and Special Concerns for Public Health Nursing:

Challenges facing the Office of Public Health Nursing:

• Nursing Shortage - The nursing shortage continues to be a critical issue facing most hospitals and health systems today. In general, specific concerns continue to focus on a critical shortage of nursing faculty and training in areas of specialty, compensation and salary issues. From a statewide perspective, the Florida Department of Health is currently experiencing a 9% public health nursing vacancy rate. This percentage is expected to rise over the next five years based on an aging workforce and pending retirements. The Office of Public Health Nursing is engaged in offering nursing workforce development opportunities (i.e. facilitative leadership, training and education, promoting online degree courses, certification programs, leadership institutes, educational leave, flex schedules etc.) to build leadership and management opportunities so we can better prepare public health nurses for the future.
  
• Succession Planning – The nursing shortage also impacts the need for succession planning as retirements of experienced public health nursing leaders increase. This challenge requires a process to capture the organizational knowledge, expertise and public health nursing performance excellence practices as these nurses leave the field. Concurrently, rising leaders in public health nursing need to be identified and mentored to enhance their skills for the responsibilities they will face.
  
• Role of Public Health Nurse in All Hazards Response – There is a critical need to have a well prepared public health nursing response to disasters and other emergency events. In order to meet this ongoing challenge, the office supports increased workforce development opportunities for training and education for public health nursing skills and competency development. OPHN is developing a program for nurse based assessment teams to be trained and mobilized into affected communities to evaluate the health status of citizens following a disaster or similar event.

Office of Public Health Nursing consultants continue to provide advocacy in support of public health nursing evidence based practices and are considered to be welcomed participants and serve on many Department planning and advisory committees as subject matter experts.

Louisiana 2007 State Report...

Projects/Issues Addressed This Year:

1. Implementation of the many lessons learned post Hurricanes Katrina & Rita.
2. All Office of Public Health staff trained in the National Response Plan, Incident Command Structure and the National Incident Management System-FEMA courses IS-00100, IS-00200, IS-00700, & IS-00800.
3. Operation Pushing Forward Preparedness Project. Nurses educate every client that presents to public health clinics on emergency preparedness topics. Louisiana Family Readiness Guides and Everybody Ready literature is given to each client/family at that visit as well.
4. Implementation of a web-based nursing management tool February, 2007.
5. Providing greater access to care for reproductive age women via the Family Planning Waiver Project.
6. Enhancement of emergency contraception use proactively in public health clinics.
7. Decreasing unintended pregnancy rates by making pregnancy a decision-driven activity.
8. Care Coordination project for children and youth with special health care needs.
   a. Pilot project in one region to provide in-depth care coordination services to children with special health care needs who are identified with high intensity service needs.
9. Medical Home project for children and youth with special health care needs.
   a. Funded three model pediatric “medical home” practices in the state to increase the capacity of primary health care services for children with special health care needs and to serve as resources to other pediatric practices in serving children with special health care needs. Care coordinators in these practices were trained on the medical home care coordination concept. In addition, the medical home model was incorporated into the Louisiana State University pediatric resident training.
10. Conducted Emergency Preparedness Trainings for Nurses Statewide on medical special needs shelters. These trainings were public/private partnerships. The Office of Public Health Nursing Services partnered with private hospitals to provide the staff resources and clinical expertise of subject matter experts to teach critical skills and medical equipment use that could potentially be needed in the shelters.
11. Convened “Care of the Chronic Diseases During Disasters Summit”. This is a new initiative to effectively manage chronic disease processes during disasters and mitigation of exacerbations. Many partners from the private and public sector were invited and participated to assist in developing strategies for emergency
    preparedness.
12. Promotion of the Smoke Free Air Act – passed in 2006
13. Expansion of the Nurse Family Partnership Project statewide.
14. Child Care Health Consultant (CCHC) Training to educate day care workers.
15. Continuing Education Program provided continuing professional development activities for nurses and physicians, et. Al through its Continuing Nursing and Medical Education programs.
16. Expansion of Louisiana Newborn Screening.

Projects/Issues Pending:

1. Senate Bill 1 - Health Care Reform Act of 2007: This bill authorizes the Department of Health and Hospitals to develop and implement a redesigned health care delivery system for Medicaid recipients and low-income uninsured citizens.
2. Transition to Adult Services for Children and Youth with special health care needs.
   a. In planning phase for the initiation of “Teen Transition” Clinics in 2 regions. The focus of these clinics will be to assess individual needs and goals of youth with special health care needs, development of a transition plan, with referrals to appropriate services and agencies. The clinics will be multi-disciplinary and multi-agency. Projected date for implementation is fall 2007.
3. Pandemic Influenza and Continuity of Operations planning. Emergency Preparedness Trainings.
4. Planning for the addition of Cystic Fibrosis screening on the Newborn Screening Test. Projected date of implementation – July 2007.
5. Development of specific guidelines to strengthen the SIDS Home Visiting Protocol
6. The integration of all chronic disease programs into the Bureau of Primary Care and Rural Health and to continue the focus on health promotion and prevention.
7. Collaborating with Chronic Disease Programs (i.e. tobacco, diabetes, asthma, stroke, etc.) to create innovative ways to develop state plans and activities that relate to all risk factors.
8. Coordination of services and programs of two major Louisiana tobacco programs (one state and one not for profit agency) to reduce duplicative efforts and increase efficiency and effectiveness.

Issues and Special Concerns for Public Health Nursing:

1. Recruitment and retention issues; Aging of the public health nursing workforce.
2. Increased need for Master’s and Baccalaureate-prepared public health nurses in Louisiana to assume leadership roles and positions, especially as the PHN workforce ages.
3. Challenge of meeting the needs of public health nursing’s ever-evolving roles.
4. Public health funding for public health nursing & public health as a whole.
5. Comparable pay scale of Public Health Nurses (PHN) with other specialties of nursing.
6. Skilled PHN workforce as it relates to information technology systems.
7. Importance of hazard pay for public health nurses providing nursing care in disasters, emergencies, dangerous areas, etc.
8. Increasing assessment, evaluation, and promotion of development of mental states and socio-emotional needs in infants and preschool children.
9. Strategic plan needed for public health nurses on a national basis; additional credentialing necessary for public health nurses as they become proficient in bioterrorism, community wellness, etc.
10. Keeping health promotion in the fore front of public health education, particularly targeting obesity among children.

Mississippi 2007 State Report...

Projects/Issues Addressed This Year:

We chose just one topic to report about an exciting new program being developed for Mississippi Public Health Nurses. In addition to the standard training activities for public health nurse orientation and disaster preparedness, the Mississippi Department of Health has recognized the need for a more extensive public health nursing education program for both new and existing nursing staff. The proposed plan is to develop a Mississippi Academy of Public Health Nursing in conjunction with the University of Mississippi, School of Nursing (SON). Highlights of current plans follow:

1. The SON is working with an MDH Advisory Committee for the purpose of reviewing materials to ascertain relevance of practical/clinical content to MDH expectations.

   SON is preparing ten educational modules (all modules will have measurable educational and practice competencies attached). The ten modules will be divided into three groups or “tiers” of study. The proposed ten modules consist of the following:
   
   Competencies and standards of Public Health Nursing Practice

   A practical approach to Special Needs Sheltering

   Community assessment and population-focused health services planning and implementation

   Communicable disease control and prevention

   Basic epidemiology for Public Health Nurses

   Chronic disease prevention and nursing interventions

   Public Health Nursing ethics and social ecology

   Local Public Health Nursing services delivery

   Genomics, informatics, and use of technology in the PHN practice setting

   One additional module based on unique Mississippi needs, as defined by the MDH and the UMC SON.
   

2. SON will prepare a training calendar, in conjunction with MDH staff and Advisory Committee, for implementation of the modules.

North Carolina 2007 State Report...

Projects/Issues Addressed This Year:

1. A new website to provide “one stop shopping” for PHNs in North Carolina has been started with the assistance of the Janet Place and Beth Lamanna of the Southeastern Public Health Training Center. The website is www.ncpublichealthnursing.org.

2. A two grade reclassification of all positions in the Public Health Nursing series. Unfortunately, even though our statute says local health departments must be in compliance with the State Personnel Act, when counties called State Personnel to ask whether they had to implement this change and the associated salary increases, they were told “No” – they just had to discuss it and make a decision on whether to implement. A few local agencies implemented before that information got widely distributed, but not many. State PHN Consultants, however, did benefit.

3. Our Committee on Practice and Education of the North Carolina Association of Public Health Nurse Administrators developed a “public health nursing specific” tool based on the new NC Board of Nursing’s continued competency requirements. Each RN is required at the time of license renewal to do a self-assessment based on the Board’s competency model and develop a continued competency plan. This on-line tool (see link on website listed in #1 above) has been very positively evaluated by PHNs who used it to complete that process.

4. Updated the biennial Directory of Public Health Nurses in North Carolina.

5. Updated the “Quick Guide on PHN Training” used by local health departments to understand the requirements of or make contact to register for on-going PHN educational programs.

6. NC now has 25 accredited local health departments through our legislatively mandated system and piloted a similar process for accrediting a state health department with a site visit by a team of national experts, led by Dr. Kaye Bender, who were a part of the national Exploring Accreditation initiative.
   

Projects/Issues Pending:

1. NC applied for a HRSA grant under the retention focus area. We proposed to revise our model of orienting new PHNs and implementing the requirement (by Administrative Code) for an “Introduction” course for all non-BSN prepared PHNs. In addition, we will establish a mentoring program for these new PHNS which will position us to be able to comply with a transition to practice model under discussion by our NC Board of Nursing.

2. We are well on the way to completing customization of a NetSmart COTS product to serve as the Health Information System for all NC local health departments as well as the Division of Public Health. The production pilot is scheduled to being in January, 2008.

Issues and Special Concerns for Public Health Nursing:

1. Imminent retirement of large numbers of PHNs with more than 30 years experience.
2. Low salaries relative to other employers of nursing.
   

New Jersey 2007 State Report ...

Projects/Issues Addressed This Year:

The New Jersey Department of Health and Senior Services has joined with the New York State Department of Health through the NYNJ-PHTC (New York New Jersey Public Health Training Center) to develop nursing summits in each state. The NYNJ PHTC is a collaborative effort of the New York State, New York City, and New Jersey Health Departments, University of Albany School of Public Health, Columbia University Mailman School of Public Health and UMDNJ (University of Medicine and Dentistry New Jersey) School of Public Health which promotes public health educational initiatives in the region through partnerships.

New Jersey has implemented two nursing summits to date. The first one was in November of 2006 and Dr. Susan Zahner, University of Wisconsin, spoke to a combined audience of academics and practicing public health nursing administrators. In addition two New Jersey academic/practice dyads presented their case stories of collaboration and synergistic benefit from these relationships. A direct outcome of the work groups formed at this summit was the purchase of a subscription to the University of Wisconsin’s on-line preceptor course for community health nurses. The access to these course modules will provide a solid base of information and practical instruction for new public health nurse hires.

The second Nursing Summit presented a panel of public health nurse educators and administrators who discussed various issues and facets of public policy affecting public health nurses in New Jersey currently.

Linda Flynn, PhD, RN, Rutgers presented the data she has collected on public health nurses in New Jersey.; Flo Rice,Ed.D,RN, Madison Boro Health Department presented an analysis of the meaning and effects of the shift to population based nursing for local health departments in New Jersey; Minnie Campbell, DNSc., RN, Kean University, presented on the elements provided by nursing education that are specifically needed in the PHN role. Sharen Clugston,MSN RNc, Director of Nursing Hamilton Township, presented the specific strategies and steps that were implemented in a local government setting to raise nursing salaries, included as a major strategy was the need to articulate and clearly describe to officials in concrete terms what public health nurses do to prevent disease and promote health; Joy Spellman, MSN, RN described the path taken from a Director of Nursing position in a county health department to a newly created CDC/State funded position teaching and demonstrating the use of manikin simulators for practice and demonstration of various symptoms caused by all hazard insults.

Two case studies were presented by practicing nurses in New Jersey which demonstrated the effect public health nursing has on influencing health policy.

Projects/Issues Pending:

The historical measures of public health performance contained in the evaluation forms of the NJDHSS for local health departments do not reflect a jurisdiction’s response to the ten essential services nor the core principals of population based health. This causes confusion on the part of local health departments regarding expectations. The disparity needs to be reconciled as it presents a threat to practicing population based public health nursing and places practicing public health nurses in a conflicted situation.

Issues and Special Concerns for Public Health Nursing:

A very large segment of the experienced public health nursing work force in New Jersey is ready to retire, the local health departments can not compete for new graduates due to inflexible salary schedules and practice standard requirements. The time and personnel requirements of preparedness initiatives for nurses continue to drain from the limited labor pool that exists. Public health nursing continues to be excluded from critical planning initiatives at the State level for all hazard events.

New Mexico 2007 State Report...

Projects/Issues Addressed This Year:

1. Billing and Electronic Health Record (BEHR): An RFI was issued in November ‘06, followed by an RFP in Dec. After an intense review process the vendor was selected, and implementation and planning are underway. Two pilot sites have been selected from the 55 NM public health offices. Partial implementation at the 2 pilot sites will be accomplished this summer, with regional roll-out starting in the fall. All 55 offices should be on board by December 2008.

2. Barbara Richardson Van: A project of the First Lady, Barbara Richardson, and Blue Cross Blue Shield of NM, this bus-size RV has been converted to a mobile dental office and exam room. Fully equipped with a dental chair, exam table, refrigeration, bathroom, and satellite hook-ups, this mobile clinic primarily provides dental screening and sealants, immunizations, and outreach throughout the state. Other activities include supporting infectious disease monitoring, attending local fairs and events, and providing street outreach services to the homeless and other hard-to-reach populations in Albuquerque, Santa Fe and other cities across NM.

3. Immunizations: A primary initiative of Governor Bill Richardson’s is to increase childhood immunization rates in NM. A variety of interventions are in progress and include: partnering with Indian Health Service, private providers, and the Navajo Nation to immunize thousands against the flu virus; expanding the WIC/immunization all local health offices and their satellite sites; collaborating with school nurses; and holding “immunization only” clinics at designated sites.

4. Nurse Advice-NM (NA-NM): As of June 1, 2007 the Nurse-Advice line will be one year old! NA-NM provides telephone triage, education and referral services to anyone in NM regardless of insurance coverage. NA-NM is receiving over 11,000 calls/month. These numbers far exceed initial projections, and have meant unexpected challenges both technical and budgetary! However, this public-private partnership continues to excel, with nurses now working from home. Plans are in the works to move home-based nurses to rural regions during the next year of operation.

5. Expansion of PHD Intranet Role: Anticipating the flurry of activity that precedes implementation of the BEHR, the Public Health Division (PHD) has placed all clinical protocols, guidelines, policies, forms (admin and clinical) on a local intranet available to all their offices. Now the most up-to-date information is always available, plus there is a significant reduction in paper usage and clutter from large-outdated notebooks and manuals in every office. The next step is to expand the calendar and communication components to include reminders and renewal notices of meetings, events, as well as expiration and due dates of posted information.

6. Pilot HPV immunization in 5th grade girls: Regional pilots are underway and PHNs are working closely with local schools and their nurses.

Projects/Issues Pending:

• Full Implementation of the BEHR in all 55 local health offices.
• Linkage of BEHR with the Lab Management System and other PHD databases (includes immunizations, STD, Breast and Cervical Cancer Screening, etc.)

Issues and Special Concerns for Public Health Nursing:

• Teen pregnancy prevention.

• Youth suicide prevention.

• Increase childhood immunization rates.

• Obesity prevention.

• Expand school based health centers as a health care delivery model.

Ohio 2007 State Report...

Projects/Issues Addressed This Year:

Prepared by Gillian Solem, RN, MSN, Chair Ohio Public Health Association, Chair, Directors of Nursing Section and Deborah L. Arms PhD, RN, Chief Division of Prevention, The Ohio Department of Health.

Ohio’s State, academic partners and local Public Health Nurses (via the Ohio Public Health Association Directors of Nursing section) collaborated on several projects.

OPHA DON section began a strategic planning process in June, 2006 to further define the group’s primary goals and objectives. Strategic Imperatives include PHN Voice, DON section Structure and Workforce Development. Goals include: Voice: The OPHA/DON section will be formally recognized as the voice of leadership for Public Health nursing in Ohio. The origin for this “voice” will include collaborative efforts with the Ohio Department of Health, the Ohio Board of Nursing, the Association of Ohio Health Commissioners, and other professional organizations to send consistent messages across the Public Health nursing discipline in the State of Ohio. Structure: The OPHA/DON section will build infrastructure designed to support public health nursing and partnerships essential for the protection and promotion of the health of all Ohioans. Workforce Development: The OPHA DON section will provide growth opportunities for current and future Public Health Nurses in both public health and nursing leadership. These opportunities will promote teamwork and excellence in assessing, promoting and protecting the health and well-being of the diverse communities we serve. In collaboration with the Ohio Department of Health, academia, and other professional organizations, the section will exchange ideas, support, address, strengthen and delineate roles and competencies for public health nursing.

Implementation of PHN training/orientation project. A multiyear collaboration to revise and enhance the training of new and practicing PHNs in Ohio came to fruition in the first class utilizing the new curriculum.

Collaboration with Rosemary Chaudry and the Ohio State University School of Public Health and Office of Workforce Development to support application for and implementation of a HRSA grant to update and revise previously developed PHN modules on PH competencies. A DON section member participates in the effort as a practice partner. DONs helped test the modules and encouraged staff to participate.

Collaboration with Sharon Stanley and an OPHLI workgroup to roll out “Public Health Nursing Surge, the Trail to Disaster Competence” Local Directors of Nursing participated on the Advisory Committee, provided a letter of support for a funding proposal, and included the curriculum as part of the December, 2006 DON conference.

Expanding representation of PH Nurses in statewide efforts. DON Section members now represent PH Nursing on the Association of Ohio Health Commissioners Public Affairs committee, the Influenza Vaccine Planning committee, the Ohio Nursing Leadership Summit, the Medicaid HMO work group, the review committee for State ESF 8,

Projects/Issues Pending:

Continuation of strategic planning process.
Enhancing/strengthening active membership in OPHA DON Section.
Establishing a statewide or regional PHN day of recognition and networking.
Results of competency survey and implications for workforce development.
Developing guidance/support manual for professional practice in Ohio.
Continued support assistance for academic partners in following initiatives

Environmental Health Nursing
Public Health Nurse Competency training in Preparedness
Revision of on-line modules to develop basic skills for practice for new PHN

Funding for PH nursing in Ohio
Enhanced communication between discipline structured local health PHNs and program structured Ohio DOH PHNs to facilitate efficient, effective practice designed to enhance and support the health of Ohioans.

Issues and Special Concerns for Public Health Nursing:

Continuing to develop methods to enhance and support public health nursing practice in Ohio, through an integrated model of collaboration between nursing leadership at the state the Directors of Nursing in the local health departments.

Continued threats to existing funding and disparities brought about by inequities in funding of public health across Ohio’s 88 counties and 133 public health jurisdictions.

Identification of critical needs for development of existing and future PHN workforce, given an aging workforce in Ohio.

Oklahoma 2007 State Report...

South Carolina 2007 State Report...

Projects/Issues Addressed This Year:

Critical Public Health Staffing—In State FY 06, the SC Department of Health and Environmental Control received funding to adjust salaries in order to retain a limited and competent workforce of registered nurses, reduce turnover and improve recruitment. This was the 5th year the request was made. As a result of the Critical Public Health Staffing allocation, the average salary for all nursing classifications is higher. Salaries are comparable across our 8 public health regions in all nursing classifications. Equity within our RN II (BSN prepared) classification has been established within each region. There is less compression between pay bands. Salaries within pay bands are differentiated based on years of state service. While too soon to judge the benefits to recruitment and retention, it has benefited individuals and we have reported cases of nurses staying who otherwise may have left. It has directly affected staff morale and restored confidence in the system.

Nursing Professional Practice Manual—The Nursing Professional Practice Manual has completely transitioned to the agency’s intranet. All policies/procedures are electronic and easily accessible by all staff. In addition, implementation of changes is a much simpler process without the hard copy paper documents.

Sheltering Operations—A nursing workgroup was formed to strengthen Special Medical Needs Shelter (SMNS) operations guidance. The document includes the definition and limitations of SMNS, general admission criteria, criteria for designating SMNS, preferred sites and levels of SMNS based on the facility itself.

Home Health Operations—The nurse consultants in our home health program worked diligently to develop an admission authorizations and consents document. The one document merged 8 documents that required patient signature into one document with one signature. In addition, the consultants strengthened the orientation guidelines for new public health nurses working within home health. The orientation consists of 25 sections and each section is available via the agency’s intranet. This builds consistency across our eight public health regions. Patient education has also been strengthened. Patient Teaching Sheets have been developed for over 30 topics. All education sheets are available electronically.

Public Health Nursing Orientation—A new plan for general public health nursing orientation will be implemented in July. The plan includes a workbook and a DVD. This provides the foundational components of the nurse’s orientation. The plan includes a mentoring component (currently being developed).

Pandemic Influenza—A comprehensive policy for mass immunization during a pandemic has been finalized. In addition, three regions participated in a seasonal flu throughput study to create baseline data to strengthen the pan flu planning process. SC has also sought retired public health nurses to fill temporary positions called Public Health Clinical Liaisons. These liaisons are working with primary care providers to strengthen disease surveillance and reporting.

School Health—A tremendous amount of work has been accomplished within school nursing. Requirements for IHP’s for students with chronic illnesses were put in place this past year. School nurse numbers are growing in SC. Over 800 nurses are employed in SC schools. In addition, we are anticipating the state legislature to appropriate 25 million dollars to put a licensed nurse in each elementary school.

Projects/Issues Pending:

Shelter Staffing Needs—Efforts are underway to identify additional nursing resources within the state system for staffing of shelters during an emergency. An initial meeting has been held with our State Emergency Operations Director to engage potential nursing resources within other state agencies.

Special Medical Needs Training—Work is ongoing regarding training for all nursing staff on roles and responsibilities when staffing a shelter. In addition, a triage tool is being finalized that will allow the nurse to determine admission based on the level of SMNS.

Electronic Medical Record—The agency has workgroups in place to evaluate moving to an electronic medical record. This would be for our clinical services areas (women’s health, STD, HIV, immunizations, etc.)

Emergency Preparedness Trainings—DHEC continues to partner with the SC Nurses Association Community Health Council and the University of South Carolina’s Center for Public Health Preparedness to provide trainings across the state around the nurse’s role during a mass casualty event.

Performance Management—The agency is moving forward with Performance Management. Within nursing, we are revising our position descriptions and employee performance management guidelines to align with the seven domains of performance management.

Preventive Health Course—We continue to provide a large number of services to reproductive age women and men. Our Preventive Health Course trains nurses to provide the comprehensive services needed for family planning and STD. In the fall, a new improved course will be offered.

Emergency Preparedness—This work is ongoing. Nursing is involved in all aspects of planning. Our focus continues to be Pandemic Influenza.

Issues and Special Concerns for Public Health Nursing:

Nursing Workforce—We are working to build capacity following significant losses in relation to the actual number of public health nurses employed by DHEC.

Budget Constraints—We continue to realign resources following changes in Medicaid and reductions in grant funded programs.

Tennessee 2007 State Report...

Projects/Issues Addressed This Year:

Retention and Recruitment of Public Health Nurses: Tennessee Department of Health will have 49% of the personnel eligible for retirement in 5 years
Retention:

• In 2006, the Tennessee Department of Personnel, moved the Public Health Nurses from a Public Health register to a Statewide Registered Nurse register

• Increased salary base which will improve recruitment and retention

• Increased ability to hire by having more nurses on the public health register.

• Statewide Nursing Supervisor Conference is being planned for 2008

• TPHA Nursing Section

• Scholarship Fund

• Awards

Recruitment:

• Student Orientation: Contractual arrangements are in place with 35 schools of nursing in Tennessee and 2 in Kentucky. The process allows nursing students of all isciplines to receive an orientation to public health in any of the county health departments.

• Recruitment Fairs

• College Career Days

CEUs: TNA approved application for the Office of Nursing to continue to award CEUs for nursing staff.

Next Generation of PTBMIS Computer Record: Currently, a combined PTBMIS computer data system and permanent paper record are utilized in 104 health departments in 86 counties and 6 metros. Since fall of 2006, the Symphony Corporation has been in the process of assessing the computer needs of the health departments across the state. This is the first step in improving the computer record system that has been in place for approaching 20 years.

Primary Care: In 2006, 52 primary care sites opened across the state These sites have seen 60,313 primary care patients. Provide care for the uninsured ages of 19-65.

Diagnosis #1 - Hypertension
Diagnosis #2 - Diabetes

Emergency Preparedness: Continued Emergency Preparedness updates are conducted at all local health departments which include earthquake and nuclear disaster training.

Call Center: Staffed with 3 nurses, 1 NP and 2 RNs who make telephone calls to prenatal patients from across the state.
Topics discussed are as follows:

• Prenatal Nutrition
• “Back to Sleep” Exercise
• Substance abuse Prenatal Care
• Parenting skills Breast feeding,
• Safety Immunizations

Projects/Issues Pending:

Public Health Nursing Protocol: Currently, the PHN Protocol is a paper manual used in all Public Health Departments. The Office of Nursing is in the process of revising the protocol for inclusion on the state intranet computer system.

Workforce Development: Opportunities are in the process of being developed to increase leadership and management skills of nursing staff at the management level.

Issues and Special Concerns for Public Health Nursing:

Infant Mortality: In 2004, Tennessee ranked 48th in the nation at 17.4%
The targeted issues are to modify the behaviors, identify barriers, lifestyles and conditions that affect birth outcomes.

Preconceptual Counseling: Preconceptual counseling is recognized by CDC as a critical component of health care for women of reproductive age.

Goal: Provide health promotion, screening, and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies.