Culture of Health Blog

Three years ago this week, the Institute of Medicine issued a landmark report, Future of Nursing: Leading Change, Advancing Health. Its recommendations include increasing the proportion of nurses with baccalaureate degrees to 80 percent by 2020. Charleen Tachibana, MN, RN, FAAN, is senior vice president, hospital administrator, and chief nursing officer at Virginia Mason Medical Center in Seattle, Washington. Tachibana is a Robert Wood Johnson Foundation Executive Nurse Fellow (2009 – 2012).

Virginia Mason Medical Center began a bachelor of science in nursing (BSN)-only hiring guideline in the summer of 2012. The change in hiring guidelines for our staff followed a decade of having educational guidelines in place for our nurse leaders. This was a critical step in our success, as our leaders were able to support and understand the need for this change. It’s important for leaders to model lifelong learning, including advancement with formal education. So, last August I also began my Doctor of Nursing Practice (DNP) program.

The publication of the Institute of Medicine (IOM) report on the Future of Nursing really provided the momentum to move to another level.  The prominence of this report has made this a relatively easy transition and provided the clarity on why this is critical for our patients and for our profession at this point in time. 

Although we have focused this requirement on new hires, it’s been impressive to see the wave of staff RNs returning to school, many for their master’s or doctorate degrees.

Marni Storey, BSN, MS, is interim director of Clark County Public Health in Vancouver, Washington, chair-elect of the Washington State Association of Local Public Health Officials, and a Robert Wood Johnson Foundation Executive Nurse Fellow (2013-2016).

I am often asked if I recommend public health nursing as a career option. My enthusiastic answer is ABSOLUTELY! I have been a public health nurse for more than 25 years and am one of a very few Americans who wakes up every day believing I have the best job in the world. There are many reasons I enjoy this profession, but three important pillars of public health nursing have kept me engaged for more than 25 years, and will keep me enthusiastic for many years to come.

The first pillar is that public health nursing services—including nursing assessment, intervention, and evaluation—are focused on a population, not on individuals. Whether you are interested in women, children, ethnic or cultural groups, or if you are interested in conditions such as HIV/AIDS, communicable diseases or obesity, the strategies used by public health nurses affect entire communities.

• View related RWJF analysis and perspectives on Nurses, Nursing and Population Health
  

While challenging, this population focus is also rewarding because, as a public health nurse, you are developing an understanding of an entire group of people or community in order to effectively carry out your nursing duties. This is very different from the individual relationships you develop in other nursing fields. Also rewarding is the chance to witness community transformation as a result of the collective impact of communities working together.

Anneleen Severynen, RN, MN, PHN, is a public health nurse working on the South King County Mobile Medical Unit for Public Health Seattle and King County in Washington State.

I work as a public health nurse on King County’s mobile medical unit, traveling south of Seattle in a van, providing for the health care needs of homeless individuals.  I perform many “nursing” tasks in my job – taking blood pressures, getting health histories, dressing wounds.  But my most important nursing skill is my ability to listen.

This morning I met Charlie.  Charlie is a 60-year-old Native American man who reported that he began drinking at age 12, while being passed around to various foster families.

At 17, he went to Vietnam to get away from abuse and neglect, only to be traumatized further by the war.

He called himself a “lost cause” and said he would probably never stop drinking, and knows that he “will die soon.”  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.

NewPublicHealth is speaking with directors of several health departments who recently were accredited by the Public Health Accreditation Board. Eleven health departments received the credential so far. We recently spoke with Mary Selecky, director of the Washington State health department, one of the first two state health agencies receive national accreditation status. Ms. Selecky recently announced her plans to retire from the health department.

>>Also read our interview with Terry Cline, health commissioner of Oklahoma, which also was recently accredited by PHAB.

NPH: How do you think accreditation will improve delivery of public health services and care in Washington State? Now that the health department is accredited, do you feel as though you are leaving the department in even better shape than it was?

Mary Selecky: Accreditation is really a quality improvement tool, and the standards that have been set by the Public Health Accreditation Board force you to examine whether you have the right processes in place for continuous, sustained quality improvement. And if you have found that you are not quite up to par in an area, then the processes help you ask what you will do to improve your performance in that area? The process helps you increase your performance, your effectiveness, and your accountability.

Public health touches people every single day—everybody in the state, from the moment they get up until they go to bed at night and even while they’re sleeping. This credential shows us that we have effective programs and measures in place to meet the needs of our communities. Drinking water systems are a good example. We regulate 16,000 drinking water systems, and I have a lot of drinking water engineers who are out in communities checking on water systems. I have to know that they’ve got a common set of operating procedures to assure the public that we’re looking out for their interests and when they turn on their tap from a municipal water system, that the water’s safe to drink. You can only do that when you have some procedures in place and that goes for the engineers, for laboratories or programs to make sure they are operating well in the community. Accreditation touches every part of the department.

NPH: How will you be promoting and explaining accreditation to policymakers?  

NewPublicHealth continues a series of conversations with local public health directors on the issues that impact their work and the health of their communities. Recently, we spoke with David Fleming, MD, MPH, public health director of Seattle and King County in Washington State. Dr. Fleming talked with us about how transportation innovation can impact the health and prosperity of a community.

>>Check out an INFOGRAPHIC on the connection between transportation and health.

NewPublicHealth: How is transportation innovation making a difference in the health of communities in Seattle/King County?

Dr. Fleming: We’ve started with transit-oriented development such as increasing bike and walking paths, which provides opportunities for physical exercise for many folks that want to do it, but haven’t been able to. It draws a larger number of people into activities and helps them exercise routinely. And in addition to increasing physical activity, you’re also increasing safety, reducing injuries, increasing the social capital in the community, getting better connections between community residents and from an economic development standpoint, you’re creating jobs and increasing property values, and therefore, improving one of the underlying social determinants of health.

NPH: What other examples of transit-oriented housing and community development can you tell us about in Seattle/ King County and what have you learned from them?

The Robert Wood Johnson Foundation’s Academic Progression in Nursing (APIN) program announced that California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas and Washington state have been chosen to receive grants to advance state and regional strategies aimed at creating a more highly educated, diverse nursing workforce. Each state will receive a two-year, $300,000 grant. 

The states will now work with academic institutions and employers on implementing sophisticated strategies to help nurses get higher degrees in order to improve patient care and help fill faculty and advanced practice nursing roles.  In particular, the states will encourage strong partnerships between community colleges and universities to make it easier for nurses to transition to higher degrees.

In its groundbreaking report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) recommended that 80 percent of the nursing workforce be prepared at the baccalaureate level or higher by the year 2020.  At present, about half of nurses in the United States have baccalaureate or higher degrees.