Innovative Strategies in a New Decade of Public Health Nursing

Houston Department of Health and Human Services (HDHHS) Nursing Administration (NA) has been challenged with providing quality public health services amidst nursing staff shortages. Three components are critical to successful delivery of clinical public health services: • Nurse retention; • Skill competency and training; and • Morale.

Nursing Administration (NA) has experienced a significant decrease in nursing staff. These employees include Certified Medical Assistants, Clinical Assistants, Licensed Vocational Nurses, and Registered Nurses. In 2002, NA employed 224 staff members compared to 88 in 2009. In light of staff shortages and budget limitations, NA was challenged to identify and address factors that effect nurses' performance, skills, and motivation. By implementing related strategies, HDHHS believes that retention, skills and morale will be improved and a model for public health nursing will be evolved.

To address the decline in nursing staff, waning work satisfaction, and to enhance training opportunities, Nursing Administration implemented a nursing staff training program beginning with unlicensed staff to administer medications. The CITEE (Competent Intelligent Empowered Employee) Business Training Program includes the development and enhancement of skills for the Certified Medical Assistants. This training will result in: • Effective service delivery; • Reduced work load demands; and • Improved morale. These factors combined will increase retention rates.

This training program is being implemented in phases. In 2004, the first phase of CITEE Business focused on Clinical Assistants becoming Certified Medical Assistants (CMAs). In 2009, the second phase was focused on training CMAs to administer medications. In 2009, in partnership with HDHHS' Human Services Bureau, phase three was launched. It incorporates specialized human services training and coaching for all levels of nursing staff. Training and activities include: • Improved customer rapport and service delivery; • Social determinants of health; and • The relationship between mental and physical health.