Shirley Orr was inspired to become a public health nurse after learning about one of its greatest success stories: the campaign to eradicate polio, a disease that had afflicted her mother 20 years before Orr was born. “As a student in high school, I learned that polio could be prevented through vaccinations,” she says. “I wanted to be a part of a profession that had the power to improve and save the lives of so many, by preventing disease and improving health.”
Today, Orr is not only a part of the profession; she is a leader of it. After two decades overseeing public health services in Kansas, Orr, a public health consultant and a Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellow (2009-2012), is now helping states meet new national public health standards and supporting a new RWJF project to develop a shared vision and agenda around the future of public health nursing.
Orr, MHS, ARNP, NEA-BC, got her start in the field long before she entered nursing school. During high school, she worked with a school nurse—an experience that taught Orr that school nursing was much more than treating scrapes and bruises, providing eye exams or screening for scoliosis. The school nurse, she discovered, counseled and provided support for students and their families and advocated on their behalf. “I saw firsthand how her work kept students healthy and helped them succeed in school and beyond.” Orr says.
She enrolled in Wichita State University, where she earned her baccalaureate and, later, a nurse practitioner certificate and master’s degree in health administration. Orr loved it from the start. “My very first job in public health was exciting and challenging,” she says.
As coordinator of prenatal services at a local health department, she collaborated with the medical community and other partners to implement a new project to prevent pre-term births. The project targeted high-risk populations, including African Americans, whose infant mortality rate was three times higher than the overall local rate. She worked on both the individual and system levels to successfully lower rates of pre-term birth in the population. “It was a perfect example of a system-wide intervention to improve health,” she remembers.
From there, Orr went to a statewide perinatology referral center, where she treated high-risk pregnant women, and then to the Kansas Department of Health and Environment, where she has spent the last two decades. In her most recent position, she oversaw technical assistance, training and funding for Kansas’ 100 local health departments and worked with statewide academic institutions to grow and develop the state’s public health workforce.
Leading the Field
During her tenure there, Orr also co-founded the Kansas Public Health Leadership Institute, which aims to support public health leaders and bring officials from health care organizations, academic institutions and other settings together to improve population health. Success stories include a new state law that supports breastfeeding mothers, community projects to reduce obesity by improving nutrition and physical activity, a statewide safe schools initiative, and a back-up emergency health communication system among ham radio operators in rural Kansas.
Orr is continuing to lead the field as an RWJF Executive Nurse Fellow. For the fellowship, she is working to advance public health practice through national standards and accreditation. She created a pilot initiative to help health departments in Kansas learn about and work to meet new national public health standards and accreditation. The project increased communication and collaboration between state and local health agencies and raised awareness about new national standards and accreditation processes. The health departments that participated in the project are now actively working to meet national public health standards and become accredited through the Public Health Accreditation Board (PHAB).
Orr recently left her position at the Kansas health department to launch a public health consulting practice. She is also teaching public health nursing at her alma mater and is helping RWJF start an initiative to gather data about the public health nursing workforce at a time of transition in the field.
Budget cuts to state and local health departments are complicating the work of public health nurses, just as health care reform is increasing the emphasis on population-wide services and as the population—and the nursing workforce—is aging. At the same time, she says, there is a huge opportunity for public health nursing in the effort to implement national public health standards and public health accreditation.
“In my opinion, the movement for national standards and accreditation is our most significant opportunity to advance public health and public health nursing practice,” she says. “The standards strengthen and define our role in collaborating with partners to improve the health of our communities. Public health accreditation provides a roadmap and a common direction for public health agencies and enables us to track outcomes of our work and improve quality and accountability.”