Questions for Public Health Nurses

I was hoping I can get some feedback and advice from my fellow public health nurses. I am a new nurse and have been working in a med surg floor for 7-8 months now. While I don't plan on leaving anytime soon, I have been thinking about what I would like to do long term and my current job is not somewhere I see myself at forever. It is a good place to learn and gain fundamental knowledge and skills of nursing, which is great. But it has also brought me a lot of tears and is also very stressful and overwhelming.... I have been thinking about public health, as I have realized I like the idea of the community as my patient, having one on one time, and having the time to educate patients. I know public health has it's own stress, but it seems like it will be an area that will suit me. I have some questions for public health nurses and would appreciate your feedback/advice.

1. If you have worked in acute care or bedside nursing, how does the stress level of those areas compare to working as a public health nurse?

2. What is your day to day routine? What is working in a public health department like?

3. Would you recommend it to nurses, who would one day like to make the change to public health nursing?

4. Do you have any other advice or words of knowledge for nurses interested in public health?

Thank you :)

Ahoy there....I'm a PHN in a very specific area (Epidemiology), but I think that some of my answer probably applies to PHNs in other areas....vaccination, maternal-child, nutrition programs, STD, etc.

1. The stress of public health is, in my experience, not even remotely comparable to the stress of floor nursing. We've got important stuff to do, we're sometimes understaffed, we're definitely underpaid....but I eat lunch every day, I pee when I want, I decide how to schedule my own day, and I walk out the door every day at 5PM. I get a bit stressed if a coworker is crabby, or my cases get complicated, or I disagree with my boss occasionally like any other human...

BUT a stressful day in our office is much easier than an easy day on the floor. It's rare that I worry about work.

2. PHN jobs vary a lot by the particular title....some people do home visits, some run clinics, some teach classes, some write or supervise grants. I have an office job; I get to work, check the cases assigned to me, and spend much of the day doing patient interviews and patient education on the phone. I get calls from clinical staff in clinics and hospitals with potential disease exposures. I go to meetings about some really nerdy stuff. I also regularly do presentations to groups of doctors, nurses, school staff, and others about communicable diseases.

3. I love my job, though it's not for everyone. I'll say that it was a big adjustment to sit on my butt all day....I've never had an office job, and at first the days went by sloooooowly. But as my knowledge increased, I started to appreciate having the time to read articles, listen to webinars, and think carefully rather than rushing around like crazy all the time. Some people wouldn't enjoy the spreadsheets and CDC algorithms and reference manuals I use all day, but I do :) Other nurses in our department run around to day cares, WIC offices, clinics, the homeless clinic, and they enjoy that instead.

4. Maybe think about what you can do to get outside experience that would make you attractive as a PHN candidate in the area(s) you like...volunteer work, networking, etc. In some places it's hard to get PHN jobs even despite lower pay, because many RNs are trying to get off their feet or back into normal-people hours. In my area, at least, you usually need a BSN, though that's probably not true everywhere.

Also, realize that you'll almost certainly take a pay cut. In my case, I thought about the benefits (great), the hours (predictable), and the importance of my mental health (high) and decided it was worth the skimpier check.

Good luck to you!

One last question, do you ever get worried that the public health departments will decrease hiring of nurses or have to let nurses go, due to decrease funding/grants, or any other reasons?

Yes, it definitely happens...my particular job is very stable (we investigate diseases/outbreaks that must be reported, by law, so our division isn't where they look first for job cuts), but you might work in a program funded by a grant that expires, or under a contract that's cancelled, or something like that. Or, sometimes they hire nurses into jobs that are set up as temporary, in the first place.

Even when programs are cut, change is pretty slow in government - budgets are made a year in advance, and then the feds cancel something, then the state makes cuts, then the counties/locals do - so it's rarely a situation where you wouldn't have some advance notice. I worked in the private sector before, and it's not like you have any guarantees there, either...plus you have those days when the census is low and they send you home, or worse yet you're on call...I don't miss that stuff!

Good luck in your job planning :)

1. If you have worked in acute care or bedside nursing, how does the stress level of those areas compare to working as a public health nurse?

Well, I don't know that I can truly answer this because I've worked in public health since I graduated nursing school. But I remember clinicals and the stress and pace of work in the hospital setting. Like Laflaca said, a bad day at the office in public health is still probably 10x better than a good day in acute care. I can use the bathroom when I want, I get a guaranteed lunch time, etc. Any job has stresses, but mine are trifles compared to acute care nursing I think.

2. What is your day to day routine? What is working in a public health department like?

I work in family planning as a specialty, but I've carved out a little generalist niche for myself to get cross-trained to HIV, immunizations, syringe exchange, and community outreach. My day to day is different because of that cross-training. Generally on a daily basis I will see appointments in family planning clinic for patients that do not need a diagnosis made (pregnancy tests and birth control refills vs symptomatic STI screenings, for example), provide coverage for the walk in syringe exchange program, complete administrative tasks like manual revisions, data entry and analysis, do work to build and maintain relationships with community partners, plan outreach events, etc. I also precept nursing students when they come to my area of the health department. That isn't every day, but I do like doing it.

Working in a public health department will very much depend on the type of position you are hired for. Some PHNs (public health nurses) do clinic work like me, others will go out to home visitations with pregnant women, new moms. Some will do epidemiology and communicable disease control, and others might do population health things and not have any direct patient contact. For example, we have a nurse who works solely on an HPV immunizations grant to boost HPV immunization rates in our area.

3. Would you recommend it to nurses, who would one day like to make the change to public health nursing?

Yes! Absolutely, if that is where you want to be.

4. Do you have any other advice or words of knowledge for nurses interested in public health?

My recommendation is always to join your state's public health nursing association if you have one, that way you get a chance to network and get job opening hints. If your state doesn't have a public health nurse association, do the next best thing and join your state's public health association. Find yours here: State & Regional Public Health Associations Your state's PHN association or public health association may offer free mentoring services to members who are new public health professionals or who want to make the transition to public health.

Good luck!