phn529

I think it depends what exactly you are going to be doing within PH. There are a lot of different PHN roles out there. For example, if you are going to be working in a clinic doing higher level assessments or triage on acutely and chronically ill individuals, acute care experience is probably preferable. If you are going to be working as a PHN in the community doing home visits, then HH experience is probably a plus. Many hospital nurses do not like the idea of going into patient's homes, or try it for a little while and then realize it's not for them. For that reason I would say getting a level of comfort with home visiting would be a plus IF your PH role required it. Otherwise I don't see much of a benefit to leaving your current position for HH before applying to a PH position. There are also PHN roles that don't require you to be in a clinic or do home visits at all, so it really just depends on the individual job description. Do you know what area of PH you are interested in pursuing? There are so many specialties..

I too really struggled with anxiety during nursing school. I knew I didn't want to do bedside if there was any possible way to avoid it. I was interested in psych too at one point for similar reasons as you but after a clinical rotation at one of the few infamous state hospitals left I just found it too draining. Now I work in public health and I have been off of all of my psych meds for almost 2 years. There are still tough days but I no longer feel like I'm on the edge of a mental breakdown every day. Are you willing to move out of Southern California to get your first 2 years or so of experience? As I'm sure you know, the market there is over-saturated with new grads, so finding a job in your specialty of choice may be difficult. If you're willing to get your foot in the door in a specialty elsewhere you may have more luck skipping the "obligatory" 1-2 years of med surg and going back to CA after you have some experience. Also, if you do go the PH route in CA you would need to get the PHN certification. California is the only state that requires that. I'm not sure what the requirements are for that but it's just something to think about. Not sure exactly what the psych market is like there, but I was looking for jobs in San Diego (any job- not just PH) as a new grad and there seemed to be no opportunities for new grads outside of hospital residency programs. I would've had a really difficult time getting into PH in my home state (PA), but I was hired as a new grad here in Arizona before I even took the NCLEX. The pay isn't great in public health, but the cost of living is low in AZ and for me the quality of life and job satisfaction of helping vulnerable populations makes it 100% worth it. Good luck!!

Yeah it's kind of crazy. On the one hand it's great that they match that much, but the annoying part is that they make us all take out 11.5%. You can't choose to do less, so on top of an already low salary it's kind of tough saying goodbye to an additional 11.5%. It's a blessing and a curse when you're trying to pay off student loans!

I am making the switch to NFP as well! I am making the transfer from a regular PHN position to NFP, and in my health department this is considered a lateral transfer, but my salary will now be grant funded instead of taxpayer funded. My salary and other details of my employment aren't changing at all. I am telling myself that it is kind of a raise though, because the amount of money invested in each NFP nurse for continuing education is so substantial. You get to go to Denver for a week of training in the beginning, and then there is a ton of continuing education after that as well. I was also told that the program helps nurses with getting additional training and certifications (such as IBCLC, for example), which is something my current position doesn't support at all. In my current PHN position I have been told that if it doesn't make the health department money, it's not going to happen. NFP on the other hand values having highly trained nurses, as the primary focus is the data and results that come out of the program. Anyone who knows the program better please feel free to correct me if I'm wrong. This is just what I've been told about the program. Would you be working for NFP through a health department or a non-government agency? Everywhere is different, but in my health department there is little to no room for negotiation with salaries. Since it is a government job everything is on a pay matrix based on experience, certifications, and education, and HR doesn't have the power to make special exceptions. If you are working for a private agency you might have more wiggle room there. If you've heard that the benefits are really good then I'm just going to assume it's government. Again, it's different everywhere, but to give you an idea, although pay is so low I want to cry sometimes (45-65k/year, and I'm at the lowest end) my benefits are pretty amazing. I pay no premium for my health insurance (we get healthy lifestyle discounts that bring the premium down to $0 for not smoking, getting a free biometric screening every year, etc. Without the discounts it's $35/pay period), and it's an amazing policy that would cost over $1000/month in the marketplace. It's a high deductible plan with HSA but my employer puts the $2000 deductible in my HSA for me each year, so I don't ever have to worry about being hit with a huge bill and not being able to pay it. Dental costs me $1/pay period. My employer also matches my retirement contribution (11.5 percent of my pay). The retirement plan is one of the very-rare-these-days state pension plans. There are also a lot of employee discounts at stores, restaurants, museums, movie theaters, etc. Unused sick time rolls over into vacation time at the end of the year which is awesome. Hopefully this gives you some idea of what gov benefits are like! Good luck in your interview and let us know if you get the job!

I will say that in my experience I have found that not all rural areas are alike. Each community has different strengths and challenges. For the most part, rural areas in the Northeast are not really that rural, as other people have pointed out. I grew up in rural Amish country with farms all around. People complained about having to drive "into town" for groceries, pharmacy, etc, but a doctors office was never really more than a half hour away. Now I live in Arizona, and I can say that compared to the East coast, rural towns out West that I've passed through are truly rural. They're not situated along big interstates but dirt or gravel roads. You'll pass one small farming town with maybe a gas station, farms, a restaurant, and a general store every couple of hundred miles. Schools are of the one-room schoolhouse variety. Some don't have primary care offices, let alone hospitals. I'm assuming if they had a true emergency a helicopter would be their only hope. Food options are limited to what they grow and what they can find in a mini-mart. My health department sends us PHNs to one of the Native American reservations, and I can say with 100% certainty that this is a problem for them. Health literacy is poor and they lives hours away from any real grocery stores with healthy food options. They basically live in rural slums. Obesity and diabetes rates are through the roof. It's very sad to see sometimes.

I'm far from an expert on this, but I would say try to get a PHN job first just to make sure it's what you really want to do. That being said, I know in some areas of the country it's really difficult to get your foot in the door in PH, so it might be worth talking to people who already work in that setting in your area and seeing what their credentials are and what is expected to become a PHN. If you are in one of those areas of the country I honestly don't know if the MPH will help you though because what they really care about is PH experience. If you want to be a PHN I think there are other things that would help you more than an MPH and won't put you further in debt. Volunteer work that shows public health interest, PRN work with private agency flu shot clinics, getting involved in disaster preparedness in your area, etc all show dedication to public health and would look great on a resume. I myself am toying with the idea of pursuing my MPH in the near future, but I have been working as a PHN for almost 2 years and would like to move into a leadership role. The bottom line is if your goal is to become a PHN you really don't need an MPH, but it may be helpful if your goal is to move up in the world of public health (Although some people I know will argue that even then it doesn't hold much value). I hope this helps!

You are correct. The docs sometimes aren't used to seeing children with no immunization history. In my state we give kids with no vaccination record a 3 dose primary Tdap/Td series if they are age 7 or over. 1 dose Tdap, followed by Td 1 month later, then 2nd dose of Td 6 months after that. (Only if they have not completed the primary Dtap series as a child. If they have had the complete primary series then they are done for 10 years after the Tdap booster) If they have any childhood Dtap doses but an incomplete series you can count those doses as well toward the 3 dose primary series. You can also count a Td booster if that was given first (often many kids come to us with a Td given at immigration), as long as 1 of the 3 doses is Tdap. Ex #1: A kid with 1 childhood Dtap on their record would get a Tdap, then a Td 6 months later. Ex #2: A kid with no Dtap history got a dose of Td at immigration. You would give them a Tdap 1 month after that, then another Td another 6 months later to complete the series. We follow the CDC recommendations. I wish it was just all Tdap and no Td. With pertussis outbreaks all the time and proof of rapidly waning immunity, I just don't get the once in a lifetime Tdap booster recommendation. But I'm just a worker bee ;-) Hope this helps!

When I started at my job I had to do the New York PHN ready class. It's pretty long, but it's totally free and you can get a certificate at the end. I don't even live anywhere NY, but it's a great course that all of our new nurses need to do. I'd recommend it because it will give you an idea of all of the different hats a public health nurse wears, and will tell you a lot about communicable disease, vulnerable populations, etc. I would imagine your potential employer would be pretty impressed if you took the initiative to complete the whole thing. http://www.empirestatephtc.org/media/pdf/phn_ready_student_guidebook.pdf Good luck!

Thank you for your reply @sourapril and for sharing that study. That's exactly the kind of thing I was looking for. I've definitely been considering the MPH track once I pay off my undergrad student loans... thanks for the insight!

My Health Department is currently in a period of transition, and we are going to start pushing towards more population based services. My nurse manager thinks this would be a good time for me to try to pursue my specific interests within public health. I personally am really interested in maternal child health, breastfeeding, and nutrition. No matter which programs we expand or implement, we need to show that they are programs best carried out by PHNs, not MPHs, nutritionists, etc. I'm not coming up with much in the literature. I was just curious what kind of community based programs you all are involved with through your job? It doesn't have to be in the areas I mentioned above. What kinds of outcomes have you seen? How do you think you as an RN add value to the program compared to a professional in another specialty? I would love to get a conversation going!

Get a second opinion. If your CXR is negative there is no reason to get TB treatment. I'm confused why they made you undergo treatment as a child, but if you're in an area of the country that doesn't have a lot of immigrants and is used to seeing only negative PPDs maybe they were just confused? My town is along the Mexican border so this is something we see all the time. Is the doctor that is suggesting treatment this time a primary care doc? Occ health? If your local health department has a TB clinic I would call them and maybe they can see you or even call and educate the doc, because based on what you've said there is really no reason for you to undergo treatment. So sorry you are dealing with this.

Yes, I agree. I knew I would be in terrible debt going into college, and that was a choice I made. That being said, I definitely wasn't aware of how much my monthly payments would be, but I probably could have found out if I really wanted to.. Ignorance was bliss for a little while there until graduation lol. I think what ends up happening a lot of the time is that people have so many different loans at once from various lenders within their financial aid package.. $1,000 here, $2,000 there, and don't realize how much they are adding up. You don't really find out what the total monthly damage is until you do the repayment counseling. For me part of the shock was also that I had no idea how much I would be making as an RN. If I had stayed in the same city where I went to school, my paychecks would be almost double what they are now. I had a job offer there at a great hospital but I didn't want to stay in a big city and I wanted to work in public health, so alas the debt burden is pretty huge. I get paid very little for an RN but I truly love what I do so it's worth it for me. I would have been back to the big teaching hospital city life if I didn't get the HRSA award though, living in the suburbs where rent is less and commuting 3 hours round-trip every day on the train. There's just no way to pay back this kind of debt on a PHN salary.

Did you go to a public or private university? Private. There was no BSN program in my town, so for college I moved to a very expensive city a few hours away that has many highly ranked programs. If you chose a private university what advantages did you expect over a public university? My program specifically was a 5 year co-op program. I went to class for 6 months then worked full time for 6 months. It was an extra year of living expenses in the end but the experience was so valuable to me. While these jobs were paid, they didn't pay as much as an RN job obviously so it didn't balance out the extra year of expenses living in a really expensive city, but I worked as a tech at 2 different top 10 hospitals and in 3 totally different specialties, so I learned a ton about what kind of nurse I wanted to be, and I felt really prepared upon graduation. Did cost play any role in selecting what university you went to? Yes. The actual tuition for me cost less than a public program in the same city because I got so many scholarships, but the living expenses are what really added up for me. What was the cost of tuition per year? I'm not sure exactly, but somewhere around $45,000 x 5 years. The 3 years where I spent 6 months working on co-op were less than the other 2 years. Like I said, I only paid a small percentage of that because I got a lot of scholarships. Did you use the student loan money for anything other than tuition, books or school fees? Yes. This is what killed me. I lived off of student loans in a very expensive city for 5 years. 5 years of rent at 1,000 per month = $60,000 just for living near school! Not to mention transportation to get to class and work, food, books, etc. My mom was out of work with cancer and my dad lost his job right before I went to college so they were unable to help me in any way. Rather than delay going to college I chose to live off of loans. When you signed for the loans, did you have any idea how much the payments per month would be? No If you are a working RN, what percentage of your monthly take home pay goes to servicing your school loans? I'm getting help with my student loans, but they are about 1/2 of my take home pay. I now live in a city with low living expenses and low wages and am getting help through the HRSA loan repayment program. If I didn't get that award I would not have been able to afford to stay at my current job in public health. If you are a working RN, knowing what you know now what if anything would you have done differently to keep the debt to a minimum? I would have applied to schools out of state and in less expensive cities, but at the time I didn't want to be farther than a few hour drive away from my sick mother. I had a great college experience and felt really well prepared after, so I don't regret my decisions. I think it's really easy to judge other people and say that a BSN is not worth $100,000, but I feel very fortunate that student loans made it possible for someone like me to have the experience I did. My family was really struggling financially and I was still able to pursue my dream (and I still am!) I would have loved to have been able to get my BSN with less debt, but everything has worked out so far and I feel very blessed.

I think you're on the right track. Only list relevant experience. I think it's perfectly acceptable to have gaps in your employment history when you're still in school. If you have extra space to add more, I would add a "skills" section. Are you bilingual? Proficient in MS office? Familiar with different EHR systems? I would never have thought to add those kinds of basic computer skills to my resume but as the youngest person in my office I am the unofficial IT person and those kinds of skills are very coveted in PH as there are a lot of reports, charting, etc. If you're looking to work for a county health department or other government job I would apply early if possible. I applied for my job in April, graduated in June, was called to interview in July, and got my job offer on the day I took (and passed, thank god!) the NCLEX. The interview and hiring process for government jobs can be very slow, so if they will allow you to apply before passing the NCLEX I would. It also might help to try to reach out to a PHN manager there to explain your timeline and your interest before you even apply. Then they will recognize your name come interview time, and you might get some ideas of the specific job responsibilities and what they are looking for. That way you can tailor the way your present your responsibilities at your past jobs to reflect the exact skills they are looking for.

So here's an update! We had a huge meeting and it went as well as I could expect really. The department director values what the PHNs are doing, and the plan is to all work hard together in the upcoming months to come up with a new vision and plan. He said that PHNs would never go away under his watch, and seemed genuinely hurt that we all thought that's what was happening. We talked about communication, and how the lack of information caused us to think the worst. They explained that the reason why interviews were cancelled for open jobs is because they want the current staff to focus on making a plan and deciding what the PHN division will look like going forward, and then after we have decided all of that we will be able to focus more on training new staff. We talked for hours about what we do and do not want to see going forward. The shift will probably go towards population based services and real community presence and partnerships, as that's what we all really love and are great at. While immunizations are obviously so important for public health, they don't require BSN nurses. Some of the nurses here are true experts in certain areas of public health, and I'm so glad that the department is recognizing this and committing to utilizing our talents out in the community and investing in the professional development of those of us who are not yet "experts" in any particular area. Personally, I would love to specialize in nutrition and breastfeeding. I have completed about half of the classroom hours required and I wanted to sit for the IBCLC exam at some point in the upcoming years, but my 1000 required clinical experience hours have been accumulating so slowly since I've been stuck in the clinic all the time. Hopefully under this new shift I can really pursue that interest and make an effort to do more community teaching about breastfeeding. I'm optimistic now that whatever change is coming is for the best, and I'm so relieved!