Nurses strive to make a positive difference for their patients, whether this involves working at someone’s bedside in a hospital, assisting individuals who have mental health issues or training other health professionals. Their impact and influence are widespread and important too, wherever they are based. They also play a significant role within the realms of public health policy and implementation, both in health promotion and disease prevention. They are expected to respond to public health crises, whether they be outbreaks of viruses such as COVID-19 for instance or natural disasters.
Public health is described as the science of protecting and improving the health of people and their communities through the encouragement of healthy lifestyles, researching disease and injury prevention as well as detecting, preventing and responding to infectious diseases. It aims to protect the health of whole populations, stretching from small neighborhoods to the entire country or region of the globe.
The term public health nursing is often used interchangeably with community health nursing, and includes advocacy, policy development and planning, and takes a multi-level view of health. It assesses population health using a comprehensive and systematic approach, paying attention to multiple determinants of health, with an emphasis on prevention. It also considers the applications of interventions at all levels and the systems that impact people’s health.
During National Public Health Week 2023, a document was published by the Executive Office of the Government, which stated: ‘Looking ahead, there is so much to do to end health disparities, keep advancing science and improve the health and well-being of all Americans. This starts by making sure everyone has access to quality health care.’ Among the strategies and initiatives mentioned is one to end hunger and reduce diet-related diseases such as diabetes and obesity. This aims to help people exercise and make healthy choices in the foods they eat, as well as provide support to individuals who want to stop smoking.
Globally, some of the health challenges that need to be addressed include mental health crises, reproductive and sexual health, malnutrition and food safety, diabetes, cancer, environmental pollution and infectious disease.
Working within public health
Many nurses work within community and public health organizations, and some are specialists in those fields. Duties and responsibilities vary depending on the role, but can include:
Advocacy:
Working with local, state and federal authorities to help improve access to health services for underserved communities.
Assessment:
Collecting data and finding patterns in disease outbreaks as well as planning, implementing and evaluating community health.
Collaboration:
Working closely with other healthcare professionals and patients in order to best serve the community.
Communication:
Maintaining contact with stakeholders, families and individuals to evaluate what is required within a specific community.
Education:
Teaching people about preventing diseases and leading a healthy life as well as empowering individuals to take responsibility for their own health.
Intervention:
Intervening in situations where abuse is suspected, whether sexual, physical or psychological.
Management:
Managing budgets and the use of public resources.
Treatment:
Performing health screenings, administering medications, immunizations, examinations and more for at-risk populations.
The places where public health nurses work are as varied as their duties and include community clinics dealing with different health concerns, government organizations focusing on policy development, outpatient clinics, schools and charity organizations.
Clinical-community linkages are an example of a way that nurses, nurse practitioners and public health agencies can work together, with community organizations and clinics collaborating to better serve clients effectively. The aim is to provide more assistance to patients in changing unhealthy behavior and to support the provision of other services to patients. For instance, nurses can network with local agencies that provide help with various issues, such as diet and exercise. This will allow appropriate additional help to be arranged for individuals following consultation.
How nurse-led programs make a difference
Nurses can both lead changes and work with other organizations to improve conditions for the wider population. According to a paper published in the National Library of Medicine about the role of nurses in improving health equity, the engagement of nurses with the social needs of the population in community settings has been long-standing. Nurses often work directly with clients in order to address social needs and have a broad knowledge of population health and the associated social and cultural issues that impact that. As they are well embedded within the community, they are often able to build trust and respect.
Home-visiting nurses are often the first line of support for individuals and families. They are able to recognize and act on the limitations some patients may be experiencing, such as the inability to afford transportation or nutritious food. By connecting with people in their neighborhoods and homes, community-based and public health nurses can promote health and well-being and partner with agencies that provide social, health and related services.
The specific knowledge and skill they provide include the ability to perform assessments of health needs, both for specific people and across the wider community, data and knowledge of environmental factors which help them to plan for and respond to issues within their community. They also provide the community and health department with input on the development of policies and programs to help improve general health and assist in implementing evidence-based public health programs.
Nurses working within their communities both lead and collaborate on a range of projects that make a positive difference to those they serve. In California, the Immunize LA Kids Coalition implemented a community action plan with culturally appropriate interventions aimed at overcoming barriers to immunization by improving practices in healthcare provider settings, leading to up to 82% of clients in the service area being up to date with the recommended immunizations by April 2006.
Based in Camden, New Jersey, the Camden Coalition is a multi-disciplinary, non-profit organization that works across sectors in order to address health and social needs. One of its programs is the Camden Core Model, which is a nurse-led care management program for clients with complex medical and social needs. It uses data on hospital admissions to identify those who frequently use emergency care. An interprofessional team of registered nurses, licensed practical nurses, social workers and community health workers engages in person with those identified in order to help them to connect with medical care, government benefits and social services.
Nurse-led programs can also help provide education to prevent illnesses within communities. For instance, The Nurse-Led Secondary Prevention in Coronary Heart Disease program in Nevada provides nurse-run clinics in general practices to promote positive lifestyles and medical aspects of secondary prevention. They offer regular follow-ups, counseling, personalized feedback and assistance in developing action plans.
The COVID-19 pandemic meant there were huge challenges in every part of society, and this impacted healthcare and its delivery in all sorts of ways. Nurses and other health professionals were at the forefront of dealing with the effects and had to come up with innovative ways to ensure patients and the wider population were still served effectively.
Atrium Health, which has facilities across the Carolinas and Georgia, expanded the organization’s existing virtual hospital in order to increase the number of people it could serve. If patients were sick but didn’t need intensive care, they could be observed and receive care within their own homes. The virtual hospital meant patients could be provided with various types of kits to help monitor blood pressure, for instance, and have daily check-in calls with healthcare providers. Nurses led this expansion and dealt with issues such as regulatory compliance, ensuring there was sufficient staffing and providing incident command.
During the pandemic, nurses played a vital role in providing complex care to communities, including those experiencing challenges such as homelessness, isolation, food insecurity and domestic abuse. Nurses were involved in the development and delivery of programs, such as street nursing, telehealth and outreach to isolated seniors, among many other things.
There are organizations working within the US to promote nurse-led care initiatives. The National Nurse-Led Care Consortium builds and manages public health programs in Philadelphia, which serve as national models. This includes programs such as the Nurse-Family Partnership, which offers a personal nurse plus advice, support and information for first-time mothers both during their pregnancy and when their baby arrives. Another example is the Mabel Morris Family Home Visit Program, which helps low-income parents of children who are five years old and under. This program includes specialty nurses providing information, support and encouragement to their clients.
The winner of the 2019 ANCC Magnet Prize sponsored by the Cerner Corporation was OSF HealthCare Saint Francis Medical Center in Peoria, IL, for its multifaceted initiative to reduce food insecurity and improve health outcomes within its community. Its nurses partnered with local stakeholders and devised an intervention that included a mobile Care-A-Van, the addition of a food insecurity assessment to nursing practice, an education program for nurses and clinicians on the assessment and prevalence of food insecurity, a community gardening intervention and an education program for children and families. These are all evidenced-based components that extend beyond the hospital walls and into the lives of the local population.
What makes a good public health worker?
Working within public health can be demanding, and there are certain characteristics, in addition to training and knowledge, that are useful for succeeding within the sector. Helpful character traits include empathy, friendliness, strong ethical values, responsibility and strong motivation.
Empathy:
When clients visit medical facilities they often feel overwhelmed, confused, anxious and sometimes frightened, so those working within public health must show empathy in order to help patients feel more comfortable and less anxious.
Friendliness:
Being kind and relating to the patients you are dealing with can go a long way to reducing fear and confusion for them and can help reduce their stress levels.
Ethical values:
All public health workers must comply with the ethical standards set by the American Medical Association, which primarily focuses on promoting effective and efficient healthcare services. These standards help to eliminate the possibility of errors made by workers. Ethical standards also focus on protecting patients’ personal information by setting data protection standards too.
Motivation:
Working within public health is often fast-paced, requiring speedy service and attention to detail. This is crucial for those employed within the field.
How to become a public health nurse
The first step to becoming a public health nurse is to earn an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) and then to study for and pass the National Council Licensure Exam-Registered Nurse (NCLEX-RN) developed by the National Council of State Boards of Nursing.
Once nurses have become licensed, it is recommended that they gain at least two years of working experience before beginning the process of becoming a public health nurse. They can then pursue certification as a certified public health nurse through the National Board of Public Health Examiners.
Gaining information and guidance from fellow professionals with more experience in the sector is also a valuable way to learn. Mentorship in nursing is regarded as a useful tool for students as they pursue their training and development. For working nurses, mentors can help with practical topics, such as managing time and stress. Texas Woman’s University equips future nurses with the leadership skills needed to be efficient nurse leaders and mentors through their online MSN-FNP program. This program allows flexible scheduling as it’s available both part-time and full-time. The curriculum is designed to give students the knowledge and expertise to work in a range of sectors within nursing.
Final Thoughts
There is a long history of nurse-led initiatives in public health promotion and disease prevention. Embarking on a career within healthcare means adopting and maintaining a commitment to education and training. Public health nurses need to be knowledgeable about new studies, innovations and ideas within the field, cultural developments that affect client groups and general health and political trends too. This can be achieved through formal education, studying for extra qualifications, attending training days and reading a variety of materials. Public health nurses play an important role in improving the provision of healthcare to every part of society.
