Health departments have a historic opportunity to bolster their workforce due to new funding. Yet they often do not have accurate or updated job descriptions or short, attention-grabbing job postings, to use as marketing tools for recruitment. New research by researchers at Columbia University Mailman School of Public Health provides examples of evidence-based job descriptions and postings that health departments can now use.

The study is the first attempt to compile existing occupation-specific job task analyses, lists of competencies, and certifications across multiple job types within governmental public health that can allow comparisons of skills, competencies, and job tasks between different public health occupations. The findings are published online in the Journal of Public Health Management and Practice(link is external and opens in a new window).

“Our aim was to review job descriptions and postings to ensure they would serve as attractive recruitment marketing tools that follow best practices and avoid implicit bias in the language used,” said Heather Krasna, PhD, EdM, associate dean, Career and Professional Development, Columbia Mailman School. “Clear job postings with specific, concrete job requirements are more likely to generate targeted, qualified applicants and can be an important part of attracting a diverse candidate pool.”

Utilizing $3 billion from the American Rescue Plan(link is external and opens in a new window) funding for workforce development in the public health workforce to mount a large-scale recruitment effort—especially one large enough to begin to replenish the depleted governmental public health workforce—new and creative methods could help attract job candidates. Even before the COVID-19 pandemic, the public health workforce had experienced challenges with attracting and retaining workers, partly due to competition from other sectors and perhaps due to complexities caused by civil service hiring, lower salaries, and slow hiring processes.

Employers need internally facing job descriptions—detailed documents that provide guidance to new hires that can serve as a rubric for performance reviews, noted the researchers. “But they also need job postings that are shorter, externally facing documents and optimized for Internet search engines,” observed Krasna.

To create these job descriptions, Krasna and colleagues conducted a literature review, interviewed public health leaders and recruitment specialists, reviewed existing resources, searched the gray literature for existing job task analyses, and reviewed and synthesized hundreds of recent job postings using both current job boards and a large-scale database of job postings. They also utilized the 2014 National Board of Public Health Examiners’ job task analysis data, information from the U.S. Department of Labor’s O*Net Online resource, and existing occupation-specific job task analyses or certification information. They synthesized the information to create position descriptions for 24 jobs common in governmental public health settings.

To ensure the descriptions were accurate, they then gathered feedback from current public health professionals in each field and finally engaged a recruitment marketing expert to change the job descriptions into advertisements.

“Although job titles may not presently be well standardized, we believe that gathering data on job descriptions could also help the U.S. Department of Labor’s Bureau of Labor Statistics to better standardize and track public health occupations,” said Krasna.

Co-authors are Phoebe Kulik, University of Michigan School of Public Health; Harshada Karnik, and Jonathon Leider, University of Minnesota.

The project was supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services (grant UB6HP31684 Public Health Training Centers).

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Health care workers in about half the states face a Thursday deadline to get their first dose of the COVID-19 vaccine under a Biden administration mandate that will be rolled out across the rest of the country in the coming weeks.

While the requirement is welcomed by some, others fear it will worsen already serious staff shortages if employees quit rather than comply.

And in some Republican-led states that have taken a stand against vaccine mandates, hospitals and nursing homes could find themselves caught between conflicting state and federal demands.

“We would like to see staff vaccinated. We think that it’s the safest option for residents, which is our biggest concern,” said Marjorie Moore, executive director of VOYCE, a St. Louis County, Missouri, nonprofit that works on behalf of nursing home residents. “But not having staff is also a really big concern, because the neglect that happens as a result of that is severe and very scary.”

The mandate affects a wide swath of the health care industry, covering doctors, nurses, technicians, aides and even volunteers at hospitals, nursing homes, home-health agencies and other providers that participate in the federal Medicare or Medicaid programs.

It comes as many places are stretched thin by the omicron surge, which is putting record numbers of people in the hospital with COVID-19 while sickening many health workers.

Nationwide, about 81% of nursing home staff members already were fully vaccinated as of earlier this month, ranging from a high of 98% in Rhode Island to a low of 67% in Missouri, according to the federal Centers for Medicare & Medicaid Services. The data is unclear about the vaccination levels in hospitals and other health care sites.

The mandate ultimately will cover 10.4 million health care workers at 76,000 facilities.

It is taking effect first in jurisdictions that didn’t challenge the requirement in court. Those include some of the biggest states, with some of the largest populations of senior citizens, among them: California, Florida, New York and Pennsylvania.

“There absolutely have been employee resignations because of vaccination requirements,” said Catherine Barbieri, a Philadelphia attorney at Fox Rothschild who represents health care providers. But “I think it’s relatively small.”

At Wilson Medical Center in rural Neodesha, Kansas, three of the roughly 180 employees are quitting, and several others have sought exemptions from the vaccine mandate, said hospital spokeswoman Janice Reese.

“We are very fortunate that that is all we are losing,” she said, noting that the hospital was not in favor of the mandate. “We didn’t feel like it was our place to actually try to tell a person what they had to do.”

Reese said the vaccine requirement could also make it more difficult for the hospital to fill vacancies.

In Florida, medical centers find themselves caught between dueling federal and state vaccination policies. They could lose federal funding for not adhering to the Biden administration mandate, but could get hit with fines for running afoul of state law.

Gov. Ron DeSantis, a Republican who has waged a legal campaign against coronavirus mandates, last year signed legislation that forces businesses with vaccine requirements to let workers opt out for medical reasons, religious beliefs, immunity from a previous infection, regular testing or an agreement to wear protective gear. Businesses that fail to comply can be fined $10,000 to $50,000 per violation.

Asked if the state would pursue fines against hospitals that enforce the federal mandate, a spokeswoman for the Florida attorney general said all employee complaints “will be thoroughly reviewed by our office.”

Some states already have their own vaccine requirements for health care workers. In California, for example, they have been required to be fully vaccinated since Sept. 30 and must get a booster b y Feb. 1.

The federal mandate is “better late than never,” said Sal Rosselli, president of the National Union of Healthcare Workers, which represents about 15,000 people in California. “But if it happened sooner, we wouldn’t have gone through the surge, and a lot more people would be alive today.”

The government said it will begin enforcing the first-dose vaccine requirement Feb. 14 in two dozen other states where injunctions were lifted when the U.S. Supreme Court upheld the mandate two weeks ago. The requirement will kick in on Feb. 22 in Texas, which had filed suit separately.

In Missouri, one nursing home served notice this week that it intends to take advantage of a state rule that allows facilities to close for up to two years if they are short-staffed because of the vaccine requirement.

“Obviously we are proponents of vaccines,” said Lisa Cox, a spokeswoman for the Missouri Department of Health and Senior Services. But “throughout all of this, we knew that mandating it would be a negative impact really on our health care system … just because of crippling staffing levels.”

Cox identified the facility that was closing as Cedarcrest Manor, in the eastern Missouri city of Washington. She said there are just 42 patients in the 177-bed facility amid the staffing shortages. A woman who answered the phone at the facility took a message but couldn’t immediately comment.

The Centers for Medicare & Medicaid Services ultimately could cut off funding to places that fail to comply with the mandate. But it plans to begin enforcement with encouragement rather than a heavy hand.

CMS guidance documents indicate it will grant leniency to places that have at least 80% compliance and an improvement plan in place, and it will seek to prod others.

“The overarching goal is to get providers over that finish line and not be cutting off federal dollars,” said MaryBeth Musumeci, a Medicaid expert with the nonpartisan Kaiser Family Foundation.

The states affected on Thursday are: California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, Washington and Wisconsin, along with the District of Columbia and U.S. territories.

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OMAHA, Neb. (AP) — More than a year after U.S. health care workers on the front lines against COVID-19 were saluted as heroes with nightly clapping from windows and balconies, some are being issued panic buttons in case of assault and ditching their scrubs before going out in public for fear of harassment.

Across the country, doctors and nurses are dealing with hostility, threats and violence from patients angry over safety rules designed to keep the scourge from spreading.

“A year ago, we’re health care heroes and everybody’s clapping for us,” said Dr. Stu Coffman, a Dallas-based emergency room physician. “And now we’re being in some areas harassed and disbelieved and ridiculed for what we’re trying to do, which is just depressing and frustrating.”

Cox Medical Center Branson in Missouri started giving panic buttons to up to 400 nurses and other employees after assaults per year tripled between 2019 and 2020 to 123, a spokeswoman said. One nurse had to get her shoulder X-rayed after an attack.

Hospital spokeswoman Brandei Clifton said the pandemic has driven at least some of the increase.

“So many nurses say, ‘It’s just part of the job,’” Clifton said. “It’s not part of the job.”

Some hospitals have limited the number of public entrances. In Idaho, nurses said they are scared to go to the grocery store unless they have changed out of their scrubs so they aren’t accosted by angry residents.

Doctors and nurses at a Coeur d’Alene, Idaho, hospital have been accused of killing patients by grieving family members who don’t believe COVID-19 is real, said hospital spokeswoman Caiti Bobbitt. Others have been the subject of hurtful rumors spread by people angry about the pandemic.

“Our health care workers are almost feeling like Vietnam veterans, scared to go into the community after a shift,” Bobbitt said.

Over Labor Day weekend in Colorado, a passerby threw an unidentified liquid at a nurse working at a mobile vaccine clinic in suburban Denver. Another person in a pickup truck ran over and destroyed signs put up around the clinic’s tent.

“It’s just another added pressure on health workers who have already been experiencing a lot of stress,” said Dr. James Lawler, an infectious disease specialist at the University of Nebraska Medical Center in Omaha, where some doctors have received online threats.

Across the U.S., the COVID-19 crisis has caused people to behave badly toward one another in a multitude of ways.

Several people have been shot to death in disputes over masks in stores and other public places. Shouting matches and scuffles have broken out at school board meetings. A brawl erupted earlier this month at a New York City restaurant over its requirement that customers show proof of vaccination.

Dr. Chris Sampson, an emergency room physician in Columbia, Missouri, said violence has always been a problem in the emergency department, but the situation has gotten worse in recent months. Sampson said he has been pushed up against a wall and seen nurses kicked.

Dr. Ashley Coggins of St. Peter’s Health Regional Medical Center in Helena, Montana, said she recently asked a patient whether he wanted to be vaccinated.

“He said, ‘F, no,’ and I didn’t ask further because I personally don’t want to get yelled at,” Coggins said. “You know, this is a weird time in our world, and the respect that we used to have for each other, the respect that people used to have for caregivers and physicians and nurses — it’s not always there, and it makes this job way harder.”

Coggins said the patient told her that he “wanted to strangle President Biden” for pushing for vaccinations, prompting her to change the subject. She said security guards are now in charge of enforcing mask rules for hospital visitors so that nurses no longer have to be the ones to tell people to leave.

The hostility is making an already stressful job harder. Many places are suffering severe staffing shortages, in part because nurses have become burned out and quit.

“I think one thing that we have seen and heard from many of our people is that it is just really hard to come to work every day when people treat each other poorly,” said Dr. Kencee Graves, a physician at the University of Utah hospital in Salt Lake City.

“If you have to fight with somebody about wearing a mask, or if you aren’t allowed to visit and we have to argue about that, that is stressful.”

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