Overcoming barriers and improving public health nursing practice

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.     

Barriers and Facilitators to the Incorporation of Environmental Health into Public Health Nursing Practice

ABSTRACT Objectives: To describe the environmental health (EH) demands placed on public health nurses (PHNs) as well as the barriers and facilitators to incorporating EH into PHN practice. Design and Sample: A cross‐sectional multimode (Web and pencil/paper) survey was used to collect data from PHNs in 1 rural western state. Research participants included 141 PHNs from a total of 228 survey invitations (61% response). Measures: A 39‐item questionnaire was developed to measure the frequency of EH demands experienced by PHNs as well as the barriers and facilitators to the incorporation of EH into PHN practice and standard demographics. Results: Significant numbers of PHNs reported less than baccalaureate preparation (29%), suggesting that EH competencies cannot be assumed. PHNs are often asked for basic EH information and cite lack of time and lack of interest on the part of the populations being cared for as barriers to incorporating EH into their practice. Facilitators included free or inexpensive continuing education programs offered via the Internet and additional Internet resources or staff resource people. Conclusion: PHNs represent a significant portion of the public health workforce and have implied and explicit mandates to address EH issues in their practice. Resources should be directed toward helping PHNs become better prepared to address the current and future EH needs of populations.     

Using Nursing Perspectives to Inform Public Health Nursing Workforce Development

ABSTRACT Recent national and regional public health workforce development efforts have been conducted through a framework of public health services research. Public health nurses (PHNs) are the single largest professional group in the formal public health system, and thus have the greatest potential for positively impacting our community health systems. Effective public health workforce development is contingent on examination of how PHNs themselves make meaning of their practice. This paper suggests that a nursing perspective should be used from which to conduct research surrounding PHN practice. Literature describing PHN practice and recent workforce assessment efforts are reviewed. Assumptions are identified regarding the nature of nursing knowledge, and a theoretical perspective for inquiry about PHN praxis is developed. Finally, a model is offered to illustrate the reciprocal influence of nursing science and public health nursing practice.     

Public health nursing practice guidelines: an evaluation of dissemination and use

Public health nursing needs to build a practice on research-based knowledge. Public health guidelines are one strategy to achieve this goal. Using research-based knowledge, the Minnesota Practice Enhancement Project (MPEP) developed positive parenting and family violence prevention guidelines for public health nurses (PHNs). The purpose of this study was to evaluate the dissemination and use of the MPEP guidelines using a survey of PHNs and telephone interviews of public health nursing directors. Results indicated that respondents viewed the guidelines as important, but identified numerous barriers to integrating the guidelines into their practice. Major barriers included lack of time in their work day, complex guideline structure, and competing agency demands and priorities. Findings were consistent with Roger's Diffusion of Innovations theory, which describes factors associated with the adoption of a new idea or practice. Recommendations for effective dissemination include administrative support and structure to increase PHN intentional use of practice guidelines, a simplified guideline format, and mentorship in guideline use.     

Self-reported competency of public health nurses and faculty in Illinois

Having a public health workforce with a high level of competency is a prerequisite for having an effective public health system. The purpose of these two studies was to assess the competency level of practicing public health nurses (PHNs; n=168) from 50 local health agencies and public health nursing faculty (n=46) from 31 nursing programs in Illinois. The questionnaire consisted of nine reliable scales using self-reported levels of competence in each PHN competency domain. Overall, PHNs reported only feeling competent in one domain: "linking people to services." Although PHN faculty felt competent across the nine domains, they did not report feeling competent to teach any of the domains. Thus, PHNs and public health nursing faculty need education and training to meet the professionally established level of competence.     

The Henry street consortium population-based competencies for educating public health nursing students

The Henry Street Consortium, a collaboration of nurse educators from universities and colleges and public health nurses (PHNs) from government, school, and community agencies, developed 11 population-based competencies for educating nursing students and the novice PHN. Although many organizations have developed competency lists for experts, the Consortium developed a set of competencies that clearly define expectations for the beginning PHN. The competencies are utilized by both education and practice. They guide nurse educators and PHNs in the creation of learning experiences that develop population-based knowledge and skills for baccalaureate nursing students. Public health nursing leaders use the competencies to frame their expectations and orientations for nurses who are new to public health nursing. This paper explains the meaning of each of the 11 population-based competencies and provides examples of student projects that demonstrate competency development. Strategies are suggested for nurse educators and PHNs to promote effective population-based student projects in public health agencies.     

Barriers and facilitators in the delivery of environmental risk reduction by public health nurses in the home setting

ABSTRACT Objective: The goal of this study was to identify the factors that contributed to or detracted from the ability of public health nurses (PHNs) to deliver environmental risk reduction (ERR) in the home setting. Design and Sample: Structured one‐to‐one interviews were conducted with 10 PHNs from 2 county health departments in the western United States that were delivering an ERR intervention in a randomized clinical trial. Results: Barriers to incorporating ERR into PHN practice were: a change in the perceived mission of public health, nurses' lack of environmental health (EH) training, the absence of a strong relationship with EH, the multidimensional role of PHNs, presentation of nurse participation by management, incorporation of ERR visits into nursing schedules, and challenges engaging parents in EH. Facilitating factors included: training and support, opportunities for capacity building, belief that ERR is important, building a more visible face for PHN, and personal interest in EH and ERR. Conclusions: Adapting PHN practice to include ERR strategies is feasible, but not without challenges. With adequate training, time, and institutional support, multiple challenges can be overcome. PHNs are well positioned to improve the health of families and communities by integrating ERR into their scope of practice.     

Public health nursing competencies for public health surge events

OBJECTIVE: To develop consensus regarding public health nursing competencies in the event of a public health surge event related to disaster. DESIGN AND METHODS: Using a 3-round Delphi approach, public health nurses (PHNs) and directors of nursing from local health departments, state nursing leaders, and national nursing preparedness experts reviewed and commented on 49 draft competencies derived from existing documents. RESULTS: The final 25 competencies were categorized into Preparedness (n=9), Response (n=8), and Recovery (n=7). The Preparedness competencies focus on personal preparedness; comprehending disaster preparedness terms, concepts, and roles; becoming familiar with the health department's disaster plan, communication equipment suitable for disaster situations; and the role of the PHN in a surge event. Conducting a rapid needs assessment, outbreak investigation and surveillance, public health triage, risk communication, and technical skills such as mass dispensing are Response phase competencies. Recovery competencies include participating in the debriefing process, contributing to disaster plan modifications, and coordinating efforts to address the psychosocial and public health impact of the event. CONCLUSIONS: Identification of competencies for surge events that are specific to public health nursing is critical to assure that PHNs are able to respond to these events in an effective and efficient manner.     

Perceptions of experiences with interprofessional collaboration in public health nursing: A qualitative analysis

In public health nursing interprofessional collaboration has become a goal, however, there is little clarity on the distribution of responsibility or approach to cooperation between the professional groups. The aim of the study was to explore public health nurses’ perceptions of their experiences related to interprofessional collaboration. A qualitative content analysis was carried out. An interview study with a purposeful sample of 23 Norwegian public health nurses (PHNs) was conducted. Data were analysed using semi-structured interviews to identify categories and themes of PHNs’ working lives. The data were classified into three major themes: institutionality: the institutional understanding of the professional roles; competence: clarifying jurisdictional borders, and recognition: professionals’ recognition of different roles. There needs to be a robust strategy in collaborative working that involves public health nurses among other professionals to avoid role overlap, interpersonal and interprofessional conflict and reduce the damaging threat or stress that comes with informal or ad hoc rules of engagement and status claiming by one profession over another.     

Articulating the Culture and Tradition of Community Health Nursing

While community health nursing (CHN) leaders speculate about the future, nurses on the front lines care for vulnerable families and populations in the midst of diminishing resources, radical changes in health care delivery systems, and unwieldy bureaucracies. Narrative data from a recent interpretive study provided an unexpected opportunity to explore how CHN practice in diverse settings is evolving in response to such changes. Data consisted of interviews and observations of 25 nurses in their practice setting. Several clinical stories or exemplars are selected to highlight how the "culture" of agency settings shapes public health nursing (PHN) practice in ways that need to be recognized and strengthened or affirmed. Clinical storytelling can play a crucial role in preserving the PHN tradition and restoring and transforming local cultures when PHNs, administrators, educators, and researchers commit to PHN excellence.     

Creating and sustaining an academic‐practice Partnership Engagement Model

Public health clinical educators and practicing public health nurses (PHNs) are experiencing challenges in creating meaningful clinical learning experiences for nursing students due to an increase in nursing programs and greater workload responsibilities for both nursing faculty and PHNs. The Henry Street Consortium (HSC), a collaborative group of PHNs and nursing faculty, conducted a project to identify best practices for public health nursing student clinical learning experiences. Project leaders surveyed HSC members about preferences for teaching‐learning strategies, facilitated development of resources and tools to guide learning, organized faculty/PHN pilot teams to test resources and tools with students, and evaluated the pilot team experiences through two focus groups. The analysis of the outcomes of the partnership engagement project led to the development of the Partnership Engagement Model (PEM), which may be used by nursing faculty and their public health practice partners to guide building relationships and sustainable partnerships for educating nursing students.     

Developing population health competencies among public health nurses in Georgia

As part of a new vision for public health in Georgia, the role of the public health nurse (PHN) is shifting from a predominantly individual and clinic-based care model to a population health practice model. Based on focus groups conducted with management and frontline PHNs in 2001, nurses in Georgia were unprepared for this transition and lacked a strong understanding of population health concepts and competencies. To prepare nurses for their new and expanded responsibilities, an online population health course was developed specifically for currently employed PHNs. The Quad Council PHN Competencies (2003) provided the roadmap in identifying the population health online course and continuing education training program priority competencies for PHNs in Georgia. Along with incorporating the competencies into case studies and didactic learning, the required projects served as evidence of competency application. The population health online course was offered from fall 2000 to spring 2005 in collaboration with Georgia schools of nursing and has enabled a cohort of nurses to lead the way as Georgia transitions into a new public health model. Nurses who completed the course reported greater experience with and an understanding of population health competencies.     

Effects of Public Health Nursing Participation in Selected Academic Courses on Self-Reported Functions and Competencies: A Collaborative Pilot Study

Abstract A profile of the education levels of practicing public health nurses (PHNs) in Mississippi in 1988 indicated that 71% of those nurses were prepared in associate degree or diploma programs. Since these programs typically do not provide formal academic courses in community health nursing, nurses currently enter the workplace with insufficient preparation for this increasingly complex role. A collaborative pilot study between the agency and a state-supported school of nursing evaluated the impact of participating in selected components of an academic community health nursing program on the self-reported competencies and functions of beginning PHNs. Twelve PHNs who were employed during six months in the geographic area contiguous to the school were selected to attend 10 classroom sessions on basic topics applicable to the generic PHN role in a southern state. A control group of 12 PHNs hired during the same period of time was also selected. Both groups completed an instrument on functions and competencies before and after the course. A significant difference was seen in certain functions and competencies between attenders and nonattenders.