Scotland County health leaders flag nurse shortage, budget and service updates; board proposes recruitment task force

Scotland County Board of Health members heard an update on county health department operations and finances and discussed steps to address a persistent nursing shortage at a meeting where board members proposed forming a three- to four-person task force on recruitment.

The health department’s presentation covered the management-support unit — which handles patient registration, appointment scheduling, medical records and vital records — and said environmental health permitting (wells, food vendors, pools, tattoo permits and sewer permits) returned to the health department beginning Feb. 1 and is being re-learned by staff.

Why it matters: staffing and budget decisions affect routine clinical services, immunization clinics, environmental health permitting and the department’s ability to respond to community events and outbreaks. Board members pressed for clearer reporting on revenues and expenditures and for a concrete recruitment strategy to reduce reliance on high-cost contract nurses.

The department reported fiscal-year expenditures as of Jan. 31, 2025. The presenter said some line items show about 57 percent spent for certain programs and that overall the department was about 51.6 percent expended seven months into the fiscal year. Immunizations were cited as a line with a high up-front purchase cost for vaccine; the presenter said the immunization line showed roughly 76 percent spent while the department had collected about $64,000 in related revenue. A board member suggested showing budgeted appropriations alongside revenue and actual spending so the figures provide clearer context.

On revenue and reallocation, the presenter said that when a program generates excess revenue late in the fiscal year the department can request the county commission approve reallocating those dollars to another line. The department also said collection rates show room for improvement; one slide discussed a collections figure near 48 percent.

Staffing was a central topic. The department described repeated difficulty recruiting and retaining public-health nurses. The presenter said the department recently posted a nurse position and that one hire worked a week and a half before going on maternity leave. The county currently uses contract nurses from a staffing vendor (referred to in the meeting as Emergys/Emerges). "We are paying $65 an hour to Emergys for the nurse," the presenter said, while the vendor reportedly pays the nurse roughly $35 an hour; the county’s aim is to hire contract nurses into county positions after a 13-week contract, but applicants told interviewers they were not willing to accept the lower in-house salary after contracting.

Board members and staff discussed recruitment approaches that might attract midcareer or experienced nurses who prefer day-shift, Monday-through-Friday schedules and benefits. Suggestions included emphasizing predictable schedules, loan-forgiveness options and other nonwage benefits. A motion was proposed to form a three- to four-person task force to develop a short list of recruitment and marketing items for the board and HR to act on; volunteers and participation from HR were discussed but a formal vote was not recorded in the transcript.

Other operational points noted by the department: - Management support staff handle patient check-in, income verification for self-pay patients, scheduling and proactive appointment reminders via text or phone. - Staff update the North Carolina Immunization Registry (NCIR) and respond to requests for records from other medical facilities. - The department bills LabCorp for certain maternity and drug-testing services (the presenter described a LabCorp reimbursement of about $10 per maternity test and a $25–$30 charge invoiced to the Department of Social Services for drug screens). - The department charges a vaccine administration fee (the presenter described $25 for the first shot and $18 for each additional shot in some cases; certain children and federally covered groups receive vaccines at no charge).

Board members asked for more interpretive reporting — for example, month-to-month immunization trends and a combined view of budgeted amounts, revenues and net position — so the board can “tell the story” behind the raw numbers.

The meeting packet also included a note that the department plans a community day in May (start and end times not finalized) to engage residents and local partners; the mobile unit and clinics were mentioned as possible participants.

Procedural notes: a motion to form the recruitment task force was made and discussed; the transcript records volunteers and an intention to involve HR, but it does not show a formal roll-call vote. The meeting concluded after a motion to adjourn that was seconded; no formal tally was recorded in the transcript presented.

Looking ahead, board members requested a more detailed immunization and clinic report for recent years and asked staff to return with clear, comparative financials and an actionable recruitment checklist produced by the proposed task force or HR.