To stay or leave: Public health nurse workforce retention in North Carolina.

States across the country have been experiencing a steady decline in public health nursing workforce, including North Carolina (NC). OBJECTIVES: To better understand retention in the NC Public Health Nurses (PHNs) workforce through an assessment of perceptions of the working environment, stress, intent to stay, and job satisfaction. DESIGN: A cross-sectional online survey using closed and open-ended questions. SAMPLE: The study population comprised of non-supervisory PHNs (n = 672) working at NC local health departments (LHD). MEASUREMENTS: Retention problem, working environment, and job satisfaction measures were adapted from the revised Casey-Fink Registered Nurse Retention Survey© (2009) to fit public health settings. RESULTS: Despite high levels of job satisfaction (79.76%, n = 473), 53% of respondents (n = 323) acknowledged a retention problem within their LHD; 35.32% (n = 203) planned to/considered leaving their position in the next 3 years for reasons other than retirement. ANOVAs and Kruskal Wallis Test results showed that those planning to leave had statistically lower scores on perceived working environment and job satisfaction and demonstrated higher negative stress levels. CONCLUSION: Like other states, NC is experiencing a PHN shortages predicted to worsen in coming years. To retain the current workforce, LHDs need to work to improve PHNs working environment, increase PHNs' pay, and alleviate stressors.

Evaluation of Optimized Procedures for High-Precision Lead Isotope Analyses of Seawater by Multiple Collector Inductively Coupled Plasma Mass Spectrometry.

The application of Pb isotopes to marine geochemistry is currently hindered by challenges associated with the analysis of Pb isotopes in seawater. The current study evaluates the performance of multiple collector inductively coupled plasma mass spectrometry (MC-ICP-MS) measurements of seawater Pb isotope compositions following Pb separation by either solid-phase extraction with Nobias Chelate PA-1 resin or coprecipitation with Mg(OH)2 and using either a Pb double spike or external normalization to Tl for mass bias correction. The four analytical combinations achieve results of similar quality when measuring 1-7 ng of seawater Pb, with reproducibilities (two standard deviations, 2SD) of 100-1200 ppm for 206Pb/207Pb and 208Pb/207Pb and 300-1700 ppm for ratios involving the minor 204Pb isotope. All four procedures enable significantly improved sample throughput compared to an established thermal ionization mass spectrometry (TIMS) double-spike method and produce unbiased seawater Pb isotope compositions with similar or improved precision. Nobias extraction is preferable to coprecipitation due to its greater analytical throughput and suitability for analyses of large seawater samples with high Si(OH)4 contents. The most accurate Pb isotope data are produced following Nobias extraction and double-spike correction as such analyses are least susceptible to matrix effects. However, Nobias extraction with Tl normalization constitutes an attractive alternative as, unlike the double-spike procedure, only a single mass spectrometric measurement is required, which improves analytical throughput and optimizes Pb consumption for analysis. Despite the advantages of solid-phase extraction, coprecipitation represents a useful Pb separation technique for samples with low to moderate Si contents as it is inexpensive, simple to implement, and the data are only marginally less accurate, especially when combined with a Pb double spike for mass bias correction.

Quad Council Coalition community/public health nursing competencies: Building consensus through collaboration.

BACKGROUND: The changing professional environment for community/public health nursing practice necessitates competencies grounded in current evidence-based practice. The Quad Council Coalition (QCC) appointed a Task Force to revise the 2011 QCC Competencies for Public Health Nursing. The goal of the competencies is to guide professional nursing practice, curricula, research, and policy development. This paper describes the process used to develop the revised 2018 Competencies. METHODS: A biphasic Delphi technique was used to conduct a detailed examination and build consensus. Four individuals representing community/public health practice and education collaborated to identify and implement a systematic process for revising the QCC Competencies. The process included multiple iterations of review and feedback using consistent methods and tools to analyze and synthesize themes. RESULTS: The primary result of this project is the 2018 QCC Competencies document that has strong consensus and provides a coherent voice from professionals on the practice of community/public health nursing. DISCUSSION: Use of current QCC Competencies will strengthen the community/public health nursing capacity to positively impact the health and well-being of populations.

Neodymium in the oceans: a global database, a regional comparison and implications for palaeoceanographic research.

The neodymium (Nd) isotopic composition of seawater has been used extensively to reconstruct ocean circulation on a variety of time scales. However, dissolved neodymium concentrations and isotopes do not always behave conservatively, and quantitative deconvolution of this non-conservative component can be used to detect trace metal inputs and isotopic exchange at ocean-sediment interfaces. In order to facilitate such comparisons for historical datasets, we here provide an extended global database for Nd isotopes and concentrations in the context of hydrography and nutrients. Since 2010, combined datasets for a large range of trace elements and isotopes are collected on international GEOTRACES section cruises, alongside classical nutrient and hydrography measurements. Here, we take a first step towards exploiting these datasets by comparing high-resolution Nd sections for the western and eastern North Atlantic in the context of hydrography, nutrients and aluminium (Al) concentrations. Evaluating those data in tracer-tracer space reveals that North Atlantic seawater Nd isotopes and concentrations generally follow the patterns of advection, as do Al concentrations. Deviations from water mass mixing are observed locally, associated with the addition or removal of trace metals in benthic nepheloid layers, exchange with ocean margins (i.e. boundary exchange) and/or exchange with particulate phases (i.e. reversible scavenging). We emphasize that the complexity of some of the new datasets cautions against a quantitative interpretation of individual palaeo Nd isotope records, and indicates the importance of spatial reconstructions for a more balanced approach to deciphering past ocean changes.This article is part of the themed issue 'Biological and climatic impacts of ocean trace element chemistry'.

The oceanic budgets of nickel and zinc isotopes: the importance of sulfidic environments as illustrated by the Black Sea.

Isotopic data collected to date as part of the GEOTRACES and other programmes show that the oceanic dissolved pool is isotopically heavy relative to the inputs for zinc (Zn) and nickel (Ni). All Zn sinks measured until recently, and the only output yet measured for Ni, are isotopically heavier than the dissolved pool. This would require either a non-steady-state ocean or other unidentified sinks. Recently, isotopically light Zn has been measured in organic carbon-rich sediments from productive upwelling margins, providing a potential resolution of this issue, at least for Zn. However, the origin of the isotopically light sedimentary Zn signal is uncertain. Cellular uptake of isotopically light Zn followed by transfer to sediment does not appear to be a quantitatively important process. Here, we present Zn and Ni isotope data for the water column and sediments of the Black Sea. These data demonstrate that isotopically light Zn and Ni are extracted from the water column, probably through an equilibrium fractionation between different dissolved species followed by sequestration of light Zn and Ni in sulfide species to particulates and the sediment. We suggest that a similar, non-quantitative, process, operating in porewaters, explains the Zn data from organic carbon-rich sediments.This article is part of the themed issue 'Biological and climatic impacts of ocean trace element chemistry'.

The geochemical behavior of Cu and its isotopes in the Yangtze River.

Copper (Cu) isotopes can be a useful tool to constrain the interaction of water and the environment, but they have not been widely applied to riverine research in the preceding decades. Isotopically heavy Cu in rivers (global average: about +0.7‰) compared to rocks (at about 0‰) has been attributed to: a) the mobilization of heavy Cu during oxidative weathering, and b) partitioning between an isotopically heavy, organically complexed dissolved pool, and an isotopically light pool adsorbed to particulates. Here, we report Cu concentrations and isotope ratios of the main stream of the Yangtze River and its several tributaries. We find that the Yangtze River exhibits anomalously heavy Cu isotope compositions compared to other rivers: δ65CuNIST 976 of dissolved Cu for the main stream, from Chongqing to Nanjing, ranges from +0.59 to +1.65‰, while the tributaries vary from +0.48 to +1.20‰. A negative correlation is observed between Cu concentrations and Cu isotope compositions. We attribute the anomalous Cu isotope geochemistry of the Yangtze River to two key features of the basin: first, the influence of the Three Gorges Dam (TGD), and second, the presence of extensive Cu sulphide deposits close to the lower reaches of the river. In the upper reaches, downstream towards the TGD, δ65Cu values increase as Cu concentrations decrease, reflecting the preferential adsorption of light Cu by sedimenting particulate phases. δ65Cu values continue to increase to a maximum of +1.65‰ in the middle reaches, at Guangxingzhou. The lower reaches, from Jiujiang to Tongling, are characterized by less positive values of δ65Cu (at about +0.60‰), due to the oxidative weathering of Cu sulphide deposits. The overall Cu-δ65Cu trend in the river reflects mixing of these waters from the lower reaches, influenced by Cu sulphides, with waters from upstream, which have lower Cu concentrations and elevated δ65Cu values.

Using the ARCC Model to Implement the 2015 ANCC COA Criteria: A North Carolina Public Health Nursing Project.

In July 2015, the American Nurses Credentialing Center's Commission on Accreditation released updated criteria for continuing nursing education, including updates to the Education Design Process. The primary nurse planner in the Public Health Nursing Approved Provider Unit in North Carolina's Division of Public Health applied the advancing research and clinical practice through close collaboration model and quality improvement strategies to facilitate the adoption and implementation of the 2015 criteria. This article describes an innovative approach to implementation using an evidence-based practice model and quality improvement tools and provides data regarding nurse planners' knowledge of accreditation criteria and role comfort during the first 6 months of implementation. J Contin Educ Nurs. 2017;48(11):501-507.