On Sunday, December 13, 2020, Pfizer’s manufacturing plant in Kalamazoo, Michigan began loading trucks with suitcase-sized containers of COVID-19 vaccines, packed in dry ice, readying their journey to healthcare customers across the country. At the same time, CDC numbers ticked over to signify more than 300,000 lives lost to a terrifying pandemic that has gripped the US in extreme loss and heartbreak. Yet the trucks represented a glimmer of emotion frontline providers had not dared to imagine for months: hope.
Nurses began to envision something they had not considered for months requiring endless endurance: a future in nursing away from the cluttered bedside of SARS-CoV-2. What that future might include could be one with the diverse needs of a generation that had survived a massive pandemic, one with both acute and chronic needs, the needs of long COVID patients and those dealing with the stressors of economic fallout. Those needs might best be met by nurses entering the field of public health nursing.
Public health nursing, defined
The ANA (American Nursing Association) defines public health nursing as “the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences.” At no time in history has the community needed nurses for a dramatic change in public needs more than during the COVID-19 crisis. Multiple deviations have occurred on a massive scale: drastic changes (hurricanes, flooding, destruction of homes, devastation from forest fires), economic catastrophe with an estimated 9.2 % of families qualifying as poverty level for 2020, plus a colossal roll-out required for vaccination in the first and second quarters of 2021. Public health nurses will be qualified to meet these needs.
To become a public health nurse, an associate degree or bachelor’s degree in Nursing is required. Some communities will employ nurses with associate degrees for community health roles, but they may also be looking for nurses with experience in public health policy or community health issues or hospice roles. While in college, or in previous jobs, the nurse interested in public health should focus on roles that look at the “bigger picture” of health policy.
While nurses in patient care deal with one patient or unit at a time, nurses in public health deal with communities. They design health campaigns and provide education for vulnerable and at-risk populations. Rather than discussing vaccine risks with peers and colleagues, for example, they would discuss vaccine fears and disinformation with communities of color or those with lack of access, targeting information to improve compliance in populations not only of potential risk but also higher percentages of denial.
Public health nurses often work for government agencies, where the salary may not be as competitive initially, but benefit packages are often comprehensive. They may also work in health departments, schools, homes, community health centers, clinics, prisons, or out of mobile vans. The nurses who work in these positions find their work highly rewarding, as they prepare information to improve access to care across large groups with cultural differences. They may need to work with scarce resources, functioning creatively to determine where their actions will be optimal. They may work alone, or in multidisciplinary teams. As Public Health Nursing has been a rapidly growing field (both prior to and during the pandemic), it is expected to be even more so following an ease in new infections.
Nurses bilingual in English and Spanish will be very much in demand.
Various occupations in public health nursing
Public health nurses primarily work less with individuals and more with community needs. The settings may vary, but they more commonly involve one of the following settings:
Public health nurses can be seen working at community health clinics or “health fairs,” working to improve the health of specific populations. They may focus on needs according to the calendar, such as Breast Cancer Awareness Month in October, or they may offer flu shots. Blood pressure screenings are also popular, as are health fairs related to discussing diabetes or obesity. Public health nurses will target the needs of the community and work on improving education and compliance.
Public health nurses spend a great deal of time teaching children about illness and hygiene, as well as nutrition. Children are excellent vehicles for learning about self-care. They absorb information readily and adopt lifelong habits for further learning. Nurses may take pig hearts to teach children about anatomy and heart disease, as just one example.
Outpatient clinics are excellent places for diabetics and patients with chronic disease to learn how to manage their illness appropriately, especially with the use of leaflets and the assistance of public health nurses. Although this has slowed during the pandemic, business will rise once new infections slow.
Voluntary organizations have had a huge role to play during the pandemic. Organizations such as the Red Cross, Doctors Without Borders, and the Peace Corps have been called into action with the 2020 forest fires, the relocation of multiple families following the onslaught of hurricanes this year, and multiple surges of the SARS-CoV-2 pandemic. During natural disasters, public health nurses assist in providing safe drinking water, and discussing ways to avoid further disease outbreaks. They also discuss hygiene, family planning, and maintaining nutrition during a crisis.
Public health nurses are often hired to be leaders in the field of health policy. Although this may initially be a job where a lot of paperwork and data crunching is required, it is also looking at “impact” where entire populations may be affected by changes and interventions. Public health nurses are ideal for studying data and determining when/where decisions may be needed to improve outcomes for the future.
Becoming an NP for public health
Although there is currently no certification exam for undergraduate nurses in public health, there is a certification for Advanced Practice Public Health Nursing through ANCC (American Nurses Credentialing Center). These board-certified nurses would carry the credential (APHN-BC). To be eligible to sit for the exam, candidates would need to complete the following requirements:
- Hold an active RN license
- Have practiced at a minimum of 2 years (fulltime) as an RN
- Have a minimum of 2,000 hours of experience in advanced public health nursing in the previous two years.
- Hold a BSN in nursing and a graduate degree in nursing or public health
- Have completed at least 30 hours of continuing CE credits in advanced public health nursing over the previous 3 years
- Fulfill at least 2 additional professional development categories (publication/research/policy development/teaching, etc.
Public health nurse practitioners may find themselves functioning at a highly independent level, practicing more autonomously than their peers in private practice. They will play a pivotal role in the care of patients in their communities and find that, while they collaborate closely with additional members of the healthcare team, they are not closely supervised, allowing them to function at the highest tier of their role. This will be especially true during disease outbreaks or natural disasters, when public health NPs work as front-line providers.
As the vaccine roll-out begins to bring the first rays of hope to a nation ravaged by the worst pandemic in over one hundred years, nurses may begin to dream of a future in nursing that is not defined by SARS-CoV-2. With those thoughts may come a desire to work on community issues, such as families and children that have been starved for food, for education, and for knowledge of how to prepare themselves for a post-pandemic future.
Nurses will be there, ready to help a nation heal their most vulnerable citizens, whether they may be new mothers, new babies, or elderly citizens needing the skills to deal with chronicity left by COVID. We will also adapt, taking skills where they are needed the most.