1. TM Partnerships for Public Health Nurses (PHN) in TB Care Judy Gibson, MSN, RN Program Evaluation Team (PET) Field Services and Evaluation Branch (FSEB) Division of Tuberculosis Elimination (DTBE) NCHHSTP/CCID/CDC National TB Nurse Coalition June 21, 2010

2. TM Presentation Outline Public Health Nurse (PHN) role and responsibilities in TB program Support for PHNs Responsibility challenges for PHNs Retention of PHNs

3. TM Know Responsibilities Resources / support UseRetain PHNs Recruit and Retain PHNs For TB Care

4. TM PHN Role and Responsibilities in TB* Skills to manage/coordinate medical and social- behavioral concerns Designing contact, source-case investigations Educating patients, contacts, families Identifying ineffective drug therapy regimens and drug toxicities Recognizing patient behaviors for poor adherence and response Developing strategies to encourage completion of therapy

5. TM PHN Role and Responsibilities in TB -Contd. Manage varied service delivery mechanisms (persons with / without medical homes) NTNC develops standards of practice for TB nursing to guide jurisdictions in creating/maintaining this specialized nursing resource * Control Statement 2005

6. TM Strengthen the nursing workforce CDC/ATSDR Nurses Work Group (CNWG) Quad Council of Nursing Organizations Core Competencies (PHN) DHHS,HRSA - Bureau of Health Professions Nurse education Nurse practice Nurse retention National Support for PHN

7. TM National Support for PHN-Contd. Governmental public health organizations: state, local (Association of State and Territorial Directors of Nursing - ASTDN) Infection control nurses (APIC) National Institutes of Health (NIH) Nursing Research (NINR) Advanced practice nurses in primary care

8. TM Regional Support for PHN Regional TB Nurse Groups: California and South East Pacific Island Nurses Network RTMCCs (Nurse Consultants) Francis J. Curry Heartland NJ Medical School Global TB Institute Southeastern

9. TM National, State, Regional Support for Local PHNs National: CDC / DTBE / Nurse Consultant National TB Nurse Coalition (NTNC) Nursing Network E-mail List State and Regional Nurse Consultants Local nurse case managers

10. TM Nursing Network E-Mail List Communication between TB nurses Hosted by CDC Nurse Consultant For state and big city consultants and case managers in TB programs Recent information sharing requests Intravenous medication primary care procedures Medicaid coverage for TB Nursing care plans for TB Satisfaction with safety needle products for TST Suicide precautions for cycloserine monitoring

11. TM Responsibility Challenges for PHNs Assure TB services provided, by Encouraging action by other entities (primary care) Requiring action through regulation Providing services directly in health department Patients with medical homes Primary care services for TB to populations living in medically underserved communities Clinical nursing information system (CNIS) for TB “Meaningful Use” of EHR and Medicare billing

12. TM Responsibility Challenges for PHNs Electronic health records (EHR) and “meaningful use” criteria for Medicare (2010- 2015) ePrescribing and refills Lab results into EHRs Public health reporting Sending clinical summary to providers and patient Personal health record (PHR) access Receiving health alerts Automated real-time surveillance

13. TM PHN Retention Issues - National Survey* TB nurses responded - 737 Percentage retiring 5 years: 34% 10 years: 75% Encounter complex TB cases Co‑morbidity, drug resistance, severity of disease, missed and delayed diagnosis Social, cultural and ethnic challenges *NTNC, 2008

14. TM Retention Strategies for PHN Develop effective orientation program Train front-line supervisors, managers and administrators Clearly define roles and responsibilities Reduce the paperwork burden (convert to electronic format) Foster an environment of teamwork (local, state, federal)

15. TM Know Responsibilities Resources / support UseRetain PHNs Recruit and Retain PHNs For TB Care

16. TM Any Questions? 16

17. TM Judy Gibson 404-639-5322 jsgibson@cdc.gov jsgibson@cdc.gov