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NC Public Health Nurse Mentoring Orientation materials. Background. Retention problems exist in all of nursing but are particularly problematic in public health Nurses entering governmental public health nursing positions appear to have knowledge deficiencies in areas such as:

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Retention problems exist in all of nursing but are particularly problematic in public health

Nurses entering governmental public health nursing positions appear to have knowledge deficiencies in areas such as:

Population focus


Health education


Case management



  • Challenges exist attracting, recruiting and retaining public health nurses
  • Public health nursing workforce is aging
  • The cost of turnover in one position is @ 75% of the annual salary of that position.

COPE (Committee on Practice and Education) of NC Association of PHN Administrators has been looking at recruitment and retention issues affecting the specialty field of Public Health Nursing. Mentoring has been identified as an effective tool in assuring the successful transition of nurses to public health.

what is mentoring
What is Mentoring?

Mentoring is a deliberate pairing of a more skilled or more experienced person with a less skilled or less experienced one, with the mutually agreed goal of having the less skilled person grow and develop specific competencies.

(Murray, 2001)

what is mentoring6
What is Mentoring?

Mentoring is a personalized one-on-one approach to learning grounded in a personal and professional relationship between a mentee (the learner) and the mentor (the teacher).

(Goldman & Schmalz, 2001)

definition of mentoring
Definition of Mentoring
  • A teacher and educator
    • “be available to help learn a new topic or area”
  • Support
    • “support person…in a nutshell”
  • A resource
    • “go to person”
  • A guide and leader
    • “coaching-building on big picture”
  • Experienced
    • “someone to show you the ropes”
  • Role model
    • “ someone you trust and respect”

They Are Different!

  • Mentoring
      • Precepting
benefits of mentoring
Benefits of Mentoring
  • To Mentor
    • Shares their successes and achievements with the mentee
    • Practices interpersonal and management skills
    • Expands horizons
    • Gains insight from mentee’s background
    • Reenergizes own career
    • Enlists an ally in promoting the organization’s well-being
    • Increases network of colleagues
    • Recognizes and increases skills in leadership & coaching
    • May reduce turnover and additional work
benefits of mentoring11
Benefits of Mentoring
  • To Mentee
    • Gains an active listening ear
    • Receives valuable direction
    • Learns a different perspective
    • Gains from mentor’s expertise
    • Receives critical feedback in key areas
    • Develops sharper focus
    • Learns specific skills and knowledge
    • Gains knowledge about the organization’s culture & unspoken rules
    • May reduce turnover and additional work
  • Mentor
    • Introduces population-based nursing concepts
    • Ensures two-way open communication
    • Assists in establishing parameters of partnership
    • Provides as much career path information as possible
    • Shares information about career opportunities and resources
    • Shares information about own job and resources
    • Provides encouragement
  • Mentor - cont’d
    • Monitors and provides sensitive feedback and guidance
    • Follows through on commitments
    • Acts as a role model
    • Respects confidentiality of information shared by mentee
  • Mentee
    • Is willing to learn and grow
    • Accepts advice and provides mentor with feedback
    • Takes on new challenges
    • Remains available and open
    • Is proactive in relationship
    • Identifies goals
    • Accepts responsibility for own development
    • Demonstrates commitment to the relationship
key considerations
Key Considerations


  • Is willing to spend a minimum of two hours/month with mentee
  • Is committed to attending mentor training and yearly updates of training
  • Exhibits characteristics such as:
  • Coaching
  • Motivating
  • Leadership
  • Listening
  • Advising
  • Proficiency in practice
  • Sharing
  • Encouraging
  • Willing to share knowledge & expertise
  • Is committed to the mentoring process
  • Has the ability to create a learning environment
key considerations mentees
Key Considerations Mentees
  • Is a new employee, where new is defined as a nurse who is new to working in a public health agency or a nurse who is in a new role in a public health agency
  • Has a working knowledge of career goals and objectives
  • Is willing to set aside time to meet with mentor
  • Is committed to participating
  • Is open to suggestions and feedback from the mentor
what is public health nursing
What is Public Health Nursing?

Public Health Nursingis the practice of promoting and protecting the health of populations using knowledge from nursing, social and public health sciences.

(APHA, Public Health Nursing Section, 1996.)

cornerstones of public health nursing
Cornerstones of Public Health Nursing
  • Public Health
  • Population based
  • Grounded in social justice
  • Focus on greater good
  • Focus on health promotion and prevention
  • Does what others cannot or will not
  • Driven by the science of epidemiology
  • Organizes community resources
  • Long-term commitment to the community
  • Nursing
  • Relationship based
  • Grounded in an ethic of caring
  • Sensitivity to diversity
  • Holistic focus
  • Respect for the worth of all
  • Independent action

Cornerstones of PH Nursing, Minnesota Department of Health , revised 2007

population based care vs
Population-based care vs.

Individual Medical care:

  • Individual Medical Care
  • Goal is a healthy person
  • Primarily focuses on current patient
  • conditions, and prevention of onset of new conditions in a particular person
  • Primary strategies are biological (medication, surgery, for example), with information and education as a supplement
  • Advocates for services for specific patients,
  • and for exceptions or adaptations to policies
  • to accommodate those patients
  • Uses medical research to determine the most appropriate care for a particular patient
  • Recognizes the impact of environment on specific patients with specific conditions. This might include presence of respiratory triggers for patients with lung diseases, or availability
  • of appropriate food for diabetics.

Population-based Care

  • Goal is an overall healthy population
  • Might involve health-improvement goals for a community or sub-set of a community that are many years (even a generation) away
  • Primary intervention strategies are provision of information, education, and communication.
  • Collaborates with other community groups to advocate for policies that will allow and encourage healthy behaviors
  • Uses community health data to plan strategies, based on the specific demographics, strengths, and weaknesses of a particular community
  • Has a broad awareness of the environment’s impact on health. This includes such things as safe food and water, sidewalks in good repair, availability of transportation, housing quality, etc.
population focus
Population Focus
  • Individuals present in clinic with communicable disease—treat individual
  • Identify population needs for disease
    • Preventing transmission
    • Communicating to your population
    • Providing treatment
  • Example: Ringworm
vulnerable populations
Vulnerable Populations

Health Disparities

Health Literacy

definition of vulnerable populations
Definition of Vulnerable Populations
  • Greater risk for poor health status and/or problems with access to health care
  • Higher probability of illness and worse health outcomes than others.
  • Multiple risk factors interact to limit resiliency.
vulnerability is multidimensional
Vulnerability is Multidimensional
  • Resource limitations
    • Economic (poverty and link to hazardous
    • environments and in adequate nutrition)
    • Educational (ability to understand health
    • information and make informed choices)
    • Social(support system)
    • Health status (physical, biological, psychological)
    • Health risk (lifestyle, environmental)

Health Disparities

  • Differences in quality of care and health outcomes by age, gender, race, ethnicity, education, income, disability, sexual orientation or geography due to:
      • Patient level factors (e.g., biology, behaviors)
      • Provider-level factors (e.g., stereotyping)
      • System factors (e.g., lack of insurance)
      • Social and political factors
connecting the terms
Connecting the Terms
  • Vulnerable population groups are most likely to experience health disparities in access to care, quality of care and health outcomes.
health literacy
Health Literacy

"The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions".

  • From Healthy People 2010
institute of medicine a prescription to end confusion
Institute of Medicine A Prescription to End Confusion

“Ninety million people in the United States, nearly half the population, have difficulty understanding and using health information”

how can nurses make a difference
How can nurses make a difference?
  • Identification (outreach and case finding)
  • Linking to health services (case manager)
  • Developing or revising programs to meet their needs
  • Educating them on how to promote health
  • Providing direct care
  • Advocating for programs and services to meet their needs


Gabriela Zabala

Office of Minority Health and Health Disparities

NC Department of Health and Human Services

Forest Toms, PhD

Training Research & Development, Inc. , Hickory, NC


To build the foundation for culturally appropriate health services capable of serving an increasingly diverse population.

when we think
“Whenwe think…

of Culture, we think of mainstream America; but when we think

of Diversity the tendency is to think of minority groups.”

american culture
“American Culture”
  • White middle-class values
  • Dominant culture
  • Mainstream culture
  • European – American (Anglo)
assumptions approaches to diversity
what s in a name
What’s In a Name?
  • African American – Black, Africans, Carribeans
  • Hispanic/Latino– Mexican, Puerto Rican, Cuban, Salvadorian, Ecuadorian, Argentinan, Honduran, Dominican, etc
  • European/Anglo– White
  • American Indian – Native American, Alaska Native, Aleutian
  • Asian– Chinese, Filipino, Korean, Japanese, Vietnamese, Cambodian, Laotian, Hmong, Pacific Islander (Polynesian, Melanesian, Micronesian)
us population composition 1990 2050
US Population Composition 1990 - 2050

American Indian

Asian/Pacific Island





American Indian

Asian/Pacific Island





American Indian

Asian/Pacific Island





Source: U.S. Census Bureau

Percentage of US Population

dimensions of diversity
Dimensions of Diversity
  • Primary
    • Largely unchangeable human differences
    • Inborn
    • Influence our early socialization
  • Secondary
    • Can be changed
    • Differences we acquire, discard and modify throughout our lives
primary dimensions of diversity











TRD,Inc. All Rights Reserved

Primary Dimensions of Diversity
secondary dimensions of diversity



Work Experience





Marital Status






TRD,Inc. All Rights Reserved

Secondary Dimensions of Diversity
  • Behavior patterns, arts, beliefs, institutions, and all other products of human work and thought
  • American Heritage Dictionary, 1991
  • A view of the world and a means of adapting to the world
  • Bilingual Health Initiative Task Force, 1994
  • Is reflected in, and influences beliefs and values, communication styles, health beliefs and practices
culture helps us
Culture Helps Us…

Organizes Our Physical

And Social Interaction

Forms Our


Shapes Our Understanding

And Perceptions

culture defines
Culture Defines

Family Roles

Family Structure




Family Relationships

Styles Of



beliefs and values
Beliefs and Values
  • What we are used to thinking and doing
  • What we feel or know is right, good, important
  • Complex concepts with many dimensions
  • Influence all other area of life and activity
  • Affect how people think, feel, act
  • Can cause conflict if people’s
  • beliefs and values are not
  • incorporated in health
  • recommendations
overview of beliefs comparison of common values
Overview of BeliefsComparison of Common Values
  • Anglo-Americans
    • Mastery over nature
    • Personal control over the environment
    • Doing-activity
    • Time dominates
    • Human equality
    • Individualism/privacy
    • Youth
    • Self-help
    • Competition
    • Future orientation
    • Informality
    • Directness/openness/honesty
    • Practicality/efficiency
    • Materialism
  • Other Ethnocultural Groups
    • Harmony with nature
    • Fate
    • Being
    • Personal interaction dominates
    • Hierarchy/rank/status
    • Group welfare
    • Elders
    • Birthright inheritance
    • Cooperation
    • Past or present orientation
    • Formality
    • Indirectness/ritual/”face”
    • Idealism
    • Spiritualism
culture and healthcare
Culture and Healthcare


Healthcare Facilities

health status minority groups
Health Status – Minority Groups
  • High risk for:
    • Heart disease, diabetes, cancer, homicides, infant mortality – African Americans
    • Stroke/diabetes, MVA, infant mortality American Indian
    • Diabetes, MVA, homicide - Hispanics
    • Diabetes - Asians/Pacific Islanders
  • Teen pregnancy
    • African Americans
    • American Indians
    • Hispanics
barriers to health services
Barriers to Health Services
  • High rates of poverty
  • Unemployment
  • Cost of care
  • Lack of insurance
  • Location and hours of services
  • Lack of transportation
  • Lack of information
  • Language
  • Cultural differences between providers and clients
definition of cultural competence
Definition of Cultural Competence
  • The process is ongoing and continuous.
  • Cultural competence is a dynamic, developmental process and a state towards which we should strive, it takes a long-term and consistent commitment to achieve.
  • It is not something that comes to the individual, the agency, or the system through a one-shot, quick-fix approach.
cultural competency continuum
Cultural Competency Continuum

Culturaldestructiveness -- attitudes, policies, and

practices that are harmful to cultures and hence to individuals within the culture.

Culturalincapacity -- the system or agencies lack(s) the capacity to help minority clients or communities. There is much bias.

Culturalblindness -- the system and agencies provide(s) services with the belief that they are unbiased. The premise is that services are universally applicable.

moving towards the goal
  • There must be a willingness and courage to confront all the feelings and attitudes that cultural competence and change indicate for the individual, the agency, and society in general.
  • As Pinderhughes (1989) states, the multicultural staff engages in dialogue about their differences in perceptions and experiences.
  • Failure to provide the opportunity to understand and process these differences among a multicultural staff can produce two outcomes:
      • staff will cover over the conflict in perceptions and orientation and block off the confusion, frustration, and strong feelings.
      • conflict can erupt and staff will become burned out and fatigued.
before taking action
  • Agencies should understand cultural dynamics and the significance of cultural identify for themselves, their clients, and their work together.
  • Opportunities for sharing and dialogue must be built into the structure of the agency or organization seeking to become
  • more culturally competent.
understanding the agency environment

As part of the agency’s commitment, it should be recognized that cultural diversity and cultural competence require an understanding of the sociopolitical environment in which an agency operates.

mentoring agreement
Mentoring Agreement

Once matched, the pair should write up a formal mentoring agreement to clarify their roles with one another. This agreement can determine the framework of the relationship.


Getting Started

  • Schedule first meeting within one week of matching
  • Review goals and objectives
  • Discuss goals and objectives and activities
  • Complete mentoring agreement
  • Exchange contact information and schedules as necessary
  • Maintain twice monthly contacts
  • Check in with contact person to share progress
  • “Close” the relationship after designated time
keeping momentum going
Keeping Momentum Going
  • Beyond goals in contract
  • Discuss networking opportunities, NC Public Health Nursing
  • Teach mentee about day-to-day LHD operations
  • Schedule visits or shadowing opportunities to other LHD clinics and services
  • Focus on work-life balance issues

Work Issues

  • Plan
  • Keep mentoring a priority
  • Acknowledge / deal with conflicts
overcoming barriers
Overcoming Barriers


  • Set a calendar
  • Nurse supervisor support
  • Facilitate approaching supervisor


  • Time
  • Other priorities
  • Role tensions
crisis management
Crisis Management
  • Changing from individual to population focus
  • Addressing health department priorities
  • Problem solving
health department priorities
Health Department Priorities
  • Require staff adjustments
    • Job priorities
    • Work schedules
    • Implementing protocols
  • Priority changers
    • Communicable disease outbreak
    • Weather events (hurricanes, floods)
    • Influx of immigrants
health department problem solving exercise
Health Department Problem Solving: Exercise
  • Ethical dilemmas
    • Client treatment
    • Work performance
  • Potential dilemmas
  • What are your health dept policies and protocols on these issues?
  • How should you be involved to work with mentee?
additional resources
Additional Resources
  • Nurse Mentoring Manual
  • Website—NC Public Health Nursing