Where were you during Hurricane Irene? Did you have to evacuate your home? Did you have to take refuge in an emergency shelter? If you did, did you think about who was responsible for preparing for this emergency?
The impact of public health nurses often goes unnoticed except in cases of extreme disasters and even then, the public may not realize what has to be done to be prepared for the worst.
“The general public doesn’t know we actually exist, that we are behind the scenes making sure things are running smoothly,” said Pat Zingariello, BSN, RN, a public health nurse with the Beverly Health Department, Beverly, MA. “Most people don’t know we are working hard to make sure there isn’t an outbreak or major illness. We make the community a safer place to live without people really knowing that.
“It is different from hospital nursing because in public health nursing we care for the entire community instead of one patient at a time,” Zingariello added. “Instead of being happy your one patient recovered, you’re happy people didn’t get sick in the first place, but it’s hard for people to see that.”
The day-to-day work of public health nurses depends on individual health departments, but critical responsibilities include investigating causes of communicable diseases, inspection of immunization records and emergency preparedness.
Their responsibilities include, but are not limited to, monitoring health trends through active and passive surveillance and data analysis, designing and implementing health promotion education campaigns and provision of disease prevention education and activities, as well as advocating at the local, state, regional and national levels to sustain or improve community health services.
Investigations of food-borne illnesses and communicable diseases, distribution of vaccines, researching grants and funding, and implementing wellness clinics are just few of the jobs with which Zingariello is tasked.
“I am a resource for residents, public and private healthcare providers and the school nurses,” Zingariello said. “We do an annual medication take-back program and a household hazardous waste day. And then our particular health department runs a dental clinical for school age children, which is very rare. You wouldn’t see that in other communities.
“We had a flu pandemic a couple of years ago, H1N1. So we were able to get our emergency site open and start to communicate to the public about how we were going to vaccinate and a lot about the vaccination and when,” Zingariello added. “We talked to people who called to relieve them of their fears.”
Beyond Extreme Disasters
“Public health is about education and intervening in small ways to make a difference,” said Flo Rice, EdD, RN, director of public health nursing with the Madison Health Department, Madison, NJ. “It is about helping the community as a whole live a healthier lifestyle.”
Efforts include promoting and providing vaccinations, as well as medical education, while other programs promote a healthier lifestyle, such as the implementation of bike lanes or offering supervision to children walking to school, and keeping an eye on elderly residents.
“Mobility is often a problem for the elderly. We have a program in town called Madison Access, where the stores uptown are alerted to put signs in their door that they will pay special attention to the elderly, people on crutches or wheelchairs,” Rice said. “If they can’t get into the store, employees will come out and help them make it easier to get around town.”
Madison Health Department also aims to reduce chronic diseases like heart and lung disease in the elderly and prevent breathing problems among its younger residents.
“Another program eliminated cars idling in front of the YMCA or any public gathering place, where they pick up children,” Rice said. “All those fumes are not particularly good in the air. So that was stopped.”
The success of public health nursing lies in the ability to work together with community entities. There must be communication, collaboration and cooperation.
“We need to reach out and get community partners like the YMCA or the universities or the churches. Everyone has a vested interest in the same things. You would all put the pieces together and have something greater than the whole,” Rice said.
Publicity and funding are two challenges for public health departments and public health nurses. If the community members aren’t aware of this critical component of their healthcare, they will not be a source of support.
|PROTECTING THE PUBLIC: Public Health Nurses Tina Zanni, RN, and Fran De Vos, RN, vaccinate community members during the H1N1/seasonal flu mass immunization clinic in Clifton, NJ.|
“It is very difficult because public health is more of prevention, and it is very difficult to be able to put a figure or number to quantify prevention,” Zingariello said. “We can talk about it and we know the work we did kept people out of the hospital, kept them in their own home, kept them from getting sick. But, we don’t have any figures to prove that.”
In times of economic downturn, public health nurses are faced with an increase in community health challenges. “Those are times when we see escalations in communicable disease” – with more people sharing living space – “substance abuse, homelessness, domestic violence, hunger” said Kitty Mahoney, MS, BSN, RN, chief public health nurse with the Town of Framingham, MA, and president of the Massachusetts Association of Public Health Nurses. “When a job loss translates into lost health insurance, many will go without medication, visits to practitioners or have recommended screenings. That is when our work really begins.”
Toward the Future
At its midyear meeting in Chicago last June, the American Public Health Association (APHA) discussed the direction of community prevention and made plans for this coming June’s meeting, “The New Public Health: Rewiring for the Future.”
The 2012 meeting will address how to strengthen the nation’s investment in prevention and public health in the face of declining budgets, more demands, an aging and shrinking workforce, changing skill sets, technology hurdles, integration of public health into primary care, as well as a lack of understanding of the role of public health by the public, opinion leaders and policy-makers, according to APHA.
“It does need to get rewired and get a new face on it so people have a better understanding because we have to change our skills set, we have to use the technology that will make a difference,” Rice said. “Public and policy members join in and are an active part in providing for the safety and health of the community.”
Catlin Nalley is editorial assistant at ADVANCE.