Health Care Providers: Who’s Best for My Camp?

by Linda Ebner Erceg, R.N., M.S., P.H.N.

With another summer tucked into history, many camp professionals use autumn to review the summer as well as decompress from it. This is often when we consider changes that would "make things better" for next season. This article is written with that in mind. Specifically, it's designed to help you through an assessment process to determine what kind of health care provider(s) is best suited for your camp.

What Should You Consider?

Start with considering the health needs of the population attracted to your camp, both campers and staff. You want a health care provider that can meet those needs. Are there medically compromised people who need day-to-day supervision by competent medical personnel? On the other hand, maybe it's a "healthy" population. Yes, there are campers and staff with chronic health concerns, but they tend to be well-managed and come with a plan that's appropriate to the risk profile of the activities in which they'll participate and sensitive to factors such as how far your camp is from definitive support at clinics and hospitals. Day camp programs typically enjoy ready access to parents as well as the individual's personal health care professional. This often makes meeting personal health needs easier than in the resident camp setting and impacts the kind of provider at camp.

The health needs of campers and staff are usually unchangeable. Consequently, these are factors that a camp must address through planning. That's an important point. This also is a reason why stating the essential functions of campers is so important. Without that statement ("In order to participate in our camp program, your child should be able to . . . ."), a camp opens its door to meeting any and all health needs. This should have been addressed for staff via the essential function statements that were part of job descriptions.

Once the scope of health needs of people are understood, consider the scope of activities offered and the camp's injury-illness history. In other words, consider the camp's risk profile. What illnesses and injuries typically occur? At what activities do these happen? Are there out-of-camp programs — overnights, day trips, extended tripping, and so forth — that impact need for health care providers in the field? Is your camp prone to illness and is this impacting campers or staff? Are any of these illnesses communicable? Make note of these risk exposures. A camp's risk profile is an indicator of what one can expect. Health care staff who can meet these reasonably anticipated needs should be hired. However, it is also possible to change a risk profile using risk reduction techniques (prevention strategies). Some health care providers are more skilled at helping a camp achieve this than others.

Next, consider the health care promises made by virtue of the agreement with parents and/or staff (employees). If camp literature states that a physician or R.N. is at camp, then that must happen. If camp literature states that "a health care provider" is at camp, that, too, must happen — but there's more latitude as to who that provider might be. If the camp provides oversight of medications, then the provider must be credentialed to provide this service. The same holds true if invasive and/or skilled cares are promised, services such as injections, catheterization, and/or diabetes monitoring.

Also consider your camp's care tradition. While it may not be written down, returning campers, their parents, and staff tend to assume that the camp will have "the same kind" of provider from year to year. It is certainly possible to change an expectation, but that often takes time and, at minimum, should be blatantly spelled out to returning people.

Then, think about the impact of regulating bodies on the question of what health care provider is needed. ACA-Accredited® camps know that HW Standards address the provider based on day or resident camp status as well as distance from definitive care (American Camp Association 2007). Some State licensing regulations specify the credential of the camp's provider while others make no comment about it. Other State licensing regulations list a variety of credentials that are acceptable and leave it to the camp to select the credential best suited to what the camp needs. Taking regulations along a different path, some providers must be licensed by the State in which the camp is located in order to use the credential they have. This is the case with physicians and nurses, both for the R.N. and L.P.N. If the camp program takes that provider across State lines, multiple licenses may be needed.

Finally, consider the way camp functions. Some high risk areas — like the waterfront and ropes course — will be staffed by first-aid credentialed people. Other programs — like tripping — have staff credentialed in reference to the time it takes that trip to access definitive care. Some camps have significant injury situations, so having a provider that's skilled in injury management is important. Other camps have low injury rates but greater impact from illness and medication management, making that skill set a priority. Often camps need a blend of providers.

Select Providers That Best Meet Your Camp's Needs

In the best possible world, each camp would have a physician and/or registered nurse who were also competent in emergency medical services at camp each day. The reality is that this is not always possible. Sometimes, we have to make do with what we have in spite of significant effort to attract the personnel we'd like.

The Camp Health Care Provider's chart (see chart) lists health care providers commonly used by camps. It compares the providers along dimensions that have impact in our camp world. For example, a physician's effectiveness is best when supported with lab and other diagnostic tools. Because camp typically doesn't have a lab, some camps make an agreement with the local medical community so the camp M.D. has access to supporting services. In a different vein, some providers are more adept at responding to emergencies than others, a factor often observed when an R.N. without EMS background responds to a camp injury. The camp's first-aid credentialed staff more readily fly into action. However, switch the scenario to an illness and/or medication urgency and the reverse is true. Knowing the strengths and challenges for each credential enables camp administrators to work more effectively with their health professional team.

Read through the elements described on the chart and compare what is there with the assessment process described in the previous section. Determine the mix of providers who would be best for your camp while keeping these points in mind:

  • For a healthy resident camp population, one that includes people with chronic conditions that are well managed, plan for one health care provider per 125 people (campers + staff), give or take a few in any direction. Plan for one provider per 150 people at a day camp serving a healthy population. This recommendation assumes the camp has an injury-illness rate similar to that reported in the Healthy Camps study (Erceg, Garst, Powell, & Comstock, 2008) and/or has demonstrated a downward trend in its own injuryillness database (U.S. Department of Health & Human Services, 2000).
  • If the camp provides medication oversight (e.g., gives daily medications, provides OTCs), then the camp needs a provider credentialed to make medication decisions. This means a physician. The only other provider that can autonomously function with medications is the R.N. who, in turn, is supported by medical protocols. NOTE: some States make exception for those individuals who have completed a medication management course, but such credentials also have limits to that scope of practice.
  • For the first provider, select a professional who can function autonomously with their credential and within the scope of care promised by the camp. Some credentials, like the licensed practice nurse (L.P.N.), require that the person be supervised when functioning — and "supervision" is defined. Others may require oversight by a physician or R.N., a parameter often attached to E.M.S. credentials. Here's where knowing how the State defines key words is important.
  • Consider a blend of providers. Some camps strategically design job descriptions so providers with key strengths can work together. For example, maybe an R.N. is needed for medication oversight and illness management, but an E.M.T. becomes important for injury emergencies and urgencies.

What About Unlicensed Assistive Personnel?

The concept of "Unlicensed Assistive Personnel" (U.A.P.) applies to providers who are not licensed to provide health care. First aiders are U.A.P.s; they have a credential but are not licensed. Student nurses might also be U.A.P.s. Since the camp isn't the student nurse's college/university, they may not function as "student nurses" at camp nor should they be represented as such. They are U.A.P.s in the camp setting and often have job titles that clearly communicate that, titles such as Health Center Assistant. Many camps have discovered how useful U.A.P.s can be in the health center and typically make sure the U.A.P. has some type of first-aid credential under which he/she can function. These camps also know that U.A.P.s need appropriate supervision. That supervisor is often the camp R.N.

If a health care professional will be expected to supervise other providers, especially U.A.P.s, write that parameter into the job description and talk about it during the interview process. Licensed providers incur a professional responsibility to "adequately supervise" the staff to whom they delegate care. Failure to do so may well impact camp but it also has ramifications to the individual's license. Consequently, be up front about this at the time of hire and discuss that delegation so both the camp administration and the licensed professional are on the proverbial "same page." This tension often arises when tripping staff head out. The RN is expected to delegate medication oversight to the trip's designated provider and may assume s/he is also responsible for the nonmedication care that tripper provides. If the camp directs that tripper to consult the R.N. every time health care is delivered on the trail then, yes, the R.N. oversees the entire scope of care. If, however, the camp expects the tripper to function under the parameters of their certificate (e.g., W.F.A., W.F.R., E.M.T.) except when medication is involved, the camp has limited the R.N.'s oversight to medications. The R.N. needs to know and understand this.

Where Can I Find These Personnel?

Knowing what one wants and actually attracting that provider are two different things. Gone are the days when an R.N. came to camp and stayed all summer. Most camps deal with multiple providers and some camps never attract that professional. The reasons are as varied as our campers. Today's health care professionals are in demand. They get higher salaries in other settings than camps can provide. Many don't even know that camp is a practice option; it's rarely talked about during the education process (although that is changing) and a large number of health care professionals weren't campers as children. They don't know what they're missing!

So what are some strategies that improve the chance of attracting a health care professional? In all honesty, there's no one, sure-fire answer. The most effective strategy is to implement a variety of recruitment strategies, follow up on every inquiry, and be ready to provide job information when it's asked for. Other key tips include:

  • Get your advertisement out there early! Health care professionals often have to ask for summer time-off in January. Waiting until spring to launch this staff recruitment effort may be too late.
  • Like other people, health care professionals use the Internet to search for jobs. Go into your favorite browser and put "camp nursing" or "camp doctor" into the search engine. Look at the top three, four sites that come up. These are the same ones that potential staff are seeing. Get your ad placed on those Web sites — before Christmas!
  • Offer your returning staff a "Finder's Fee" if they locate a provider who signs a contract with you. These people know camp; they know the kind of person who'd fit in as well as the one who wouldn't. Get them working for you by rewarding their recruitment effort with cash.
  • Write a letter to the parents of last summer's campers who identify themselves in the health care profession. They know how their child benefited from being at camp. Ask them to consider a camp experience for themselves and then describe the benefits from the camp nurse's or physician's perspective. If your camper enrollment form doesn't capture parent occupation, change it – now.
  • Carefully consider the allocation of those precious advertising dollars. Put them where they really count! For example, consider purchasing a set of labels from the Board of Nursing in your camp's State. Then send a letter to those nurses about your camp's need. Do the same for your State School Nurses Association.
  • Consider advertising in venues largely under utilized by camps such as the American College Health Association. These people provide health care at college and universities. Their programs often close for the summer and/or cut back on both personnel and hours. These are great camp health care providers! They're often used to working with young adults (and their parents) who are away from home, can make a decision without ten other professionals standing at their elbow, and are used to teaching self-care in addition to meeting health needs.
  • If your camp serves a particular population, recruit the adults affiliated with that population. Maybe it's a faith community and you can place your camp's ad in bulletins or online message boards. Maybe it's a parent advocacy group with a vested interest in having the right health care provider at camp. Get groups like this working for you.

Do something different this autumn. Take time to strategically determine the mix of health care providers to best meet the needs of your camp program and the people who are there. Then design a recruitment strategy that intentionally targets that need. This isn't an easy task; it'll take some intentional effort — but it's well worth that effort. I look forward to hearing how you do and about your ideas. Let's make "Healthier Camping for All" a growing reality!

References
American Camp Association (2007). Accreditation process guide. Monterey, CA: Healthy Learning.

Erceg, L.E., Garst, B.A., Powell, G.M., and Comstock, R.D. (2008). Exploring early results from the American Camp Association's surveillance study of injuries and illness. Camping Magazine, 81(2), 22-28.

U.S. Department of Health & Human Services (2000). Healthy People 2000. McLean, VA: International Medical Publishing, Inc.

Linda Ebner Erceg, R.N., M.S., P.H.N., is the health and safety coordinator for Concordia Language Villages and the executive director of the Association of Camp Nurses.

Originally published in the 2008 September/October issue of Camping Magazine.