June 8, 2013 Concurrent Session IV-O

Public Health Nurses’

Self-Reported Practice Competency

Rosemary Chaudry, PhD, MPH, PHCNS-BC Delaware General Health District

rchaudry@delawarehealth.org Barbara Polivka, PhD, RN

University of Louisville D. J. Sam Chapman, MPH, RN

Ohio Department of Health ACHNE Annual Institute

6/8/2013 8:30 – 9:45 A.M. Concurrent Session IV-O 11

Funding

 The author gratefully acknowledges funding for this study from a 2011 ACHNE Small Research Grant.

Presentation Objectives

practice competency.

2. Discuss three differences in self-reported PHN practice competency by PHN characteristic practice competency by PHN characteristic. 3. Describe one evidence-based training strategy

to address an identified competency need in PHN practice.

Background



 PHN workforce PHN workforce -- factor in PH system performance, factor in PH system performance, outcomes, attainment of nation health objectives outcomes, attainment of nation health objectives 

 Funding challengesFunding challenges–– limited workforce devp. budgetslimited workforce devp. budgets

–

–NACCHO, 2009 survey: 46% staffing loss, 23% cut work timeNACCHO, 2009 survey: 46% staffing loss, 23% cut work time Ohio survey results: 72% staffing loss 43% cut work time Ohio survey results: 72% staffing loss 43% cut work time

–

–Ohio survey results: 72% staffing loss, 43% cut work timeOhio survey results: 72% staffing loss, 43% cut work time



 For PHNs, additional challengesFor PHNs, additional challenges

–

–Shortages of qualified PHNsShortages of qualified PHNs

–

–Low salaries compared to other specialtiesLow salaries compared to other specialties

–

–Research, education fundingResearch, education funding

–

–Aging PHN workforceAging PHN workforce

–

–Need qualified educators AND ENeed qualified educators AND E--B education programsB education programs

Background



 Related researchRelated research

–

–Issel et al., 2006 PHN selfIssel et al., 2006 PHN self--report of competenciesreport of competencies

–

–Schaffer et al., 2010 Included 10 Essential Services as Schaffer et al., 2010 Included 10 Essential Services as measure of competency in students, novice PHNs measure of competency in students, novice PHNs

–

–Cross et al., 2006 SelfCross et al., 2006 Self--competency ratings higher by competency ratings higher by years practice

years practice

Polivka et al 2000 CE needs of rural & small HDs; Polivka et al 2000 CE needs of rural & small HDs;

–

–Polivka et al., 2000 CE needs of rural & small HDs; Polivka et al., 2000 CE needs of rural & small HDs; more applied CE

more applied CE

–

–Chaudry, 2007 Gaps between current and desired Chaudry, 2007 Gaps between current and desired levels of competency

levels of competency

–

–Zahner & Gredig, 2005 Areas for improving PHN CEZahner & Gredig, 2005 Areas for improving PHN CE



 Ohio PH Association PHN sectionOhio PH Association PHN section

–

–Focus on PHN voice, workforceFocus on PHN voice, workforce

–

–Support for studySupport for study

Study Design, Purpose, Framework

 Design: Descriptive survey

 Purpose: To describe self-reported competency levels of public health nurses (PHNs) currently employed in local health departments (LHDs) in p y p ( ) Ohio.

 Frameworks:

–

–Adult learning theoryAdult learning theory

–

–EssentailEssentail Services of PHServices of PH

–

–Definition of PH Nursing practice Definition of PH Nursing practice (ANA, 2007)(ANA, 2007) –

Definition of Public Health Nursing

“Public health nursing is

the practice of

promoting and protecting

the health of populations

p p

using knowledge from

nursing,

social,

and public health sciences”

(ANA, 2007, p.5)

7 7

The CORE FUNCTIONS & ESSENTIAL SERVICES of PH

Core Function Essential Service

Assessment 1. Monitor community health status 2. Diagnose & investigate health problems Policy Development 3. Inform, educate, & empower people

4. Mobilize community partnerships 5. Develop policies & plans

Enforcement 6. Enforce laws & regs that protect health 7. Link to health services, assure care 8. Assure competent workforce

9. Evaluate personal & popn-based services Across all 3 CFs 10. Research -new insights and solutions

9 9

Study Aims

1. Describe PHN self-reported practice competency 2. Compare competency by respondents’ personal

and practice characteristics, LHD characteristics 3. Identify PHNs’ preferences for and perceived

barriers to obtaining nursing continuing education * Contribute to PHN practice, research, education,

voice!

Methods

 Human subjects approval -OSU IRB

 Population: RNs employed as PHN in LHDs in Ohio

–Email requests to PHN directors (DONs) for names of

ll PHN l d i th i LHD

all PHNs employed in their LHD

 Recruitment

–PHNs recruited by email invitation

–

–IncentiveIncentive-- drawing for $25 gift carddrawing for $25 gift card

Methods

 Data Collection:

–Mailed survey, Tailored Design Method (Dillman, 2000) –Survey instrument based on Issel et al. (2006)

–Competency areas addressed nursing and PH sciencesCompetency areas addressed nursing and PH sciences

10 Essential Services of PH (Core PH Steering Cte., 1994) PH Intervention Model (Keller et al., 2004)

–Included questions on nursing practice, CE preferences & barriers, personal characteristics

Results – Sample, Instrumentatio

n

Responding sample: 259

–Study sample (RNs only) n=255 (41% RR)

–Response rates for Issel et al., 2006 84%; Chaudry, 2007 85%

Instrumentation:

–ES & PH intervention category subscales Cronbach’s alphas (.88 - .96) EXCEPT YellowPH category (.797)

–Issel et al., 2006 Cronbach's alphas for ES .90 - .97

Results – Nursing Practice

–Work:

Full-time year round 88%

Part-time year round 8%

Full-time < year round 2%

Part time < year round 2%

Part-time < year round 2%

–Position in LHD:

Staff PHN 72%

PHN Admin (not DON) 10%

PHN Admin – DON 14%

Varies- Admin/staff 4%

Results – Nursing Practice

 Type of LHD: County: 54% City: 20% Combined: 25% Combined: 25% Other/missing: < 1%

 Years of non-administrative clinical nursing practice: –All specialty areas: x 21 yrs. (SD 11.3; Range 1 - 49)

Results – Personal Characteristics

–LPN diploma 4% –RN diploma 19% –AD nursing 33% –AD non-nursing 3% BS i 50% - MS PH nursing 2% - MS other nursing 5% - MS PH 2% - MS other 4% Doctorate nursing 0 –BS nursing 50% –BS non-nursing 12%

 Sex: Female 98%, Male 2%

 Completed any PHN Ready modules? 26% yes

- Doctorate nursing 0

- Doctorate PH 0

- Doctorate other <1%

Results –

Personal Characteristics

If have MS in PHN, other nursing, or PH:  PHCNS-BC or APHN-BC certified? 3% yes

 If not already certified, considered taking exam? –Yes, plan to look into taking 8%

–Yes, registered to take <1%

–No, not eligible 4%

–No, not interested 4%

–No, not familiar with reqts. 15%

–No, no benefit to me 7%

–No, wouldn’t pass <1%

Results – Average competency rati

ngs

3 = I do or can do this 5 = I can do as expert, intuitively

–ES 1 2.4

–ES 2 2.8

–ES 3 2.8

–ES 4 2 8

PH Intervention Wheel Categories

Pink 2.9 Green 3 4 –ES 4 2.8 –ES 5 2.1 –ES 6 2.7 –ES 7 3.6 –ES 8 2.5 –ES 9 2.2 –ES 10 2.5 Green 3.4 Blue 3.5 Orange 2.9 Yellow 2.7

Results – Associations with Competency Ratings

HD Type Position Completed PHN Ready

ES 1 X X X ES 2 X X ES 3 ES 4 X ES 5 X X ES 5 X X ES 6 ES 7 X ES 8 X X ES 9 X ES 10 X Orange X

Results – Associations with Competency Ratings

BS Nursing: ES 5

MS PHN: ES 1, 9, 10

MS other NSG: ES 1, 3, 4, 5, 7, 8, 9, 10; Orange

MS PH: ES 1, 2, 5, 9

MS Other: ES 5, 10

Years clinical nursing: .064 decrease in ES 10 rating/yr. .012 decrease in Pinkrating/yr.

Results – Preferred format for CE

% Giving rating of 1 or 2 5 point sale 1=most, 5=least

Agency in-service: 76% Online/web-based at work: 67% Traditional classroom: 54% Online/web-based at home: 42% Video/CD: 31% Journal offering: 26%

Results – Barriers to obtaining CE

% Giving rating of 1 or 2 5 point sale 1=most, 5=least

Time- my workload: 60%

Time from work-no coverage: 52%

Time from work- no supv. support: 17%

Time from work no Board Dir Support: 20% Time from work- no Board, Dir. Support: 20%

Cost to HD: 56%

Cost- mine 49%

Can’t find needed courses 18%

Disappointed with past CEs 13%

Need to use my own/vacation time 21%

Discussion

 Low competency areas (less that 3 “I do or can do this”)

–ES 1-6, 8-10 range 2.1 – 2.8;

–PH Intervention Wheel categories P, Y, O2.7 - 2.9

 Moderate competency areas (3 = I do or can do this):

–ES 7 3.6

–PH Intervention Wheel categories g B3.4, G3.5

 Significant associations:

–HD type (5 ES, Orange), PHN position (6 ES)

–PHN Ready (2 ES)

–Yrs. clinical nursing (negative association ES 10, Pink)

–Education- ES1, 5, 9, 10;

BSN, MS PHN, MS other Nsg, MS PH, MS other

Discussion

 Preferred CE methods: >50% preferred traditional classroom, online/web, agency in-service

 Barriers to obtaining CEs: > 49% noted time from work, HD cost, personal cost

 Comparison to other studies:

–Issel et al. 2006: only ES 7 exceeded cutoff of able to perform, ES 5, ES 10 were lowest rated; comparable rating levels

–Zahner & Gredig 2005: travel time, PH/PHN topics

–Cross et al. 2006: PHN position, years PHN positive associations

–Chaudry 2007: Greatest gaps between current and desired competency for policy, social marketing (yellow)

Discussion

–Tool internal consistency

–Distribution of characteristics

 Limitations:

–Low response rate low, nonrandom sample, sample limited to one state

–No information on HD (budget, leadership, etc.), other personal characteristics

–Self report only, no objective verification

–Education question allowed multiple answers

–ES, PH Intervention categories not competencies

Implications

 Low levels of competency are concern with focus on population-based care outcomes; community, systems, policy interventions; PH accreditation

 Key barriers to CE are cost- agency, personal;

–current federal focus on primary care, continued funding challenges for PH versus continuing challenges and expectations

 Concerns about PHN competency, EB teaching

–Limited research, instrumentation

–Need evidence base for workforce CE

–Implications for PH nursing clinical precepted learning