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