ER nurse here, so what do you do as PH nurse?

klone, MSN, RN · Jun 15, 2015

First, I know very few public health nurses who do not work with patients. So if you don't want any direct patient care, I recommend you go into nursing management or education.

Asking what a public health nurse does is about like asking "What does a nurse do?" The role is SO varied and different, depending on where you work, that it would be hard to answer it.

For instance, I work at a community health clinic - we provide services mainly to the people in the community around the clinic, which is an inner-city, poverty stricken area (but it's becoming "gentrified" so we're seeing more people with private insurance). Other than the fact that it's a community health clinic, it's no different from any other OB/Gyn clinic, except we see mostly poor, uninsured, sex workers, inner-city teens, etc.

Within our hospital network, we also have a nurse home-visiting program (Nurse Family Partnership) where the nurses visit the homes of pregnant first-time moms, and then continue to visit them throughout their baby's first 2 years.

We have an HIV clinic, a TB clinic, an STD clinic, an immunization clinic. We have a community health clinic that is considered the "headquarters" to Denver's Burmese refugee population, so that clinic sees mostly refugee patients.

Our clinic is also Title X funded, so we do a LOT of education on STIs, birth control options, options counseling for unwanted pregnancy.

I'm pretty sure I have barely scratched the surface on the varied roles of community health nurses, these are just the ones through my employer that I can think of off the top of my head.

rearviewmirror, BSN, RN · Jun 15, 2015

very interesting, thank you for the input on that. so it's safe to say that many of public/community health revolves around working in clinic settings, like an outpatient setting hospital clinics, but in this case, patients tend to be uninsured and more indigent.

jead1 · Jun 22, 2015

First, I know very few public health nurses who do not work with patients. So if you don't want any direct patient care, I recommend you go into nursing management or education.
Asking what a public health nurse does is about like asking "What does a nurse do?" The role is SO varied and different, depending on where you work, that it would be hard to answer it.
For instance, I work at a community health clinic - we provide services mainly to the people in the community around the clinic, which is an inner-city, poverty stricken area (but it's becoming "gentrified" so we're seeing more people with private insurance). Other than the fact that it's a community health clinic, it's no different from any other OB/Gyn clinic, except we see mostly poor, uninsured, sex workers, inner-city teens, etc.
Within our hospital network, we also have a nurse home-visiting program (Nurse Family Partnership) where the nurses visit the homes of pregnant first-time moms, and then continue to visit them throughout their baby's first 2 years.
We have an HIV clinic, a TB clinic, an STD clinic, an immunization clinic. We have a community health clinic that is considered the "headquarters" to Denver's Burmese refugee population, so that clinic sees mostly refugee patients.
Our clinic is also Title X funded, so we do a LOT of education on STIs, birth control options, options counseling for unwanted pregnancy.
I'm pretty sure I have barely scratched the surface on the varied roles of community health nurses, these are just the ones through my employer that I can think of off the top of my head.

Hey, do you recommend that a new grad become a community health nurse or that they get some experience first? I am a senior in nursing school (yay) and I have this passion for public health nursing/community health nursing. I tried to shrug it off or rather fight it because I heard public health nurses don't use many skills and with me being a new grad, I should go straight to the floor so I can get some experience. The thing is I don't want to do bedside nursing. I would love to work in a clinic or anything with the community. What are your thoughts??

RHIA, RN · Jun 22, 2015

Rearview, have you considered PI? I have been in PI about a year and a half, M-F 7:30- 4:30, mostly on a computer, no patient care so I cannot wear scrubs. I took the job for the schedule. I miss patient care and I intend to get back to it when I am done with school.

klone, MSN, RN · Jun 23, 2015

What's PI?

RHIA, RN · Jun 23, 2015

Sorry, PI is Performance Improvement.

guest464345 · Jul 13, 2015

I'm a former ER nurse working in public health....I have a 9-5 desk job, patient contact only by phone, all evenings/weekends/holidays off, humane pace, a regular-type job, wonderful nerdy coworkers. I'm an epidemiology (disease surveillance) nurse, investigating reports of communicable diseases and outbreaks. It's not a job that's available everywhere, but it's one example of the little non-bedside niches you can find for yourself :) As an ER nurse I wanted to hide in a cave most of the time, but now I love my job!

enigma2441 · Jul 26, 2015

I'm a former ER nurse working in public health....I have a 9-5 desk job, patient contact only by phone, all evenings/weekends/holidays off, humane pace, a regular-type job, wonderful nerdy coworkers. I'm an epidemiology (disease surveillance) nurse, investigating reports of communicable diseases and outbreaks. It's not a job that's available everywhere, but it's one example of the little non-bedside niches you can find for yourself :) As an ER nurse I wanted to hide in a cave most of the time, but now I love my job!

Laflaca, did you have any prior public health experience prior to obtaining this job. I have always had an interest in public health especially after meeting a retired nurse who worked for the UN and traveled all over Africa providing care. She was also an NP. I'm am undecided if I want to the NP route and get a post masters in public health thereafter or get my MPH now and then pursue such areas as either epidemiology or infectious disease. I've also looked into obtaining a dual MHA/MPH degree. As you can see I'm still researching and trying to figure it all out.

guest464345 · Jul 31, 2015

Hi again - I got this job with only one year of nursing/hospital experience. I didn't have public health experience as an RN, but I came from a related previous career (social work) and am bilingual (which they needed). So that helped.

The NP route and the MPH route are totally different scenarios, so you definitely want to clarify your goals before spending a ton on either one. If you want to do direct work with patients, the NP route makes sense....our programs use NP's and PAs in various clinics (TB, refugee, STI, etc). And I think NPs also find opportunities in global health, if that's what you're interested in. The MPH's in our office are mostly employed as epidemiologists or various levels of number- and policy-crunchers. If you really want to do policy work or planning, I'm not sure there's any advantage to getting the NP.

I think being an epidemiologist is a cool job, but if you're planning to work in public health you should also research career prospects/pay....in our county health department, epi's with an MPH or even a doctorate do not get paid a lot. Their pay scale is actually a bit lower than the BSN/RN scale. I imagine they can work in the private sector - hospitals, drug companies, research places - and earn more, but not totally sure about their options.

Happy career hunting! :)

Oedgar · Sep 2, 2015

Laflaca... can you tell me more about this position? I have an interview for disease surveillance as well on sept 11th. My background is LVN with experience in Peds, outpatient Ob/gyn... I have some additional college coursework in computer applications, health information management, and A&P. I comfortable with computers and learning new software..I am proficient in Word and PowerPoint,and have a basic knowledge of Excel. Do you think this is sufficient? Can you tell me more about your phone interactions with patients? thanks.

guest464345 · Sep 2, 2015

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.