Public Health Nursing: A Changing and Diverse Nursing Profession

An inside look at the public health nursing field with Stacy Hardie, RN*

Public health nursing has seen many changes over the last several years, yet still offers nurses a great amount of professional diversity. Nurses working for a public health department may find themselves on a public health home visit, a clinical assignment such as the STD, Immunizations, Teen Health or TB clinics. Due to the struggling economy, changes in health care services provided by other private and public organizations and a trend to move to population based activities have resulted in significant impacts on public health departments and nurses working within those departments. "When I first started we [the Washoe County Health Department] were much more diverse. We had Child Health, Geriatric, Podiatry and Travel Immunization Clinics. We also managed an adult day care and Visiting Nurses Program. Now these programs are gone or managed by other agencies. However, other opportunities have emerged in areas such as epidemiology or public health preparedness." Stacy Hardie, a Public Health Nursing Supervisor at the Washoe County Health Department and program manager for Teen Health Mall and Family Planning, points out. Many of the nurses who have been in Public Health Nursing are adapting to new opportunities in these fields.

What is Public Health Nursing?

Public health nursing is defined as promoting the health and wellness of all individuals in all communities through the practice of nursing and advocating public policy. "There is so much diversity in what a nurse can do in the public health field, so it is difficult to paint a specific profile" says Stacy Hardie, RN. Stacy adds that, "one component of Public Health Nursing is the public health home visit. The visits are not necessarily skilled nursing visits, but some nursing assessment skills are certainly utilized. Often a family assessment is conducted and then the Public Health Nurse will make recommendations and referrals and provide the client or patient with the necessary education to help the family. Yet, there is so much more that a public health nurse does and can do."

A major function of the Washoe County Health Department in Reno, NV is operating their communicable disease program. Specifically, public health nurses play an intricate role in this program. Reportable diseases (STDs and TB) are brought to these nurses and they are responsible for uncovering the source of infection, contact follow up and treatment. "Although the Epidemiology Program is no longer in our division the nurses do help with outbreaks if needed." Stacy is quick to point out.

The Washoe County Health Department Teen Health Mall is supervised by Stacy Hardie, an RN in Washoe County NV. Nurses at the Teen Health Mall provide reproductive health services that include exams, birth control, STD testing and treatment and pregnancy testing and referral. We do encounter pregnant teens and we discuss options including the importance of prenatal care. In addition, public health nurses provide anticipatory guidance by educating families and clients about what to expect as a teen mom. This is one of Stacy Hardie's favorite aspects of her job and she has been granted a lot of flexibility to create programs around teen pregnancy prevention. "We work with school districts to develop public service announcements directed at teen pregnancy prevention and have had them run on local television channels to increase awareness in the community." Public health nursing isn't all about in-home patient visits. It's about the community, creating the awareness of healthy lifestyles, and wellness education.

Something to keep in mind while researching Public Health Nursing positions is that Public Health Departments vary by community. Some are still very clinically oriented and others don’t provide any clinical services at all.

A Path to Public Health Nursing

The nice thing about nursing is that there is so much variety, thus so many directions to take your career. Where one area of nursing may be very unappealing to some, there is most likely something out there that will be more uplifting or more appealing to others. Stacy Hardie, RN found her way to public health nursing via a personally unpleasant couple of years at a local hospital in the Urology, Nephrology, and Medical Overflow Unit.

Stacy Hardie went straight into college from high school with pre-med intentions and leaning toward the field of dentistry. However, she later found the financial and time commitments to be too much and believed she lacked the appropriate level of proficiency in some areas of math. She grabbed the college major catalogue and started evaluating prerequisites for pre-med or science related majors when she came across nursing. Already two years into college she found that she could enter the baccalaureate nursing program and complete her education in one additional year (5 years). As she puts it, "I was one of those people who went career path, oops!"

Stacy attended the Orvis Nursing School at the University of Nevada, Reno where she completed a rotation in public health nursing. "It was one of the rotations I really enjoyed!" She recalls that "it was really nice to work with a population that was well as opposed to in a hospital setting where people are generally not at their best. I enjoyed the thought of working with people and helping them try to prevent illness as well as working with people who might be a bit more happy day to day."

Stacy graduated from the Orvis School of Nursing and found herself working at a local hospital. As mentioned above, she was working in the Urology, Nephrology and Medical Overflow unit. She explained that this was a really tough floor in terms of the patient type. For example, nurses on this floor would deal with the End Stage Renal Disease patient who were also diabetic, had multiple amputations, had lost their kidneys from the disease, resulting in the need for dialysis. These were challenging patients to manage medically as well as mentally. They are often extremely depressed. "I have to say that if I could have done this differently I don't know that I necessarily would have gone right into nursing, because I don't think I was well prepared emotionally for that kind of work." Often, recent nursing school graduates are thrown into this type of hospital setting and they don't get a lot of support dealing with these cases. The people who can tolerate their position stay there and those that cannot tolerate it move on. "I moved on after almost two years." recalls Stacy.

After two years Stacy left the local hospital. Having positive memories about her public health nursing rotation, she applied to a job posting for a public health nurse with the Washoe County Health District and was hired. At the time she was hired the Washoe County Health Department had around 40 to 50 nurses working in the clinics and in public health nursing positions. Stacy recalls that "there was an incredible amount of diversity, I had the opportunity to work in any one of the many programs and clinics. It was absolutely fantastic!"

Public Health Nurse Management Roles and Duties

As a program supervisor for the Washoe County Health Department Teen Health Mall and Family Planning, Stacy Hardie’s day is chalked full to the point where she feels that she might never get everything done completely or in a timely manner. Since many of the programs at the Washoe County Health Department have gotten smaller she has had more time to assist in other areas, such as organization of H1N1 clinics and vaccinations. But for the most part she is busy every minute she is in the office. She manages the day to day activities of the clinic and deals with any issues or problems that arise. In addition, she does an abundance of grant writing, grant fund management, data analysis, quality assurance, staff training, staff evaluation and other related tasks.

There is never a shortage of things to tackle on Monday mornings. Stacy starts her day by reviewing everything that is scheduled for the week and then creates a prioritized a plan to help ensure that everything gets done. For example, the federal government recently granted Stacy's program additional funds based on a supplemental grant she had written, so now she has to figure out how and where to utilize the funds efficiently. She is planning on using these funds to open a night clinic, which was one of the requirements set by the federal government when Stacy applied for the grant money. Now she is trying to get the staff hired and trained for this clinic. This has become one of her priorities recently.

Stacy believes that "as a manager or leader in public health nursing, if you give good, clear direction to your staff initially, you can expect better results from your employees. Good communication between employees and supervisors is essential and makes for a more productive place of work.

Being a leader in public health has its challenges as well as its highlights. One of the items Stacy has been recently struggling with is new data showing an upward trend in Nevada's teen pregnancy rate after a nearly eight-year decline. Experts are working on ways to analyze the data and determine what exactly caused the noticeable blip in the data. Stacy shares her thoughts, "what I and other pregnancy prevention workers would tell you is that it's decreased funding to these programs that has caused this to happen." This is a very tough situation to be in as a leader. There can be a lack of awareness in government, which results in certain cuts being implemented without the proper research as to what impact these cuts will have. The Teen Health program is critical to the communities throughout Northern Nevada. "People don't understand how challenging it is to be a teen parent," Stacy points out. The state of Nevada was ranked number one in the Nation for teens who have had a baby and then turn around and have another (subsequent births). Why is this?

This is just one of many frustrations that a public health nurse leader may encounter, but experience in the field and taking advantage of leadership and management workshops or classes help prepare public health nurse managers for the challenges that they face each day. A public health nurse that desires to be in a leadership position must be open to their own professional development and be prepared for the inevitable changes that will present themselves. These changes are integral pieces in how the future public health nursing will evolve.

Changes in Public Health Nursing

Public health nursing is facing changes that will have an influence on health care practices and those nurses working in the field. Not all of these changes will be negative and some will even have a positive impact on public health nursing. As with any career, nurses in the field of public health will be expected to adapt to new changes and new environments.

Decreased funding and the increasingly complex nature of the health care system have the biggest impact on public health at this point. Bioterrorism, disease pandemics and natural disasters are more of a threat now than in the past and new education and research angles will need to be implemented to combat these threats. Public health nursing will adapt to these changes via various training and adjustments within public health departments.

According to Stacy Hardie, RN, prior to 9/11 there was a larger pool of money for Maternal Child Health issues.. After the events of 9/11, there came a need for public agencies to be prepared for bioterrorism, which is now one of the overriding foundations of the Washoe County Health Department and most likely the majority of public health departments around the country. As a result, the public health pool of money did not get bigger and bioterrorism became the priority. "Much of the funding for maternal and child health was lost and so were many of the state grants. All of these funds were applied towards bioterrorism funding," recalls Stacy.

However, part of the bioterrorism funding does go to public health and much of it is designated to training health care professionals in the mass dispensing of whatever medications are needed to treat. Stacy Hardie, RN commented that, "we have had to learn how to formulate in what is called incident command system (ICS), which was originally designed by firefighters in order to best utilize resources. We have adapted this strategy into public health in order to manage any bioterrorism event in the most efficient manner possible." For example, if there were a pandemic like the H1N1, it would be training in the mass dispensing of the H1N1 shots. Another example is if there was a bioterrorism incident involving anthrax, public health professionals have been trained to set up a system for dispensing antibiotics to all those exposed.

The redirect of public health funding to bioterrorism hasn't been all bad. Public health nurses have just had to learn to adapt and be efficient with what they do have. "It (bioterrorism training) has been very interesting. It's another skill, another tool in your belt." Learn more about disaster preparedness nursing.

Adapting to the Changes in Public Health Nursing

"Things evolve over time and changes happen," Stacy points out. Take advantage of all educational opportunities when they present themselves, whether it is a one day training or earning an advanced degree. Taking these steps will help keep you on the cutting edge and increase your value. Stacy Hardie, RN took advantage of such opportunities. The Washoe County Health Department has a public health leadership institute. Stacy took one class over the period of a year that included course work, book assignments, and final projects. Stacy has nothing but good things to say and briefly describes that the training, "was all about leadership, getting special training as a manager, how to handle the media, and supervisory skills." She also completed a lot of supervisory training through the county. According to Stacy, “Washoe County is very supportive of what they provide on site and will also reimburse a portion of course tuition if the course is relevant to an employee's work and they earn a "B" or better."

Public Health Nurses must take advantage of these educational opportunities that will help enable career advancement as well as prepare them for the future. Complacency will only lead to failure.

The Public Health Nursing Profession: Looking Forward

Changes are inevitable. Changes are integral to advancement in public health care and public health nursing. Public health nurses are critical to public health and must maintain their adaptability and dedication to their profession. Nurses in public health offer very important insights and services. Hardie says, "I feel it (public health nursing) is a phenomenal field for those looking for an alternative to acute care and would love to welcome new public health nurses in if there are positions. Only time will tell."

*Stacy Hardie, RN holds a BSN and currently works for the Washoe County Health District in Reno, NV. She is program manager for Teen Health Mall and Family Planning programs. Stacy was honored as Nurse of the Year in 2001 for the work she did on the wonderful projects done with regards to teen pregnancy prevention in Nevada. "It was lovely. I was just doing my job," says Stacy.

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