How Can Health Agencies Support HAI/AR Staff Recruitment and Retention?

Some answers have been edited for clarity.

ERIN LAIRD:
Hello, everyone. My name is Erin Laird, and I'm the director of emerging infections at ASTHO. State and territorial Healthcare-Associated Infection and Antimicrobial Resistance (HAI/AR) programs are critical in HAI prevention and control. HAI/AR programs have had several significant federal investments during the COVID-19 public health emergency. HAI programs need support from state and territorial health agency leaders to meet the requirements of these new investments. That's why ASTHO made a report highlighting eight ways health agency leaders can support HAI/AR programs.

In this interview, I'm speaking with Bryna Stacey, the HAI/AR program coordinator for the Kansas Department of Health and Environment (KDHE), and Kansas' Health Officer, Dr. Joan Duwve, to talk about three of these eight strategies in the report, specifically how health agency leaders can support workforce recruitment, retention, and resiliency in HAI/AR programs.

Bryna, many public health roles evolved during the COVID-19 response as workers adapted to the changing dynamics of the pandemic. How did the roles in your HAI/AR program change during the COVID-19 response?

BRYNA STACEY:
Well, that is a great question. We had a lot of changes in roles and many changes in general. So, a little background: when I started in 2017, it was two epidemiologists and me. That was our program. We were all boots on the ground. We were all doing infection control assessment and response (ICAR)—often in a team but sometimes alone. And so, a big change that came about during the pandemic was that we had even more need to meet as far as response due to all the COVID-19 outbreaks in long-term care and other settings. So, having just three of us was not going to cut it anymore.

With all the increase in work, we also got a boost in funds via the Strengthening HAI/AR Program Capacity (SHARP) supplement, which was great. We were told to increase our team, so I did just that. I got a few more epidemiologists. I brought on about seven infection preventionists as well as some contracted infection preventionists. And it's been amazing because, with that increase of people, we've been able to increase the amount of response and help by going directly out on-site and doing ICARs.

LAIRD:
Recognizing the growth of your program, are there things that you're doing to support the retention of this new HAI/AR workforce?

STACEY:
Getting that expertise is already hard enough. We're state public health; we're not super competitive as far as pay. So that's something that I think we've all at least tried to justify, and we've tried to put those slightly higher pay rates that we can, especially when we are bringing in people who have a nursing background, infection preventionist background, things like that. That's something that I've tried to work on, and I've heard some others say it as well. I'm also working with our HR team here at KDHE to bring on or implement a promotional-level system for staff and the HAI/AR team.

LAIRD:
Dr. Duwve, the new SHARP funding from the American Rescue Plan Act emphasized the need to build and sustain a strong public health workforce and provided states access to necessary resources for comprehensive HAI/AR programs. How can state and island area health officials support HAI/AR programs with the recruitment of a trained workforce?

JOAN DUWVE:
Thank you for that question. It's a difficult question. It's a challenge to find and recruit staff with education specifically in the niche area of HAI/AR—in infection prevention. Infection preventionists have such a specific role that there's really no formal training opportunity in higher education. A lot of what they do they learn on the job. And because public health salaries really can't compete with clinical salaries, the HAI programs across the country either can't find staff willing to work for what we can pay them, or when we can hire staff and get them trained, it isn't unusual for them to leave to work in a hospital for a higher salary. We are essentially training infection preventionists who may move on and work elsewhere. But that isn't all bad. We're training a network of infection preventionist partners who will work with us to support the public health system wherever they might land.

We also know there's a lot of work and demand for HAI/AR staff. We have to remember to balance the hiring of more staff to meet the demands of program expansion with our funding so that we can sustain any increase in the level of work that we do. Much of our funding comes from federal programs. And so, we have to think about what happens next year or the year after, when we may have a different level of funding and may not be able to support any program expansions.

At KDHE, we try to compensate for lower salaries by creating a great work environment that offers hybrid and fully remote work opportunities and recognizing the great work that staff are doing across the agency. A couple of ways we do that is by valuing each individual and trying to be supportive of their needs. We have great policies for working parents, such as allowing parents to bring their infants to work. We also have lactation rooms to support new moms. And because parents can work from home, they don't need to take sick days if they have to stay home with an ill child. They can be home with that child and do their work from the comfort of their own home.

Those hybrid and fully remote positions benefit the employee and provide opportunities for us at KDHE to tap into talent across the state. People may live in different regions of the state and may want to stay there; their families have been there for years. And so, we're able to hire them where they are. Having infection preventionists in the far reaches of our state means they can be hands-on during ICAR visits at hospitals and nursing homes.

We also know that opportunities for advancement are critical for staff retention. Bryna is doing a great job developing promotional levels for HAI/AR program staff, similar to what KDHE has already put in place for our epidemiologists. So that's important because staff can see a path for them to develop leadership and supervisory skills. And, hopefully, they will choose to stay and grow with us here at KDHE.

And one more thing. It's important to recognize staff for their hard work and dedication to the citizens of Kansas. And we know that during the COVID-19 response, our infection preventionists have given 200%. We have prioritized formalizing staff recognition and put into place some programs to make sure that staff know how much we appreciate all the hard work they have done.

LAIRD:
Thank you, Dr. Duwve. Another important workforce issue that the pandemic brought to the forefront was our frontline workers' mental health and well-being. The ceaseless demands of the COVID-19 pandemic response took a tremendous toll on the mental health of the public health workforce. While we continue to see improvements, there's still work to do to support the workforce's mental health. Bryna, can you talk about how the Kansas HAI/AR program has supported staff mental health and well-being?

STACEY:
Something we'd always tried to do and found beneficial was to send more than one person on an on-site visit because it relieves the burden of all the pressure being on one person and is an opportunity to bounce ideas off someone else. That's something that we've continued to do, and we've only been able to do more with the increased team.

On top of that, I also implemented a rotating schedule of sorts where each person only does a certain number of ICARs a week, and each person has a full week of travel off from ICARs because it can be a lot—having done it before I know that just traveling can be a lot. So, I had to implement this for their well-being. I was worried they were going to burn themselves out.

LAIRD:
Thank you for sharing your experience and perspective from the HAI/AR program, Bryna. Those are some great examples of policies and practices that helped prevent or manage burnout.

I would also like to hear from Dr. Duwve on how the health department can support its workforce. What plans does your agency have for supporting the mental health and well-being of your staff moving forward?

DUWVE:
It's important for staff to feel like we are listening to and supporting them. We must think about how we support the dimensions of their lives outside of their work at KDHE, not just what they can do for us as employees.

As a mom with two young children during my medical residency program, one of my senior residents offered me some grace I will never forget. My kids were sick, and I was on call in the ICU when she looked at me and said, "You know, I can find someone else to do this. But your kids only have one mother; you need to go home."

At KDHE, we value each individual, and we try to be supportive of their needs. As I've mentioned, we have policies for working parents and opportunities to work from home if you have a sick child. Also, the hybrid and fully remote positions not only benefit the end employee and KDHE, but they benefit the whole family. They allow individuals not to have to commute to the office, provide a little bit extra time in the day for people to cook a meal, get some exercise, or pursue an interest outside the home and outside of work—it is a chance to nurture themselves. We hope that this helps keep our employees happy and healthy, and then, when they come into the office or turn on their computers and work from home, they're ready to give 100%.

LAIRD:
Dr. Duwve, I would love to close out by hearing from you on the most important thing you have learned about the role and value of the HAI/AR program and how it has helped Kansas in the last couple of years.

DUWVE:
One thing that COVID-19 taught me was how critical the HAI/AR program is for keeping our older Kansans and our healthcare workforce healthy, especially in our long-term care facilities. Bryna was able to significantly expand the infection preventionist program early on during the pandemic, and I know that this expansion saved the lives of Kansans.

LAIRD:
Thank you both for sharing your insights and experiences on how HAI/AR programs and state and island area health agencies can build and support the HAI/AR workforce. Continued partnership between HAI/AR programs and health agency leadership is critical to infection prevention, detection, and response efforts. I encourage everyone listening to check out the ASTHO report titled “Eight Ways Health Department Leaders Can Support Effective HAI/AR Programs” for more insight on how health departments can bolster their HAI programs.