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

[rearviewmirror]

Hi, I have been doing bedside nursing for awhile and after transitioning to ER, I finally realized that bedside care is just not me. I am looking into lots of venues and PH/community nursing is a strong candidate, but I don't know ANYTHING about Public/community health nursing, and all I can think of it is working at HIV clinic or something.

Little things about what I want: no direct patient care (or as little as possible), work at desk, regular hours, room for advancements, business or casual formal attire, relatively relaxed and normal pace setting (compared to acute hospital setting), and just something "normal" people would do for living, not working 7pm-7am, listening to ridiculous complaints, dealing with unreasonable administrators, well I guess you see I am done with bedside care.

I know that public health sector has lots of diversities, but I am just very new to it, so could you guys and gals enlightened me a little bit on it please? Thank you.

[guest464345]

PS - good luck on your interview Oedgar!!!

[Oedgar]

Thank you. This gives me a much better idea. It really sounds like it's for me. I like predictability and a set of rules to follow. I am always on the computer doing research... I am a frequent flyer at the CDC website! I talk to patients all the time about STI's... given the I work in ob/gyn. Thank you!!

[guest464345]

Hope you get the job! Keep us posted :)

[moni777]

Laflaca,

Where do you work? Are they hiring? I have always been interested in epidemiology nursing :)

[vickymarie]

I tried to shrug it off or rather fight it because I heard public health nurses don't use many skills

This was something hat always genuinely bothered me when I heard it. A lot of people say that public health nurses "lose their skills".

No.

Public health nurses have a different skillset that they use on a daily basis, that they work hard to develop. They develop skills in case management, creative assessment techniques, trend identification, teaching, resource-finding - and none of those skills are less important that clinical skills that nurses use at the bedside.

Do you tell an ER nurse or an OR nurse that they "lost their skills" because they no longer are proficient in using OB/L&D maneuvers and equipment that they learned about in nursing school? No. Most people would consider that ridiculous.

Public health nursing simply expands on different skills, just like any nursing specialty.

[sugarmagnoliaRN]

I know this is an old post, but do you mind sharing what kind of office you are employed in? Is it the state health department? County? Just kind of wondering where I'd need to look for opportunities like this :) Thanks!

[sugarmagnoliaRN]

Laflaca - I know this is an old post, but do you mind sharing what kind of office you are employed in? Is it the state health department? County? Just kind of wondering where I'd need to look for opportunities like this Thanks!

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.

[sugarmagnoliaRN]

Ugh so sorry for the duplicate posts y'all - staying up late to transition to a night schedule so I can stay up for my 3 12's in a row, 7p-7a ... my brain has officially turned to mush!

[marieezy22]

Is it hard to join the Public Health Service? I am in RN school with 6 months left to go and then I will have one year to get my bachelors degree. I've been an LVN for 3 years.

[guest464345]

Sorry to not respond for so long....I work for a county public health department, a large urban/suburban county.

[PHNMike]

I came from the ER into public health (I work for a large, well funded County Health Department, currently in epidemiology doing investigations on reportables, but I was in the STI/Imms clinic before this). You'll have to get used to the patient being a group (a town, a community, a family) rather than an individual and, as compared with ER nursing, TONS of teaching opportunities.

[PHNMike]

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