Health department mass exodus- am I being paranoid?

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I work for a county health department, and over the last few months there have been so many people leaving for other jobs or retiring. As more people leave, we get spread more thin and even more people get fed up and leave. A few new people have been hired but most have already left and many more are planning to within the next few months (I know this from private conversations with those people only).

Without giving too much identifiable information away, I'll basically summarize that at this point we have only a handful of PHNs left and almost no middle or upper management. I'm worried that there isn't anyone advocating for the PHN division anymore to the upper management in the health department. Since we can't keep the positions full I'm afraid they're going to get rid of the PHN division altogether, lay off the few nurses who are left, and give the more important responsibilities like vaccinations to other divisions within the health department that also have clinical space and responsibilities and are well staffed with LPNs. We used to be able to do a ton of community outreach, home visits, etc, but at this point we are so short staffed we are barely able to staff the vaccine clinic, and without the population based services that we have already all but given up our jobs could really be done by an LPN or MA. I guess the best case scenario would be if they kept public health nursing but re-shifted the focus to the community outreach we all love and came here for, but I'm afraid that without management to advocate for us we will be out of jobs entirely.

They were going to be holding interviews soon for the many open PHN positions and had 12 applicants lined up but just announced they are putting them on hold. It's probably because they need a panel of managers for the interviews and staff to do the new hire training which we don't have enough time or staff for. The other possibility, as I mentioned above, is that major changes are coming and we might all be out of jobs soon.

I've been losing sleep over it because I am an HRSA loan repayment award recipient and I need this job to keep the award and pay off my student loans. Am I just being paranoid? Has anyone else experienced similar issues or seen a health department get rid of public health nursing entirely? I honestly don't even know if that is something they can do but it is my worst fear. Any insight would be appreciated as I feel nobody here at work is being honest with me. Thanks :)

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I heard of something somewhat like what is going on at your health department. At my first nursing job (PHN at a local health department in a rural county) perhaps 3 months before I was hired the middle management for nursing services were all fired and replaced. Then the county laid off all of the clinic based PHN staff (family planning, immunizations, health care for children with special needs) and posted fewer positions than there had been when everyone was laid off. If staff PHNs wanted to work there still they had to reapply for their jobs. Most chose to leave instead, so only a few of the subject matter experts stayed on. Then they brought in "emergency on call public health nurses" (also known as me, and eventually a few other nurses) to work full time positions but without any benefits. Rather than create FTE positions for the areas they needed staffed, they just hired more "emergency on call" positions and reduced hours for that staff and created such a hostile environment that most of the original staff who were rehired after the big lay off either found new work or just quit.

I stayed in that environment for 9 months before I left. It's been about 4 years since all that happened, and from what I understand that county health department has completely outsourced the clinic services to be run by a local FQHC instead of staffing it with PHNs from the county. I'm not sure how it shook up for the home visitation programs (nurse family partnership mostly) because I didn't really interact with that staff.

At any rate, with the scenario you described, I don't think you're being paranoid. It's unfortunate, but it looks like the writing is on the wall. If I was in your shoes, I might be dusting off my resume and start looking for other work in anticipation of needing it soon.

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Thanks for the insight SiwanRN. I'm so sorry you went through that, but I really appreciate you sharing. After looking at the county policies and procedures it seems to me that my health department wouldn't be able to lay us off and make us reapply to our jobs, but I guess there are always loopholes to be exploited. I was hoping for some comforting words about the vital role PHNs play in the community or something like that, but realistically I don't think we're too far off from the scenario you described. Well, nothing to do but wait and dust off that resume. I'm really stressed because I also went into public health right out of nursing school and I'm afraid it'll be hard to find another job without acute care experience. What kind of work are you doing now?

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I am still going strong in public health. :) I did have to move to another county to stay working in a local public health department (my preferred environment, rather than a community health position in an NGO) but it was absolutely worth it to me. There was no room for professional development at my first position. Now I am encouraged to attend public health conferences, cross train to new areas, and participate in my state's public health nurse association. I hope you are able to find a happy ending as well.

When I moved I wasn't able to find a public health position right away so I picked up a PRN gig at a surgical abortion clinic. I kept the side job after being hired full time in public health in order to keep up some acute care skills. It's good to keep a toe in the acute care setting just in case. But if it helps you to know, I was hired at the PRN gig a year out of nursing school with only public health as any real experience outside of school. You can do it! Best of luck to you, and keep us posted.

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That's so encouraging, thank you! I'm glad to hear everything has worked out for you so well! I'll definitely keep you posted.

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I just left Public Health after 14 years. I was tired of 8 years of no raises, administration thinking law enforcement, who goes to the SAME homes, thinking safety was an issue for THEM but not us, and not feeling valued. We were told if we didn't like it we could leave. Several long time nurses have left. Other long time nurses are just waiting a few years to retire. They are being replaced with new grads. No one else will work for the salary they are paying. I was making less than a new grad in a hospital, and I have been a nurse since 1997. Yeah. In CA.

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So here's an update! We had a huge meeting and it went as well as I could expect really. The department director values what the PHNs are doing, and the plan is to all work hard together in the upcoming months to come up with a new vision and plan. He said that PHNs would never go away under his watch, and seemed genuinely hurt that we all thought that's what was happening. We talked about communication, and how the lack of information caused us to think the worst. They explained that the reason why interviews were cancelled for open jobs is because they want the current staff to focus on making a plan and deciding what the PHN division will look like going forward, and then after we have decided all of that we will be able to focus more on training new staff. We talked for hours about what we do and do not want to see going forward. The shift will probably go towards population based services and real community presence and partnerships, as that's what we all really love and are great at. While immunizations are obviously so important for public health, they don't require BSN nurses. Some of the nurses here are true experts in certain areas of public health, and I'm so glad that the department is recognizing this and committing to utilizing our talents out in the community and investing in the professional development of those of us who are not yet "experts" in any particular area. Personally, I would love to specialize in nutrition and breastfeeding. I have completed about half of the classroom hours required and I wanted to sit for the IBCLC exam at some point in the upcoming years, but my 1000 required clinical experience hours have been accumulating so slowly since I've been stuck in the clinic all the time. Hopefully under this new shift I can really pursue that interest and make an effort to do more community teaching about breastfeeding. I'm optimistic now that whatever change is coming is for the best, and I'm so relieved!

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It's great that your director expressed belief in the value of public health nurses! That's a pretty awesome outcome and I'm glad it sounds like you get to stay put in an area of health care that you thrive in. A nurse in one of our home visitation programs just finished her IBCLC certification so I know what a huge amount of effort and dedication it takes to accomplish that. Props to you for pursuing it. As a nursing instructor of mine said... "You've got it. Now, nurse on!"

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I am still going strong in public health. :) I did have to move to another county to stay working in a local public health department (my preferred environment, rather than a community health position in an NGO) but it was absolutely worth it to me. There was no room for professional development at my first position. Now I am encouraged to attend public health conferences, cross train to new areas, and participate in my state's public health nurse association. I hope you are able to find a happy ending as well.

When I moved I wasn't able to find a public health position right away so I picked up a PRN gig at a surgical abortion clinic. I kept the side job after being hired full time in public health in order to keep up some acute care skills. It's good to keep a toe in the acute care setting just in case. But if it helps you to know, I was hired at the PRN gig a year out of nursing school with only public health as any real experience outside of school. You can do it! Best of luck to you, and keep us posted.

This is encouraging! I don't plan to quit anytime soon, but I often worry about what will happen if I want to move on to another job since I don't have acute care experience.

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