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.

The Adaption of the Work Environment Survey for Public Health Nurses.

The study presents the iterative process of the adaption and psychometric properties evaluation of the Work Environment/Support/Encouragement section of the Revised Casey-Fink Nurse Retention Survey© (2009) to measure the work environment of public health nurses (PHNs). This secondary data analysis was based on data collected from a convenience sample of 596 PHNs across North Carolina that were originally used to study PHNs workforce retention. Classical test theory analyses were used to evaluate scale reliability and identify potential problematic items that were further examined from a substantive perspective using content validity survey. Confirmatory factor analysis and exploratory factor analysis were performed to evaluate the construct validity and assist further development of the scale. Analyses suggest a three-factor structure for the retained 19-item scale including managerial support, professional nursing role, and recognition, with reliability ranging from alpha of .859 to .959.