Local health districts and the public health workforce: a case study of Wyoming and Idaho

Workforce turnover at local health departments: nature, characteristics, and implications

BACKGROUND

Employee turnover, defined as total separations from employment, is expensive, can result in lost capacity, and can limit local health departments' (LHDs') ability to respond to public health needs. Despite the importance of workforce capacity in public health, little is known about workforce turnover in LHDs.

PURPOSE

To examine the extent to which LHDs experience turnover and identify LHD characteristics that are associated with turnover.

METHODS

A cross-sectional data set of employee turnover and LHD characteristics from the 2013 National Profile of LHDs was analyzed. Descriptive statistics and bivariate analyses were conducted in 2014 on turnover rates. The effect of the following LHD characteristics on turnover rates were examined: population size, governance type, degree of urbanization, top executive experience level, expenditures per capita, and LHD budget cuts.

RESULTS

In 2013, LHDs experienced a mean turnover rate of 9.88%; approximately one third of turnover was due to retirements. LHDs with shared state and local governance experienced a higher turnover rate than LHDs with exclusive state or local governance. LHDs that are units of state agencies had a significantly higher retirement rate than those governed by local authorities. Top executive experience level, per capita expenditures, and LHD budget cuts were also related to turnover rates.

CONCLUSIONS

LHDs experienced a lower overall turnover rate than state health departments in 2011 and lower than all local and state government agencies in 2012. Strengthening leadership skills of new top executives and ensuring adequate funding may reduce turnover in LHDs.

Job satisfaction in rural public health nurses

OBJECTIVE

The purpose of this study was to determine whether nurse managers and staff nurses in rural public health offices were satisfied with their jobs, whether managers were more satisfied than staff nurses, and whether their achieved educational level impacted their job satisfaction.

DESIGN

A nonexperimental comparative study was conducted of currently employed public health nurses (PHNs) to determine job satisfaction levels by using Stember's Web-based 80-question job satisfaction survey.

SAMPLE

The sample consisted of 88 PHNs employed as either managers or staff nurses in county public health office settings during April 2006.

RESULTS

In general, both nurse managers and staff nurses reported high job satisfaction. No significant differences existed between the composite job satisfaction scores of the managers and staff nurses. Significant differences existed between managers' and staff nurses' job satisfaction in the categories of "influence" and "interpersonal relationships" with managers less satisfied than staff nurses.

CONCLUSIONS

Both staff nurses and managers in public health were satisfied with their jobs. Managers attributed any sense of decreased job satisfaction in the areas of influence and interpersonal relationships. Further study is needed to determine what contributes to satisfaction of PHNs in order to promote positive work environments conducive to retention and recruitment.

Enumeration and composition of the public health workforce: challenges and strategies

The field of public health needs a comprehensive classification data system that provides a better assessment of the size and composition of its workforce. Such a data system is necessary for understanding the capacity, trend projections, and policy development critical to the future workforce. Previous enumeration and composition studies on the public health workforce have been helpful, but the methodology used needs further improvements in standardization, specificity, data storage, and data availability. Resolving this issue should follow a consensus-based course of action that includes public and private stakeholders at the national, state, and local level. This prime issue should be addressed now, particularly in the current environment of comprehensive health care reform.

The TERRA framework: conceptualizing rural environmental health inequities through an environmental justice lens

The deleterious consequences of environmentally associated diseases are expressed differentially by income, race, and geography. Scientists are just beginning to understand the consequences of environmental exposures under conditions of poverty, marginalization, and geographic isolation. In this context, we developed the TERRA (translational environmental research in rural areas) framework to explicate environmental health risks experienced by the rural poor. Central to the TERRA framework is the premise that risks exist within physical-spatial, economic-resources, and cultural-ideologic contexts. In the face of scientific and political uncertainty, a precautionary risk reduction approach has the greatest potential to protect health. Conceptual and technical advances will both be needed to achieve environmental justice.

Relationships between nurse- and physician-to-population ratios and state health rankings

OBJECTIVE

To evaluate the relationship between nurse-to-population ratios and population health, as indicated by state health ranking, and to compare the findings with physician-to-population ratios.

DESIGN

Secondary analysis correlational design.

SAMPLE

The sample consisted of all 50 states in the United States. Data sources included the United Health Foundation's 2006 state health rankings, the 2004 National Sample Survey for Registered Nurses, and the U.S. Health Workforce Profile from the New York Center for Health Workforce Studies.

RESULTS

Significant relationships between nurse-to-population ratio and overall state health ranking (rho=-.446, p tf?>=.001) and 11 of the 18 components of that ranking were found. Significant components included motor vehicle death rate, high school graduation rate, violent crime rate, infectious disease rate, percentage of children in poverty, percentage of uninsured residents, immunization rate, adequacy of prenatal care, number of poor mental health days, number of poor physical health days, and premature death rate, with higher nurse-to-population ratios associated with higher health rankings. Specialty (public health and school) nurse-to-population ratios were not as strongly related to state health ranking. Physician-to-population ratios were also significantly related to state health ranking, but were associated with different components than nurses.

CONCLUSIONS

These findings suggest that greater nurses per capita may be uniquely associated with healthier communities; however, further multivariate research is needed.

A profile of public health educators in North Carolina's local health departments

The purpose of this study was to provide a profile of the public health education workforce in North Carolina. A survey was administered to all practicing health educators at local health departments (LHDs) in North Carolina. The study specifically attempted to answer four questions: (1) Who functions as health educators in LHDs in North Carolina? (2) What is the educational background and professional training of North Carolina LHD health educators? (3) What are the characteristics of health educators' positions in North Carolina? and (4) How do these characteristics of health educators (demographics and education) as well as their titles, job responsibilities, and supervisory relationships differ according to the size of the LHD? The study showed that most public health educators in North Carolina are white females; most do not have Certified Health Education Specialist certification; that younger health educators are more likely to have health education degrees; and that almost two thirds of public health educators have administrative responsibilities.

The Role of Public Health Nurses in Bioterrorism Preparedness

BACKGROUND

Public health nurses have a central function in the public health system. Nurses conduct disease surveillance, which is an important first step in recognizing diseases caused by bioterrorist agents. Unfortunately, the current public health infrastructure and expectations for public health nurses are not clearly defined and therefore pose serious difficulties for conducting disease surveillance. Increased surveillance activities for bioterrorism preparedness add more responsibilities to the work of public health nurses.

METHODS

A qualitative study on disease surveillance was conducted with public health officials at regional and local levels, working in a variety of urban and rural settings in one large public health region in Texas. Data analysis was supported by qualitative research software, The Ethnograph.

RESULTS

The study found that the nurses working at the local level were extremely dedicated to serving their communities, had formed informal partnerships that are essential for disease surveillance, and effectively used informal communication channels to obtain critical surveillance information. The study revealed that nurses had unmet needs and experienced multiple barriers to conducting disease surveillance.

CONCLUSIONS

The study's findings could have implications for public policy and nursing leadership. Defining the structure of the public health system and the scope of public health nurses' responsibilities will serve as the cornerstone for improvement of bioterrorism preparedness.

A federal agency's role in fulfilling the public health core functions: the childhood lead poisoning prevention program model

The Institute of Medicine identified 3 core functions of public health: assessment, policy development, and assurance. Federal, state, and local public health agencies all have an obligation to provide these vital functions to ensure conditions in which people can be healthy. However, the few publications that provide core function applications only focus on applications at the local or state levels. The Centers for Disease Control and Prevention's Childhood Lead Poisoning Prevention Program uses a comprehensive public health approach. This article describes the Centers for Disease Control and Prevention's leading role in applying the core public health functions to prevent childhood lead poisoning.

Are the public health workforce competencies predictive of essential service performance? A test at a large metropolitan local health department

Since many training initiatives employ the core public health workforce competencies as objectives, it is important to demonstrate an association between competency and essential service job performance. A cross-sectional survey of 420 employees of a local health department was conducted in 1999, with a response rate of 76 percent. Each of ten essential service performance measures was regressed on four core competency measures, controlling for employee experience and education. The competencies explained 2 percent to 20 percent of the variance in essential service performance. While offering support for the core competencies as a foundation for training program content, the results also make clear the large role that other individual, organizational, and community influences may have. Explaining additional variance in performance will require incorporating these variables into future studies.

Rural health care providers in the United States

One of the most recalcitrant problems of the rural health landscape is the uneven distribution and relative shortage of medical care providers. Despite considerable efforts by federal and state governments over the past three decades to address these problems, rural provider distribution and shortage issues have persisted. The purpose of this article is to identify the challenges for rural health research and policy regarding health provider supply in the first decade of the 21st century. While the emphasis in this article is on physicians, workforce concerns pertaining to nurses, nurse practitioners, and physician assistants are briefly described. Physician supply, geographic and specialty distribution, age, gender, quality of care, recruitment and retention, training, productivity and income, reimbursement and managed care, federal and state ameliorative programs, safety net, and telehealth are discussed. Also highlighted are issues concerning rural health care workforce research, methods, and data as well as a series of policy-relevant questions. Solutions to rural health personnel problems can only be successfully addressed through multifaceted approaches. No vision of the future of rural health can come to fruition if it does not promote stable, rewarding, and fulfilling professional and personal lives for rural health care providers.

Rural public health: policy and research opportunities

Changes in the health care system, medicine, and technology as well as in the characteristics of rural communities raise issues that impact the responsiveness of the rural public health system to emerging threats to health. These issues, which are systemic in nature and primarily involve the infrastructure of public health, include the capacity of rural public health to manage population health, utilize information technology, monitor performance of the essential public health functions, develop leadership and the public health workforce, and promote the interaction and integration of public health and health care. This article provides an overview of policy and research implications, and it suggests that each of these issues contributes to the capacity of public health to effectively improve the outcomes of health in rural communities.