Shortage of Georgia public health nurses at crisis level

(WTXL-TV) A report released by the Georgia Department of Public Health (DPH) says that there is a severe shortage of public health nurses in Georgia.

Georgia’s population has grown by one and a half million in the last ten years, but the public health nursing workforce has shrunk, according to the report. From 2003 to 2011, Georgia has lost an estimated 392 public health nurses, which is about about 22 percent, due to high turnover rates, lack of funding and non-competitive salaries. 

Georgia currently has 1,400 public health nurses, said Carole Jakeway, chief nurse and director of the division of district and county operations at DPH, and nearly 20 percent of public health nurse positions are vacant, she said.

“Even though there are just 1,400 of us, we are the backbone of public health,” said Debra Adams, district nursing and clinical director of the Valdosta-based South Health District.

The South health district, like most of the 18 public health districts, has a hard time recruiting and retaining public health nurses.

“Our turnover rate is in the double digits,” Adams said. For fiscal year 2011, Adams reports that the South health district had a total nursing vacancy rate of more than 20 percent.

One reason for the high turnover is DPH’s inability to fill the vacancies left by retiring nurses; the low, non-competitive salary keeps qualified nurses from applying.

“We have lost a lot of seasoned public health nurses, so we are really in the process of trying to get a whole new crop in and to be able to do that you need to be competitive in the market place,” said Susan Kristal, nurse manager for Barrow County.

Although the pay scale varies based on county, the average entry-level salary for a public health nurse was $31,474 in 2002. That was raised in 2008 to the current $36,770, Jakeway said.

“Right now we’re OK, but from time to time, we do have nurses leave and most of the time it’s because of the low pay,” said Marcia Massengill, county nurse manager in Clarke County. “Then when we attempt to recruit, it has been very difficult to compete with the salaries offered by private practices and hospitals; we can’t even compare to those salaries.”

DPH estimates the salary to be as much as $25,000 below market.

The average starting salary for a new nurse in the private sector was $61,000 in 2006. By June 2012, that had risen to $65,837, Jakeway said.

Because of the low salaries, the state is seeing mostly recent graduates and inexperienced nurses apply for the open positions, Massengill said.

“Right now we’re OK but from time to time, we do have nurses leave and most of the time it’s because of the low pay,” said Marcia Massengill, county nurse manager in Clarke County. “Then when we attempt to recruit, it has been very difficult to compete with the salaries offered by private practices and hospitals; we can’t even compare to those salaries.”

The average starting salary for a new nurse in the private sector was $61,000 in 2006. By June 2012, that had risen to $65,837, Jakeway said.

“Experienced, seasoned public health workers are very valuable because this is not your typical nursing job,” said Kristal, who has worked in public heath for nearly 12 years. “[Public health nurses] have to have some experience and some seasoning to know how to handle the different things that come up because every day is a new challenge.”

This is particularly important since registered nurses (R.N.) in public health diagnose and treat patients without a physician, an element unique to public health nursing.

“We’re asking a brand new nurse to do complete exams and be independent almost to a nurse practitioner level and they just graduated,” said Massengill, who has worked in public health for 29 years.

It takes a great deal of time and money to train the new recruits to work independently and this training makes public health nurses very competitive for private sector jobs. Many times, after at least nine months of on-the-job training, recent hires leave for less stressful and higher paying jobs – further fueling the high turnover rate.

“It has an impact all the way throughout the state,” said Kristal.

With the shortage of nurses and funding, some clinics have had to cut hours, like Clarke County’s Teen Matters clinic.

The full-time youth clinic opened in 1995. To provide services to more patients, a part-time Teen Matters clinic was added a few years ago while the older clinic maintained its full-time schedule. Teen clinics provide contraception and education to sexually active teens.

“With budget cuts in the last year, both clinics are now part-time, which is particularly frustrating because we have a very high teen pregnancy rate here in Clarke County,” said Massengill.

Georgia has one of the highest teen childbearing rates, estimated at more than 14 thousand in 2010. Teen births cost Georgia taxpayers at least $465 million in 2008, according to data released by The National Campaign to Prevent Teen and Unplanned Pregnancy. Most costs are associated with negative consequences for the children of teen mothers, such as public health care, child welfare, adolescence or young adult incarceration and lost tax revenue.

In the face of mounting vacancies, some nurses are doubling up on their duties.

“Our primary TB nurse left recently and took a higher paying job,” said Lori Tanner, who, as county nurse manager, directs the Walton County Health Department, the West Walton Health Center and the Adolescent Center for Education Services. “I oversee our county TB program so when a nurse leaves, I am the one who fills in the gaps to make sure services are provided.”

The nurse shortage overall limits the number of patients the clinic and nurses can see, said Adams, of the South health district.

Jakeway agrees that the nurse shortage affects all Georgians, and says that with fewer staff at the local level, the nurses have to regroup and set priorities to make sure patients are served.

Some, however, are hopeful that since public health became an independent state agency, plans which have existed for years to make public health nursing a more competitive field will finally move forward.

This is a top priority for DPH’s commissioner, Dr. Brenda Fitzgerald.

“We want to make sure we have very qualified people in these positions,” Fitzgerald said.

Plans, which were devised several years ago, now may be underway to implement a new nursing workforce development plan, according to Jakeway. The plan is intended to address recruitment and retention issues, create a competitive salary structure and develop a progressive career track. It remains to be seen, however, if the state budget will accommodate the plan.

“We are working to make sure the plans we have will fit with the state’s budget,” Fitzgerald said. “We are being very conservative and the government is being conservative, so we are moving forward but with reason and thought.”

Jakeway is optimistic. “We are in the best position ever in all my years here,” said Jakeway, who has worked in Georgia public health since 1989.

Others are still concerned with how the state will fund the many programs that aid countless Georgians and the increase needed in salaries to compete with the private sector to hire more experienced nurses.

“There’s still that perception of the health department as ‘the clinic where the poor people go’ and that’s not all together true; we’re seeing people from all different walks of life,” said Massengill. “But bottom line is I don’t know where the funding is going to come from.”

But many nurses, including Massengill and Tanner, remain hopeful.

“I’m hoping that with [public health] being its own Department, there will be more concentration on what the needs of the community are,” said Tanner.

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