Navigating the Future of Public Health Nursing

Public Health Nursing Panel

Estimated read time: 1:20

Summary

In this special episode of the RN Mentor Podcast, a distinguished panel of public health nursing experts shares their insights into the challenges and opportunities facing the profession. Moderated by Lauren Carol, the discussion covers the unique roles public health nurses play in addressing population health, the critical importance of understanding social determinants of health, and the urgent need to boost the workforce amid growing demands. The panelists reveal strategic plans for improving public health nursing education and practices, ensuring a robust presence in shaping future health policies and communities.

Highlights

Introduction of eminent public health nurses sharing their expertise 💬.
Emphasis on the broad impact of public health nurses and their role in policy and community health 🏥.
The discussion on challenges in public health nursing education and the transition from acute to community settings 📚.
Insight into enumeration as a strategy to advocate for adequate resources 🧮.
Envisioning a future where public health nursing is integral to all health discussions 🌟.

Key Takeaways

Public health nurses view entire populations as their patients, working to influence health policies and systems 🌍.
There is a significant push to include public health components in nursing education at all levels 🏫.
Enumeration and proper definition of public health nursing roles are critical for resource allocation 📊.
Interest in public health nursing is growing among newer generations, driven by the opportunity to influence health policy and engage in community care 🧑‍⚕️.
A major challenge remains in communicating the full scope and importance of public health nursing beyond clinical settings 📢.

Overview

The episode kicks off with introductions to key public health nursing figures, highlighting their impactful careers and current roles. Lauren Carol steers the conversation, framing public health nurses as essential to managing population health, effectively managing the health of communities through policy and systematic health interventions.

An engaging discussion unfolds regarding the inclusion of public health education across nursing programs, with panelists stressing the need for such education at the associate degree level and up. This leads to a broader conversation about the role of public health nurses in advocating for changes in policies and systems to better serve populations.

The panel concludes with a forward-looking perspective on public health nursing, exploring challenges such as workforce shortages and the importance of accurate enumeration. They express optimism about innovative educational strategies and the role public health nurses will play in future initiatives, stressing the vitality of their work in driving health equity and systemic change.

Chapters

00:00 - 03:00: Introduction and Guests The introduction sets the stage for a special episode of the RN Mentor podcast, featuring a collaboration with Nurse Vitals PRN. It opens with music and a warm welcome message.
03:00 - 09:00: Discussion on Public Health Nursing Roles The chapter begins with the introduction of individuals participating in the discussion, including Lauren Carol, a public health nurse from Alaska. Lauren is highlighted for his significant credentials: he is a John's Hopkins fellow with the Bloomberg American Health Initiative, was chosen as an American Journal Public Health Think Tank member in 2021, and is a past president of the Alaska Public Health Association. The chapter sets up a discussion on the roles of public health nursing with a focus on Lauren's expertise and background.
09:00 - 21:00: Education and Curricular Training In the chapter titled 'Education and Curricular Training,' the focus is on key personnel within public health and their contributions to health policy and education. Dr. Aisha Mix, a notable figure mentioned, holds the rank of captain in the US Public Health Service and plays a significant role as a senior health policy administrator for the US Immigration and Customs Enforcement Health Service Corp. Her background includes serving as an assistant Surgeon General and the 12th chief nursing officer in the US Public Health Service, highlighting her extensive experience and leadership in public health education and curricular training.
21:00 - 29:00: Enumeration and Workforce Challenges This chapter introduces key figures in the public health and healthcare sector, focusing on Dr. Susan Hayes, the Chief Nursing Officer at the North Carolina Department of Health and Human Services, and Dr. Joyce Edmonds, the Director of Midwifery and Reproductive Health. The chapter seems to aim at discussing roles and challenges faced by these professionals in the healthcare workforce.
29:00 - 41:00: Future Vision for Public Health Nursing The chapter titled 'Future Vision for Public Health Nursing' features insights from a senior research scientist at Arad Labs at Harvard School of Public Health, who previously chaired the APAA Public Health Nursing section. This individual is also the Editor in Chief of a well-regarded journal in obstetrics, gynecology, and neonatal nursing. Additionally, Dr. Christa Jones is introduced as a clinical associate professor and director at the University of Illinois Chicago College of Nursing Vaana campus. Their roles and contributions to public health and nursing are discussed.
41:00 - 45:30: Conclusion and Closing Remarks The chapter likely concludes the narrative, emphasizing the significance of various public health and nursing leadership roles. The speaker acknowledges their positions as chair of the Council of Public Health Nursing, president of the Association of Community Health Nursing Educators, and chair of the Illinois Nursing Workforce Center. Furthermore, there is a recognition of Dr. Jamie Wats, an essential figure for the group, though absent. Dr. Wats is noted as a public health nurse and faculty member at UNC Greensboro, contributing leadership and guidance. This segment wraps up with possible closing remarks on the collective efforts and roles in public health nursing.

Public Health Nursing Panel Transcription

00:00 - 00:30 [Music] [Music] hello and welcome to a special episode of the RN Mentor podcast and nurse vitals PRN combo uh I'm going to start
00:30 - 01:00 uh with some introductions with uh the individuals that that are joining us this this today uh I'm going to start with my co-host uh for this episode Lauren Carol uh Lauren is a public health nurse from the state of Alaska uh he is a John's Hopkins fellow with the Bloomberg American Health Initiative chosen to be an American Journal Public Health Think Tank member in 2021 and past president of the Alaska Public
01:00 - 01:30 Health Association uh I also have Dr Aisha mix uh Dr Mix is a captain in the US public health services um or excuse me US Public Health Service and services uh as a senior health policy administrator for the US Immigration and Customs Enforcement Health Service Corp Dr Miss has uh seever has served as an assistant Surgeon General and a 12th chief nursing officer in the US Public
01:30 - 02:00 Health Service uh we also have Dr Susan Hayes Dr Hayes uh excuse me Dr Susan Hay little Dr Susan Hayes little is a North Carolina Department of Health and Human Services Chief nursing officer for the public health portfolio we also have Dr Joyce Edmonds uh Dr Edmonds is a director of Midwifery and reproductive Health at uh ZW
02:00 - 02:30 and a senior research scientist at uh Arad Labs at Harvard School of Public Health she is the immediate past chair of the apaa public health nursing section she is also the Editor in Chief of the Journal of obstetrics Gynecology and neonatal nursing we also have Dr Christa Jones Dr Jones is a clinical associate professor and director of the University of Illinois Chicago College of Nursing vaana campus Dr Jones serves
02:30 - 03:00 as chair of the Council of Public Health nursing organization president of the association of Community Health nursing Educators and chair of the Illinois nursing Workforce Center also I want to recognize Dr uh Jamie wats isy who is not joining us this morning today uh but she was essential in putting this group together uh and she is a public health nurse and faculty member at UNC greensbor Bor who let the and let the
03:00 - 03:30 who leads uh the coordinated efforts for this incredible uh panel so thank you everyone for joining I'm going to hand that off to uh uh Lauren and we're going to get this conversation about public health going so welcome thank you so much olly and welcome panelists and also uh special thanks to Ali in the RM Mentor podcast I understand you just had a fourth birthday so happy birthday to the podcast and thanks platform so
03:30 - 04:00 panelists we've we're going to Jump Right In we have four kind of main areas and I'll address each of you with a question I would just encourage the rest of you to hop in um so let's get started kind of the four areas that we'll touch um during this hour so we'll be Workforce who are we as public health nurses our competencies um enumeration and then fourth and lastly let's talk about touch on uh our shortage our Workforce
04:00 - 04:30 shortage and how we're going to move into the future so first off uh Dr Aisha mix could you speak a little bit about who we are as public health nurses and touch on how we tell our story thank you for that Lauren um always a pleasure to join my very esteemed public health nurse colleagues so it's funny when people ask me that question I always tell them the very simplified version first right and I tell people you you know you understand
04:30 - 05:00 that nurses care for patients period right as a public health nurse our patients have to happen to be population so instead of doing the same work that we normally do for an individual we actually have elevated it and so our impact and our Focus are on segments of populations or entire populations themselves so when I explain the work of a public health nurse I get people to understand that as a nurse we're responsible for addressing people's engagement and their response to their environment and how that intersects with
05:00 - 05:30 health so when you look at that as a group of people that's who we are right that's how we actually engage and interact and support the Health Care system so Public Health nurses then have populations as patients and what we're there to ensure is that we're alleviating suffering we're addressing needs and all of the work that we do is targeted to and linked to those specific needs so that we can have the most positive and optimal outcome again just as for individual patients that are
05:30 - 06:00 identified by the populations that we serve thank you so much Dr Susan little did you want to chime in on that from your perspectives yes um Public Health nurses so I've been a public health nurse myself since 1996 so a number of years served in various roles at the state local and actually International level and the
06:00 - 06:30 what's I think so unique about public health nurses is our ability to be flexible and look at Health from an individual all the way to a population level and every time we even look at an individual in clinical care that if we may be working in clinical care it is always from a perspective of the population that we're providing that clinical care thanks so much Dr Edmonds you bring a
06:30 - 07:00 unique set of perspectives you've been in the field for a while what might you add thank you um yes I've had the privilege of working as a public health nurse prior to my academic career and the local state and federal level and I always describe public health and the specialty as uh the ability to sort of zoom in and zoom out like Dr little said that ability to sort of look and meet individual families where they live work
07:00 - 07:30 and play in their communities being a trusted source of information um but then also zooming out and understanding the systematic and structural facilitators and barriers to health um and operating in that space both you know at the individual family level but at that policy level um thinking about changing organizations the structures uh the laws the
07:30 - 08:00 regulations um that shape our health got it and Dr Christa Jones I'd like to pull you into the conversation and I want to ask a very broad question when you're working with students and you're kind of thinking in that space but you're also thinking about core competencies and scope and standards of practice what things come up for you when you're working with students thank you and I I appreciate the time to here with his esteemed um
08:00 - 08:30 colleagues on the panel uh we look at um Public Health nursing practice um certainly has um others have stated um promoting and protecting the health of populations using Knowledge from a holistic standpoint um nursing social and Public Health Sciences and focusing in on um how we improve the population Health whereas um many of our other curricular courses perhaps are focusing in on the individual level and we're
08:30 - 09:00 really looking at how do we look at things like you know her immunity for example or you know what is the um detriment upon a population um when so many individuals within that population are suffering from same um diseases or diagnosis or um other types of chronic conditions and things and how do we address that and how do we address um both Equity um in terms of care and equitable um resources
09:00 - 09:30 in communities that are more marginalized and disadvantaged and so with students we talk about all of these various social determinants of Health that impact not only the health of the individual but the overall health of that entire population and what are the resources that can come to Bear to address those um issues and concerns where are the limitations and where can we best and most effectively apply funding to assure that the resources are
09:30 - 10:00 where they are needed most and I'd like to just build on that excuse me but I just think that we are as a as a sort of specialty while we're small we're miny because we can be flexibly deployed we have a range of um Advanced Knowledge and Skills that allow us to move in and out of different places that it's not just isolated to like a unit or a hospital
10:00 - 10:30 um and I think that really makes us unique I'll add on that Lauren um that's one of the things that I think is so important about public health nursing is our flexibility to to move in and out and pivot into the different roles whether we're working in clinical or whether we're working in policy whether we're working with communities with whichever role we might be working in public health nurses have that ability to to Pivot and when I'm
10:30 - 11:00 working with the nurses in North Carolina and the nurses in Across the Nation when I have that opportunity I talk a lot about how one of the joys of Public Health nursing is the ability to be able to Pivot we may be working with that individual uh patient or family one day and the next day will writing Statewide standing orders for covid vaccines it's a um it's a very
11:00 - 11:30 exciting uh career in profession because it has that ability to move into different Realms of practice now I have something to disclose I'm a little biased because I have also been a public health nurse for a while but I have a question this sounds exciting to me but do you think students are getting the full picture of what public health nursing is or could be
11:30 - 12:00 Dr Jones it's a great question uh so one of the things that um I think is critically important is um whom is providing that instruction you know to students within those courses uh many of us have talked about our years of experience I myself have um just celebrated last year 30 years um has a population health and um nurse working in various settings um in the community so we want to um engender
12:00 - 12:30 a passion in students for this work so we have to get them into all different types of settings um to which public health is all encompassing so it's Correctional nursing school health nursing we're looking um at you know fly qualified Health Centers and um Health departments and Community agencies and you know everywhere in which um environmental and climate influences are
12:30 - 13:00 occurring that's a part of Public Health nursing um we were just talking about the covid pandemic and disaster preparedness and um all of these other as I said social Tris and other influences there are lots of opportunities um to practice population Health nursing and so we want to have individuals in the classroom that come with an understanding of the skills and the competence needed to practice in um
13:00 - 13:30 autonomously and independently in many of these settings um that we're all discussing and can provide leadership in these settings um so we have to give students exposure but we also have to um have individuals who um have that knowledge and capability and talents in those areas to provide um the information that students need to be able to be adequately prepared to assure a competent Public
13:30 - 14:00 Health Workforce um and what we find in in some of these um and some institutions is that um often times individuals are asked to teach these courses without a lot of experience in these public or population Health areas and that can therefore then be um detrimental on whether or not students receive that adequate knowledge and um information to adequately prepare them for these settings um and most
14:00 - 14:30 importantly to engender a passion for them to go into that field uh Lauren really quick question uh and anybody on the panel that you want to uh chime in I'm going to put my academic hat on for a second um because um most associate degree programs I don't think well I say all associate degree programs pretty much do not include a public health component in them um I know in California where I teach um there you know it's part of the
14:30 - 15:00 bachelor's degree program and when you when you complete it you can apply for your phn certificate and you it's part of that process and I'm happy to say the board recently uh blessed uh everything and for the next couple of years it's free to get that certificate so thank you uh California for that uh is is so uh whether it's initial or renewal um but I have a question um just because like for example uh new the new essential curriculums came out for
15:00 - 15:30 baloria degree Pro degree programs and master's degree programs do you think the um the uh accrediting bodies need to be more purposeful in saying Ambulatory Care Nursing needs to be integrated into all programs whether associate degree bachelor's degree because I think one of the issues we have is we have faculty that only have a cute care setting uh experience as a result and inlex is all
15:30 - 16:00 acute care setting um so is there an opportunity uh for us to say this Ambulatory Care needs to be integrated as opposed to just making these generalizations of Public Health Dei underserved like those are the key words but nobody's saying amatory care and everybody's kind of deferring to acute care setting or not really mentioning public health or or Ambulatory Care in
16:00 - 16:30 that uh in that concept um I I I'll just respond to that I think that's a really interesting question because um like you mentioned associate degree programs and baloria programs traditionally were very different based on the whether they had a public health nursing and then a leadership component now that is changing and I would say that the one thing that's consistent is the inconsistent y so much like healthcare
16:30 - 17:00 there's a wide variation in the quality of programs and the ability of programs to have trained faculty as well as dedicated practice Partners who have the relationships with those faculty um when you talk about Ambulatory Care I think it's like you're starting to get into this idea of setting and um I would really like to see Public Health nursing move away from being defined based on setting because like we
17:00 - 17:30 mentioned we're able to practice in multiple settings whether it's in an impatient an ambulatory a clinic a neighborhood you name it and so I don't necessarily think that we should um move forward with thinking about competencies by by setting yeah thank you for that yeah and I work at now I'm at a fqc so we have that community outreach arms uh you know
17:30 - 18:00 with mobile health clinics and things like that that uh serve like the underserved and and homeless population so so yeah I completely I completely get it but those are like two areas when we're when we're looking at moving away from that accute care settings and that's why I kind of put a both we've been talking about this for years and I don't think nursing um is the most Progressive in relation to its curriculum and its movement forward and again I think there are some schools of
18:00 - 18:30 nursing that really have excellence in this area um and others that don't um but getting better criteria for what we're talking about when we talk about these populationbased competencies um and getting people to have a elevated understanding of that is is definitely needed yeah thank you thank you
18:30 - 19:00 what I'll add you know as I always think about that and even going back to what um Dr Jones was mentioning it's not so much a public health course or a community health course I think you know where we have an opportunity both at the associate degree level as well as the baloria level is to help people Elevate the thinking so that we don't stop at just considering the patient and the family but no matter what the conversation we're having we still link
19:00 - 19:30 it and go even further to talk about the population Health impacts right um because it could be simple things right whether you're in your Maternal Child Health class there are aspects of that that are very specific to individualize Patient Care in a hospitals there are other aspects that have something to do with other settings but even beyond that there's everything that has to do with bringing in the social determinance of Health in the entire population level context in order to provide care for that person and that family and so being
19:30 - 20:00 able to infuse that into each and every course and having students have that exercise and critical thinking because to me when you're in a pre-licensure program regardless of what degree level it's really setting the stage for where you're going to springboard when you are a Bonafide and I say Bonafide because I see Public Health nursing as a specialty when you are a Bonafide practicing public health nurse you've actually reached the highest levels of these particular competencies and you're able to apply them no matter where you are
20:00 - 20:30 and so if you learn the basics and you understand what that looks like for some that may become their calling for others it may not but guess what they've been exposed to it and so they understand it and so what my hope is that if you instill that at the pre-licensure level they have that much more appreciation so they will then seek out those who are expert in the area and then the public health nurses will be utilized way more than we currently are but I think that that really is the gap um in infusing it entirely um in Academia and then being
20:30 - 21:00 able to link Academia and practice because as long as they're considered these entirely separate entities Will Never Move the needle so I think that that is the first step in just making sure that you know when we're talking to universities colleges we're not talking about how can we give you a course you know it's it's beyond just the course I I'd like to add um so I appreciate so much that I was inv invited to to bring the voice of
21:00 - 21:30 practice at the at from North Carolina's Public Health nursing to this conversation and while I can't speak to accreditation of BSN or ADN or diploma programs I can talk to what it's really like out there for public health departments and other health agency who wish to hire Public Health nurses there is
21:30 - 22:00 a um a belief that the minimum entry level into public health nursing practice is a Borat degree and um and that's evidence-based and everything but the reality of it is I'll take North Carolina as an example the majority of new nurses who graduate from nursing schools in North Carolina are from ADM programs we're
22:00 - 22:30 very rural State the majority of our nurses in North Carolina are adns and the majority are working in rural areas so there is not an option in many of our counties to be able to hire BS and prepared nurses so what we've done in North Carolina is really look at our uh our Public Health nurses and those
22:30 - 23:00 who are interested and we have had um for many many years many decades Administrative Code that stated if a nurse becomes a public health nurse in a local Health Department if they do not have a BSN they have to take an introductory course in the principles and practices of Public Health and public health nursing within the first year of practice but what I've been hearing ing for over a decade now that I've been at
23:00 - 23:30 the state level is that after those non BSN nurses take that course they are more prepared as a public health nurse than the BSN uh prepared nurse so we've taken a different approach in North Carolina because we do don't want our non BSN nurses to feel marginalized we need them they are holding up at least in
23:30 - 24:00 governmental Public Health nursing they're holding up Public Health nursing in North Carolina so we have a um a new Public Health nursing credential program that allows all public health nurses and governmental Public Health to take this course within their first year and that's equalizing the Baseline fundamental information that all the public health nurses have it's also addressing what Dr
24:00 - 24:30 Edmunds talked about was which is the consistently inconsistent education about public health nursing in the BSN programs and in the ADN programs and it's been very popular extremely popular in North Carolina and um and it has helped address uh competency differentiations that we were finding all over the state I just wanted to um add something on to that because I don't want us to
24:30 - 25:00 leave with you know everything is Bleak right and I'm really kind of you know we've brought out here's the challenges here are some of the concerns but you know we're really facing right now um a new paradigm shift um we on the heels of the Robert Wood Johnson future of nursing report the American Association of colleges of nursing has put out the new Essentials and the essentials are really calling for a shift away from greater investments in acute care to moving into how do we reinvigorate
25:00 - 25:30 Public Health values and principles in every single course to what Dr Mix um stated previously it has to be intertwined throughout the entire curricula and right now colleges and universities of nursing across the United States are reenvisioning their curriculum and you know there is a call for um asserting that in each of these courses they develop um a set of curricular competency that allow opportunities for students to develop
25:30 - 26:00 interventions at the individual level you looking at the family level the community level systems level and population levels in all of those courses so I think we're really poised um knowing that those requirements have come forth to work with colleges and universities um across the United States to support academic practice Partnerships clinical Partnerships me to what you're referring to um Dr little there so that we can prepare students to
26:00 - 26:30 address the issues of today and tomorrow racism poverty climate change environmental Injustice violence you know um chronic conditions on down the line um I I think it's it's a really wonderful time for public health nursing right now um postco um certainly where we were all called you know to act but to really act now about changing education thank you folks before we move enumeration I want to ask both Dr Mix
26:30 - 27:00 and Dr little you know we may have folks listening to the podcast that are nurses or brand new Public Health nurses so I'm just curious what what are you seeing that engages the workforce especially the newer folks that are coming on that haven't had years to kind of develop their practice into a Bonafide practice as Dr Mix was mentioning so is it the our folks do they connect with
27:00 - 27:30 competencies do they connect with the challenge of prioritizing workloads uh what is it what what is it that you see that that your employees and team really connect with that keeps them in it and makes them want to learn the specialty I'll start with that um so we all know that nurses nursing is a calling and I think that we as nurs is as we're in nursing school and as we
27:30 - 28:00 progress through our career at different stages we are even called to subspecialties or Specialties and subsp Specialties I was called very early on in my n nursing school career to Public Health nursing and um what I've found in myself I've seen in many many others is that being able to meet the individuals in the families where they are even in their homes in
28:00 - 28:30 their pantries educating uh pre-diabetic or or pregnant women with gestational diabetes about what works in their in their Pantry for their their their um nutrition and what doesn't it's the opportunity to get to meet these patients and families on a different level level than is experienced in the Acute Care
28:30 - 29:00 Center uh and uh setting I believe that um there are many nurses who are not drawn to Public Health nursing as I and many nurses were not drawn to a cute care setting um so I think it's um a servant heart I think it's the the awareness of what Dr Mix was talking about and others about the
29:00 - 29:30 social determinant of health and how they really ecological influences on health that you really are able to see and address in public health nursing practice and I would actually Echo a lot of what basically all of what um Dr little has said and I will also add that from the federal Public Health nursing Workforce it's also the ability to influence change um so at our level many
29:30 - 30:00 of the nurses at the federal level have an opportunity to engage with policy and program development which are other aspects of Public Health nursing as well and so we see it from a different perspective in that we have an impact on things like resource allocation because we know that those things make a difference for communities but in order to actually do that and be a part of that you have to be able to assess the needs of a population right and those are the things that we bring as nurses is that ability to um bring the voice
30:00 - 30:30 advocate for the communities understand what their needs are at many different levels tying in those social determinants of Health but but then being in a position to actually be in action so what's drawn um what draws many of the federal Public Health nurses many will tell you that I came into the federal government because I wanted to be a part of the decisionmaking to make sure that folks are understanding what's happening out in the community that was my calling as well right in addition as The Uniform service within the Public Health Service of HHS we also have the
30:30 - 31:00 opportunity to engage in emergency response um you know disaster preparedness and things of that nature which again are part of Public Health nursing competencies but when we deploy in that manner we again are addressing the needs of the population and the impacted community so we have a subset of nurses who can deploy and provide that direct care but we have even more nurses who can actually engage in the community collaboration um the development of workg groups you know
31:00 - 31:30 cross- sector engagement you know all of the other aspects of Public Health nursing that my colleagues have mentioned to you that are above and beyond the direct patient care that can be provided to one person at that particular given time so it does definitely tie into what Dr little was saying is that sense of purpose and service and then again when you have an opportunity to influence the change and actually make the circumstances better we take advantage of that as well thank you folks so much Dr Edmonds you
31:30 - 32:00 know I still before we move on to eneration I have this like question that keeps burning in my brain and it's kind of related to De bont's piece that they published in 2019 about you know meeting individual social needs fall short of addressing determins of health so I guess a broad question might be in your thinking and as you're visualizing the future matters so what what is the what are you
32:00 - 32:30 seeing and what do you think about the differences between meeting social needs and understanding what social determinants of Health are and incorporating that into practice wow that's a tough question um but a good one thank you for that um yes language absolutely does matter and I think meeting individual social needs is the duty of all healthc care providers working with individuals but
32:30 - 33:00 understanding that those needs have been um created and they're um or formed or shaped by these larger systematic social determinants of Health um and I know that's another very popular term that um has various meaning depending on you know who you're talking to and um how it's how it's applied but I think um we have to go beyond meeting individual
33:00 - 33:30 social needs to really thinking about the structures that shape that need um and how those structures are inequitably distributed um in a society that then in turn some people have more of those needs and than others I don't know if that answers the question or if any of my other colleagues have can add to that
33:30 - 34:00 you know in my experiences uh of things like cross- sector collaboration it took me kind of a while to figure out that when responding to an immediate need like access to medication assisted therapy folks are engaged because individuals and families need access to healthcare meantime while I'm sitting around the cross- sector table I'm thinking about determins of health and I'm looking to engage the folks to work
34:00 - 34:30 Upstream but I discovered maybe those are different partners and there's kind of a yes like what we all need to work on it and we all need to continue working on it and any other would you folks like to chime in on that anyone else yeah I'll chime in and I think what you've described is that perfect connection between public health and nursing right um Public Health automatically brings the conversation Upstream right to exactly what Dr Edmunds was saying you may have that
34:30 - 35:00 immediate need for that person but you have to actually think beyond that right someone is unhoused yes they actually need a place to live however what are the circumstances that were existing in this community that led to groups of people being unhoused right and so when you move Upstream the immediate response is of course we've got to address that but as a nurse you're also taking to context you know so how are people living in this situation and what else is it impacting to your point that may actually be the reason why they're not
35:00 - 35:30 accessing care because I I actually don't know where I'm going go to sleep tonight so you have these multiple and competing priorities that individuals are facing however when you move it upstream and then you turn it into a conversation that is the voice of that population therein lies Public Health nursing and I think that is an important distinction between identifying you know a person's individual social needs and addressing social determinance of Health but that's also a perfect example of helping people understand the difference between Public Health nursing and Acute
35:30 - 36:00 Care Nursing or Direct Care Nursing um those concrete examples I find are often helpful to help people understand the nuances that differentiate and also help people understand that neither of us can do it alone right um we have to work together but we're working differently and I think that that's what brings us to the best results ultimately great I'm going to chime in real quick and um just because you know I'm hosting hosting air coding
36:00 - 36:30 uh so uh I mean I mean this is this is something that normally is not translated well in the academic setting unfortunately and I think that's one of our biggest issues that we're not really talking we're we're bringing in population but we're not really and even after I finish I I think I was I was in my PhD program before my light bulb went on about what social determins of health is and what population health is and it took me a while to get there just
36:30 - 37:00 because my setting was not the correct setting for me to really understand and now that I'm at fqhc like uh all kinds of light bulbs are going off uh in my head because we have an arm that is engaged with a policy from a from a California Sacramento to National DC and and the population that we're serving is 70 plus% Hispanic our Workforce however is also 70% % plus uh Hispanic uh because
37:00 - 37:30 and our clinics are in the communities that our population comes from right so that's a huge difference than individuals who are working uh in the acute care setting and their patients are coming from all over the place and you as an individual aren't necessarily living in those communities and don't really understand so when your Workforce is from the community that you're serving I think also makes a huge difference because you have that understand understanding of the needs and the drive to make the changes
37:30 - 38:00 automatically I think with appropriate resources uh also Drive some of the changes you're trying to make within those populations so I think somehow we're missing something definitely in Academia but in practice in the core of Nursing and I always tell this people the core of nursing is population Health it's not the individuals you're touching but the populations that you're you're engaging with um and I think that's that's that's a key component that uh somehow needs to be translated into how
38:00 - 38:30 we're preparing the workforce moving forward and I'll dip into perhaps a little political discussion but I think it goes beyond academics I think we live in a very individualistic Society where we're not thinking about the greater good we're not thinking about the whole we're thinking about ourselves and we have structures and finances and a system that supports the individual yeah definitely great thank you well I'm
38:30 - 39:00 sitting here thinking um it takes a it took me a while too for my light bulb to come on and it takes time and space and also like things like living locally and working with local populations can be helpful but at the same time while prioritizing the needs of a community it can be challenging for example if there's a syphus outbreak that can shift priorities immediately ESP especially if the cus outbreak is being managed at the
39:00 - 39:30 same time as a pressus outbreak and preparing for say measles and so this kind of brings up the question is how many public health nursing folks or public health Workforce is needed um so the the subject of enumeration enumeration I want to ask each of you get each of your perspectives what is enumeration what does that mean to you folks um and what are the pros and cons and what do we need to move forward
39:30 - 40:00 well I'll um start responding I mean enumeration is really thinking about counting um quantifying who's doing something how many phns for example there are where are they um and more importantly what are they doing um and so it's really about thinking about our Workforce it's supply and demand and it's really thinking about the current Supply so we can come up with
40:00 - 40:30 um an optimal way to think about population phn ratios for Optimal Health outcomes but unfortunately I think the issue is because even though we're having an increased ability to communicate the value of Public Health nurses in terms of the impact that they have on communities and health we don't have a reliable way of deter determining how many phns there are and what they're
40:30 - 41:00 doing we and as I'm sure many many other states have such a nursing shortage and when you layer that with our very rural State and um access to nursing is nursing um staff members is being able to recruit and retain is has so so many challenges
41:00 - 41:30 um for me as a chief public health nurse and for the nursing administrators across the state it is very difficult to advocate for public health nurses having an adequate Staffing level of Public Health nurses when there is not a a known uh
41:30 - 42:00 formula and during a nursing shortage there is risk that public health nurses are replaced with uh licensed practical nurses or or um credentialed uh EMT or even mas and CNAs and we all know that they don't they can't carry out R in scope of practice and um I I think that causes
42:00 - 42:30 issues for being able to carry out the Public Health Mission and what we're required to do by law and Rule when we don't have an adequate number of Public Health nurses so in the practice world it's very difficult not having that formula like they do in the cute care setting um to be able to use to Advocate because
42:30 - 43:00 leadership they like statistics they like facts they like they they need your ask to be supported by facts and numbers and evidence yes and we have a lot of evidence from Linda Ain and many many others that have established like the RN patient Staffing ratios and we have don't have the equivalent of that in
43:00 - 43:30 public health but we are working on it and um all of us and this team in fact um have a partnership that involves cphn the US Public Health Service under um Dr Aisha mix Susan little we are all working on this um important issue of enumeration and the reality is public health nurses you know there's we're two to six% of the total RN Workforce it's a relatively small specialty right um but
43:30 - 44:00 it's it's extremely important one um and more resour resources are needed and efforts to really accurately um be able to capture um and count phns yeah I was just going to add um to that Dr emmens as well um yeah and the latest statistics that came out in 2020 um there's been a decline from 4% of the workforce if you think about the entire
44:00 - 44:30 nursing Workforce cute ambulatory population Health um School nursing everything um 4% to 2.9% um in 2020 um at the start of the pandemic um we certainly know across the board um there's an estimation of 5% of the workforce Left Post pandemic so you know dwiddle away you know even more you know after that so um certainly Less in terms of um numbers to address needs you know
44:30 - 45:00 goodness if we would ever have another you know pandemic in the next couple of years um would you know we still have to rely like we did before on lots of retired nurses coming um to um the assistance of everything from assessments to vaccinations to dispelling myths um and you know rumor in communities and neighborhoods um to um you know engendering um individuals and motivation for people
45:00 - 45:30 um to be a part of the process from businesses on you know on down the line um we also know that there are significant disparities in salaries so if you look at us Bureau of Labor Statistics Public Health nurses um on average make anywhere from eight you know to $20,000 less than a cute and Ambulatory Care um counterparts um and um to Dr Little's comments um before what we're finding in the research and the data now is that
45:30 - 46:00 our generation of nurses that saw this has a calling those numbers are now starting to dwindle and now we're seeing you know uh gen Z Gen X nurses new nurses coming into the fold who um are really looking at um balanced work um Lifestyles excuse me Balan with you know personal life and work and you know um what am I going to be you know required to do what's the flexibility in time and also you know what am I going to be paid and so we have some of these barriers
46:00 - 46:30 and challenges that we you know have to address from a salary standpoint from an enumeration standpoint and the other thing is those numbers that I just gave out um are only those that we've been able to track you know to Dr emin's point there is no consistent way in which community population Health nursing is defined to get that number you know are you counted in that number if you're in a school setting are you counted in that number if you're at an fqc are you counted in that number at a
46:30 - 47:00 health department and the way everybody defines that is different um we're currently in my state in Illinois we're doing our registered nurse survey right now because everyone is um has to renew every two years and we have lots of different settings that are listed for individuals but we're finding that some of the nurses themselves don't even see themselves in those categories um so they are truly working as community population Health nurses but they're
47:00 - 47:30 searching to put themselves somewhere else and so they're not truly you know being being counted um and where we know we have significant gaps we also see some overcounting you know where people are saying you know in acute Ambulatory Care settings well sure everyone here is is a population health nurse but are they really addressing back to our previous comments individual needs or are they truly addressing community population Health needs um so there has to be some
47:30 - 48:00 standardization and it also gets into what exactly are they doing so regardless of where they're working like what are their functions and that's uh the piece that is missing yeah yeah and I think one of the other things you know I've been in this conversation of nursing Workforce nursing shortage etc etc for the bulk of my nursing career and even from a federal level it remains is a challenge um so I'm not sure if you all are aware
48:00 - 48:30 that you know the national sample survey of registered nurses the newest report was just released right so that's been released there's always been the conversation um and the questions about a shortage because a nursing shortage does not exist everywhere you know in some places there is a surplus of nurses in others there are hardly any nurses and so when we talk about having a nursing shortage you know it always has to be mentioned with the caveat of who you're talking about and where you're referencing because it looks different
48:30 - 49:00 right so whether there's a nursing shortage of Public Health nurses whether there's an acute care shortage whether there's a shortage in this rural community those nuances are very very important and I think the other aspect that makes it challenging um as far as determining the number of nurses and when you have a shortage is because the number of nurses that you need is directly correlated with the needs of that community and so if you're not assessing the needs of the community and how to meet their needs and then identifying how many nurses you need
49:00 - 49:30 you're doing it backwards right so it's very difficult to say that Community a needs 10 nurses and Community B just because Community a did they need 10 nurses also without actually assessing the nuances that make the populations or even the patients different we're missing the mark and I think often times you know nursing is struggling to fit into a model utilized by other health care professions or other sect s in general and it just does not fit now I
49:30 - 50:00 say that also knowing that we often don't have the time or the resources to do it the right way so you know I still believe that this conversation of nursing Workforce is a public health issue and so as public health nurses understanding and identifying what Workforce is needed to meet the needs of a community is a population Health discussion and I think that's an important aspect where Public Health nurses are not pulled into identifying and designing strategies to meet the needs of whole communities we're asked to meet the needs of individual people
50:00 - 50:30 and often times we're not a part of the decision making in order to really really assess what's needed for a community because that will tell you whether you have enough nurses or not and that's Public Health nurses acute care nurses or any other type of nurse because as the nurse strategizing for a community you understand the continuity the Continuum of health and you can figure out what Workforce is actually going to help to meet those needs you know a a public health nursing Mentor mind Tim struna once he kind of
50:30 - 51:00 outlined that when engaged in its entirety Public Health nursing practice is a very important tool for improving and protecting population health and then the pandemic came along and the public health Workforce really focused on that novel virus and non-communicable diseases were you know Left Behind um and from that perspective so kind of brings up the question and you've all touched on it but I want to ask in a different way so that the question is
51:00 - 51:30 why is there a shortage why don't we have enough Public Health nurses I I believe it goes partly to what Dr Edmonds spoke about is that while a public health nurse can clearly Define what he or what they do uh in general there's not a clear
51:30 - 52:00 definition of what public health nurses do that is understandable or by non non-public Health nurses so apaa American Public Health Association Public Health nursing section and many other lead nursing organizations in the United States have adopted a definition but I think it needs to be updated so that it is understandable outside of our
52:00 - 52:30 profession and we definitely as Dr Edmonds and many others spoke about today need to get as far away from setting as part of the definition as we can because that is limiting us yeah and I would add to that that I think the way we reimburse in terms of the way Healthcare is funded is still at the very much of the individual level level um and so thinking about block funding thinking about reimbursable
52:30 - 53:00 services that are tied to these unique Public Health nursing functions um would go a long way to um having more open positions available in in at least in governmental Public Health yeah and I think the two of you together I think what you're also pointing out is understanding that public health nurses can work in many different capacities
53:00 - 53:30 and the job title if you will doesn't have to say public health nurse every time you know there are many roles many job titles many positions that can be held by public health nurses and I think that also becomes a barrier because often times you know the public health nurses are not recognized until and unless the title says such but when it comes to higher level opportunities executive level opportunities often times the public health nurses are overlooked because those job titles are
53:30 - 54:00 not called Chief public health nurse in many states and so we've got to do a better job of ensuring that people understand that the restrictions that are imposed that prevent nurses from holding positions actually prevent the nursing perspective at the decision-making table I'd like to touch on what Dr Edmonds talked about as far as reimbursement in North Carolina Ina starting in the 1990s we created this
54:00 - 54:30 novel uh role for public health nursing Public Health nurses it's called the enhanced role registered nurse now it's clearly in the clinical area um but through a partnership with Medicaid uh they are reimbursed for the work that they do it's all the work that they do has to do with um the work understanding orders and their um assessing evaluating and treating
54:30 - 55:00 patients uh all within the legal uh scope of practice and it's wonderful because it really generates income for local Health departments and it's exclusive to local Health departments but if that's one role that at least in North Carolina has we've been able to make that work and but but the clinical practice and that's only one small part of clinical Public Health nursing practice um clinical practice and all
55:00 - 55:30 the other roles and functions of Public Health nursing are as just as important as that individual clinical care for the overall population Health and Care of the populations and until we're able to as Dr Edon said identify a way that validates the importance of the work that public health nurses are doing
55:30 - 56:00 inside and outside of the clinic out in the communities with populations in different in different settings and with different groups we're not going to be able to get the recognition that public health nurses deserve in the recognition of the importance of the work that they do I think it's um that recognition is tied to
56:00 - 56:30 reimbursement I agree and I would say you know it's a two-fold issue uh one robust curricular reform in academic institutions that Embraces community population Health competencies throughout all courses within the curriculum that provide students opportunities to experience the role of community public population Health nursing so that they will be exposed to it and um perhaps develop um you know not only an appreciation but an interest
56:30 - 57:00 in the role um and then the jobs have to be there so that's the second part you know the jobs have to be there and the equity as I talked about in disparities um that exist currently in um what community public population Health nurses are paid to peer counterparts and other Specialties um so you know that's part of it and the other thing I didn't touch on previously though was um you know previous to the pandemic funding and Public Health across the board in all sectors had been going down for
57:00 - 57:30 years um and so you know institutions you know don't have opportunities um for positions um for nurses into um uh Dr um Little's Point um some of them are you know hiring other um special um specialty um practice practices to fill those roles because can be hired at a lower wage than a um registered nurse can be um and
57:30 - 58:00 you know that's created issues in many of our communities that we saw um when you know the pandemic hit um unfortunately a lot of those funds that were brought to bear have now been exhausted and we kind of see this year things are going kind of right back the same way in many of those um uh institutions throughout you know our our areas you know particularly in rural marginalized um areas of the
58:00 - 58:30 country so with our remaining time shift gears here a little bit you know I'm sitting here thinking about 911 Hurricane Katrina H1 M1 and four years ago up till now covid-19 it's been rough but also there's a lot of upshots and I'm kind of in chronic underfunding of Public Health and Public Health nursing I'm kind of thinking some of the upshots are when you have a Workforce that has very few
58:30 - 59:00 tools it develops an incredibly creative Workforce and that that's a good thing so I want to kind of start to wrap this up by asking you folks over the past two to three years what are some of the upshots in public health nursing that you've been thinking about and highlighting and also what do you think about the future of Public Health nursing what are you reenvisioning as we move into the future
59:00 - 59:30 I like to save the tough question for the last no I think that's great I think one of the upshots is actually the people here in this room at this podcast and coming together and working together um for the the for on behalf of the specialty on the behalf of the population um and the I believe there is growing consensus within the specialty
59:30 - 60:00 within Public Health nursing about the key needs and priorities um and I think working together um with our professional organizations with our practice partners with our leaders with our colleagues in other nursing Specialties with our colleagues in other public health um areas I think that there is recognition of the public health nursing specialty um and people um are eager to find
60:00 - 60:30 Creative Solutions um to maintain and enhance it and so the vision is like I'd love to see a really robust strong Public Health nursing Workforce where you know back you know where we can think about a population ratio that's meaningful like one population health nurse for uh 3,000 people or back to a neighborhood Public Health nursing model
60:30 - 61:00 um so that would be my answer one of the things that I have noticed during the the the pandemic and sense is that um an upshot is that with the extra funding uh the local Health departments were able to bring in support for public health
61:00 - 61:30 nurses and and like such as medical assistance and things like that which allowed the public health nurses to really start to work at the top of their license and I I think that when when that happened and the nurses were able to use their the nurse nursing
61:30 - 62:00 practice the nursing the art of nursing their critical thinking they were really able to um come up with some creative ways to address the pandemic they were able to create new ways of carrying out the public health programs that they were involved in and I've seen um while we've had a lot of turnover in North Carolina I've
62:00 - 62:30 seen a great amount of innovation happening because they had time to really use those skills the art art and science of Nursing and the nursing process because they were given support for the first time in many years I think that's a great way um and a really beautifully elegant way to say that Dr little um you know I would say I
62:30 - 63:00 have the distinct pleasure of being the chair of the Council of Public Health nursing organizations and we bring to bear the preeminent nursing organizations across the country that are in population health and um we're working on how do we support each other how do we collaborate together how do we bring our voices together around a singular issue because there is strength enough numbers and there's power in numbers you know so how do we advocate
63:00 - 63:30 for a particular issue um and you know what change can we have and um you know whether that be funding or you know that be enumeration um um many of the um individuals as a part of that group are are here on this podcast today and um so working collaboratively together it's really engendered um additional Partnerships um and you know I would say you know the other thing that has been um I think of benefit to us is to take advantage of the fact that you know Co
63:30 - 64:00 brought a lot of challenges but it also brought a lot of opportunities for us to measure outcomes you know Public Health nurses making a difference that has been a challenge it's been a challenge for Scholars for quite some time and so how do we then translate that into everything that we do you know from Mom and baby you know diets to you know working with the elderly to working you know on neighborhood councils to addressing um domestic violence and um
64:00 - 64:30 racism and poverty I mean there's all these things that we do that we don't measure and we we don't have the data to go back to funding sources to say look and see what we did we need more money because we did this and so it gave us an opportunity to start quantifying things and I think we can continue to build on that and I think that is the upshot is we can you know our El elevator speech is getting better defined on who we are um and you know now it's kind of show me
64:30 - 65:00 the money so you know we need to get to the point of show us the money so we can do what we need to do to improve the health in our communities and the only thing that I'll add to that because those have been beautiful responses is you know continuing these conversations that connect the dots um from the local to Regional to State and the federal level because often times we're operating in vacuums and when it's time to work together we don't have visibility and so you know the nuances that are the same nuances that are different being sure
65:00 - 65:30 that we're in communication um so that when disasters occur that's not the first time we're having conversations right um the other is making sure that we're infusing leadership in all of these conversations um we have to continue to develop nurse leaders across all sectors across all Specialties and in particular in public health nursing and we want to make sure that we're creating that role and ensuring that people understand that they can aspire to sit in those roles and have those Communications have those decision
65:30 - 66:00 making um ensure that they expect a seat at the table and if they don't have a seat to bring a chair and if they don't have space for the chair to actually create their own table and the conversations such as the ones that we're having today so I think it really is that continued conversation um but we've made great strides in opening up the doors of communication um creating playbooks that people can plug and play in order to Institute this work where they are but I think even more importantly remaining connected over these past four years for conversations
66:00 - 66:30 such as this wow I have three thank yous number one I just want to thank you panelist for being available you know every time I've reached out to you folks you've been there and that means a lot and also thanks for everything that you're doing for your community so you continue to inspire folks and and it makes a difference number two I'd like to thank Jamie Watts eisy for teaming up with me behind the scenes to do the nuts and bolts but lastly thank you Ali into the
66:30 - 67:00 RN Mentor podcast for this platform with that I'll turn it back to you thank you thank you everyone uh this this has been I've learned a lot and I appreciate the work that all of you are doing I'm I'm humbled by the work that you're doing it's it's a heavy lift uh and and and just my two cents on this is I'm going to say I think uh Public Health nursing along with some other nursing areas that are uh often uh go unnoticed we have to realize who we're competing with and our competition
67:00 - 67:30 is really uh part of it has to do with Academia because Academia is very acute care Focus unfortunately uh and we're we're competing with the shiny IV poles and the beeping machines and the designer scrubs so I think I think I think we have some we have we need we we may need a publicist uh uh at some point to like I think something like the Johnson and Johnson uh campaign for nursing I think that did had a big boost
67:30 - 68:00 I think we would uh maybe we need to reach out to Johnson and Johnson say hey can we look at a public health nursing uh campaign uh so that would be fantastic if we see that happen maybe if they're listening they've got their own podcast I don't know if they listen to this one but maybe we'll push it that way all right well thank you everyone uh again I greatly appreciate everybody's time and uh and and really it means a lot to me for for you to choose uh this platform to uh come and speak and
68:00 - 68:30 hopefully we can do this again I think there's a lot more discussions to be had uh maybe we can do this on a regular basis so again thank you so much and I want to wish all of our um listeners a fantastic rest of your day and we'll bring more uh content for you to uh tune into thank you so much and have a great one n [Music]
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