Why Now? Taking Action for the Future of Public Health Nursing Pamela A. Kulbok, DNSc, PHCNS-BC, FAAN, University of Virginia Susan M. Swider, PhD, APHN-BC, FAAN, Rush University Pamela Levin, PhD, APHN-BC, Rush University APHA Annual meeting November 20, 2014

Presenter Disclosure s Pamela A. Kulbok No Financial Relationships to Disclose Building a Community Health Worker Program 2

Support Division of Nursing (DN), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number D09HP03144, APHN Leadership: Strategies for Education and Practice Robert Wood Johnson Foundation, Executive Nurse Fellows Program,

Factors Influencing PHN Practice PositiveNegative Patient Protections Affordable Care Act (ACA) (2010), i.e., CHNA and CHIPs Future of Nursing Report (2010) and Campaign for Action National Prevention Strategy (2011) RWJF Future of PHN report (2012) AACN-CDC Cooperative Agreement (2012) New models of healthcare delivery and care coordination RWJF – Building a Culture of Health Initiative (2014) Diminishing public health workforce Budget cuts in public health Aging and retiring PHN workforce PHN accounts for only 2% of nursing workforce Low percentage of BSN prepared nurses in public health PHN salaries are not competitive with acute care settings Lower paid staff are replacing public health nurses, i.e., health educators Insufficient data supporting PHN value-added to public health workforce

Factors Influencing PHN Education PositiveNegative Patient Protections Affordable Care Act (ACA) (2010) Future of Nursing Report (2010) and Campaign for Action National Prevention Strategy (2011) AACN-CDC Cooperative Agreement (2012) Healthy America Initiative (2013) RWJF – Building a Culture of Health Initiative (2014) APRN Consensus Model eliminating PH/CNS role (2008) Educational standards require integration of population health across program levels Aging PHN faculty PHN salaries in education are not competitive with other settings Decreasing positions in PHN agencies for BSN and MSN graduates Decreasing number of PHN graduate program Recent focus of HRSA/ANE grants on individual care for multiple chronic conditions and IPE

Factors Influencing PHN Research PositiveNegative Future of Nursing Report (2010) and Campaign for Action National Prevention Strategy (2011) NINR “Key Themes” for Nursing Research includes: ▫ Wellness: Promoting Health and Preventing Illness New funding sources – Patient- Centered Outcomes Research Institute (PCORI) Healthy America Initiative (2013) RWJF – Building a Culture of Health Initiative (2014)  Use of empirical data in practice hindered by: ▫ Educational level (less than BSN) ▫ Lack of access to scholarly journals in PH settings Researchers may lack: ▫ PH education or experience to conduct community-based research ▫ Training and skills to address population-focused outcomes Uncertainty about DNP prepared nurses’ (other than PHN/DNP) approach to population-focused research

Invitational Forum on the Role and Future of Nurses in Public Health Purpose To develop consensus amongst public health nursing leaders in education, research and practice, and key stakeholders outside of PHN, on action steps needed to enhance and promote the ability of public health nurses to work effectively to improve the health of the public (November 2, 2013)

Forum Process  Planning Group  Invited participants  PHN leaders in practice, research, education  Key stakeholders: governmental, funders, nursing  Range of perspective including ACHNE, APHA, and APHN members  25 attendees  Facilitated groups: Education, Practice, and Research

Forum Group Assignments  What are the three most important actions to be taken:  To help PHNs practice to the full scope of their education and license to help improve the health of the public?  To help educate PHNs to practice to the full scope of their education and license to help improve the health of the public?  To advance the evidence base that supports PHNs practicing at the full scope of their education and license to help improve the health of the public?

Forum Work Product Priorities for Action Goals/ outcomes Barriers Resources (needed and available) Responsible party Priority rankings (1,2,3)

Forum Priority Outcomes  Identify and Support Current and Emerging Roles of Public Health Nurses  Create and Secure Innovative Models for Sustainable Funding of PHN Practice and PHN Interventions  Develop and Support Leadership Skills in PHNs at All Levels of Practice, Education and Research

Final Report Quad Council of Public Health Nursing Organizations Invitational Forum on the Role and Future of Nurses in Public Health: Final Report Available

Subsequent Steps  Constituents of ACHNE, APHN, APHA-PHN prioritized actions (each using different approach):  APHN prioritized (by members): May 2014 Annual Meeting  ACHNE prioritized (by members): June 2014 Annual Institute  PHN-APHA prioritized (by leadership): September 2014  Quad Council of PHN Organizations  Selected three strategic priorities for future planning (October 10, 2014)

Quad Council’s Three Strategic Priorities  Develop and Support Leadership Skills in PHNs at All Levels of Practice, Education and Research  Identify and expand funding for PHN relevant research including comparative effectiveness studies for public health interventions across provider/health professional type.  Develop business case of PHN practice, including payment model.

Proposed Action Plans from Quad Council Round Table Session  PHN Leadership Skills  Funding for PHN relevant research  Business case of PHN practice Discussion, Questions or Comments Thank You!