An 'Invisible' Workforce: ANA works to support public health nursing and public health infrastructure

Nevada RNformation, May 2004 by Trossman, Susan

And people often don't get the concept of population-focused nursing practice. Or, they think that government-provided services only benefit the poor.

"Our concern as public health nurses in the District of Columbia is the health and welfare of our entire population," said Sharon Payne, RN, a public health nurse and nurse consultant with the Medical Assistance Administration of the DC Department of Health. "We make sure the population lives in a healthy environment, we build partnerships with other stakeholders to ensure everyone has access to care, we educate and empower the community, and we advocate and provide primary prevention services."

And although public health nurses work with the vulnerable and the underserved, their activities promote health within the entire community, contends Payne, president of the DC Nurses Association. For example, public health nurses are part of a program called the "48-hour Newborn Initiative," which guarantees an RN to visit to any family with a newborn, regardless of income.

Alaska Nurses Association member and public health nurse Hisa Fallico, BSN, RN, agreed that the notion of public health touching all is one that is often lost among consumers.

"People don't make the connection that the hand-washing we're teaching in schools and other public facilities - or the immunizations we give - make the rest of the world safe," said Fallico, program manager for the Department of Health and Human Services, Disease Prevention and Control program based in Anchorage.

Fallico pointed to her department's work. During the july to September back-to-school rush, public health nurses immunized more than 3,500 children. They also saw 2,700 clients as part of their tuberculosis oversight program and performed 975 PPDs during the same time frame.

Her department also is working with Environmental Services on a new public health threat - the influx of rats, once a non-issue in the cold climate of Alaska. And her community recently had to deal with the first suspected case of SARS in Alaska, which tested the ability of emergency response and health care providers to prevent a potential outbreak while allaying the fears of the public. (The case was negative.)

Even when the public has direct contact with public health nurses, they often don't realize it.

"We don't wear a uniform, a badge, or a white coat," Fallico said. "We don't have a stethoscope dangling from our neck, and we often are out in the community or in a clinic." Fallico said public health nurses within her state and others have often been mistaken for school nurses, Red Cross nurses, hospital nurses, or even health aides who are helping out in the community.

But ANA and RNs nationwide hope to bring the work of public health nurses and the importance of public health to the forefront as health care policy is shaped.

At ANA's june House of Delegates meeting, nurse leaders passed a resolution that calls for ANA to advance the crucial nature of the public health nurse's role in promoting and protecting the health of individuals, families and communities.

"I am so pleased that this measure passed," Bender said. She said the resolution comes at ta critical time when nurses are in short supply and attempts to substitute registered nurses in public health roles have resurfaced. Like their hospital staff nurse counterparts, public health nurse jobs are often viewed as solely "skills-oriented."

The resolution also calls for ANA to persuade policy-makers to invest in information systems technology and training to strengthen the public health infrastructure - particularly in this post 9/11 world. Bender said that the use of technology has been lagging in most public health departments, although the recent infusion of federal dollars to help public health departments prepare for bioterrorist events and other disasters has helped.

The resolution also directs ANA to advocate for federal funds to health departments to attract, retain and continually enhance the role and compensation of public health nurses; for the better enumeration of public health nurses; and for further development and implementation of quality indicators that are sensitive to public health nursing functions.

Other Actions

A large part of Dotson's role in Montana has been to educate the public, and particularly county commissioners, about their responsibilities to protect the public's health -such as tracking and reporting communicable diseases. She also routinely explains to lawmakers ways in which public health nurses function within the community. Unfortunately, many of those ways have been subject to tradition and political whim.

"There is very little understanding as to what public health ought to be," Dotson said. "Particularly in the small communities, if a county commissioner's mom or somebody's aunt needs foot care, then the commissioners believe that's what public health nurses ought to be doing."

As government funding dwindles further, Dotson believes public health nursing departments across the nation need to focus more sharply on what the CDC refers to as the three core functions of public health: assessment, policy-making and assurance.