PHN with no doctor on site?


I'm just finishing my RN to BSN program and have discovered a possible interest in public health. The public health office in town is a one-nurse operation, so no job openings at the monent. Our location is very limited, since we're on a small island with no desire to move. I'm just wondering how it works, with no doc in the office. I'm used to having a doc at the other end of a phone line, anyway. Granted, I would have daytime hours and there would be docs in the clinic upstairs, but I'm accustomed to working off of orders in a chart, and I suspect this situation would be different, with well-baby assessments and such. Any insights?


136 Posts

Specializes in public health, heme/onc, research. Has 7 years experience.

I'm assuming that this is a local city or county health department. In general the director of the health department is a MD. That person is usually responsible for signing off on standing delegation orders for immunizations, std screening, tb services. Where I work we are regularly in contact with the MD especially for chest clinic (tb). I think our SDOs are reviewed yearly and updated based on best practices (ACIP, Pink Book, CDC, etc.). The clinics in the region where I work accept people on a walk in basis but encourage appointments. I hope this helps!


21 Posts

Specializes in Extreme generalist.

Thanks. It's good to start figuring out how things work. For the moment I'm staying in the hospital and I love it, but I'm interested in the public health arena- eventually.


3 Posts

I've been in community health nursing for quite some time now. Basically if you don't have a doctor on site then you would either have to go through your client's medical providers to seek assistance for them or if they don't have a medical provider then you would assist them in obtaining one or setting them up to see one. You'd surprise how a lot of people do not know how to navigate through the healthcare system and/or even advocate for themselves.

PHNs often have standing orders or protocols in place - documents that describe the criteria under which a nurse may administer vaccines, administer meds, withhold meds, etc. The physician signs off on them, and as long as the nurse is performing the delegated task within the confines of that document, he or she is operating within his or her scope of practice. Here are examples: Vaccine Standing Orders for Healthcare Providers

I have worked in clinics at local health department with no physician on site, but I always had access to a doc when I needed one. I usually relied on consultants at the state health department in each program area to guide me through situations out of the norm. If public health nursing is new to you, be prepared for scope of practice issues to come up...they will. Knowing your nurse practice act in your state is essential.


3 Posts

sbruc I absolutely loved that link. Thank you! That link will be of high interest to my superiors because the organization that I work for has a medical director however he is not on site and we just started doing vaccinations at the location in which I am in. We started with flu vaccines however they are thinking of moving on to more vaccines in which they can charge the insurance and profit from. Again thank you for the link!