Category Archives: Nurses
Rockingham County, N.C., is one of several counties profiled in videos produced for the 2014 report of the County Health Rankings, a joint project of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, and released yesterday. The Rankings shows how communities across the country are doing and how they can improve on their health.
Rockingham evolved from a wealthy county to a poor one very quickly after losing two major industries only a couple of decades ago. The community suffers from high general smoking rates, high obesity rates and high rates of smoking during pregnancy. When the 2010 County Health Rankings were released, Rockingham was ranked at 71 out of 100 counties on health measures. The community's poor standing served as a wake-up call.
One new program set to begin this spring is the Nurse-Family Partnership, a decades-old, evidence-based community health program that serves low-income women pregnant with their first child.
Nurse-Family Partnership is based on the work of David Olds, MD, a professor of pediatrics, psychiatry and preventive medicine at the University of Colorado Denver. While working in an inner-city day care center in the early 1970s, Olds was struck by the risks and difficulties in the lives of low-income children and over the next decades tested nurse home visitation for low income families in randomized controlled trials in Elmira, New York, Memphis, Tennessee and Denver. Results have shown that the program improved pregnancy outcomes; improved the health and development of children; and helped parents create a positive life course for themselves. There are now Nurse-Family Partnership programs in 43 states, the U.S. Virgin Islands and six Indian tribal communities.
In the Nurse-Family Partnership programs, the mothers receive ongoing visits from the nurses in their homes from the first trimester until the baby is two years old. Program goals include:
- Improve pregnancy outcomes by helping the new mothers engage in good preventive health practices, including comprehensive prenatal care from their healthcare providers, improving their diets and reducing their use of cigarettes, alcohol and illegal substances.
- Improve child health and development by helping parents provide responsible and competent care.
- Improve the economic self-sufficiency of the family by helping parents develop a vision for their own future, plan future pregnancies, continue their education and find work.
According to Heather Adams, executive director of the Rockingham County Partnership for Children, there are about 5,000 children under the age of five in Rockingham County. Over half live in poverty and are born to mothers under the age of 20 and many of the children are in single parent households.
“The County Health Rankings really gave us some concrete data to show us what we knew anecdotally was really true,” said Adams. “Nurse-Family Partnership really rose to the top as a really strong program that could help meet some of our needs.”
As part of its County Health Rankings coverage, NewPublicHealth recently spoke with Elly Yost, MSN, PNP, director of nursing practice at the Nurse-Family Partnership national office in Denver, Co. Yost is a pediatric nurse practitioner who previously worked in hospitals and community practice settings.
Health care professionals who smoke often represent a significant obstacle to getting patients to stop smoking. Among registered nurses (RNs) in particular—whose population historically has a high percentage of smokers—smoking limits their ability to be strong advocates for cessation interventions. In 2003, Robert Wood Johnson Foundation (RWJF) grantee Linda Sarna, PhD, RN, FAAN, began a study at the UCLA School of Nursing to monitor smoking rates among health care professionals, with an emphasis on RNs. The study showed a significant drop in smoking rates among registered nurses and the results were featured in the January special issue of the Journal of American Medicine, which commemorated the 50th anniversary of the U.S. Surgeon General’s landmark report on the health consequences of smoking.
The UCLA study found that the proportion of registered nurses who smoke dropped by more than a third from 2003 to 2011. While RN smoking rates held relatively steady between 2003 and 2007, they fell from 11 percent in 2007 to 7 percent in 2011. The drop represents a 36 percent decrease in smoking rates among RNs—more than double the 13 percent decline among the general U.S. population during the same time period. The study also found that RNs were more likely to quit smoking than the general population.
Tobacco Free Nurses, an RWJF-funded national campaign led by Sarna and Stella Aguinaga Bialous, DrPH, RN, helped to reduce the prevalence of smoking among RNs. Founded in 2003, the nurse-led program aimed to dissuade nurses from smoking in order to prevent smoking-related health issues among RNs and their patients. Tobacco Free Nurses works by supporting smoking cessation efforts among nurses and nursing students; encouraging nurses to advocate for a smoke-free society; and giving nurses tobacco control resources to help patients with cessation efforts.
In addition to the significant decline among registered nurses, the UCLA study found that smoking rates also fell for most other health care professionals. However, licensed practical nurses (LPNs) did not see any significant decreases. Approximately 25 percent of the LPN population still smokes, which is the highest percentage of smokers among health care professionals.
>>Bonus Link: Learn more about the last 50 years of tobacco control in RWJF’s interactive timeline.
The Robert Wood Johnson Foundation Human Capital portfolio’s blog, a forum for discussion about the challenges of building a diverse, well-trained health care workforce, features a “Day in the Life” series this week featuring public health nurses. With their own words, these nurses talk not just about what they do, but why they do it—the importance and meaning of their efforts.
For Anneleen Severynen, RN, MN, PHN, of the South King County Mobile Medical Unit for Public Health Seattle and King County in Washington State, it’s about being able to help one person at a time. Anneleen wrote about Charlie, a 60-year-old Native American man who started drinking at the age of 12, bounced around foster homes, returned from service in Vietnam hurting even more, and now calls himself a “lost cause” who expects to drink himself to death.
“As I sat silently, I listened to him grieve the loss of his culture and detail the many kinds of discrimination he has suffered. Though he spoke with the slurred speech of a chronic alcoholic, his eloquence moved me. I noticed tears in his eyes as he described a few happy childhood memories with his father—memories not quite lost to him.”
By helping him to open up she was also able to get Charlie to agree to a few medical tests. He was given a prescription for high blood pressure. She doesn’t know whether he’ll follow through, but she knows that because she took the time to listen, he now has a better chance.
“Every day I get the chance to make a difference in people’s lives, and to help them know that they matter. I can help one person at a time make small choices that will improve their lives and health. As long as there is someone to hear their stories, there are no lost causes.”
A new report funded by the Robert Wood Johnson Foundation (RWJF) and produced by the University of Michigan Center of Excellence in Public Health Workforce Studies offers—for the first time ever—a comprehensive assessment of the state of nursing and nurses in state and local health departments. Enumeration and Characterization of the Public Health Nurse Workforce: Findings of the 2012 Public Health Nurse Workforce Surveys looked at—among other things—size, composition, educational background experience, retirement intention, job function and job satisfaction of nurses.
RWJF recently spoke with Paul Kuehnert, MS, RN, CPNP, team director of Public Health at RWJF, and an alumnus of the RWJF Executive Nurse Fellows program, to discuss the report.
Among the report’s findings is that while public health nurses report high levels of job satisfaction, they’re also concerned with issues such as job stability, compensation and the lack of opportunities for advancement. It also found that about 40 percent of public health departments have “a great deal of difficulty” hiring nurses.
“It should be a high priority to address gaps and take steps to strengthen the public health nursing workforce,” said Pamela G. Russo, MD, MPH, RWJF senior program officer. “Public health nurses are likely to need training to keep pace with the changes as health care reform is implemented and public health agencies focus more on population health. The size, makeup, and preparation of the public health nursing workforce greatly affect the ability of agencies to protect and improve the health of people in their jurisdictions.”
Earlier this month, we reported on a convening of experts to better understand, define and chart a future course for the field of public health nursing. Shirley Orr, MHS, APRN, NEA-BC, a public health consultant and Robert Wood Johnson Foundation Executive Nurse Fellow, shared her thoughts on the evolving roles of public health nurses, the value of nurses for advancing population health goals and more.
We asked readers and event attendees to weigh in on the potential opportunities in public health nursing, and the responses we heard were insightful and lent an interesting perspective on moving the field forward. Some excerpts from the comments include:
- "I reaffirm the need for public health nurses to have opportunities for further skill development, particularly in the leadership arena. PHNs are trusted by their communities and have such great potential to lead community health improvement efforts; however, they often lack the skill and confidence to engage 'grass top' leaders." – Julie Willems Van Dijk
- "We need to work carefully to document the effectiveness of PHNs in roles that benefit from that unique combination of public health knowledge and clinical judgement/expertise." – Susan Swider
- "We are finding that community health assessment (MAPP, in our case in Homer, AK) is a natural outgrowth of the community-wide relationships that PHN's have over time. PHN's are respected and thus able to confront community barriers to change, building consensus to address unmet needs and to address disparities." – Sharon Whytal
- "Public health nursing provides the essential framework & skill set required for successful integration of the whole person into the family & community." – Kindra Mulch
Another attendee, Janet Zoellner, recorded her thoughts on her blog, Nursing... Public Health Style. From her blog post on the Forum: "A lot of attention was drawn to the profession's relative inability to articulate why a public health nurse should serve in their community... We need a dose of bravado." She concluded with a call to action: "Whether it is systems work, education partnerships, community coalitions, etc. it all still boils down to hard work and looking across the table at our public and our partners to gain understanding... and each other's phone numbers."
Thanks to all for the contributions, and for continuing to communicate the value of public health nursing.
>>Read the full set of comments on the public health nursing post here.
Public health nursing is a profession in flux, and experts are convening next week to better understand, define and chart a future course for the field.
The future potential for public health nursing will be the topic of a forum convened by the Robert Wood Johnson Foundation on February 7-8. The goal of the forum is to provide a better understanding of the current roles of public health nurses in improving health, how those roles are evolving in the changing health environment, and the implications for the future of public health nursing education and practice.
Shirley Orr, MHS, APRN, NEA-BC, a public health consultant and Robert Wood Johnson Foundation Executive Nurse Fellow whose fellowship project focuses on advancing public health practice through standards, accreditation, and workforce competency, helped to plan the event. Ms. Orr previously served as Director of Local Health for the Bureau of Local and Rural Health for the Kansas Department of Health and Environment.
NewPublicHealth spoke to Shirley Orr about the upcoming forum.
NewPublicHealth: What are the critical issues facing public health nursing right now?
Shirley Orr: Public health nursing practice has strong roots in history and it has always had a focus on prevention and health promotion. But now the public health system, as well as all of the health care delivery system, is changing, and it needs to change. Despite the fact that we spend more than many, many countries on health care in the U.S., our health outcomes don’t reflect that. So, public health nursing is one part, but a very integral part, to transform the system and especially to bridge public health and health care at the community level. In particular, public health nursing has a clear role in engaging communities around health. This is so important because to be able to truly improve health we need to focus more and more on the social determinants [at the community level].
In preparation for the forum, I’ve spoken to nurses individually and as part of focus groups and I have heard a sense of urgency about the need to have a clearly articulated, shared vision about public health nursing so that we can communicate more effectively with the public and with stakeholders about what our role is and how we can better support health in the future.
NPH: What is the goal of the upcoming forum?
Shirley Orr: We have several.We’ll have fifty people attending who represent diverse stakeholders in health, public health and public health nursing education and practice. The overall goal is to develop some consensus around a shared vision for the future of public health nursing, and beyond that shared vision, a shared agenda and begin to prioritize some action steps around that agenda.
NPH: How do public health nurses add value to advancing population health goals?
Shirley Orr: Public health nurses function at many levels within the public health system. There are public health nurses who work at the highest levels of leadership in national, state and local organizations in a collaborative way to shape health policy. There are public health nurses on the ground in many important roles including working in communities to advance safe neighborhoods, assure sanitary conditions, safe food and water supplies. The roles within public health nursing are very broad and very diverse.
NPH: How do you see the roles of public health nurses evolving over time?