The standard definition of community health is the synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations and/or aggregate populations.
The CNS piece applies concepts of advanced practice, and includes 5 subroles of the CNS, which are Researcher, Clinician, Educator, Collaborator/Consultant, and Advocate/Change Agent. In most cases all of the subroles are realized equally. However, one may focus on one role for an extended period of time if needed.
There are many settings in which a community health CNS can work. Any setting where there is a population of people who need and gain benefit from health care, preventive services and education. A few examples are schools, military bases/posts, Home health, occupational health sites, parish nursing, public health departments, and health care facilities with community outreach programs. There are also positions in hospitals where community health concepts can be applied, such as infection control, etc.
I currently work as an RN at a private co-ed boarding school for grades 9-12. I run the health center for students, faculty, faculty children and staff. The students and some faculty live on campus, so I currently work under standing orders of our school physician, and have quite a bit of latitude in what I do. We also have a small stock of medicines (within the pharmacy laws of my state) that we use to treat the most common illnesses we see. With an advanced practice degree, I will be authorized to expand my scope of practice. If I stay at this job, the physician is willing to serve in a collaborative agreement and help me get prescriptive authority after 1800 hours. Having the APN degree will help in that I wont have as many restrictions to nursing practice, and I can go forward with treatments as long as I have the skill, knowlege, and ability to do so without an official physicians order.
I think there is a great need for community health CNS's. With the population aging, patients are more ill, hospitals at full census, staffing shortages and such, it just makes sense to me to offer health care in such a way that identifies people at risk, helps them to take control of their own health, and intervenes before things get so bad that they have no choice but to be hospitalized. I hope this all makes sense.
Linda
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