Public Health Nurse Career
Although not always visible in the communities where they work, public health nurses continually meet the needs of their largest patient, the community at large. In this informal narrative, RN Pat Iyer shares her experiences as a public health nurse.
The Public Health Nurse in the Community
Public Health Nurses nurse the communities where they work. In a given day that might include attending to the needs of a specific individual, but we must be prepared for any possibility. A case of Hepatitis A, a new arrival to the country needing immunizations for school, an elder who needs her blood pressure checked on a regular basis, communicable disease surveillance, TB case management, or emergency preparedness planning could be part of my daily assignment. Each individual situation requires its own level of expertise. Some patients require care for an indefinite period of time while others will return to their homes, their care complete after the visit. The public health nurse work assignment is anything but routine.
The History of Public Health Nursing
The historical roots of public health nursing evolved from the district nursing concept first developed during the mid-1800s in England1. Nurses helped the poor and sick by providing them with channels within their own community which enabled them to get well. Florence Nightingale directly aided in the success of district nursing by training these first "health nurses."2
Boston was among the first communities in developing district nursing associations. Many communities also had Visiting Nurse Associations that addressed and met the needs of poor sick children and those infected with disease. The advent of managed care in the 1980s dramatically changed the health care delivery system and reimbursement system. Public health nurses were often called upon to fill the gaps in services.
What does a Public Health Nurse do?
As a public health nurse my work is truly community based. My office is located at the Randolph Board of Health and I interface with other local government employees in the municipality. Randolph is located south of Boston, nestled near the Blue Hills off Route 128 and surrounded by five different towns. Since 22% of Randolph residents were born outside the United States, it is a unique population and one of the more diverse towns outside the city of Boston. This requires cultural competence when working with both town residents and staff.
Nursing a population means that you must use a systematic approach to prioritize and balance the patient's needs and the town's needs to be successful in what you do. In some cases, the informal application of the nursing process is a helpful way to prepare me for my work and the diverse projects I have. Public Health Nurses work autonomously and often alone. Thus, we must be innovative in our approach to our patient base.
In my state, public health nurses are linked by our common organization, the Massachusetts Association of Public Health Nurses (MAPHN) and by the mandated requirements of public health service. Most public health departments have formal agreements with a town physician. We have standing orders for vaccine administration, signed annually, giving us guidance for both pediatric and adult vaccinations. Some public health nurses actually administer medications to individuals. I do have a small treatment office. My clinic is more conducive to intermittent wellness visits, injections, weights, Mantoux testing, and for checking cardiopulmonary status. Though the majority of my patients come to my office, I do see some patients at home.
TB case management is a large part of my work. Early identification, contact testing, and support throughout the course of treatment is a mandatory state requirement. In some cases, I may be required to observe patients taking their medication to confirm compliance. The duration of treatment may last from six months to a year, depending on the severity of illness.
The Public Health Nurse and Nursing Leadership
Public health nurses see the larger scope of the community's health. Like other branches of nursing, our work force is aging and many of our organizational efforts are geared to recruitment and educating future public health nurse leaders. Our autonomy in providing care to the patients in the community insures the health of that community, one person at a time. In closing I share this quote from Lillian Wald, who wrote this visionary statement at the age of 26 in 1893:
"Seek out those in need by being in the community. Visit people where they live to understand the conditions that affect their health. Stress prevention by teaching people how to promote their own health and the health of their families. Respect each person as an individual without judgment using every means possible to promote health and strengthen families."3
Pat Iyer is a Registered Nurse employed by South Shore Visiting Nurses Association. She has been contracted to provide public health nursing services to the Town of Randolph for over eight years. She has practiced nursing in a variety of settings for over 24 years and is currently pursuing her Master's Degree in Nursing Leadership at Framingham State College. Pat is currently 2nd Vice President of the Massachusetts Association of Public Health Nurses. For more information on public health nursing, please visit www.maphn.org.Nursing Degree Scholarships
A number of federal, private, and nonprofit organizations offer nursing and healthcare scholarships. Read more about nursing scholarships here:
Get matched to a Public Health Nursing program
Sources:
1 and 2) Swanson & Albrecht, 1993, pp 30-31, Community Health Nursing: Promoting the health of the Aggregates. Philadelphia, PA, W.B. Saunders Company.
3) Wald, L (1971) "The House on Henry Street", New York, NY, Dover Publications, Inc., (reprint of House on Henry Street, NY, NY Henry Holt & Company, 1915.)