The Role of Public Health Nurses

Public health nurses integrate community involvement and knowledge about the entire
population with personal, clinical understandings of the health and illness experiences of
individuals and families within the population. They translate and articulate the health and
illness experiences of diverse, often vulnerable individuals and families in the population to
health planners and policy makers, and assist members of the community to voice their
problems and aspirations. Public health nurses are knowledgeable about multiple strategies
for intervention, from those applicable to the entire population, to those for the family, and
the individual. Public health nurses translate knowledge from the health and social sciences
to individuals and population groups through targeted interventions, programs, and
advocacy.

Public health nursing may be practiced by one public health nurse or by a group of public
health nurses working collaboratively. In both instances, public health nurses are directly
engaged in the inter-disciplinary activities of the core public health functions of assessment,
assurance and policy development. Interventions or strategies may be targeted to multiple
levels depending on where the most effective outcomes are possible. They include
strategies aimed at entire population groups, families, or individuals. In any setting, the role
of public health nurses focuses on the prevention of illness, injury or disability, the
promotion of health, and maintenance of the health of populations.

Examples of Activities of Public Health Nurses

The activities of public health nurses include the following:

1. Provide essential input to interdisciplinary programs that monitor, anticipate, and

respond to public health problems in population groups, regardless of which disease
or public health threat is identified;
2. Evaluate health trends and risk factors of population groups and help determine
priorities for targeted interventions;
3. Work with communities or specific population groups within the community to
develop public policy and targeted health promotion and disease prevention
activities;
4. Participate in assessing and evaluating health care services to ensure that people are
informed of programs and services available and are assisted in the utilization of
available services.

Provide health education, care management and primary care to individuals and families
who are members of vulnerable populations and high risk groups.

The Role of the Public Health Nurse

Ideally, the work of public health nurses is defined as "primary prevention," which means preventing disease,
injury, disability and premature death. Public health nurses work as a team with other public health professionals
such as environmental health specialists, health educators, epidemiologists, public health physicians, and
nutritionists. As members of this team, they work with local communities to assess and prioritize the major health
problems and work on a plan to alleviate or eliminate these problems and the conditions that contribute to their
development.

Public health nurses are able to assist individuals and families to take action to improve their health status. Often
this takes the form of teaching about healthy lifestyle choices in the home, in the workplace, and in community
settings. Public health nurses assist people in applying improved health behavior choices to their everyday lives.
Examples of personal behaviors that can contribute to health problems are tobacco use, improper diet, lack of
physical exercise, unsafe sexual practices, and driving while intoxicated.

Public health nurses also recognize that the community and environment in which people live can affect their
ability to make healthy lifestyle choices and can affect whether or not such choices exist at all. Thus, public
health nurses may spend a significant portion of their time on ensuring healthy living conditions in the
neighborhoods where they work and on improving the health status of the entire community, not just that of
individuals. Examples of community issues on which the public health nurse may work are reducing tobacco sales
to minors, fluoridation of drinking water, identifying and reducing workplace hazards, immunization of all children
against communicable diseases, and reducing the risk of drowning through community education, pool safety, and
construction regulation.

Public health nurses are found in a variety of settings, including schools and the workplace. Public health nurses
who assist workers at the job site are called occupational health nurses. Some nurses work in local government
health departments as general practice nurses in neighborhoods. In some health departments, the community
intervention role of public health nurses is not well established and their work is confined to home visits and clinic
work. Their primary role is that of case manager and they have a varied caseload of individuals and families whom
they assist with illness-oriented concerns, such as communicable diseases and health problems of mothers and
children. Sometimes, these case manager public health nurses specialize in one area, such as follow up of cases of
lead poisoning or sudden infant death syndrome. Much of the funding for public health work has been fragmented,
coming to local government jurisdictions from state and federal sources for a specific problem or intervention
only. As a consequence, public health nursing in many settings has become more specialized and even more
concentrated on caring for individuals and families, usually in the home.

Many public health nursing experts feel that this emphasis on caring for people with a disease or condition has
hindered public health nurses from being full participants in public health and has diverted public health nursing
away from its prevention role. Some in public health nursing would even argue that, as a result, the practice of
public health nursing has lost its way and needs to refocus on the true mission of public health: to look at the
health problems of a community as a whole and work with the community in alleviating those problems. They
would argue that there is the mistaken perception of public health nurses as providers of personal care only. The
challenge for public health nurses in the future is to apply the nursing process (assessment, diagnosis, planning,
implementation, and evaluation of interventions) to improve health, not just of individuals, but also with larger
segments of the population in partnership with the community.

Trends and Future Directions

The practice of public health nursing has been greatly affected by sources of funding. Much of the past focus on
clinic work and personal health care for the indigent and uninsured has been driven by the need to limit nursing
work to what was reimbursable by a third party, such as Medicaid in the United States. Many public health nurses
practice in local health departments, which are seen as the providers of last resort for care of the sick poor and
the uninsured. County hospital care and out patient services have taken much of the public health funding and
attention away from the primary goal of public health, that is, improving the health of the entire community.
However, this is gradually changing, with a major shift in the 1990s to health plans (managed care) and the
movement of Medicaid populations, in most states, into managed care programs. This has made caring for sick low-
income people more financially viable for the private sector. Consequently, local health departments and their
public health nursing staff have been encouraged to shift their activities back toward the primary mission of public
health, which is to work on the causes of health problems and to prevent them.

Read more: http://www.answers.com/topic/public-health-nursing#ixzz1IScyvTfY

The Public Health Nurse’s Role in Achieving Health Equity:

Eliminating Inequalities in Health

Introduction

The Association of State and Territorial Directors of Nursing (ASTDN) has long
espoused the values of health equity and social justice. In May 2006, the
Association convened its members and an invited panel of community
experts in a series of explicit learning opportunities and conversations to
revive and rededicate ourselves as state-level public health nursing leaders
to the elimination of health inequalities and disparities in the United States
and its Territories. Many of the concepts and suggestions described as Public
Health Nursing roles, responsibilities and obligations were identified through
that and subsequent discussions.

Purpose

This paper is an outgrowth of ASTDN’s commitment to the elimination of

health disparities and the achievement of health equity for all, and
underscores the important role public health nurses play in eliminating
inequities in health. Its purpose is to inspire public health nurses to serve as
leaders and major contributing forces in the elimination of health inequities
in the United States and its Territories.

The nursing profession was one of the early innovators in the recognition of
the importance of culture in health with its recognition of transcultural
nursing. Our values of health equity and social justice evolved out of direct
experience, witnessing the visible and sometimes deadly hardships
experienced by resident and undocumented populations at the turn of the
20th Century. Visible and deadly hardships persist today, some obvious and
some insidious, most notably black infant mortality, escalating rates of
chronic diseases and the impact of the social gradient on quality of life.
Despite the enormity of the challenges that public health nurses face every
day, it is imperative that public health nurses continue to move forward and
develop successful evidence-based strategies and approaches in their
practice settings. The incremental steps taken may not seem to make a
difference in the present but could be the foundation for the achievement of
health equity in the future. Public health nurses have always been and must
continue to be catalysts and change agents. We may just be the “continuing
expression of an ideal.”

This paper is a call to public health nurses across the United States and its
Territories that we may find our voices, renew our commitment to the
elimination of health2 inequities, and help build durable public policy that
promotes and protects health for all and assures conditions that support safe
and healthy communities.

Definitions

For the purposes of this position paper, ASTDN based it definition of health
disparity from Carter-Pokras and Baquet in the seminal publication entitled:
“What is a Health Disparity?” (2002).

According to Carter-Pokras and Baquet, most dictionaries define disparities

as inequalities, a “condition of being unequal.” Taking this to the next level,
inequities represents a judgment – Is the inequity unjust or unfair? One must
factor-in not only “who is deciding what is avoidable and unjust, and how it is
decided.” Thus, “disparity in the context of public health and social science,
therefore has begun to take on the implications of injustice, but nonetheless
may be distinguished from the general term ‘inequality.’ A health disparity
should be viewed as a chain of events signified by a difference in: (1)
environment, (2) access to, utilization of, and quality of care, (3) health
status, or (4) a particular health outcome that deserves scrutiny.

Such a difference should be evaluated in terms of both inequality and

inequity, since what is unequal is not necessarily inequitable.” (Carter-
Pokras, Baquet, 2002) ASTDN is defining health equity as an ideal state
marked by fairness and the achievement of optimal health and wellbeing for
all populations, where disparities in health status are eliminated across
populations by race, ethnicity, gender, geography, disability, religion, sexual
preference and mental status. Health equity may be viewed as an equal and
fair distribution of health and wellbeing.

Public health nurses in the United States and its Territories need to be aware
that research on health disparities and health equity is an emerging and
evolving body of work and currently lacks agreement on common definitions.
This body of work is led by notable researchers, institutions, and
organizations that include the USDHHS
Office of Minority Health, the National Institutes of Health, the Association of
State and Territorial Health Officers, the National Association of City and
County Health Officials, and the Kaiser Permanente Institute of Health Policy,
to name a few. At this writing, work continues to resolve conceptual
differences in the definitions of health disparity and health inequality. The
current incomplete condition of research should not dissuade public health
nurses in their efforts to assure health equity.

Public Health Nursing’s Roles, Responsibilities and Obligations

Awareness, respect and humility: Awareness is the first step in the

development of cultural sensitivity and competence. The public health nurse
must be self-aware and self-reflective of his/her own perceptions of culture.
Awareness of cultural differences and the ability to effectively care for
cultures different from one’s own begins with keeping an open mind; with
careful, respectful listening; and with careful attention to cues. One must
understand the culture and the environment in order to promote healthy
behaviors across populations and to develop public health policy anchored in
the underlying social determinants of health.

In addition, the public health nurse needs to be aware that provider

behaviors and their clinical decisions, coupled with health system factors
(such as language barriers, lack of availability and access to services, and
gaps in care imposed by payors) often carry negative history. Such obstacles
present barriers that need to be overcome as the public health nurse works
in partnership with families and communities. Cultural competence
represents a bridge between family, community, provider, and system. As
public health nurses, we must be humble in acknowledging what we don’t
know about serving diverse populations and dedicate ourselves to lifelong
learning.

Getting help from a trusted “cultural guide” can help the PHN be proficient in
the culture of the population served. Seeking out diverse cultural
experiences or emersion experiences can increase the nurse’s comfort level.
Public health nurses must truly listen, honor, and respect needs, preferences,
desires, and the hopes of our clients for themselves, their families, and their
communities.

Public health nurses should not be daunted by the challenges that they face
to provide and promote culturally competent care. It must be acknowledged
that it will sometimes take courage to move forward in uncertain situations.
The public health nurse should be willing to take risks and have
conversations at all levels of organizations and government to make systems
of care more respectful and competent to serve diverse populations.

Recognizing the multiple social determinants of health: Improving the

health of families and communities requires more than responding to the
manifestations of illness or the outcomes of risk. Rather, it requires that
public health nurses focus on the underlying causes of illness, injury,
premature death, and disability – the social determinants of health. This
model suggests a powerful co-mingling and interplay of risk and supportive
factors. The physical environment, genetics, individual biologic and
behavioral response, access to health care, level of prosperity, stress, early
life and experience, social support, social exclusion, work environments,
unemployment, addiction, availability of food and transportation have all
been linked to health outcomes. (Sources: R.G. Evans and G. L. Stoddart,
1994, and The Social Determinants of Health: The Solid Facts, World Health
Organization, Europe, 2003).

The recognition that health is determined by multiple and interacting factors

calls for partnerships and collaboration from the public, private, nonprofit,
and voluntary sectors. Systematic approaches are needed to reduce high
personal, social and economic costs of poor health and to establish pathways
to strengthen individual, family and community health.

Capitalizing on community strengths: A strengths-based approach

ensures that the assets within a community are engaged in helping
communities work toward health improvement. A strength-based approach
ensures that the problem-solving capacity of the community itself, its skills
and assets, are actively engaged in achieving better health and safety.

According to the U.S. Institute of Medicine, ”Communities and community

organizations can be vital contributors to the resources and capacity of a
public health system. A community’s right to self-determination, its
knowledge of local needs and circumstances and its human, social, and
cultural assets, including the linkages among individuals, businesses,
congregations, civic groups, schools, and innumerable others, are all
important motivations for community health action. In cases in which
community health promotion and protection activities are initiated by a
health department or an organization, engaging the community is a primary
responsibility. Realizing the vision of healthy people in healthy communities
is possible only if the community, in its full cultural, social, and economic
diversity, is an authentic partner in changing the conditions for health.”
(Institute of Medicine, 2003).

In their work, Building Communities from the Inside Out: A path toward
finding and mobilizing a community’s assets, John P. Kretzmann and John L.
McKnight provide a framework for community-building. Each community has
unique assets upon which progress can be built. Instead of focusing on
deficits, the process must start with finding the assets, skills and capacities
of residents, associations and institutions.

This process includes assets mapping, building relationships, mobilizing for

economic development and convening the community to develop a vision
and plan, and leveraging outside resources to support locally-driven
development. Using an assets-building model, the public health nurse will
not consider people to be clients or recipients of aid, but full contributors to
progress. An assets-based approach is internally-focused and relationship-
driven, relying on the agenda and problem solving capacity of the
community itself and on the building and rebuilding of relationships among
populations, their associations and institutions.

As public health nurses, our work in achieving health equity must follow this
same path, building upon the assets within a community, building new
relationships, strengthening existing relationships, rebuilding weakened
relationships, strengthening the capacity of people within the community to
care for their own health and the health of each other.5

Leadership: The public health nurse provides leadership in both nursing

and public health. (Source: PHN Scope & Standards of Practice, ANA, 2007.
page 38) Public health nurses are granted a societal privilege to practice,
therefore have a responsibility to understand, learn, and take individual and
collective action on health disparities. Public health nurses are, therefore,
advocates for health equality and social justice. Public health nursing leaders
advocate for structures within state and local health departments that foster
participation by public health nurses in systems and community
interventions, not just with individuals and families. Information about
communities, and the importance of ethnicity, language, and culture, needs
to be translated and interpreted to policy makers in a way that encourages
doing “the right thing.”

Public health nursing leaders must also uphold the highest of ethical
standards.
Public health nurses are bound by the ethical provisions for all nurses made
explicit in Code of Ethics for Nurses with Interpretative Statements (ANA,
2001), Principles of Ethical Practice of Public Health (Public Health Leadership
Society, 2002), and Environmental Health Principles and Recommendations
for Public Health Nursing (APHA, 2006) .

Achieving cultural competence: Cultural and linguistic competence is a

set of congruent behaviors, attitudes, and policies that come together in a
system, agency, or among professionals that enables effective work in cross-
cultural situations.

According to the U.S Department of Health & Human Services, Office of

Minority Health publication, What Is Cultural Competency? (Retrieved July 15,
2008 from

http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=11):

 Culture refers to integrated patterns of human behavior that include the

language, thoughts, communications, actions, customs, beliefs, values, and
institutions of racial, ethnic, religious, or social groups.

 Competence implies having the capacity to function effectively as an

individual and an organization within the context of the cultural beliefs,
behaviors, and needs presented by consumers and their communities.
(Adapted from Cross, 1989).

The public health nurse systemically enhances the quality and effectiveness
of nursing practice and attains knowledge and competency that reflects
current nursing and public health practice. Cultural competence must be an
expectation for all public health practitioners. Public health nurses take steps
to acquire knowledge of the populations they serve, model respect for varied
cultures, and insist on accountability in cultural competence. Public health
nurses assure their organizations assess the level of cultural competency
and move toward sensitive and effective services and interactions.

Public health nurses work within systems that can better support diversity
and equity in health outcomes. Employment and administrative systems
must be structured to welcome and embrace diversity and appropriately
recruit and support minority candidates. Systems must establish structures
to systematically review agency policies in order to identify and eliminate
discrimination and racism in both employment and the services that
agencies offer to communities. The public health nursing workforce should
ideally reflect the diversity of the populations that are served and reflect the
demographics of the larger community. Public health nurses have numerous
opportunities to encourage under-represented groups to enter the public
health professions and the profession of nursing.

Each public health nurse, at every level needs to look within themselves and
practice inclusiveness, listening to understand, and recognizing the
knowledge and power of each individual and group, making certain that
committees and teams on which we work have diverse representatives
(ethnic, racial, geographic, gender, sexual orientation). Public health nurses
must be role models and exemplify the principles of social justice, increase
the cultural competence among their staff, and work to close gaps in health
outcomes that impact populations disproportionately.

Assessment, population diagnosis and priority-setting: Assessment is

a core function of public health and of public health nursing. Recognition of
health disparities and tracking of progress toward their elimination requires
appropriate data. Public health nurses ensure that wherever possible, data
are collected to document any disparities and track progress toward their
elimination. Good data are needed to ensure the appropriate evaluation of
new strategies. Public health nurses work with communities and populations
to provide context and meaning to the data,and to generate and test
innovative solutions to community problems.

Data collected relative to health disparities need not be confined to numeric

data.

The explanation of numeric data can be accomplished through focus groups

and interviews with group members, which can provide far better
understanding of the issues impacting health than numbers alone. Armed
with this information, the public health nurse has more comprehensive
assessment data to determine population based diagnoses and priorities.
Comprehensive assessment is necessary to identify and plan for improved
health outcomes. Priorities and plans are established with the early and
ongoing input of populations and not once a program is in its final stages of
development.

Partnering with others: A core competency of public health nursing is the

ability to establish partnerships. Public health nurses partner with groups and
population sin planning interventions to address and resolve health issues,
enabling them to learn from the community and formulate appropriate
solutions. The public health nurse develops plans that reflect best practices;
identifies strategies, action plans and alternatives to attain expected
outcomes; and implements the identified plans through partnerships within
the community.

State and local health agencies, as well, need the partnership of other
agencies and disciplines to effectively remove barriers to care and solve
human conditions not conducive to health. Public health nurses may be the
first to reach out to other agencies and institutions to ensure their
populations are better served.

The public health nurse establishes collegial partnerships while interacting

with representatives of the population, organizations, and health and human
services professionals, and contributes to the professional development of
peers, students, colleagues, and others. The public health nurse employs
multiple strategies to promote health, prevent disease, and ensure a safe
environment for populations.

The public health nurse collaborates with and provides consultation to

representatives of the population, various community groups, organizations,
health and human services professionals and elected officials to facilitate the
implementation of programs and services and to provide for and promote the
health of the population.

Creating an environment for care: A core value of public health agencies

is the construct of caring. Public health nurses have unique power in design
of programs and services for diverse populations. It is the nurse who creates
and upholds caring environments by assessing, correcting, controlling and
preventing those factors in the care environment and in clinical and
community relationships that can adversely affect health. The caring
environment is critical to the maintenance of the caring relationships and to
the continued and sustained relations with the community. A trustful,
sensitive environment supports individuals, families and communities to
engage in their care, to change and evolve and to adapt healthful behaviors
and lifestyles. The strength of public health nursing lies in its capacity to
uphold a caring environment regardless if the focus is caring for the family or
caring for the individual.

Creating an environment for care extends beyond delivery of services to the

infrastructure of the state or local health department itself. Its mission is to
assure conditions in which people can be healthy. Infrastructure, in this
context, includes all core public health functions and essential public
services, which must be anchored in effective public health policy. Public
health nursing leaders must ensure adoption of agency policies that actively
and effectively support diversity of the workforce and uphold the value of
diverse partnerships. Policy-level interventions grounded inhuman values,
social justice, and the underlying determinants of health foster an
environment for care and lend an “upstream” focus.

Advocacy: Advocacy is a standard of practice for public health nursing.

According to the national scope and standards of public health nursing
practice, advocacy is defined as “the act of pleading or arguing in favor of a
cause, idea, or policy on someone else’s behalf, with the object of developing
the community, system, individual, or family’s capacity to plead their own
cause or act on their own behalf.”

(Public Health Nursing: Scope and Standards of Practice. American Nurses

Association, 2007, pg 40) Public policy is the primary tool for solving
inequalities in health.

To be effective, public policy must move toward an ecological

approach to health improvement, recognizing the interplay of public
policies related to health, social welfare, housing, transportation, and
education.

The public health nurse incorporates the identified needs of the population in
policy development and program or service planning, evaluates
effectiveness of advocacy and strives to resolve conflicting expectations
from populations, providers and other stakeholders. To do so guard the
safety and best interests of the population and preserves the professional
integrity of the nurse. The public health nurse advocates protecting the
health, safety, and rights of the population.

Public health nursing leaders are often uniquely placed in government

agencies and are often in a position to be consulted on issues related to
policy and legislation.

These opportunities should be embraced as an opportunity to help “put the

face” on public health issues and problems. The stories of those we serve
can provide a powerful motivation to policymakers and legislators.

Educating the current and future public health nursing and nursing
workforce: Cultural competence is a journey, with insights and lessons
learned along the way, and with our goals perhaps never being fully realized
as populations8and culture continually change. The educational process
must start with awareness and sensitivity to those whose culture is different
from our own. We are not fully competent in our profession unless we are
aware of and sensitive to the needs of others and can work effectively within
communities to facilitate the changes necessary to bring about greater
equity in health outcomes.

Public health institutions and institutions of higher education in nursing have

an obligation to help facilitate this process and support this journey with
their staff and students.

Creating public and agency policies that support and celebrate

diversity: As public health nurses and the organizations that employ them,
we must not only embrace diversity, but celebrate it. Agencies may
celebrate diversity by showcasing and sharing culture and customs across
various groups. This may also lead to deeper understanding across the
agency for the various populations served.

Evaluation and research: Each public health nurse must see his or her role
ashore than custodial of current policies and programs. Rather, public health
nurses must constantly be aware of opportunities to improve programs and
services to better serve communities and population groups at increased risk
of illness, injury, premature death, and disability.

The public health nurse is constantly evaluating his/her own nursing practice
in relation to professional practice standards and guidelines, ethics, relevant
statutes, rules and regulations and against the unmet and evolving needs of
the populations served. The goals for health improvement and health equity
can be supported through thorough, objective evaluation of what works and
what does not work, and through subsequent alterations in policy and
practice. The public health nurses’ role as stewards of public investment
demand it, as does the public trust.

Conclusion- The need for continued, open dialog: Health equity

requires “upstream” thinking and action. There is no one correct way to
achieve this vision –the important thing is to begin. Our journey toward
health equity will require a willingness to pause, to listen, to consider, and to
reflect. We must insist on open, honest, constructive dialogue and we must
be willing to learn, to assimilate our new knowledge, and to create change.

We must continue to engage our partners to guide and advise us on our

journey.
Our moral compass is the tenets, cornerstones, and standards of public
health nursing practice. Our partners include the profession of nursing, our
communities, and representatives of government and the public, private,
nonprofit, and voluntary sectors in our states and territories.

Above all, we must believe that health equity is achievable and within our
reach. It is our role and responsibility as public health nurses to provide
leadership in making this happen.

Attachment

Examples of the Public Health Nursing Role with Regard to

Core Public Health Functions and Achieving Health Equity

Core Function: Assessment

The PHN identifies inequities within specific populations and identifies

vulnerable groups.

The PHN is obligated to gather and use data that identifies populations who
suffer disproportionately from disease, injury or poor health.

The PHN makes data available and accessible to public.

The PHN translates data into information that describes the health disparities
in his/her locality, state or territory.

In order to assure accuracy of assessment and realistic planning for

community services, the PHN establishes trust with individuals and
populations through:

 Respecting others’ beliefs and customs;

 Listening;

 Discarding preconceived notions;

 Having open concern and understanding;

 Communicating positively;

 Using motivational techniques;

 Self-awareness and recognizing personal biases and fears;

 Discarding “I know best” attitudes;

 Honoring the skills, knowledge, and capacity of families and communities;

 Approaching health behaviors realistically;

 Advocating for communities; and,

 Respecting individuals’ privacy.

Core Function: Policy Development

The PHN recognizes the impact of the chronic stress of racism and poverty
on health.

The PHN raises awareness of the root causes of health disparities, much in
the same way PHNs educate on the causes of disease.

Recognizing the broader construct of health, the PHN promotes social justice
and sound social policy in areas of housing, education, employment and
recreation and articulates the connection between public health and social
justice.

The PHN works within and between governmental agencies, non-

governmental partners and elected officials to create dialog that increases
understanding of the social determinants of health and how policies and laws
can improve health for all.

The PHN listens with an open mind and advocates for and with clients and
communities in describing barriers to health care services.10

The PHN acts as an advocate for both individuals and groups to remove
organizational and institutional barriers.

The PHN promotes and engages diverse and expanding partnerships to learn
about health disparities and work with communities to formulate sustainable
solutions to health inequities.
The PHN aspires to being inclusive and assuring a diverse and balanced
representation in policy development by including non-traditional partners
(e.g., faith-based organizations, civic organizations, labor unions,
businesses), groups with opposing views, and clients of various demographic
groups.

The PHN provides policy leadership by serving on teams or directing efforts

clarifying the role of state and local health departments and boards of health
in eliminating health disparities.

The PHN participates in and translates regarding innovations in eliminating

health disparities into practice and policies.

Public health nurses advocate for cultural competency to be incorporated

into position descriptions.

Core Function: Assurance

The PHN enforces nondiscrimination policies and hiring practices to ensure a

diverse and welcoming workplace.

The PHN develops and enforces laws and regulations that protect health and
ensure safety.

The PHN identifies population groups who are not in the system or do not
present for care and provides case management for high risk population
groups.

The PHN advocates for workforce diversity in state and local health
departments with a special focus on the recruitment of professional nurses
and the core public health disciplines.

The PHN provides a visible presence to elementary, middle, and high school
students encouraging them to consider nursing as a profession.

The PHN reaches out to newly licensed nurses at the local, state, and
national levels to socialize them into the profession by serving as a coach,
preceptor or mentor.

The PHN seeks out adjunct faculty appointments to bridge academia and
practice.

The PHN internalizes cultural competence as a core value and major job
expectation.
The PHN works systemically within state and local health departments to
assure that professional nurses and the core public health disciplines are
grounded in cultural competency.

The PHN systematically and reflectively examines policies and programs with
11 communities and recommends change where needed to assure that
public health policies and programs are culturally competent.

The PHN uses quality improvement methods (Plan, Do, Check, Act) that
involve diverse communities to pilot and test health promotion and disease
prevention programs prior to large scale mobilization in the community.