Saturday, March 10, 2012

Happy Birthday Lillian!

Today is the birthday of Lillian Wald, credited with the founding the field of public health nursing. Lillian Wald was born to a life of privilege yet found her calling in nursing. Summoned to help a sick woman by a little girl, Lillian walked through a battered neighborhood and into a filthy tenement house to tend to the woman's needs. Afterward Wald wrote,"that morning's experience was a baptism of fire. Deserted were the laboratory and academic work of college. I never returned to them... I rejoiced that I had a training in the care of the sick that in itself would give me an organic relationship to the neighborhood in which this awakening had come." 

Much is said today about social determinants of health and the "Lifecourse" perspective. This visionary nurse had it right many years ago when she helped to establish banks, libraries, vocational training and clubs all in addition to physical and mental health services. Her Henry Street Settlement lives on today, more than one hundred years after its inception. 
In Rock County we too are involved on our own Henry Street. Our public health nurses have a home base on Henry and Riverside Street in Beloit, WI. We go out from there to serve the whole person, honoring the memory and carrying on the tradition of this great lady. 

Happy Birthday Lillian!

Tuesday, February 14, 2012

Future of PHN Forum - How to fit this in a blog???

I had the pleasure of attending a very interesting meeting of the minds on Wednesday in Princeton, NJ. The Robert Wood Johnson Foundation and National Network of Public Health Institutes are both organizations I have heard of and utilized as resources for the work we do in our local health department. It was a little unreal to really put people and structure around these organizations as I did at this seminar. It was a full day and I can't possibly do justice to the occasion in a blog post, but I'll summary a few of the things that hit me as I listened, learned and participated.

  • Enumeration: We do not yet know the basics. What is a public health nurse? Where are they located? Who calls themselves by this name and how many of us are there? The enumeration group is working on the very basics of identifying and counting public health nurses in all their locales in the US.
  • Public Health Accreditation: Kaye Bender gave some insights into the value of accreditation. I see public health accreditation as in its infancy. As many other competing factors take the dollar in public health will accreditation actually result in "value added" to local public health? We are the cowboys of nursing. We take to the range and get the job done whatever it is. It's great, and also may be barrier to a thoughtful and deliberative process of accreditation...and it is very, very expensive for a super limited local health department budget. We'll see how this develops!
  • The Quad Council: Lots of discussion was held on the competency framework. I have read them, digested them and the competencies do outline the things we do and think about each day. The difficulty is that there is a huge disconnect between the competencies and identifying these in relationship to the essential services of public health. In the meantime, we keep doing the job and doing it well.
  • Why a nurse? A lot of attention was drawn to the profession's relative inability to articulate why a public health nurse should serve in their community instead of a more economical PH graduate. We ought to be better at this! Is it humility? Lack of clarity? The fact that nobody would actually believe the scope of our daily practice? Many of the nurses I work with devalue their contributions every day. We need a dose of bravado. The "Oh, it's nothing really" approach leads stakeholders to think..."Public health nursing?'s nothing....really!"
  • Education for nursing students: This is a huge area for me in local public health. With perhaps 100 or more BSN nursing students in my jurisdiction how am I to support each and every one with a competent, engaging PHN rotation while I am responsible to the taxpayers to actually provide an expertly delivered service? Crickets chirping when I ask this question! One very intriguing concept is the academic health department. This seminar allowed the chance to learn about some alternatives such as this model and also simulation of PH scenarios in practice. How could it be funded?
Wrapping up: I have had a difficult time settling on the most important information from this seminar. I will try. Our profession is in trouble. Some is of our own making. We haven't done very well at applying the priniciples of business to show the value our services add to the population. We have a product, which is health. Everyone wants it.

In public health nursing we are not data or research-rich. We have to get better at knowing what works and replicating it. On the other hand (in my opinion) the evidence based programs available, such as the nurse-family partnership are far, far too costly and data-driven for a public health agency with a generalist staff, such as my own. We keep a lot of data and share it widely. That is pretty rare from what I see in county health departments.

Yes we need funding. Yet I see other agencies chasing grant dollars without any passion for the actual work that they will have to perform. Isn't there some happy medium we could reach? We also ARE funded to do some of the work. Couldn't we do this work better instead of wishing away all of our professional lives to have more?

Finally, whether it is systems work, education partnerships, community coalitions, etc. it all still boils down to hard work and looking across the table at our public and our partners to gain understanding... and each other's phone numbers.

Cheers everyone!

Tuesday, February 7, 2012

Are you still a nurse?

Doing some homework at the airport prior to boarding for the Future of Public Health Nursing Forum in New Jersey. I'm reading a brief that will be presented by Dr Susan Zahner from the UW School of Nursing faculty. One quote from a survey participant grabbed me. "I don't feel like a nurse anymore". If you manage public health nurses I see a primary role of yours - to help your colleagues see how they bring health to their clients. To see how their daily care for the community is ... Nursing! Simple? I think not! 

Friday, February 3, 2012

What is the Future of Public Health Nursing?

I'm taking a look at the materials sent for the Robert Wood Johnson Foundation Forum on the Future of Public Health Nursing I will be attending next week. I'm very interested in what this Forum will advance as key priorities in our profession.

A thought I have had over the last few months is that we have a unique role in that we accept the task of "going out" in our communities. I know of many professions that are trying to play a role in public health. All well-meaning and some effective in their own way. In my mind a constant and unrelenting role of nurses in our profession is hopping in the car to meet someone .... out there. Not many people in service will do that these days. Too inefficient! But is it?

Whether the task is labeled individual services or population health, it most likely will start and end with a smile, handshake or hug and a relationship that has said "You have value to me. I'll meet you where you're at".

Cheers everyone!