A critical gap: Advanced practice nurses focused on the public's health

Social entrepreneurship and public health nursing knowledge: Opportunities for innovating nursing education in population health

Public health nursing (PHN) competencies are fundamental for addressing population health inequities. Few pathways exist for employing these competencies in the United States (US). Social entrepreneurship in nursing education might provide opportunities for innovating engagement in population health. Partnerships between business and nursing schools have the potential to fulfill this opportunity.

PURPOSE

Explore opportunities for re-invigorating public health nursing through social entrepreneurship education in nursing-business partnerships in U.S. universities.

METHODS

Reviewed programs in nursing/business school partnerships from Carnegie-classified R1 Universities. Identified appropriate coursework.

RESULTS

Of 96 identified nursing schools, eight had business school partnerships, providing 12 programs. Most programs (n = 11) targeted graduate students and addressed core competencies for entrepreneurship. Five business schools had entrepreneurship expertise. Five nursing schools had PHN expertise. Three programs included population health competencies.

DISCUSSION

Despite missed opportunities for advancing social entrepreneurship education among undergraduate and graduate nursing students, existing curricular offerings in the partnerships provide promise. Business/nursing partnerships and PHN knowledge can stimulate the preparation and agency of nurses in addressing population health inequities.

A country's efforts toward creating an advanced practice nurse in public health

AIM

The study goal was to inform the creation of a blueprint for an advanced practice nurse (APN) in public health.

BACKGROUND

No internationally accepted standard for an APN in public health exists. Activities of public health nurses (PHN) traditionally have centered on health promotion and disease prevention, but many have added other population-based activities such as chronic and acute disease treatment.

INTRODUCTION

An APN in public health is needed to address the global challenges threatening the physical, social, and mental health of populations worldwide.

METHODS

This qualitative study was comprised of six focus groups, each containing a different group of stakeholders (n = 40). Study results followed the requirements of the consolidated criteria for reporting qualitative research (COREQ).

FINDINGS

Two major themes emerged: the APN role in public health and core expectations. From the APN role theme, four subthemes emerged on APN domains of public health practice and functions. From the core expectations theme, nine subthemes emerged on the APN's qualifications and behaviors.

DISCUSSION

Agreement among stakeholders was found in the nine core expectations; however, among the four different visions of an APN in public health, two fit a population-based model rather than the traditional PHN model.

CONCLUSIONS

A single APN role in public health is insufficient to address the breadth and complexity of today's global challenges as detailed by the sustainable development goals. Due to the interaction between health and the biopsychosocial environments, we need APNs with different areas of expertise.

IMPLICATION FOR NURSING POLICY

Nurses working at universities, in public health services, and as healthcare policymakers are needed to create a multistage strategy that gradually introduces several different types of APNs in public health.

Community, Public, and Population Health Content in Nursing Curricula: National Survey Results

BACKGROUND

Policy, societal, and system changes are prompting nursing programs to expand population health content in curricula. This study examined the current state of community, public, and population health (CPPH) education in nursing curricula throughout the United States.

METHOD

This descriptive study examined CPPH education in nursing programs nationally. A survey was developed and distributed to nursing programs from January to May 2021.

RESULTS

CPPH content integration occurred across all program levels, and the majority of the participants were involved in the development of CPPH-specific curriculum. Programs experienced reductions in CPPH curriculum due to coronavirus disease 2019 (COVID-19), lack of experienced faculty, budget constraints, and an emphasis on acute care.

CONCLUSION

The continuation of CPPH education in current nursing curricula is critical. National and academic nursing organizations must continue to monitor CPPH content in nursing curricula to assure a competent CPPH nursing workforce. [J Nurs Educ. 2024;63(5):282-291.].

Addressing diversity, equity, and inclusion: A response of professional nursing organizations to the future of nursing: 2020-2030 recommendations

One way in which professional nursing organizations have chosen to address the social determinants of health (SDoH) is through policy work focused on diversity, health equity and anti-racism activities. The recent report, Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (FON 2020-2030), calls on professional nursing organizations and/or nursing coalitions to focus on addressing the SDoH to mitigate health inequities, including a focus on addressing racism and promoting practices to ensure the diversity of the nursing workforce. While these recommendations highlight issues of high importance to nursing and the broader society, they assume that professional nursing organizations or coalitions have not been sufficiently engaged in this work to date. Our goal was to better understand the current and/or ongoing activities of professional nursing organizations around their anti-racism work of diversity, health equity, and inclusion (DEI) activities recommended in the FON 2020-2030 report. To address this goal, we conducted a needs assessment of professional nursing organizations to document their DEI activities and the timing of these activities relevant to the recommendations in the report. The 26 responding organizations indicated they had been engaged in work addressing DEI issues for periods ranging from 4 months to 51 years. Minimal funding was the major barrier to advancing this work. Creating a vigorous shared DEI agenda across the profession, as suggested in the FON 2020-2030 report, will require input from nurses across the profession, as well as identification of resources to support this critical endeavor.

Doctor of Nursing Practice and Its Application to School Nursing

School nurses who are considering a terminal degree in nursing have two options, a Doctor of Nursing Practice (DNP) or a Doctor of Philosophy in Nursing (PhD). There are several factors for school nurses to consider when determining which terminal degree is best suited for them. This article focuses on the relevance of a DNP degree to school nursing, by first reviewing the evolution of DNP programs and then pivoting to discussions by three school nurses on why they chose this terminal degree and the projects completed during their courses of study. A main focus of a DNP project is to gather, analyze, synthesize, and translate research into practice, often operationalized as quality improvement (QI) in clinical settings. School nurses, practicing independently from other healthcare professionals while often managing large workloads, stand to benefit from obtaining or working with a nurse prepared at this level.

Public health nursing workforce and learning needs: A national sample survey analysis

OBJECTIVES

Generate national estimates of the public health nursing workforce's (1) demographic and work characteristics and (2) continuing education learning needs in the United States.

DESIGN

Secondary data analysis of the 2018 National Sample Survey of Registered Nurses.

SAMPLE

Total 7352 of the 50,273 survey respondents were categorized as public health nurses (PHNs), representing an estimated 467,271 national workforce.

MEASUREMENTS

Survey items for demographics, practice setting, training topics, and language(s) spoken fluently were analyzed.

RESULTS

Workforce demographic characteristics are included. Mental health training was the most frequently endorsed topic by PHNs, followed by patient-centered care and evidence-based care. Training topic needs vary by practice setting.

CONCLUSIONS

Results here can be used as a needs assessment for national public health nursing professional development and education initiatives. Further research is needed to refine and survey a nationally representative sample in a manner meaningful to public health nursing practice.

Veränderungen in anhaltenden Extremsituationen

Background

The Covid-19 virus caused increased challenges for nursing professionals.

Objectives

This study aims to explore psychosocial stress in the work environment of nursing staff resulting from the pandemic within an Austrian hospital. In addition, differences in the experience between nurses and nursing assistants, in leadership and management positions, as well as between wards with (suspected) Covid-19 positive patients and wards without Covid-19 patients will be recorded.

Design and Methods

In a mixed-method study, a web-based survey was conducted using the Copenhagen Psychosocial Questionnaire (COPSOQ). The qualitative data was collected with four open questions. The results were analysed descriptively and inferentially with a one-way analysis of variance and the Mann-Whitney-U test. The qualitative data were analysed using content analysis.

Results

A total of 104 participants completed the survey. The results show that there is a burden on nursing professionals (p = 0.03) within the area of emotional and quantitative demands (p < 0.01), but no differences between the individual nursing groups emerged. Leadership and management positions report less stress than the rest of the nursing staff (p ≤ 0.05). When distinguishing between Covid-19 (suspected) wards and non-Covid-19 wards, two scales (demands for hiding emotions % possibilities for development) were statistically significant (p ≤ 0.04).

Conclusion

The results of this study illustrate the psychosocial burden of the Covid-19 pandemic on nurses with different characteristics and are in line with current research. Further studies should address the impact of the burden on nursing practice.

Advancing health equity: Organizational characteristics emphasized by health department nurse lead executives

OBJECTIVE

To compare nurse and non-nurse lead executives' relationship with organizational characteristics supporting performance and health equity in local health departments (LHD).

DESIGN

This was a cross-sectional quantitative study.

SAMPLE

The final national sample consisted of 1447 LHDs using the 2019 Profile of Local Health Departments survey.

MEASUREMENTS

We used multivariable logistic and negative binomial regression analyses to explore the relationship between nurse versus non-nurse LHD lead executives and involvement in ten organizational characteristics including community health assessment (CHA) and community health improvement plan (CHIP) completion and policy activities related to the social determinants of health (SDOH).

RESULTS

Multivariable logistic regression models showed that, for nurse lead executives, the odds of having completed a CHA is 1.49 times, and the odds of having completed a CHIP is 1.56 times, that of non-nurse lead executives. Negative binomial regression models predicted nurse lead executives, compared to non-nurses, to perform 1.18 times more SDOH-related policy activities.

CONCLUSION

Results suggest that nurse lead executives are more likely than non-nurses to emphasize assessment in their work and engage in upstream-focused policy activities. As such, they are important partners in work to facilitate health equity.

Intention and motivation to pursue higher education among registered nurses and midwives: a cross-sectional study during COVID-19

OBJECTIVES

To determine the intention and motivation of nurses and midwives to pursue their higher education considering several factors.

METHODS

This is a cross-sectional study were a 16-item online survey was distributed using a convenience sampling method to approximately 12,000 nurses and midwives between May - July 2021.

RESULTS

A total of 513 eligible nurses and midwives participated in the study. Most of the respondents were females (76.61%), with a bachelor's degree (72.3%) and well experienced (11-15 years) (35.4%). Most nurses and midwives are highly motivated to pursue higher education (79.14%). The most motivating factor for the respondents is their professional goals (85.2%), While the most dissuading factor was the cost. Regarding COVID-19, about 28% of the respondents said that the COVID-19 pandemic has a negative effect on their desire to go for higher education.

CONCLUSIONS

The nurses and midwives were highly motivated to pursue higher education regardless of their demographic status, available resources, and barriers. Furthermore, the eagerness of the nurses and midwives to pursue higher education, which is rooted in their desire to grow in their profession.

Our Nursing Profession at a Crossroads: Time to Chart a Course for the Future

Nurse navigators, in a role that originally focused on a single health condition and improving specified services for an individual patient, have expanded to include care management and care coordination. As the role evolves, nurse navigators are demonstrating proficiency and achieving success transforming care delivery to improve population health while improving quality outcomes, patient satisfaction, and decreasing cost. One innovative health system's clinical nurse specialist team partnered with primary care providers, ancillary care teams, home care, skilled nursing facilities, community agencies, and partners in public health and schools. Clinical nurse specialists, now called "transitional care nurses (TCNs)," have created an accountable community of health for their high-risk population. By following patients from one setting to the next, TCNs identified opportunities for improvement, created innovative programs to bridge gaps, improved teamwork, and integrated care, resulting in lower cost, high-quality care. Results included 50% reduction in hospitalization for patients with chronic disease, pre- and post-TCN partnership. Patients with diabetes were supported with access to diabetes coaches, which resulted in a 12% reduction in AIC, while patients completing pulmonary rehabilitation programs experienced reduced readmission rates from 24% to 2.7%.

Enumeration of Public Health Nurses in the United States: Limits of Current Standards

Recent national initiatives in nursing and public health have emphasized the need for a robust public health nursing (PHN) workforce. In this article, we analyze the extent to which recent national enumeration surveys base their counts of this workforce on the definitions, scope, and standards for practice and practice competencies of the PHN nursing specialty. By and large, enumeration surveys continue to rely on practice setting to define the PHN workforce, which is an insufficient approach for meeting the goals of major nursing and public health initiatives. We make recommendations for the development of new standards for PHN enumeration to strengthen the broader public health infrastructure and evaluate PHN contributions to population-level outcomes. (Am J Public Health. 2022;112(S3):S292-S297. https://doi.org/10.2105/AJPH.2022.306782).

Challenges Facing Public Health Nursing Faculty in the United States: COVID-19 as a Catalyst for Change

We present an analysis of challenges facing public health nursing faculty members (PHNF) in the United States and their broader societal implications. The COVID-19 pandemic has exacerbated these challenges, making them untenable. Current academic structures-influenced by the broader sociopolitical climate-are problematic for PHNF: they disincentivize PHNF from researching social determinants of health and public health systems, teaching systems-level content that may be deemed "controversial" and that is not included on licensure exams, and engaging in service through advocacy and community partnerships. The fault lines within health care, public health systems, and higher education indicate that it is time to reevaluate how to incentivize socially just and equitable outcomes. Toward this goal, we propose that collective action and systemic change, including the perspectives of PHNF, is needed to better realize our shared goals. The analysis serves as a catalyst for conversations about academic structures, health care systems, the role of public health, and the kind of society we envision for ourselves and future generations. (Am J Public Health. 2022;112(S3):S314-S320. https://doi.org/10.2105/AJPH.2022.306819).