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Nursing Transcends Hospital, Office Walls / Public-Health Arena Adds Prevention and Teaching to Role

Posted on: Wednesday, 15 March 2006, 03:03 CST

By DONNA C. GREGORY

When most people think of nurses, they automatically envision them in hospitals and physicians' offices, checking a patient's blood pressure or drawing blood for lab tests.

But nursing isn't limited to just clinical settings, and it isn't just about treating sickness.

When it comes to health care, the field of public-health nursing actually takes an entirely different approach.

"Public-health nursing focuses on disease and injury prevention in the first place," explained Joanne Wakeham, director of public health nursing with the Virginia Department of Health.

"Public-health nurses are those who prefer making an impact on a larger scale by addressing the needs of an entire community. They are those who want to be out there in the community looking at what's happening in terms of health care, communicable disease, emergency preparedness, so it really is a larger scope of interest."

Escape the daily grind

This approach offers tremendous career opportunities for nurses looking to escape the daily grind of hospitals and physicians' offices.

"You can work in a clinic. You can work out in [clients'] homes. You can work out in the community. You can work with individuals. You can work with families. You can work with community groups," explained Wakeham. "The focus is on prevention of illness and the promotion of health, which is quite different from hospital-based nursing."

The Virginia Department of Health currently employs about 800 nurses in a variety of roles throughout the state.

Settings for specialization

Some work in clinic settings where they might concentrate on women's health, or care for patients experiencing chronic illness.

As a public-health nurse with the Chesterfield Health District, Beverly McGary specializes in women's health. Her days are usually divided between working in the county's intake area and its clinic, counseling women about birth control, pregnancy, sexually transmitted diseases and other health concerns.

"I may be seeing a new maternity patient who is coming to begin her prenatal care with us. I would do her medical history, family history and social history, and then I would order all the lab work. In the course of the interview, I would also do teaching as far as prenatal care. We discuss breast feeding. We always discuss nutrition," explained McGary.

Less chaotic environment

McGary left hospital nursing after she remarried so she could have more time with her family. Although she admits she made the move for selfish reasons, "it ended up being very interesting and very rewarding. It is a little less chaotic in that you have a full caseload, but you don't see emergencies.

"There's more opportunity to get to know your patients. Right now, I'm seeing the third generation of patients, so you get to know entire families," she said. "You see patients and you make a difference in their lives because they usually have limited financial resources. If it were not for the services we provide, they might not be able to receive medical care."

Other public-health nurses offer at-home services.

"Some districts make home visits and work with families who need further knowledge about a particular illness or injury," said Wakeham. "We see a variety of persons in the home. It could be working with infants that were born prematurely or children with developmental delays. In the senior years, they could be doing assessments of their ability to function on their own and making recommendations on what kinds of equipment or services they need to remain independent, or determining if a person needs more direct- care assistance."

A community resource

Public-health nurses also work out in the community, serving as school nurses, or reaching out to child-care centers, senior centers and other populations.

Cris Sheppard is the school nurse at Manchester High School in Chesterfield County.

"There really is no typical day," said Sheppard. "The needs of the kids are so varied. I could talk to 10 kids over the course of the day and it could be 12 different health issues I'm dealing with."

Sheppard routinely consults with students, parents, faculty and staff on a variety of health issues. She might respond to a student fainting in the hallway, or educate faculty on how to respond if a student ever experiences a seizure or asthma attack. She might check a teacher's blood pressure or administer an annual flu shot.

Position carries autonomy

"Because I am a public-health nurse, I also have duties through the health department that might take me outside the school," explained Sheppard. "For example, I might go into the schools as part of a team to conduct health screenings. There is a huge variety in terms of the people I work with. It's a position in which there is a lot of autonomy."

Educate to prevent illness

Rebecca Parsio is a public-health nurse supervisor for the Virginia Department of Health. She oversees the Colonial Heights office and the child health team.

"I really believe that the key to health is prevention, and I particularly like working in the community, providing preventative education to people who otherwise would not get the message," said Parsio. "I also like the science that's involved. It involves looking at the community and using health statistics to identify problems and changes and then developing programs to meet those needs."

Parsio currently is supervising the rollout of a child-care consulting program that ultimately will assign a nurse to every state child-care center in an effort to increase immunization rates. So far, the program has led to a 5 percent rise in the number of children who are up-to-date on their immunizations.

"It's understanding what the overall needs of the population are and that's what I really like," said Parsio. "I really like to do health education, and I like to find a new topic people don't know about. I like the issues where people respond."

Public-health nurses also work in epidemiology, emergency preparedness and response, communicable disease and other areas.

The state employs nurses at all levels: nurse practitioners, registered nurses, licensed practical nurses, certified nursing assistants and community health-care workers.

Vacancies, but no shortage

"We're always really wanting persons to consider employment in public health," said Wakeham. "We're not really experiencing at the present time a large shortage [in nurses]. We do have vacancies, but what we're most interested in doing is getting nurses to think about employment in the community-health or public-health setting."

It "is really a different way," said Parsio, "to look at health."

ILLUSTRATION: PHOTO

MEMO: Special Supplement: MEDICAL JOBS

Source: Richmond Times - Dispatch

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