Specialized Training in Public Health

klone, MSN, RN · Jun 2, 2014

Well, it's not beyond an RN's scope of practice to do a sterile speculum exam (I used to do them all the time in L&D to collect fFN or GBS), so I imagine that it wouldn't be that much different to train an RN to collect for a Pap. As far as STIs, she could also swab for GC/CT when doing a spec exam, or she could have the patient self-swab or just collect a dirty urine sample and send it for culture (we do the latter two quite often at our public health clinic). I don't know if breast exams would be outside an RN scope of practice, but I do teach breast self-exams to patients all the time. Bimanual exams would definitely be outside an RN scope, but I don't think you're asking about assessing for adnexal masses or anything like that, are you?

As far as TREATING for STIs - that would require an Rx, which would require someone with prescriptive authority. However, our facility has a large 24-hour nurseline, and I know that nurseline (plain old RNs) can, through very strict algorithms and protocols, diagnose and prescribe abx for simple UTIs and things like that, without the patient having to be seen by a care provider, so maybe it's like that. It would be considered a "standing order" under general supervision of a LIP.

As the RN of our clinic, I call in Rx's for abx for STIs for patients all the time under our care providers' names, then call the patients and either counsel them over the phone, or set up an appt for them to come in for counseling/education, and then they pick up the Rx. They never HAVE to see the actual care provider in person.

finallyRN7, BSN · Jun 2, 2014

Klone, thanks for responding. The information regarding the STIs and PAP make sense to me. But just to be clear, is a bimanual and pelvic exam the same thing, just different terms? If so, if a RN receives specialized training to perform a pelvic/bimanual exam, then shouldn't the training accompany some sort of certification as proof of the RN being qualified to perform such an act? Although I'm not aware of any such certification. Also, I assume, to your point, that one can only be legally/ethically trained to only perform what is within their scope; certification or not right? Thanks so much for your elaboration/education on this.

Med Surge 2 · Jun 3, 2014

You may also want to look at your states administrative code. Texas specifically increases the scope of practice for nurses working for a health department (government entity) Rule 193.4 - specifically mentions physical exams, paps etc. There is a list of types of medications that the doctor can prewrite prescriptions for. The nurse will fill in the patients name. Remember that nurses who are working for military, or other government agencies may well have different scopes of practice while working for the agencies.

finallyRN7, BSN · Jun 4, 2014

Med Surge 2, thank you for this information. I have definitely learned something new regarding a nurse's scope of practice in public health. I remember doing a couple of clinical days at a health department during my associate program but never received information about the potential for an expanded nursing role. I see that a nurse has a lot more autonomy in public health nursing. Thanks again guys for the info.

trufflelilyRN · Jun 4, 2014

Public Health Nurses were the very first Advanced Practice Nurses, and we didnt even know it. LOL. Your Health Officer is responsible for providing standing orders allowing nurses to perform duties beyond what we normally do in our scope of practice. Some Health officers are more permissive than others. Perhaps because some nurses are better than others. Most Heqlth Officers I have worked with have a trust relationship with the nurses employed by the jurisdiction. The military accomplishes this with protocols signed off by the preventive medicine Commander of appropriate rank. Over the forty years I have worked in Public Health, this has not changed. Public Health has been my life, my love

thehumbleRN · Jun 4, 2014

I really appreciate this post. Who knew that all this was possible for RN's.

trufflelilyRN · Jun 4, 2014

At the health jurisdiction where I worked in the 1970s the Public Heqlth Nurses carried large caseloads of MCH and infectious disease patients. Did we diagnose? Sure we did. That specialized training available to PHNs has served me well my entire career. If a referral came in from the school that Susie was out with measles and Mom didn't drive and they lived ten miles out of town, the nurse made a visit. We had algorithms even then, and it was measles or it wasn't. About three years ago I was working at an Army clinic and a young child is brought in with suspected measles. Not one provider or nurse in the clinic had ever seen a case of measles, so primary care called PublicHealth to weigh in. I walked to the exam room to find a toddler smiling laughing and playing with his mom. He had a fine macular rash, and low grade temp, but was in no acute distress. I was able to confidently say, "Nope, ain't measles. He is not sick enough." The impression of a child with measles is imprinted in my brain.

This being said, PHNs are, or should, never be making decisions if they are not comfortable. Every PHN has, or should have, access to resources. Local health jurisdictions come under the umbrella of state health jurisdictions. State health departments answer to CDC. State jurisdictions have consultants to answer any question and provide direction. CDC is the granddaddy of Public Heqlth, and the final word in Public Health practice. Hope this helps.

thehumbleRN · Jun 5, 2014

How do you get training for PHN?

RschIVF40 · Jun 5, 2014

Hi humble RN

To add to what trufflelillyRN stated regarding "standing orders" and "Advance Practice RNs" in the Public Health arena, this is also the case in some specialized departments within the hospital clinic setting as well. As long as the MD has specific / detailed standing orders as well as policies and procedures and the RN has been confirmed by the physicians as documented and trained in the procedures, they are allowed to work beyond their scope of practice under the MD's orders. They are referred to as Nurses in an Extended Role. NOTE: At least in the hospital setting, they also get paid more for this additional training / work as well!

trufflelilyRN · Jun 5, 2014

Unfortunately, PHNs usually do not get paid more. LOL