Sure. The basic idea of the job is this: your patient is really the whole community....your goal is to prevent or contain the spread of disease. Three of the main job functions are: 1) investigating disease reports and classifying them, 2) Implementing control measures and 3) providing education to patients, providers, and the community
So using the example of whooping cough. I get a report (from a lab, a clinic, or a school) that a kid might have pertussis. I have a "case definition," usually defined in state law, about what constitutes a case of pertussis for our purposes. Kind of like the epidemiological version of diagnostic criteria - we don't diagnose diseases, but we classify cases depending on whether they meet certain requirements. In my state, a report counts as a confirmed case of pertussis if it meets the right lab criteria (culture or PCR results on an NP swab) and the right clinical criteria (at least two weeks of cough plus one of the following: paroxysms of cough, "whoop," posttussive vomiting, apneic periods, cyanosis). If a case has the symptoms but not the right labs, it might be classified as "probable" or "suspect." The case definition is different for every diseases - some are complicated, and some are very straightforward. Classifying the case is for our reporting purposes; diagnosing is a separate question left up to the provider.
Unless it's immediately obvious that this isn't pertussis, there are a bunch of things I will do:
To figure things out, I review medical records and interview the parent. I might ask the parent questions about symptoms, when they started, etc. I will ask a lot of questions about other people who were in contact with the kid - does she go to school? Was she at camp? Who lives in the household? What kind of living situation is it? I might have to call a bunch of other people - maybe the babysitter, or an aunt who was coughing. If I check our records and I see that another kid in the same classroom had pertussis two weeks ago, I will do further investigation about the possibility of an outbreak. I will check everyone's vaccination status, and we may need to follow up about kids who are unvaccinated.
Depending on what I find out, I might need to implement some control measures. For instance, I might have to arrange for the child to get antibiotics (which stop her from being contagious), or get meds for her siblings and parents (which help prevent them from catching it). I might need to find out if the medical assistant in the clinic who did the NP swab was wearing a mask when the kid coughed all over her. I might need to check on people's vaccination status. I have to figure out when the kid was contagious, and call her school with instructions about when she can return, whether they need to notify other parents of an exposure, and what to watch out for in case other kids get sick. I may have to track down other family members who might have had a cough, and watch out for any pregnant women, infants, or immunocompromised people who may have been exposed. For some diseases - not usually pertussis - I might have to go out and collect specimens from the person.
I do LOTS of education on the phone with cases and families. It's the most satisfying part of my job. They often tell me that their PCP or hospital staff were so rushed, they just handed over a brochure and didn't explain much. So in this case I explain what pertussis is, how it's transmitted, etc. Parents always have TONS of questions - can she get it again? How long will the symptoms last? Can you catch it even if you're vaccinated? Why do we have to take antibiotics? Depending on the disease, I may follow up with the patient a few times (I don't work with TB or Hansen's disease, but those ones have LONG follow ups), or it may be a single phone call and then maybe emailing an info sheet.
I also spend a lot of time advising MD's, PAs and NPs about what tests to consider, especially for less-common or high-profile morbidities, and how to handle potential exposures in their clinic. For instance, today a doc called me with questions about how to handle a patient with possible bacterial meningitis.
In my office the nurses really just need email, internet research, and basic Word/Excel skills, plus the ability to use electronic medical records. The epidemiologists are the only ones who need to use statistical programs and superfancy databases. I would say the important skills for nurses are:
**Willingness to learn, study, and enjoy a lot of weird new stuff. Most of the diseases I deal with, I had never heard of as a hospital nurse - for instance, today I had my first case of Q fever. My coworkers who were nurses for 20 years before coming to Epi say the same thing. You really have to learn it on the job. I never thought I'd love reading articles from the CDC, but I do!
**Methodical, thorough, semi-obsessive personality....not a job where you can "wing it," you have to follow a set definition and set procedures. You have to know your stuff, or look it up, before giving people answers - you're the authority!
**Comfortable interviewing people about delicate topics (this week I had a detailed conversation with a case about anal sex while he is infected with shigella. Many epi nurses spend a lot of time on STI's and HIV)
**Love of patient education, and ability to work with people with very different levels of health literacy, economic status, etc
**Patience with the government world...if you're coming from a hospital, you will be surprised by how slow things move, and how many meetings you attend!
**Depending on your office, you may need to do some public speaking - our nurses regularly present all over the place, to day care providers, hospitals, school nurses, etc
**Willingness to re-frame your thinking about nursing....some nurses and providers switching to epi struggle with wanting to diagnose illness, or take charge of cases, or become directly involved in care. We have to leave that stuff to hospitals and PCPs. I don't work in a clinic...my patient is the whole community.
Anyway, that's a LONG description of the job I do. I love it. Feel free to PM me or ask anything you want.