RWJF Forum on the Future of Public Health Nursing

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?

Shirley Orr: We’ve seen lots of evolution over the years. At the turn of the century public health nurses really focused their work on advancing sanitary conditions. At that time many people died prematurely because of infections often brought about by unsafe water and other unsafe living conditions. Today, lost years of life are more often attributed to chronic disease. So as public health nursing has transitioned to meet those needs, the work that we do changes in focus, particularly in now focusing on prevention of chronic disease.

NPH: What are some of the key themes that are going to be discussed at the upcoming forum?

Shirley Orr: The forum will have a lot of discussion about transition, I’m sure. For instance, within the new framework provided by the Affordable Care Act, what specifically are the opportunities, the unique contributions that public health nursing can make? We hope to have a dialogue around the value-added proposition of public health nursing and the unique contribution that public health nursing can bring in working as part of a team of many partners within public health, health care, and community stakeholders broadly. Something else that’s very important is helping to identify articulate that value and to develop clear and consistent messages about that.

NPH:  What do we know about the public health nursing workforce and what do we still need to find out?

Shirley Orr: One of the things we will be looking into over the coming year is exactly what the workforce currently looks like. Where do public health nurses practice, for example? We have some data, but we need to do a better job of quantifying information about the workforce, especially in terms of how we need to prepare for the future. There will likely be a large number of public health nurses leaving the workforce in the coming years, so certainly that presents issues of recruitment and retention. Retirement has been one factor of nurses leaving the workforce in recent years, but there has also been the economic downturn that has led to budget reductions and to reductions in positions.

NPH: What is the potential for public health nurses to have an impact across public health?

Shirley Orr: There is such a wide range. Policy level involvement and impact is enormous. Certainly, we know that the built environment is a great determinant of health and helping to shape, for instance, local policies that have an impact there is very important. Now especially, community health assessments and health improvement planning present a particular opportunity for public health nursing. Community health assessment has long been the purview of public health nursing, but it has new importance today because we know we really need that strong basis of assessment about what are the needs in our communities and the great need to use that critical information to drive our investments in health and health services.

>>Read more about community health assessments, a component of community benefit activities required to maintain non-profit hospitals’ tax-exempt status.

NPH:  What are some current examples of nurses being employed in a particular innovative or successful way to address public health challenges?

Shirley Orr: You know, I think a lot of that is emerging, and in recent conversations I’ve had I’ve heard of some great examples. One nurse I spoke with recently came to practice initially as an associate degreed nurse. She has completed an undergraduate degree and is now enrolled in a certificate program in public health informatics. So that’s one area where there is a lot of opportunity in the future. And we need more nurses prepared educationally to be able to conduct research, because we need a broader evidence base for public health nursing. We have nursing researchers that are working on that, but we need more individuals prepared in that role specifically.

>>Recommended reading: Read the story of one public health nurse who overcame incredible odds to found a career based on helping the most vulnerable populations stay healthy.

Weigh in: What educational and training opportunities are needed to expand the role of public health nurses in ways that improve population health?

Can you describe a program or initiative that is engaging public health nurses in a particularly successful or promising way to address population health challenges?