Low Pay is Making it Hard for Georgia to Keep Public Health Nurses

Georgia has lost more than 20 percent of its public health nurses since just before the Great Recession, in part because they can make a whole lot more working in hospitals and other health care facilities than for the state.

The Department of Corrections is advertising some prison guard positions with a starting salary of $24,000 a year, and heavy turnover in some other areas of state government are costing taxpayers millions in increased training and recruitment costs.

The recession stalled pay raises for more than 200,000 teachers and state employees, and even with a much stronger economy, the government is having a hard time catching up and keeping workers from leaving for better-paying jobs.
Gov. Nathan Deal put extra money in his budget proposal to raise the pay of employees in high-turnover areas, but one top lawmaker, Senate Health and Human Services Chairwoman Renee Unterman, R-Buford, said last week that the state is only giving “lip service” to the need to keep public health nurses.
“We talk about health care transformation when you can’t keep the health care providers you have,” Unterman told Department of Public Health Commissioner Brenda Fitzgerald at a recent budget hearing. “We are getting them out of nursing school, and they won’t go to work for you.”
Similar complaints have come from other areas of state government over the past decade.
The state cut its workforce during the Great Recession and, at the same time, furloughed workers. That meant those who stayed not only didn’t get raises, they saw their pay decline as they were forced to take days off without pay.
Salaries in many areas, such as for prison guards and social work, were already low, and turnover has long been a problem. The pay cuts only exacerbated the situation.
Deal and lawmakers have approved small pay raises of late, but turnover in some areas of state government has continued to be a major problem as workers have been able to find higher-paying jobs in other governments or the private sector.
Legislators have beefed up pay in specific areas, such as the salaries of Department of Natural Resources rangers and GBI staffers. And Deal recommended an extra $40 million in the upcoming year’s budget for special pay boosts for certain employees, such as prison and juvenile justice workers.
A state report found that three jobs — adult and juvenile corrections officers, social workers, and health aides in the Department of Behavioral Health — account for a big chunk of the state’s turnover.
Unterman, a nurse and social worker by training who has long been an advocate for public health programs, is in position to do something about the huge decline in public health nurses. She is vice chairwoman of the Senate Appropriations Committee, which helps write the state budget. She wants to greatly increase the extra $1.8 million Deal recommended go toward helping recruit and retain public health nurses in the upcoming year.
The entry-level salary for a registered nurse in the public health system — $32,418 — is 44 percent below the average starting salary for RNs in Georgia, according to the state Department of Public Health.
In 2003, in the midst of a fiscal recession for state government, Georgia had just under 1,800 public health nurses. In fiscal 2008, just before the Great Recession hit, there were 1,526. Last year the count was 1,196.
“The main problem is, you have baby boomer nurses who are all retiring and the young nurses, if they look at the entry-level pay, they won’t go into public health,” Unterman said. “They love public health, but they just can’t do it and put food on the table.”
Unterman said last week that she hadn’t decided how much more money she plans to request for public health nurses. But she added that a 10 percent raise would cost the state about $2.8 million.
Officials say public health nurses treat some of the state’s most vulnerable people, particularly in rural areas, and that fewer nurses mean delays in detecting and treating diseases, more unplanned pregnancies, and other problems. Unterman called them “frontline” workers when there is an outbreak or natural disaster. She said that the trend is to shift more state health efforts to county public health programs.
Fitzgerald called the nurse decline a “crisis.” She said the job vacancy rate for public health nurses was almost 19 percent last year.
“We really need a basic workforce,” she said.
State Sen. Butch Miller, R-Gainesville, a member of the Appropriations Committee, responded: “We are on your side. We are just as frustrated as you are.”
Monica Swahn, a professor of epidemiology and biostatistics in Georgia State University’s School of Public Health, called nurses the “backbone of the public health system,” and she said the decline in their numbers was “quite alarming.”
“Public health nurses fill a really critical (health care) gap,” she said. “I see this as a larger problem, that the state of Georgia is not investing a lot of money in the public health infrastructure.”
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