The Evolving Role of a Public Health Nurse
Public health nursing boasts a long and noble history, founded and championed by many of the healthcare heroes of our history textbooks. Unfortunately, it has long been relegated to the sidelines of public perception and health care procedure due to its unclear role within the greater field of healthcare providers available to today’s public. However, the turbulent healthcare arena and the public’s increasing need for healthcare reform and innovation may provide the climate necessary to revitalize the role of the public health nurse in today’s healthcare field.
Origins of the Public Health Nurse
Coined by Lillian Wald in the late 19th century, the term “Public Health Nursing” refers to a framework of healthcare ideology and initiatives that is “built upon an understanding of all the problems that invariably [accompanies] the ills of the poor” (“What Is a Public Health Nurse?”, Buhler-Wilkerson). Though the model helped catalyze the professionalization of visiting nursing and its role in healthcare quickly developed during the beginning of the 1900′s, “This growth was characterized by an idiosyncratic mix of initiatives providing an unpredictable assortment of both preventive and curative nursing services” (Buhler-Wilkerson).
Differences in ideology between curative and preventative emphasis caused overlaps and gaps in patient care, and the emergence of the hospital as a central hub for health care relegated public health nursing to an insignificant role in the public eye during the second half of the twentieth century. According to Buhler-Wilkerson, Wald’s vision of a public health nursing force has not yet come to fruition: “Over the years, public health nurses have assumed a variety of roles and titles, but in the absence of an influential or cohesive constituency, Wald’s vision of nurses as guardians of the public’s health could only be partially realized” (“What Is a Public Health Nurse?”).
However, today’s shifting health environment could provide just the impetus the public health nursing profession needs to reach its pinnacle in terms of both public awareness and practitioner effectiveness. “The 2010 Affordable Care Act represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs. Transforming the health care system to provide safe, quality, patient-centered, accessible, and affordable care will require a comprehensive rethinking of the roles of many health care professionals, nurses chief among them” (“The Future of Nursing”, Institute of Medicine).
Current State of Nursing within the Healthcare Field in the United States
The healthcare arena has understandably experienced significant evolution since the time of Lillian Wald. Unfortunately, the climate shifts have involved the mitigation of the nursing role in both the public eye and the medical care process. In addition, nursing education has been so parsed into specialties and concentrations that nurses are often rendered ill-equipped and ineffective. “Much of nursing education revolves around acute care rather than community settings that include aspects of primary care, public health, and long-term care” (“The Future of Nursing”, Institute of Medicine).
This produces nursing professionals that can perform tasks, but must pursue further education and spend more time in the classroom before they can help steer the holistic, comprehensive health treatment plans needed by our vulnerable populations. Because nurse roles are being increasingly shut out or cut from budgets and treatment plans, nurses have found it more and more difficult to effectively provide patient care within the current system.
In the words of Carolyn Clancy, director of the Agency for Healthcare Research and Quality, “‘The nursing shortage is severe and getting worse, and it greatly impacts quality. This means mitigating the absurd workload for nurses and not trying to reduce costs by cutting nurse positions’” (“Nursing’s Prescription for a Reformed Health System”, Robert Wood Johnson Foundation).
The Future of Public Health Nursing
The healthcare arena is rife with ideas and debate about how to improve the healthcare arena and how to more effectively train and utilize our nursing professionals. Many advocate an increase in education as well as an increased ratio of practicing nurses that have earned high-level educational degrees. “A more educated nursing workforce would be better equipped to meet the demands of an evolving health care system” (“The Future of Nursing”, Institute of Medicine).
However, reform should begin at the start of a nurse’s education. By preparing nurses to perform not just care-related tasks but instead to equip them with a broader array of skills and competencies from the beginning, they will be prepared to not only act within the current healthcare construct but to actively participate in its improvement. “…[Public health nurse] knowledge and competencies prepare nurses to take a leadership role to assess assets and needs of communities and populations and to propose solutions in partnership” (“Evolving Public Health Nursing Roles”, Pamela Kulbok).
The climate of today’s healthcare field is one of expectant change. Because of trends towards more community-oriented, holistic care options and the increasing need for long-term and chronic-based care, nurses are in a strategic position to help form the health landscape of tomorrow. “Policymakers agree that health reform should achieve these key goals: expand access to care, especially primary care; improve quality by delivering safe, evidence-based care; reduce costs for patients and for payers; and promote prevention through public health programs. Nursing initiatives embody promising policies that address this reform agenda” (“Nursing’s Prescription for a Reformed Health System”, Robert Wood Johnson Foundation).
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“Evolving Public Health Nursing Roles: Focus on Community Participatory Health Promotion and Prevention.” Pamela Kulbok, et. al. OJIN: The Online Journal of Issues in Nursing. May 31, 2012. <http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No2-May-2012/Evolving-Public-Health-Nursing-Roles.html>
“Nursing’s Prescription for a Reformed Health System: Use Exemplary Nursing Initiatives to Expand Access, Improve Quality, Reduce Costs, and Promote Prevention.” Robert Wood Johnson Foundation. March 2009.<https://folio.iupui.edu/bitstream/handle/10244/789/20090408chartingnursing9.pdf?sequence=1>
“The Future of Nursing: Focus on Education.” Institute of Medicine of the National Academies. October 2010. <http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Education.aspx#sthash.GBAx9dq1.dpuf>
“What Is a Public Health Nurse? Historical Visions of Public Health Nursing.” Karen Buhler-Wilkerson, PhD. University of Pennsylvania. <http://www.nursing.upenn.edu/nhhc/Welcome%20Page%20Content/What%20Is%20a%20Public%20Health%20Nurse.pdf>