MPH 560 Week 5 Public Health Workforce Analysis Example

Twenty-Nine Vacancies and an Exit Interview Pile: Analyzing Recruitment and Retention in a County Health Department's Workforce

[Student Name]

University of Phoenix

MPH/560: Public Health Systems and Services Administration

Week 5 Assignment

[Instructor Name]

[Date]

The county health department, its staffing numbers, salaries, exit interview themes and plans are composites written for a model paper; national findings come from the sources cited.

In January, the county health department's human resources manager presented the year's staffing report to the director: 29 of 142 budgeted positions were vacant, including four of seven public health nurse positions, two of five environmental health specialist positions and the department's only epidemiologist. Thirty-one employees had separated during the year, a turnover rate of about 22%. A pile of exit interviews sat on the table. The director asked for an analysis and a plan. This paper provides both.

The Workforce

The department employs nurses, environmental health specialists, health educators, community health workers, nutritionists, epidemiologists, emergency planners, administrative and clinic staff and managers. About 40% of staff have worked there fewer than three years, reflecting pandemic-era hiring and recent turnover. About one in five are eligible to retire within five years.

Where the Vacancies Are

Vacancies concentrate in roles that compete with hospitals and private employers. Public health nurses can earn substantially more at the county's hospitals. Environmental health specialists are recruited by state agencies and consulting firms. Epidemiologists and data analysts are sought by universities and health systems.

What Exit Interviews Said

Exit interviews from the 31 departing employees clustered into five themes: pay below comparable jobs, cited by 18; burnout and workload after the pandemic, 14; limited advancement, 11; supervision and communication, 9; and harassment or hostility from the public during vaccine and mask controversies, 7. Many cited more than one reason.

The National Picture: An Exodus

The department's experience mirrors the nation's. Using workforce survey data from 2017 and 2021, researchers found that nearly half of all state and local public health agency employees in their sample left their organizations between 2017 and 2021, rising to three-quarters among employees 35 and younger or with shorter tenures; if trends continued, more than 100,000 staff could leave by 2025 (Leider et al., 2023a). Half the workforce turned over in four years, and the youngest staff left fastest.

Why People Leave and Stay

The same survey sheds light on intentions. In 2021, 30% of state and local public health employees were considering leaving and 20% planned to retire. Job dissatisfaction was strongly associated with intent to leave, with adjusted odds of 3.8, and pay dissatisfaction, being younger than 36 or older than 64 and being hired for the COVID-19 response also raised the odds; employees who intended to stay cited benefits such as retirement, job stability, flexibility and satisfaction with their supervisor (Leider et al., 2023b).

Reading the Local and National Data Together

Both sources point to pay and dissatisfaction, but they also show that benefits, stability, flexibility and supervisors keep people. That distinction matters for the plan: pay adjustments can reduce departures to hospitals, but they will not fix burnout or poor supervision.

Competency Gaps

The department also faces skill gaps. Staff and managers identified needs in data analysis and visualization, communication with skeptical audiences, policy development and community engagement, and working across sectors. These skills are central to the chief health strategist role that modern public health expects.

The Evidence Base

Workforce planning is hampered by limited research. A systematic review of US public health workforce literature from 1985 to 2010 analyzed 126 documents and found most were descriptive, with few empirical studies, and called for research on workforce effectiveness and measurable outputs to inform capacity planning (Beck & Boulton, 2012). The department will need to evaluate its own strategies rather than rely on proven models.

The Cost of Vacancies

Vacancies carry costs beyond recruitment. With four nurse positions open, home visits to new mothers fell by a third, and the immunization clinic cut its evening hours. Without an epidemiologist, the overdose dashboard went unupdated for three months. Remaining staff covered extra duties, which fed the burnout that drove further departures, a cycle the plan must break.

Who Left

Separations were not evenly spread. Of the 31 employees who left, 17 had worked at the department fewer than three years, and 12 were younger than 36. Nine had been hired with pandemic-era funds and left as grants wound down or as their roles changed. Several bilingual staff left for better-paid jobs, reducing the department's capacity to serve Spanish-speaking residents.

Strategy One: Targeted Pay Adjustments

The department proposed a market study and adjustments for nurses, environmental health specialists and epidemiologists, estimated at $410,000 a year. The cost compares with the expense of recruiting and training replacements, which human resources estimated at about $25,000 per departure.

Strategy Two: Flexibility

Many roles can include hybrid schedules or compressed workweeks. The department will adopt a flexible work policy for eligible positions, a low-cost change that national data suggest helps retention.

Strategy Three: Career Ladders

Creating advancement steps within professions, such as public health nurse I, II and III, lets staff grow without leaving for management or other employers.

Strategy Four: Supervision

Supervisors will receive training in coaching, workload management and recognizing burnout. Stay interviews will be held annually with every employee.

Strategy Five: Protection From Harassment

The department will adopt a policy on public harassment, including security for public meetings, support for staff targeted online and legal guidance.

Strategy Six: Pipeline Partnerships

Partnerships with the local university and community college will offer paid internships in nursing, environmental health and data analysis, creating a path into jobs for local students, including bilingual students.

Strategy Seven: Skill Development

Staff will receive protected time for training in data skills and communication, with a small budget for certifications. Training addresses the competency gaps, and skill development also signals investment in staff, which younger staff named as a reason to stay during the first stay interviews among early-career employees who want to grow.

Costs and Funding

The full plan costs about $560,000 a year, mostly pay adjustments. Reduced turnover could offset part of that cost; halving separations would save roughly $390,000 in recruitment and training.

Measures of Success

The department will track vacancy and turnover rates by profession, time to fill positions, reasons for leaving, results of an annual engagement survey and the share of staff under 36 who stay three years.

Sequencing

The department will start with low-cost steps in the first quarter: the flexible work policy, stay interviews and the harassment policy. Supervisor training and career ladders follow within six months. Pay adjustments require the county's budget cycle and would take effect the next fiscal year, with the market study completed in time to support the request.

Limits

Salary competition with hospitals may outpace what the county can pay. Flexibility is limited for field and clinic roles. The evidence on specific retention strategies in public health is thin.

Conclusion

Twenty-nine vacancies and 31 departures reflect a national pattern of public health workers leaving, especially younger staff. Exit interviews and survey research point to pay, dissatisfaction, supervision and flexibility. A plan combining pay adjustments with flexibility, career ladders, better supervision, protection from harassment and local pipelines addresses those causes, with measures to show what works.

References

Beck, A. J., & Boulton, M. L. (2012). Building an effective workforce: A systematic review of public health workforce literature. American Journal of Preventive Medicine, 42(5 Suppl. 1), S6-S16. https://doi.org/10.1016/j.amepre.2012.01.020

Leider, J. P., Castrucci, B. C., Robins, M., Hare Bork, R., Fraser, M. R., Savoia, E., Piltch-Loeb, R., & Koh, H. K. (2023a). The exodus of state and local public health employees: Separations started before and continued throughout COVID-19. Health Affairs, 42(3), 338-348. https://doi.org/10.1377/hlthaff.2022.01251

Leider, J. P., Shah, G. H., Yeager, V. A., Yin, J., & Madamala, K. (2023b). Turnover, COVID-19, and reasons for leaving and staying within governmental public health. Journal of Public Health Management and Practice, 29(Suppl. 1), S54-S63. https://doi.org/10.1097/PHH.0000000000001634