Finding common ground in public health nursing education and practice

Preparation of the public health nursing (PHN) workforce requires public health nurses from academia and practice to collaborate. However, a shortage of PHN clinical sites may lead to competition between schools of nursing for student placements. The Henry Street Consortium, a group of 5 baccalaureate schools of nursing and 13 local health departments in the state of Minnesota, developed a model for collaboration between PHN education and practice. This paper describes the development process--the forming, storming, norming, and performing stages--experienced by the Henry Street Consortium members. The consortium developed a set of entry-level core PHN competencies that are utilized by both education and practice. It developed menus of learning opportunities that were used to design population-based PHN clinical experiences. In addition, the consortium created a model for training and sustaining a preceptor network. The members of the Henry Street Consortium collaborated rather than competed, used consensus for decision making, and respected and accepted different points of view. This collaboration significantly impacted how schools of nursing and local health departments work together. The consortium's ability to retain its relevance, energy, and momentum for both academic and agency partners sustains the collaboration.     

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.     

Use of health fairs to develop public health nursing competencies

This paper describes a community-campus partnership for health education established through the effort of faculty, students, and the community. Health fairs designed to address issues of concern to a community agency were originally conducted with nursing students. This partnership between nursing and a community was expanded to include social work, physical therapy, and medical students. A shared learning experience was structured through the presentation of health fairs in collaboration with agencies in Burlington, Vermont. One goal of nursing education is to produce professionals who have the beginning competencies of public health nursing. Reflection on the process, relationships, and outcomes of the health fairs revealed that students attained these beginning competencies in all eight public health nursing competency domains. Combining community-campus partnerships and an interdisciplinary focus enabled nursing students to become more responsive to community needs and to learn to work collaboratively toward creating healthier communities, thus building skills required for public health nursing.     

Development of public health nursing competencies: an oral history

This paper identifies the external and internal forces that led to the initiation and completion of a set of Public Health Nursing (PHN) competencies by nursing representatives from the Quad Council (QC) organizations: the Association of Community Health Nursing Educators, the American Public Health Association/Public Health Nursing Section, the Association of State and Territorial Directors of Nursing, and the American Nurses Association Congress on Nursing Practice and Economics. Discussion on the need for competencies began in 1988 with the Institute of Medicine report, The Future of Public Health, which cited a widening gap between the education and practice of public health (PH). PH leaders promptly responded by initiating many interactions to improve academic programs and enhance workforce development, including the development of competencies for PH professionals. PHN responded through the Quad Council of Public Health Nursing Organizations, which completed development of a set of national PHN competencies in 2003. The unfolding of that process is reported from the content-specific oral histories of five PHN leaders who served on the QC and participated in developing the PHN competencies.     

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.     

Partnerships for learning population-based public health nursing: Web-delivered continuing education for public health nurse preceptors

Public health and other community health nurses frequently serve as preceptors to undergraduate student nurses learning population-based nursing in community/public health practicum courses. The extent of preparation and support for the preceptor role provided by schools of nursing is often limited. One strategy to address this problem is to provide targeted, Web-delivered continuing education (CE) to preceptors. A Web-delivered CE course entitled, "Partnerships for Learning Community Health Nursing," was created and pilot tested. Course content includes preceptor roles; assisting students in learning population-based public health nursing, critical thinking, and cultural competence; learning styles and teaching strategies; what to do in challenging situations; evaluation and feedback; and specific information about school policies, procedures, and course assignments. Precourse knowledge was assessed using a mailed survey. Postcourse knowledge and satisfaction were assessed using questions embedded in the course. Postsemester knowledge and satisfaction were evaluated through a postsemester survey. Knowledge gain was tested using repeated measures ANOVA and paired t tests. Thirteen preceptors participated in the pilot test. Repeated measures ANOVA indicated that knowledge gain occurred (multivariate F=55.603, df=2, error df=11, p<.0001). Participants increased knowledge from pretest to posttest (t=-10.25, p<.00001) and from pretest to end of the semester (t=-4.95, p<.0003). Knowledge decline from end of course to end of semester was not significant (t=1.94, p=.08). Participants reported satisfaction with the course. Web-delivered CE for community/public health nurse preceptors can support preceptor learning and is an acceptable method for receiving this type of education. Further research is needed on the impact of preceptor education on student learning.     

Matching a graduate curriculum in public/community health nursing to practice competencies: the Rush University experience

An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing.     

Evaluation of a statewide public health nursing training in Utah

Public health nurses continue to struggle to provide culturally relevant services that focus on the multiple needs of an ethnically diverse population while at the same time providing services to the population at large. This article describes the formative research, implementation, and results of a statewide effort to broaden UtahAEs public health nurses perception about their role and responsibility in addressing and serving the emerging needs of underserved and atrisk populations in Utah. A total of 51% of Utah state and local health department public health nurses participated in the training. There was a statistically significant increase in the mean level of perceived understanding of topic material from pretest to posttest, and 80% of participants reported applying what they learned in the training to their practice. Our experience demonstrates that even with limited resources, it is possible to deliver high quality training to a large proportion of public health nurses practicing in urban, rural, and frontier populations; observe significant results in their comprehension of training material and, most importantly; see application of what they learned in the training to their health care practice.     

The report of the conference on redesigning nursing education for public health

The following paper extracts some highlights from a conference on nursing education for public health, convened by the Division of Nursing, Bureau of Health Professions, Health Resources Administration, of the U.S. Department of Health, Education and Welfare in May 1973. This brief examination of selected discussions among participants about trends in health care, the challenges they believed they would face in improving health status, and the inferences they drew for planning public health nursing education may provide a partial foundation for examining current issues in the education of public health nurses. Although public health nursing roles have evolved dramatically over the last 34 years, the issues raised during the conference have not been completely or adequately resolved. The difficulty of predicting or prophesying the future during a period of rapidly changing social and political conditions, and the importance placed by these leaders of public health nursing on participating in the formation of goal-directed public policy remain salient lessons for the contemporary reader.     

Improving public health nursing education: recommendations of local public health nurses

OBJECTIVES: This paper reports recommendations for improving public health nursing (PHN) undergraduate, graduate, and continuing education (CE) made by staff-level public health nurses working in local health departments (LHDs). Implications for academia and practice are discussed. DESIGN: A cross-sectional written survey was used to collect data from 424 public health nurses in 76 LHDs in Wisconsin (68% response rate) in 2003. Recommendations for improving undergraduate, graduate, and CE were made through responses to open-ended survey questions. Content analysis was conducted to identify major themes among responses. RESULTS: Major themes emerging from the recommendations for undergraduate education included the need for more clinical public health experiences and population-focused practice content. Graduate education improvement recommendations included addressing access barriers and increasing organizational incentives. Improved access and more public health content were the major recommendations for improving CE. CONCLUSIONS: Implications for academia focus on increasing opportunities for students to experience population-focused PHN and to learn organizational and collaborative practice skills, supporting PHN preceptors and building evidence for PHN intervention through research. Implications for practice include the need to expand opportunities for students with LHDs and to collaborate with academic partners for education and research.     

Three population-patient care outcome indicators for public health nursing: results of a consensus project

ABSTRACT Objectives: Difficulties in recruiting nurses into public health settings threaten the public's health. Gaps in existing data make determining the health impact of workforce changes numbers difficult to perform. Public health practice leaders are left to make difficult staffing and program decisions without knowing how the health of their vulnerable populations will be affected. The objective of this study was to identify indicators that could be used to document the effect of the shortage of public health nurses (PHNs) on the health of a population. Design and Sample: A consensus‐building process was used. Nursing directors from 6 local health departments (LHDs) in 2 states participated along with 3 public health system researchers. Results: The findings from this collaborative process suggest that it is possible to identify outcome indicators across states and multiple LHDs that may be sensitive to PHN staffing levels and interventions. Possible connections between PHN staffing and each population‐patient care indicator (rates of Chlamydia, first trimester prenatal care, early childhood immunization) are presented. Conclusions: The process used here in identifying these indicators and the proposed nursing‐sensitive population outcome indicators themselves provide a template for the development and analysis of additional outcome indicators sensitive to the quality of nursing and other health care.     

Use of public health nurse competencies to develop a childcare health consultant workforce

The purpose of this article is to describe the efforts in the state of Georgia to train public health nurse-childcare health consultants (PHN-CCHCs) using the framework of the "Core competencies for public health practice." Objectives: The goal of the training was twofold: (1) to prepare a statewide cadre of PHNs as the primary workforce for Georgia's emerging childcare health consultation (CCHC) system and (2) to prepare their district nurse directors to lead and support CCHCs. Design: Administrators attended a 2-day workshop followed by access to executive coaching for their management teams. PHNs participated in a three-phase training program, with phases 1 and 3 offered as 3-day workshops with field experiences, and phase 2 offered online and as a practicum. Sample: Forty-four administrators and over 85 PHN-CCHCs completed the training. Results: Graduates of the program reported satisfaction with training and reported the use of PHN core competencies in CCHC. Graduates also found enhanced skills in using core competencies to be applicable to a variety of population-based practices. Beyond CCHC being instituted in selected health districts, interest in CCHC has occurred statewide. Conclusions: The PHN-CCHC program enhanced the knowledge and use of core competencies and heightened interest in CCHC statewide.     

Public health nursing competencies 1953-1966: effective and efficient

The Quad Council of Public Health Nursing Organizations developed public health nursing competencies in 2003. They are guides for determining skills at two levels, and they identify public health nurses as providing care to individuals and families or to populations and systems with the nurse having proficiency, awareness, or knowledge. The primary purpose of this paper is to discuss historical nursing roles and qualifications as judged by the 2003 competencies, including educational preparation and experience for the administrative and staff nurse. The historical exemplar for the nursing roles is a combination public/private nursing association, referred to as the partnership, that took place in 1953-1966. Primary sources include archived material from the Instructive Visiting Nurse Association, Richmond, VA. Administrative responsibilities were divided between the chief nurse and the nursing supervisors. Staff nurse responsibilities included clinic activities, home visitation, and referral coordination between health care organizations. The delineation of nursing roles demonstrates nurses' meeting the 2003 competencies. Based on the Quad Council's 2003 public health nursing competencies, the partnership nurses were competent.     

Development of the public health nursing competency instrument

This paper describes the development and initial testing of an instrument to measure population-based public health nursing competencies. Although multiple lists of public health competencies exist, literature review did not elicit a valid instrument that could measure changes in public health nursing competency over time. The public health nursing competency instrument, consisting of 195 measurable activities organized in the framework of the nursing process, was developed. Competency scores of practicing public health nurses significantly increased after a continuing education series, and the instrument was confirmed by experts to be a valid reflection of public health nursing practice. The time required for instrument development exceeded expectations because of the multiple stages of delineating competencies and validating data with national experts.     

Collaborative design and use of an agency feedback form for student clinical practicum experience in community/public health nursing

Evaluation of students in community and public health (C/PH) nursing clinical practica is a challenge, especially when preceptors are expected to evaluate students from different academic nursing programs. The need for a standardized student evaluation tool was identified during federally funded collaborative meetings held between C/PH academic and practice partners in Northeastern Wisconsin. This article focuses on the development and appraisal of the standardized Agency Feedback Form (AFF) for Student Practicum Experience in Community/Public Health Nursing, which was designed to meet the identified need. Four baccalaureate nursing programs implemented the AFF for 3 purposes: (1) to provide a consistent and easy evaluation form for preceptors to complete; (2) to communicate useful information about students' individual professional behaviors observed during practicum; and (3) to increase students' and preceptors' understanding of the population-based nursing interventions, using the Public Health Intervention Wheel. Future uses and implications of the AFF are also discussed.