Growing public health nursing:
Public Health Nursing Education Framework
discussion document
July 2013
Funded by: The Ministry of Health
Project managed and written by the Public Health Nursing Education Framework Working Group, the Public
Health Association of New Zealand and Head Strategic Limited
Cover image from: Public health nursing: functions and activities, Department of Health, Wellington, 1985.
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Public Health Nursing Education Framework
Contents
Part 1: Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
What is the purpose of this discussion document and who is it for? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
How can you provide feedback on this document? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Who are public health nurses and what do they do? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Why is a Public Health Nursing Education Framework needed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
What could be included in the Public Health Nursing Education Framework? . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Workforce development challenges and opportunities for public health nursing . . . . . . . . . . . . . . . . . . . . . . . 11
What is the current public health nursing education pathway? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Part 2: Isues and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Step 1 – Prior to starting a Bachelor of Nursing degree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Step 2 – Bachelor of Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Step 3 – Nursing Entry to Practice Programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Step 4 – First and subsequent PHN positions (after NETP) for registered nurses (with or without other
nursing experience) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Step 5 – Advanced public health nursing roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Step 6 – Nurse practitioner – PHN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Step 7 – Nurse academic – PHN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Where to from here? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Appendix 1: Te Uru Kahikatea objectives relevant to public health nursing . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Appendix 2: Individuals involved in this project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Appendix 3: Public health nursing demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Appendix 4: History of public health nursing by Elizabeth Farrell, 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Appendix 5: Short-, medium- and long-term visions for PHN workforce development . . . . . . . . . . . . . . . . . 35
Appendix 6: Generic Public Health Competencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Appendix 7: New Zealand Certificate in Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Appendix 8: Public Health Leadership Programme (PHLP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Discussion Document – July 2013
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Part 1: Context
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Public Health Nursing Education Framework
What is the purpose of this discussion
document and who is it for?
Public health nurses play an important role in
supporting individuals, families, communities
and populations to meet their own health and
wellbeing needs. Future-proofing the public health
nursing workforce by ensuring its competence
in a changing society is essential to meet the
population and personal health needs of New
Zealand communities.
At present, there is no national framework for
public health nurses’ professional development.
This discussion document is part of a nurse-led
project to set a way forward.
The purpose of this discussion document is to:
• summarise the current educational
framework for public health nurses (PHNs)
• outline the key issues that PHNs experience
on their educational journey
• ask for feedback on the proposed
recommendations which will inform the
development of the Public Health Nursing
Education Framework.
A framework could support the development
of all registered nurses who work to change
determinants of health such as infectious diseases
or child protection. While it focuses on public
health nurses, the framework also includes nurses
who work in primary health care.
Public health nursing is not about the role of a
registered nurse, but about the essence of his/
her practice. Many primary health care nurses
take a population health approach in their daily
work, and play an important part in addressing the
determinants of health.
Who is this discussion document
for?
Public health nursing key stakeholders – nurses,
nurse leaders and managers – are the main
audience for this discussion document.
However, we would also like feedback and
comment from anyone interested in the
development of public health nursing. This
might include professional bodies, nursing and
public health education providers, nursing school
representatives, District Health Boards, public
health doctors, community workers who work
with public health nurses, and government
agencies concerned with health service
development and with population health.
The Education Framework to come out of this
discussion document will allow PHNs (and other
registered nurses who undertake public health and
population health work) to access education that
develops both their public health and population
health nursing knowledge and skills.
The framework aims to be flexible and to have
multiple entry and exit points.
How did this discussion document
come about?
The need for this project was identified by a
group of experienced public health nurses. It was
strongly supported as a priority by a 2012 national
meeting of representatives from public health
disciplinary groups.
The Ministry of Health has funded this project and
provided advice and support. The project connects
to Te Uru Kahikatea: The Public Health Workforce
Development Plan 2007-2016,1 which includes a
number of goals and actions relevant to public
health nursing (see Appendix 1).
The major outputs for this project will be:
1. consultation on this discussion document
with a range of stakeholders
2. a national Education Framework for public
health nurses and other registered nurses
doing public health and population health
work
1. Te Uru Kahikatea: Public Health Workforce Development Strategy 2007-2016. Ministry of Health, Wellington, 2004.
Discussion Document – July 2013
5
Public health/population health
Public health has been described as “the science and art of promoting health, preventing disease and
prolonging life through the organised efforts of society.” Public health work focuses on improving the
overall health of populations, such as children, through interventions such as immunisation, health
screening checks, or safer housing.
Population health focuses on the health outcomes or status of population such as groups, families
and communities. A population health approach takes account of all the influences on health (the
determinants of health) and how they can be tackled to reduce inequalities and improve the overall
health of the population.
3. an implementation plan to identify next
steps, roles and responsibilities and
timelines to bring the Education Framework
to fruition.
How the project is being managed
and supported
This project is led by the Public Health Nursing
Education Framework Working Group, a group
of experienced public health nurses, nurse
leaders and nurse educators. The Public Health
Association is providing project and administrative
support to the working group.
The working group is supported by an advisory
group of people with expertise in public health
nursing, Māori health, Pacific health, public health
workforce development, project management,
and professional nursing practice.
The advisory group includes members from Health
Workforce New Zealand, Nursing Council of New
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Zealand, District Health Boards’ Directors of
Nursing, the New Zealand Nurses Organisation and
the Public Health Association (see Appendix 2).
The Ministry of Health’s Chief Nurse Business
Unit and the Public Service Association have also
expressed support for this project.
The working group would also like to acknowledge
the very experienced and highly skilled public
health nurses who have spent many years
committed to making a significant difference in the
lives of many in their communities.
Whether or not they choose not to travel the
journey along the Education Framework, they can
play a vital role in supporting the next generation
of PHNs to pursue continuing education.
Appreciation is extended to this group in
anticipation of the encouragement they offer to
members of the nursing workforce following in
their footsteps.
Public Health Nursing Education Framework
How can you provide feedback on this
document?
There are several ways you can provide feedback
on this document and its recommendations.
Hard copy
You can provide comment on the hard copy, and
mail it to us at:
Public Health Association of New Zealand
PO Box 11-243
Wellington 6142
By email
You can email comments to Leona Head at
leona@pha.org.nz.
Online discussion forum
We invite you to share in the online discussion
about the issues at the user-friendly Loomio
discussion space. You’ll find links to the online
discussion at www.pha.org.nz.
Currently, there is
no continuous or
coherent professional
and educational
development pathway
for public health nursing
in New Zealand.
Discussion Document – July 2013
7
Case study 1
While visiting her assigned school, Rachel was told by the school that Josef, a nine-year-old Tongan
boy with whom Rachel had been working with for a number of months, had not been at school for
the past three days. Rachel decided she would home visit on her way back to the office.
On arriving at Josef’s house she could see preschool children playing on the doorstep and a dog
running around the yard. Rachel asked for the dog to be tied up and after this was done she spoke
with Josef’s mum, Anna. Josef had been off school unwell.
When she was talking to Josef he told Rachel he had a ‘wicked’ sore throat. Rachel immediately
arranged to take a throat swab to screen for Group A Streptococcus – the cause of rheumatic fever.
Rachel also assessed the health status of other family members and provided education regarding
sore throats and rheumatic fever. Anna told Rachel that her nephew had rheumatic fever and
was on injections. Rachel also assessed and discussed the early childhood education needs of the
preschoolers with Anna along with their immunisation status.
Who are public health nurses and what do
they do?
Public health nurses (PHNs) are registered nurses
who use their nursing expertise, alongside their
wider knowledge of communities, to promote
health and wellbeing.2
They play an integral role in delivering public
health services in New Zealand. PHNs work
in many settings, such as schools, homes and
community health services. They operate across
many sectors – for instance some public health
nurses are based at Work and Income offices.
PHNs work with complex population and personal
health issues, such as those described in Case
Study 1.
PHNs have a range of competencies that are
important to the health sector in Aotearoa New
Zealand. As a relatively small workforce – there
are only 700-800 public health nurses nationwide3
– their core work is often not visible to the
public, except in the event of a national public
health crisis such as H1N1 border screening and
communicable disease outbreaks.
Appendix 3 provides known demographic
information about the public health nursing
workforce from 2010.
To gain insight into the unique contribution PHNs
have made to improve the health of communities
both locally and internationally, you can read
about the historical development of public health
nursing from the late nineteenth century to the
present day in Appendix 4.
Most PHNs are involved in co-ordination and
case management between families/whānau and
communities, and the health, social and education
sectors. Their wide-ranging work may include:
• health assessments and treatment, for
instance treating children with skin diseases
2. Working for a better future: Careers in Public Health, Ministry of Health, 2006 at page 8.
3. The New Zealand Nursing Workforce. Nursing Council of New Zealand. 2010.
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Public Health Nursing Education Framework
Case study 2
Margaret works in a community health centre providing a range of services to support health and
wellbeing among community members. Because the health centre is located in school grounds,
Margaret is able to work closely with the local school and their families as well as with other
community members.
Margaret provides the following types of services for community members and their families: general
health checks, diabetes support, hearing checks, B4 school checks, quit smoking support, cervical
screening smears, housing, income and welfare support, counselling, access to dietary advice,
respiratory guidance, and/or referral to any other health or social service as required. A common
scenario is a child identified by the school who is not managing their asthma.
Margaret is able to visit the home, provide education and support for the family and child regarding
asthma, and support the school through education and information for teachers about children with
asthma. As part of the home visit, Margaret is able to assess any housing, social or financial needs
with the family and arrange for appropriate support.
• disease prevention
• refugee health
• child protection
• communicable disease control, such as
primary prevention of rheumatic fever
• working with teachers to promote health
programmes in schools
• facilitating multidisciplinary ‘strengthening
families’ meetings
• developing one-stop-shop health services for
young people
• playing a major part in implementing schoolbased immunisation programmes
• advocating for healthy home environments
with families and communities.
Within this work, PHNs have an important role
establishing partnerships and communication
strategies with Primary Health Organisations to
improve health outcomes for communities.
Discussion Document – July 2013
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Why is a Public Health Nursing Education
Framework needed?
In response to changing needs – and in some
cases due to reduced funding and changes in
government strategies – public health nursing
and public health nursing roles have changed
significant over the last 20 years.
Accessing opportunities and funding for
professional development in public health nursing
has become increasingly challenging.
Currently, there is no continuous professional
and educational development pathway for public
health nursing in New Zealand. Individually, PHNs
may choose to undertake qualifications after
completing their undergraduate nursing degree,
but those qualifications are not specific to public
health nursing, and may not even be related to
public/population health.
There is some regional or organisational public
health nursing education; however, national
consistency is an issue, and what is available is not
linked to any professional development pathway.
High quality, consistent public health nursing
services in New Zealand demand national public
health nursing education. This will increase the
opportunity for nurses to develop population
health knowledge and skills, and could be available
to other RNs who work in the community.
The Education Framework is intended as a
conceptual framework that organises the
hierarchy of qualifications relevant to public
health nursing in New Zealand. It will frame the
education pathway from beginner to expert, with
multiple entry and exit points.
This pathway aims to help those involved in public
health nursing to advance towards the top of their
scope of practise, using advanced competencies
and clinical skills. It may also allow PHNs to gain
recognition as a highly skilled nursing workforce,
and could help attract registered nurses into public
health nursing.
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Over time the Education Framework could, for
example:
• increase the number of highly qualified
PHNs who can provide evidence-based
public health nursing services to vulnerable
communities
• lead to better population health outcomes,
as PHNs increase their clinical expertise
and better understand the effect social
determinants of health have on inequalities,
chronic health needs and unmet community
health needs
• lead to health cost savings through PHNs
initiating preventative measures and early
interventions for vulnerable populations.
This could avoid costly hospital admissions
and long-term health problems: for example,
the earlier detection and treatment of skin
infections, oral health issues and hearing loss
• enable nurses to advocate for better access
to services for Māori, Pacific, and other
populations with particular needs
• improve collaboration with multidisciplinary
teams and build coalitions with a range of
services
• increase the number of PHNs who can
successfully lead the management of
complex health issues influenced by poor
housing, inadequate social support and
poverty.
Public Health Nursing Education Framework
What could be included in the Public Health
Nursing Education Framework?
The Education Framework could:
1. set a direction for the development of the
public health nursing (see Appendix 5)
2. align professional development (PDRP),
registration pathways and education
pathways
3. set out a pathway for the stages of
qualification, and enable career progression
4. create a platform for a public health
competencies framework
5. provide a platform for positive change.
Workforce development challenges and
opportunities for public health nursing
Current challenges
• Expectations on the primary care sector to
reach vulnerable communities have not been
fully realised, and may require a skill set that
is not widely available.
• Other areas of the health sector have been
given greater priority than public health.
• Structural changes in the health sector may
have marginalised the relatively small public
health nursing workforce in some areas.
• While many younger nurses are coming to
the PHN workforce, the workforce is still an
ageing one.
• There is very little information available
about New Zealand’s public health nursing
workforce to guide workforce development
planning.
• Due to financial constraints, employers are
often unable to arrange release time for
study and provide backfill arrangements.
• There is little or no financial recognition for
gaining additional qualifications.
• There is a perception that new graduate
nurses lack practical experience, which can
inhibit organisations from employing new
graduate nurses and PHNs.
• Health Workforce New Zealand (HWNZ)
does not currently fund non-clinical graduate
nursing courses, creating a barrier to
nurses wanting to work towards the Nurse
Practitioner level.
Opportunities
• There is strong interest among public health
nurses in taking a greater role in improving
health gains in both personal and population
health.
• Public health nursing is gaining visibility
Discussion Document – July 2013
11
through the current focus on emergency
preparedness and response.
• The Public Health Generic Competencies
(see Appendix 6) provide a strong foundation
for public health knowledge and skills.
• There is growing recognition of the need
to fund non-clinical post-graduate nursing
qualifications, and interest in expanding
the criteria for HWNZ funding to include,
for example, post-graduate Public Health
Diploma and Masters’ degree programmes.
• Distance learning is making study more
accessible.
• There are well-developed communication
and consultation mechanisms such as the
PHA conference, NZ College of Primary
Health Care Nurses’ conference, the
PHN leaders’ national email tree and
the regional managers’ meetings, the
publichealthworkforce.org.nz website, and
the nzno.org.nz website, etc.
• National strategies and policy documents,
including Te Uru Kahikatea, NCNZ Scopes
of Practice, NZNO Colleges and Sections
Nursing Knowledge and Skills Framework
(e.g. respiratory, diabetes, primary health
nurses), and the DHBNZ Career Framework
for the Health Workforce provide direction
for public health nursing.
• International frameworks and models of
public health nursing practice, such as the
USA ‘Minnesota Wheel’ and the UK Career
and Development Framework for health
visiting and school nurses are influencing
practice.
What is the current public health nursing
education pathway?
Table 1 (opposite) summarises the current career
steps and education for PHNs. This is the starting
point for the Education Framework.
The sections that follow Table 1 review the
relevant issues for each of those steps and make
recommendations for change.
Please provide your feedback on the issues and
recommendations. Your comments will inform the
final framework.
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Public Health Nursing Education Framework
Discussion Document – July 2013
13
Nurse Academic
7
PhD
Master’s that meets NP requirements
(prescribing courses)7
Master’s degree
Nurse Academic/clinician
Expert – Nurse Practitioner
Designated roles
Advanced PHN roles
Proficient RN
Transition RN
NETP
(i.e. supervised as a student)
Support/Advanced support
NA
National Health Careers Framework
Nurse Practitioner
RN with
prescribing
(optional)
Registered Nurse
NA
Registration
Pathway5
Expert/expert with
expanded practice
Proficient
Competent
Beginner
PDRP
4 The Nursing Council of New Zealand’s 2010 nursing workforce data report indicated there were only a very small number of ‘enrolled nurses’ (ENs) in public health – less than 23. ENs
are not included in this pathway, but will be considered within the workforce required to support the RN PHN workforce.
5 Once initial registration is gained, a nurse maintains registration by meeting the Nursing Council of New Zealand’s Annual Practising Certificate (APC) requirements.
6 NCNZ is currently consulting on community nurse prescribing – once approved, this could be a useful model for PHNs.
7 NCNZ is currently consulting on specialist nurse prescribing.
Nurse Practitioner
6
PG Diploma
Designated roles (e.g. nurse
educator, nurse manager, nurse
specialist)
NZ Certificate in Public Health (see Appendix 7).
Level 5 but relevant to public health nursing
(prescribing courses)6
Short courses, Nursing Knowledge and Skills; e.g.
vaccination, Cervical Smear taker certificates, etc.
PG Certificate
Orientation to PHN
NETP
Advanced PHN roles
NETP
3
Bachelor of Nursing
5
Nursing related
2
Secondary education
First and subsequent RN/PHN
positions
Various options
1
Education Pathway
4
Career Progression
Step
PDRP: Professional Development Recognition Programme – advances professional development in nursing and supports nurses to demonstrate competency to the NCNZ
NETP: Nursing Entry to Practice Programme – provides graduate registered nurses with support and development during their first year of practice.
Table 1: Current career, education and registration pathways for public health nurses in New Zealand Aotearoa4
Part 2: Issues and recommendations
This section presents the seven steps of the proposed pathway. It outlines the current situation and
issues, and asks for your comment about the recommendations.
Providing feedback
We invite you to comment as much as you would like on the recommendations for each step. You
can also provide general comments on the framework.
Your feedback will inform the development of the Education Framework and its recommendations.
As well as providing feedback by email or hard copy, we also invite you to share in an online
discussion about the issues. You’ll find links to the online discussion at www.pha.org.nz, along with
other ways to provide feedback.
14
Public Health
Health Nursing
NursingEducation
EducationFramework
Framework
Step 1 – Prior to starting a Bachelor of
Nursing degree
Current situation
Students have little information about public
health nursing as a career.
Issues
High school students should be exposed at an
early stage to information on careers in public
health, nursing and public health nursing. This
could increase their uptake of science-related
subjects, and improve the pool of young people
who could progress into nursing. People should
understand what their options are before they
start a programme of study.
Not promoting career opportunities may mean
that opportunities to grow the potential workforce
pool for nursing and public health are lost,
reducing graduate nursing numbers and causing
future workforce shortages.
Issues and recommendations
Issue 1.1
Opportunities to grow the potential workforce pool may be lost if career opportunities are not promoted
at an early age to high school students.
Recommendation 1.1
Agree / Disagree
PHN stakeholders actively support initiatives
to encourage secondary students and secondchance learners to meet entry requirements for
nursing.
Comment
Discussion Document – July 2013
(please circle)
15
Step 2 – Bachelor of Nursing
Current situation
Public health nurses complete a generic Bachelor
of Nursing qualification from one of 16 nursing
schools in New Zealand.
All schools of nursing are monitored and audited
against the Nursing Council New Zealand (NCNZ)
nursing education standards, which outline
broadly the requirements for curriculum content
and clinical experience.
health are embedded in various courses within
their Bachelor of Nursing programmes.10
Nursing students complete placements as part of
their nursing training.
In addition, related theory from the disciplines of
sociology and epidemiology are also evident.
Issues
The Generic Public Health Competencies are
the foundation knowledge and skills expected
of all people working in public health. These
competencies (shown in Appendix 6) could be
used as a guide for the NCNZ education standards.
The education standards that guide nursing
schools are not prescriptive. There is relatively
little on population health, with only a reference
to “primary health care and community settings”
in the “expectations for clinical experience”.8
The curriculum content standard is focused on
matching theory with the national registered
nurse competencies.
The language used to describe the indicators of
“competence” focuses on personal health and
nursing care of the individual, with only occasional
reference to nurses working with individuals and
their whānau and wider communities.9
However course information on four nursing
schools’ websites clearly reflects that the concepts
of population health, public health, and primary
health care, the role of the nurse in community
settings or the role of the nurse in population
Recognising the unique context of Aotearoa
New Zealand, nursing education aims to prepare
nurses to understand their Treaty of Waitangi
responsibilities to address inequalities between
Māori and their fellow New Zealanders.11
Despite the best efforts of the NCNZ, this concept
remains unfamiliar and relatively misunderstood.
A barrier for students who wish to do a public
health placement as part of their training is that
many organisations have insufficient capacity to
offer placements to students.
Students may decide not to look for public
health placements as there are relatively few job
opportunities compared to other areas of nursing.
8. Nursing Council of New Zealand. (2010). Education programme standards for the registered nurse scope of practice. Wellington:
Nursing Council of New Zealand.
9. Nursing Council of New Zealand. (2007). Competencies for registered nurses. Wellington: Nursing Council of New Zealand.
10. UNITEC. (2013). Bachelor of nursing: Programme summary. Retrieved from www.unitec.ac.nz/?946294E9-57DF-472E-A5F2ED52FB43859F. Southern Institute of Technology. (2013). Bachelor of nursing: Course content. Retrieved from www.sit.ac.nz/
courses/Invercargill/Bachelor_of_Nursing. Auckland University of Technology. (2013). Bachelor of health sciences: Nursing.
Retrieved from www.aut.ac.nz/study-at-aut/study-areas/health-sciences/undergraduate-courses/bachelor-of-health-sciencenursing.
11. Nursing Council of New Zealand. (2011) Guidelines for cultural safety, the Treaty of Waitangi, and Māori health in nursing
education and practice. Wellington: Nursing Council of New Zealand.
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Public Health Nursing Education Framework
Issues and recommendations
Issue 2.1
The education standards guiding nursing curriculum content and clinical experience do not specifically
require the inclusion of concepts of population health and community settings.
Recommendation 2.1
Agree / Disagree
Negotiate to increase the required level of
knowledge and skills in population health and
community settings in the Education Standards,
using the GPHCs as a guide and including a
‘reducing inequalities’ focus.
Comment
(please circle)
Issue 2.2
The indicators of “competence” in the national registered nurse competencies, appear to focus on
personal health and nursing care of the individual.
Recommendation 2.2
Agree / Disagree
Negotiate a review of the registered nurse
competencies using the GPHCs as a guide to
include population health and community settings
content.
Comment
(please circle)
Issue 2.3
Variable population health and reducing inequalities content in schools of nursing curriculum content.
Recommendation 2.3
Agree / Disagree
Encourage or incentivise schools of nursing
to review the levels of public health nursing
knowledge and skills in the curriculum content
in their nursing programmes, using the GPHCs
as a guide and including a focus on reducing
inequalities.
Comment
(please circle)
Issue 2.4
There are few placements available for students who wish to work in population health and community
settings.
Recommendation 2.4
Agree / Disagree
Facilitate partnerships between schools of nursing
and public health nursing employers to offer and
promote PHN student placements.
Comment
Discussion Document – July 2013
(please circle)
17
Step 3 – Nursing Entry to Practice
Programme (NETP)
Current situation
Once graduated, most nurses enter the nursing
workforce through the national, DHB- managed
NETP programme. NETP provides graduate
registered nurses with support and development
during their first year of practice. The programme
offers a range of placements, including placements
in public health nursing.
Issues
The content of the NETP programme has variable
amounts of population health knowledge and
skills.
Some PHNs believe that the NETP programme
does not fully prepare graduates to work
effectively in population health settings. Graduates
who want PHN placements as part of the NETP
programme have trouble accessing placements,
with the result that many end up working in other
nursing areas.
Resource constraints also affect the investment in
graduate nurses who wish to be on the PHN career
pathway. PHNs often work in small teams, which
have limited time and capacity to support newly
qualified nurses who wish to be PHNs.
The result is that new nurses who gain placements
do not always have a positive experience of the
NETP programme.
It is beneficial to expose
high school students
to careers in public
health, nursing and
public health nursing.
This could potentially
increase their uptake of
science-related subjects,
and improve the pool of
young people who could
progress into nursing.
18
Public Health Nursing Education Framework
Issues and recommendations
Issue 3.1
The content of the PHN NETP programmes delivered at DHB level have variable amounts of population
health knowledge and skills.
Recommendation 3.1
Agree / Disagree
Work with DHBs to review NETP, and to increase
the national consistency of public health
knowledge and skill content, using the GPHCs as
a guide.
Comment
(please circle)
Are there other existing programmes that you
believe might improve NETP?
What suggestions do you have to help nurses
have positive NETP programme experiences?
Issue 3.2
Graduate nurses seeking PHN placements on the NETP programme have difficulty securing positions.
Recommendation 3.2
Agree / Disagree
Encourage or provide incentives for organisations
to invest in newly qualified PHNs and to offer
NETP programme placements.
Comment
Discussion Document – July 2013
(please circle)
19
Step 4 – First and subsequent public health
nursing positions (after NETP) for registered
nurses with or without other nursing
experience
Current situation
While some registered nurses choose public health
nursing from the beginning of their nursing career,
many more work in a variety of other nursing
settings before starting public health nursing
practice. Often these registered nurses have
gained life experience that deepens their nursing
knowledge and skills, which can be invaluable to
their public health nursing work.
New PHNs, with or without previous nursing
experience, complete in-house orientation
programmes, professional development training to
meet Annual Practising Certificate requirements,
and other in-service short courses, or graduate/
post-graduate education. While these training
opportunities have different degrees of relevance,
few are specific to public health.
Issues
New PHNs
Public health nurses are offered local or regional
orientation programmes, which may vary in
content, length and learning expectations. These
programmes often focus on the particular local/
regional requirements of the organisation,
role, and community, and may provide limited
opportunity for participants to strengthen their
population health and public health knowledge
and skills.
Registered nurses with other experience
Nurses moving into PHN roles with previous
nursing experience often do not receive any
orientation to population health concepts and
practice. Nor is it usual for them to receive tailored
orientation suitable to their existing experience.
They are also unlikely to receive any recognition
of the valuable prior learning and expertise they
bring to their PHN role.
20
Nurses doing public health nurse work in primary
health care settings
Orientation programmes are usually specific to
PHNs, so there are only ad hoc opportunities
for registered nurses with a population health
approach in primary health care settings to receive
any orientation to public health.
Ongoing education after NETP
After orientation to public health nursing, apart
from the PDRP programme, ongoing education is
not coordinated. Training is often specific to areas
of an individual’s work, such as immunisation,
child wellness, or housing, and may not even
relate to public health.
There is no formal education pathway upon which
PHNs can structure their career development, or
where nurses doing public health nursing related
work can access programmes to meet their
knowledge and skill needs.
Continuing quality education is a cost to
employers. However, if public health nursing
education is not given priority, nurses may not
receive the training needed to equip them to
be safe and effective practitioners. A lack of
investment in nursing development can reduce job
satisfaction, and a nurse’s sense of achievement,
of being valued and having a vision for one’s
future, which in turn affects public health nursing
recruitment and retention.
The public health generic competencies provide
a solid foundation in public health. However,
these competencies have largely not yet been
used as a basis for local/regional PHN orientation
programmes or for PHN education.
Public Health Nursing Education Framework
Issues and recommendations
Issue 4.1
PHN orientation programmes are variable in content, length and requirements.
Recommendation 4.1
Agree / Disagree
Support the development of nationally consistent
standards for orientation programmes (using the
GPHCs as a guide), that are suitable for:
• new PHNs
• nurses with other nursing experience
• nurses with a population health approach
in primary health care settings.
Comment
(please circle)
Issue 4.2
Experienced nurses bring valuable knowledge and skills that are often not recognised.
(please circle)
Recommendation 4.2
Agree / Disagree
Develop some form of national “recognition of
prior experience” process.
How important is this and what do you suggest?
Issue 4.3: There is no formal education pathway for public health nursing career development.
Recommendation 4.3
Agree / Disagree
Develop a national Public Health Nursing
Education Framework that provides a pathway
for structured public health nursing career
development.
Comment
(please circle)
Issue 4.4
Resource and other access barriers restrict opportunities for public health nursing career development.
(please circle)
Recommendation 4.4
Agree / Disagree
Identify access issues and barriers to tertiary and
non-tertiary training (including in-service) and
develop recommendations to improve access.
Comment and what do you suggest?
12. Generic Competencies for Public Health in Aotearoa New Zealand. Public Health Association of New Zealand for the Ministry of
Health; 2007.
Discussion Document – July 2013
21
Step 5 – Advanced public health nursing
roles
Current situation
Advanced PHNs (for example, nurse educators,
nurse managers, or nurse specialists) improve
population outcomes by using an ecological
approach to problem-solving.
They add value to the community they serve.13
They have well-developed relationship skills14
and are able to navigate complex health care
systems.15 They manage and co-ordinate care to
patients, individuals’ families and communities,
and provide leadership and education to others
using evidence-based approaches.16
Most countries offer post-graduate study for PHNs
at this level. A number of tertiary institutions in
New Zealand offer post-graduate qualifications
ranging from certificates to Master’s degrees.
However, these qualifications are not necessarily
specific to PHN practice, but may be, for example,
specific to primary health care nursing).
One of the aims of a Master’s degree is to
empower nurses through building capacity,
advanced knowledge, skill and practice.17
The Public Health Leadership Programme offers
leadership development opportunities (see
Appendix 8) and is a useful option for public
health nursing.
Issues
The work of PHNs is both complex and diverse
in nature. It requires a specific, yet broad, skill
set and a comprehensive knowledge base, so
nurses can meet the needs of the populations
they serve. To ensure this happens, the advanced
practice/expert PHN must have the opportunity
for targeted post-graduate education as part of a
career development plan.
The challenges to such opportunities include the
availability of relevant post-graduate education,
and the costs.
In New Zealand, nurses working in organisations
which receive funding from a District Health Board
(DHB) can apply to Health Workforce New Zealand
(HWNZ) for funding for post-graduate papers
and qualifications. HWNZ has clearly defined
specifications that must be met in order to qualify
for funding. All applications are ranked in order
of priority as set by the DHB and incorporate the
key priority areas determined by the MOH. This
funding is limited, and difficult to access if the
application has a low ranking. Many DHBs also
link post-graduate funding to the completion of a
Professional Development Recognition Portfolio.
Internationally, there appear to be a limited
numbers of public health nurses studying at
Master’s degree and Doctoral level.
The most common contributing factors affecting
13. Swider, S., Levin, P., Cowell, J., Breakwell, S., Holland, P., & Wallinder,J. (2009). Community/public health nursing practice leaders’
views of the doctorate of nursing practice. Public Health Nursing, 26(5), 405-411.
14. Kaiser,K., Barr, K., & Hays, B. (2003). Setting a new course for advanced practice community/public health nursing. Journal of
Professional Nursing, 19(4), 189-196.
15. Evin, P., Cary, A., Kulbok, P., Leffers, J., Molle, M., & Polivka, J. (2008). Graduate education for advanced practice public health
nursing: at the crossroads. Public Health Nursing, 25(2), 176-193.
16. Ibid 15.
17. Naruse, K., Tashiro, J., Sakyo, Y., Ichikawa, W., & Karani, A. (2008). Stakeholders’ perception of the desired Master’s programme
for Kenya in community health nursing: areas of competency. Japan Journal of Nursing Science, 5,61-67.
18. Zahner, S., & Gredig, Quynh-Nga. (2005). Improving public health nursing education: recommendations of local public health
nurses. Public Health Nursing, 22(5), 445-450.
22
Public Health Nursing Education Framework
career progression of nurses working in public
health nursing include:
• a lack of organisational support and
incentives from employers to study,18 such
as lack of available leave, no backfill support
and difficulty obtaining flexible schedules for
people who need to work full-time
• no remuneration for post-graduate
achievement
• limited funding for PHNs for post-graduate
education; for example, HWNZ funding
is limited to clinical study. Access to this
opportunity is controlled by DHBs, so a nurse
who does not work for a DHB cannot access
HWNZ funding for study
• little clear information about what postgraduate study is needed, and what is
available.
In the absence of a targeted PHN post-graduate
qualification, PHNs are choosing individual papers
or courses of study such as primary health care,
health promotion and public health leadership.
Advanced public health
nurses have welldeveloped relationship
skills. They manage
and co-ordinate
care to patients,
individuals’ families and
communities.
Discussion Document – July 2013
23
Issues and recommendations
Issue 5.1
In the absence of a targeted PHN post-graduate qualification, PHNs are studying other nursing areas such
as primary care, mental health, business, Māori studies, health promotion and leadership.
Recommendation 5.1
Agree / Disagree
Negotiate with HWNZ and facilitate collaboration
between nursing and public health educators
to identify opportunities for postgraduate
qualifications that more clearly incorporate public
health nursing practice.
Comment
(please circle)
Issue 5.2
Access to and employer support for, advanced study for PHNs is unreliable.
Recommendation 5.2
Agree / Disagree
Negotiate with HWNZ and work with employers to
improve access and support for advanced public
health nursing education.
Comment
(please circle)
Issue 5.3
Little clear information about what post-graduate study is needed and what is available.
24
Recommendation 5.3
Agree / Disagree
Complete needs assessment of what public health
nursing post graduate qualifications are needed,
then develop a guide of what is available.
Comment
Public Health Nursing Education Framework
(please circle)
Step 6 – Nurse practitioner – PHN
Current situation
The Nursing Council of New Zealand requires
completion of a ‘clinical master’s’ among
the requirements for designation as a Nurse
Practitioner. In 2010, there were only two public
health nurse practitioners in New Zealand,19 one in
the Waikato and one in Canterbury.20
Issues
Similar to Step 5, the key issues here relate to
access to opportunities and employer support
to advance to these higher public health nursing
practice levels. Applications for funding can be
submitted to assist a nurse to progress to nurse
practitioner level, but this needs support from the
organisation they work for, as it is an expensive
programme including the requirement to have
supervision.
New Zealand’s economic climate means
organisations have strained resources and
investment in advanced education for PHNs may
not be a high priority.
Additionally, uncertainty around the employment
opportunities for this level of practice may
discourage nurses from pursuing NP status.
Issues and recommendations
Issue 6.1
There is insufficient promotion and resourcing to encourage nurses to progress to PHN NP level.
(please circle)
Recommendation 6.1
Agree / Disagree
Identify the key access issues to becoming a PHN
NP and develop recommendations.
Comment and what do you suggest?
Issue 6.2
There are a limited number of positions in New Zealand for this level of practise.
Recommendation 6.2a
Ascertain organisations’ interest in developing
PHN NP roles and concurrently promote PHN NP
opportunities.
Agree / Disagree
Recommendation 6.2b
Agree / Disagree
Negotiate with the Ministry of Health and HWNZ
to establish a PHN NP pilot (similar to the Diabetes
NP pilot) to grow the PHN NP workforce and
increase the impact PHNs have on population
health outcomes.
Comment
(please circle)
Comment and what do you suggest?
(please circle)
19. The New Zealand Nursing Workforce. Nursing Council New Zealand, 2010 at page 19.
20. Ibid at page 23.
Discussion Document – July 2013
25
Step 7 – Nurse academic – PHN
Current situation
PHNs who teach at the post-graduate level
typically have or are planning to obtain a PhD.
There are few PHN nurse academics in New
Zealand, as teaching positions are limited and the
demand for PHN academics currently appears
minimal.
Consequently, people in this workforce are
often employed by universities and professional
organisations for policy development.
• the lack of a continuous PHN education
pathway, so that the pool of people who can
reach this level is very small
Issues
• a lack of understanding of the benefit of
having advanced PHN academics
The key factors impacting on the development of
PHN academics include:
• the perception that there is no real
recognition for reaching this advanced level.
• a limited number of PHN academics who
can teach/supervise study, which makes it
difficult for aspiring nurses to access this
level of supervision and leadership
Currently, only a driven, determined and wellresourced person can reach Nurse academic
status. Opportunities for PHN leadership across
New Zealand fall to just a few.
Issues and recommendations
Issue 7.1
A lack of appropriately prepared academics to drive PHN workforce development at the highest academic
and political levels in New Zealand.
Recommendation 7.1
Agree / Disagree
Provide national scholarships for PHNs to access
education opportunities that lead to advanced
education levels.
Comment
(please circle)
Issue 7.2
A lack of ongoing education pathways to lead people to the nurse academic stage.
26
Recommendation 7.2
Agree / Disagree
Promote pathways to PHN academic level and the
benefits of more people attaining this level.
Comment
Public Health Nursing Education Framework
(please circle)
Where to from here?
Much needs to be done to achieve the tenyear vision for public health nursing workforce
development.
The success of public health nursing growth and
development in New Zealand requires careful
planning and prioritisation, driving leadership and
widespread commitment. A contemporary, wellpositioned public health nursing workforce needs
investment through a national infrastructure and
from the organisations where nurses work.
To make this happen two things will be needed:
1. Ownership of this work
Because workforce development issues for
PHNs will continue, it is critical to plan how
these issues will be addressed once the
Education Framework is developed, and
identify who will take responsibility for the
work arising from the Education Framework.
Thanks to the public health nursing sector, and
everyone interested in the development of public
health nursing, for your time and contributions to
this discussion document.
We will let you know about future opportunities to
influence directions for this work.
2. Connections with other public health
disciplines
The project team and the advisory group will
be exploring how this work connects with
the developing multidisciplinary approach
to public health initiative, led by a group of
sector leaders with support from the Public
Health Association.
Public health work
focuses on improving
the overall health
of populations, such
as children, through
interventions such as
immunisation, health
screening checks, or
safer housing.
Discussion Document – July 2013
27
Appendices
28
Public Health
Health Nursing
NursingEducation
EducationFramework
Framework
Appendix 1: Te Uru Kahikatea objectives
relevant to public health nursing
Te Uru Kahikatea (TUK)21 is the national strategy to
grow and develop the public health workforce in
Aotearoa New Zealand.
TUK Goal 1: Develop an effective and sustainable
public health workforce
Public Health Sector Professional Development
Objective 4:
Build infrastructure for public health professional
development.
Action 4.2
Establish (where they do not already exist)
professional development mechanisms or
key public health workforce groups to lead
professional development, develop competencies
and standards, and achieve external recognition;
in particular:
• work with leaders/stakeholders for public
health nurses, community health workers
and other public health disciplines to identify
ways of supporting the professional needs of
the respective workforce groups.
Te Uru Kahikatea is the national strategy to grow and develop
the public health workforce in Aotearoa New Zealand.
21. Te Uru Kahikatea: Public Health Workforce Development Strategy,
2007-2016. Ministry of Health, Wellington, 2004
Discussion Document – July 2013
29
Appendix 2: Individuals involved in this
project
Project sponsorship
Public Health Workforce Development, National Health Board, Ministry of Health
Health Workforce New Zealand, National Health Board, Ministry of Health
Working group
Jenny Hugtenburg – Project Manager, Regional Public Health, Wellington.
Viv Head – Workforce Development Consultant, Head Strategic Limited
Rhonda Mikoz – PHN, PHN Professional In-Service Development Coordinator, Canterbury DHB
Jan Waldock – NZ College of Primary Health Care Nurses
Lizzie Farrell – Clinical Nurse Manager and PHN, Kidz First, Counties Manukau DHB
Paul Watson – Senior Advisor, Nursing, Ministry of Health
Keriata Stuart – Strategic Advisor, Māori Public Health, Public Health Association
Evelyn Hikuroa – Nurse Lecturer, Manukau Institute of Technology
Advisory group
Diana Lennon – Professor Medical and Clinical, Department of Paediatrics, Auckland University
Grace Wong – Senior Lecturer, Auckland University of Technology
Marjorie Schaffer – Professor of Nursing, Bethel University, Minnesota
Phil Shoemack – Medical Officer of Health, Toi Te Ora Public Health Service
Rhonda Mikos – PHN, PHN Professional In-service Development Coordinator, Canterbury DHB
Taima Campbell – Director, Hauraki health Consulting
Amy Hamerton – Senior Policy Advisor, Health Workforce New Zealand
Maureen Kelly – Education Manager, Nursing Council of New Zealand
Vicki Noble – Director of Nursing, Primary Health Care, Capital and Coast DHB
Denise Kivell – Director of Nursing, Counties Manukau DHB
Lizzie Farrell – Clinical Nurse Manager and PHN, Kidz First, Counties Manukau DHB
Sarah Little – Director of Nursing, Auckland DHB
Ruth Anderson – Manager Workforce Intelligence and Planning, Health Workforce New Zealand
Angela Clark – Professional Nursing Advisor, New Zealand Nursing Organisation
Jill Clendon – Nursing policy adviser/researcher, New Zealand Nursing Organisation
Laurie Mahoney – Senior Lecturer, School of Nursing, Otago Polytech
Warren Lindberg – Chief Executive, Public Health Association
Viv Head – Workforce Development Consultant, Head Strategic Limited
30
Public Health Nursing Education Framework
Appendix 3: Public health nursing
demographics
In 2010, the Nursing Council New Zealand
completed a survey of the total nursing workforce
in New Zealand. They received a 95-100 percent
response rate to the survey. In interpreting
the survey, please note it allowed for multiple
employment areas (up to two) and multiple
practice areas (up to two).
Some PHNs may have identified themselves in
these other categories rather than the broad
‘public health’ category.
Numbers in the workforce in 2010
• 789 nurses identified as PHNs in their
application for their annual practicing
certificate
• 266 PHNs work 1.0 FTE or more
• 268 PHNs work 0.9 FTE or less
• The remainder work in more than one
employment setting, so are likely to be part
time in public health.
Country of registration
Demographic characteristics
• 763 female (97%); 26 male (3%)
• 516 > 45 years of age (65%)
• 274 < 45 years of age (35%)
• 514 identify as NZ European/Pākehā (65%)
• 76 identify as NZ Māori (9%)
• 36 identify as Pasifika (5%)
• 287 identify as other nationalities or not
stated (36%).
Post-registration qualifications
• 590 (77%) were first registered in New
Zealand
• 481 (63%) PHNs report holding one or more
post-registration qualifications
• 117 (15%) were first registered in Australia,
the UK or North America
• This compares to 58% of registered nurses
overall.
• 57 (7%) were first registered in other
countries.
Areas of professional specialisation
Who employs public health nurses?
• 2 Nurse Practitioners – Public Health
• Majority of PHNs are employed by DHBs
• 1 Waikato
• Public Health Units
• 1 Canterbury.
• Departments such as child health, family
health.
Discussion Document – July 2013
31
Appendix 4: History of public health nursing
by Elizabeth Farrell, 2013
Introduction
In order to understand the scope of public health
nursing better, it is useful to trace the historical
development of public health nursing from the
late nineteenth century to the present day. This
information is included to assist the reader to
gain insight to the unique contribution PHNs have
made to improve the health of communities both
locally and internationally.
Public health nursing in the past
Public health nursing began as a health service
to ‘poor women’ and their families in Britain and
America in the mid-nineteenth century. It arose
in response to the poverty, unemployment and
high infant mortality that became evident to local
authorities within communities.
In the early nineteenth century in Britain, Florence
Nightingale introduced a model of nursing
education, which influenced the development
of nursing as a profession, firstly in Britain and
then the United States of America (USA) and later
Australia and New Zealand (Francis, 2001).
The introduction of the ‘health visitor’ in England
was an attempt to provide poor families with
nursing care as well as advice on preventative
health measures such as “domestic hygiene and
child nurturing” (Francis, p.171).
Not surprisingly, Florence Nightingale included
epidemiology in the curriculum for nurses training
at her schools of nursing thus supporting an
early model of health care that was based on the
health needs of the community (Francis). This first
attempt to define population health became part
of the foundation of public health policy in Britain,
USA and ultimately in New Zealand.
In the USA, the influences of the Nightingale
trained nurses can be found in the literature about
early community nursing and visiting nursing
services that developed in the late nineteenth
century to care for the growing population of
poor and sick of all ages. In 1893 Lillian Wald, an
American nurse, with an interest in public health
32
nursing, established the Henry Street Settlement
in New York City. By 1905, a public health nursing
service was providing a home visiting service to
the settlement homes in the poorer parts of New
York City.
These PHNs were trained in public health as well
as general nursing and were able to use these
newly emerging strategies to prevent infectious
diseases such as tuberculosis, typhoid and the
common childhood illnesses diphtheria and
whooping cough (Buhler-Wilkerson, 1985).
In 1902, Wald introduced PHNs to schools in New
York through her concerns for the number of
children absent from school.
“Many children were absent for lack
of shoes or clothing, because of
malnourishment or because of serving their
families as babysitters” (Hawkens, Hayes &
Corliss 1994, cited in Stanhope & Lancaster,
2000 p.27).
Interestingly, there was concern at the number
of school children who suffered from common
conditions such as pediculosis, ringworm, and
discharging ears, conditions that remain common
problems for children living in New Zealand today.
New Zealand became the first country to
introduce a statute to register and regulate nurses
and this was achieved by the passing of the
Nurses Registration Act in 1901 (Wood, 2001).
The registration of nurses followed a three-year
training course and passing the state examination
(Lambie, 1951).
Preventative health nursing services were
introduced in 1906 with the development of
The Royal New Zealand Society for The Health of
Public Health Nursing Education Framework
Women and Children (now known as The Royal
New Zealand Plunket Society), and the passing of
the Child Welfare Act 1907 (Wood, 2001). In 1909,
the Backblocks Nursing Service and the Native
Health Nursing Service provided nursing care to
families in the very isolated newly settled areas of
New Zealand (Lambie, 1951). By 1927 the school
health service was well organised with a medical
officer having overall responsibility for regional
and geographical areas in New Zealand. Dr Eleanor
McLaglan commented at the time:
“The nurse’s job was to visit homes to
supervise the treatment of minor conditions
and to advise where to take the children for
more complicated treatments, often making
appointments and personally escorting
them there. Ideally each nurse would stay
some time in the district and get to know
the children by sight” (Tennant cited in
Bryder, 1991, p.137).
Thus, nurses were central to these early attempts
to provide preventative health strategies as well as
treatment of diseases.
McLaglan also described the difficult living
conditions where the nurses found their clients
and spoke of “slums and wretched courts behind
the respectable houses were the hunting grounds
of excellent nurses who were skilled in tracking
unhappy and neglected children to their homes”
(Bryder, 1991, p.137).
Many PHNs of today would relate to this
statement as being very similar to their current
nursing practice. Tracking highly mobile children to
follow up unaddressed health concerns and often
more serious child protection situations is routine
public health nursing practice today.
Public health nursing in the present
Public health has been described as “the science
and art of preventing disease, prolonging life and
promoting health through the organised efforts of
society” (Cowley, 1998, p.29).
Public health nursing practice has been described
as “population focused community orientated
nursing practice that emphasises the prevention
of diseases and disability and takes place through
assessment, policy development and assurance
activities of nurses working in partnership with
communities and or groups” (Williams cited
in Stanhope & Lancaster, 200o, p.15). Just as
the early PHNs responded to the needs of the
community so do present day PHNs.
The client base can vary from one small child to
a whole school community or even the entire
country. One example was H1N1 Influenza
epidemic in 2009 in New Zealand, when PHNs
were involved in border control and contact
tracing in an effort to prevent wide spread disease.
The effectiveness of public health
nursing
The effectiveness of public health nursing is well
documented in the literature. Zerwekh (1991)
discusses the invisibility of the profession but
highlights the effectiveness of PHNs in many
neighbourhoods in America, while from a New
In the early nineteenth
century Florence
Nightingale (left)
introduced a model
of nursing education,
which influenced
nursing as a profession.
In 1902, Lilllian Wald
(right) introduced
public health nursing to
schools in New York.
Discussion Document – July 2013
33
Zealand perspective Gallagher (1999) likens the
practice to strands or threads of a tapestry – all
the threads make up the tapestry but in isolation
mean little. It is the intimate understanding of
the health needs of the community and the
development of relationships with members of
the community – whether with a family, a school,
or a smaller community – that is unique to public
health nursing.
In New Zealand, PHNs’ scope of practice is
determined by contractual obligations with the
Ministry of Health (MOH), through local District
Health Boards. Under Section 125 of the 1956
Health Act, PHNs have a statutory right to assess,
and if necessary examine, a child at school if there
are health, care and protection concerns. Child
protection issues such as neglect, emotional,
physical and sexual abuse are routinely assessed
by PHNs along with other health concerns such
as skin infections, hearing impairment and ear
disease.
Advice and information is given to individuals
or groups about the prevention of infectious
disease such as whooping cough as well as vaccine
preventable diseases. This is also is supported by
school based vaccination programmes.
Environmental and social issues
affecting public health nursing
practice
Compounding the work of the PHN is the
pervading poverty and social exclusion that
often result from unemployment, lack of work
skills and associated poverty. Family violence
and substance abuse are often part of the fabric
of these communities, and while the impact on
health is often not always noticed by other health
professionals working in hospitals and clinics, it is
inescapable to the PHN who brings the services to
the door through home visiting.
A current public health nursing
initiative
In most public health nursing services in New
Zealand, PHNs work in a defined geographical
area and become experts in their knowledge
of the community infrastructure and support
agencies available in that community. PHNs,
because they have direct contact with individuals
and families, are also in an ideal position to lead
health promotion initiatives at the grassroots.
They can work with a family or a school group to
develop health promotion initiatives in response
to identified local health needs.
A current example is the MOH 2012 rheumatic
fever prevention funding to establish sore throat
clinics in schools where there is a high incidence
of this disease. This multidisciplinary approach
reflects the collaborative partnerships used
by PHNs to include people affected by a given
health concern and is an example of a population
approach to addressing the health concern.
More recently models of PHN practice have been
developed especially in the United States of
America which have been utilised in part by some
PHN managers/leaders into the New Zealand
context.
References
Bryder, L. (Ed.). (1991). A healthy country. Essays on the social history of medicine in New Zealand.
Wellington: Bridget Williams Books.
Buhler-Wilkerson, K. (1985). Public Health Nursing: In sickness or in health? American Journal of Public
Health, 75(10), 1155-1161.
Francis, K. (2001). Service to the poor: The foundations of community nursing in England, Ireland and
New South Wales. International Journal of Nursing Practice, 7, 169-176.
Gallagher, L. (1999). Expert public health nursing practice: A complex tapestry. Nursing Praxis in New
Zealand, 14(3), 16-27..
Health Act (1956). The New Zealand Statutes Reprint, 1907-1957,1, New Zealand Government Printer
Wellington.
Lambie, M. I. (1951). Historical development of nursing in New Zealand 1840-1950. Wellington: Ministry
of Health.
Stanhope, M., & Lancaster, J. (2000). Community and public health nursing (5th ed.). Missouri: Mosby.
Wood, P. J. (2001). A century of registered nursing in New Zealand 1901-2001. Nursing New Zealand.
Centenary Souvenir, p. 6.
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Public Health Nursing Education Framework
Appendix 5: Short-, medium- and long-term
visions for PHN workforce development
Year 1: Adoption of an education/training
framework that identifies the workforce
development requirements of PHNs, to enable
PHNs to make an increasingly positive contribution
to health outcomes in New Zealand Aotearoa,
achieved when:
• communication and consultation with
stakeholders is effective
• PHN demographics are known and taken into
account
• entry/orientation programmes for new PHNs
are known and an approach to making them
more consistent is agreed upon
• a literature review on PHN education and
career frameworks internationally informs
the approaches taken in Aotearoa New
Zealand
• education and training gaps are identified
and a plan is in place to address them
• PHN issues are considered integral to
relevant projects, e.g. multidisciplinary
approaches to public health; National
Certificate in Public Health
• the education/training framework for PHNs
is supported by PHNs, PHN leaders, the
Ministry, HWNZ, nursing and public health
education providers, and DHB Directors of
Nursing
• a plan is in place for further PHN workforce
data collection
Year 2 – 5: Public health nurses work at the top of
their scope of practice, achieved when:
• education, training and professional
development opportunities support
extension of the PHN scope of practice
• recognised mechanisms are in place to
enable PHN leaders to interact regularly with
each other
• barriers to accessing the PHN education
pathway as identified through the
implementation at year one are minimised.
Year 6 – 10: Their communities and colleagues
recognise public health nurses as leaders, achieved
when:
• highly skilled PHNs work alongside public
health colleagues who have a recognised
public health qualification
• PHNs lead work streams
• PHN specialist registration is in place
• PHN career and educational pathways are
well understood and funded.
• an owner/champion/s for the next 2-3
years is agreed (i.e. a home for the
implementation of what this project
develops, ensuring it is embedded in future
structures).
Discussion Document – July 2013
35
Appendix 6: Generic Public Health
Competencies
The Generic Public Health Competencies are the
minimum baseline set of competencies that are
common to all public health roles and disciplines
across the health sector, and that are necessary
for the delivery of essential public health services.
They are a minimum in all areas of what all public
health practitioners are expected to be capable of
doing in order to work effectively in the field.
The competencies provide a ’whole of sector’ view
of the workforce development required to meet
the public health aims of improving the overall
health status of the population and reducing
health inequalities. They are intended for use
by practitioners, managers, policy makers and
analysts, educators and trainers, and funders and
planners.
The competencies also form the basis of the
Certificate of Public Health, discussed in the next
appendix.
1. Public health knowledge
• Health systems
• Public health science
• Policy, legislation, and regulation
• Research and evaluation
• Community health development.
36
2. Public health practice
• Te Tiriti o Waitangi
• Working across and understanding cultures
• Communication
• Leadership, teamwork, and professional
liaison
• Advocacy
• Professional development and selfmanagement
• Planning and administration.
For more information see Generic Competencies
for Public Health in Aotearoa New Zealand, written
by the Public Health Association of New Zealand
in association with the Health Promotion Forum of
New Zealand, Māori community health workers,
New Zealand Institute of Environmental Health,
Public Health Nurses Section of New Zealand
Nurses Organisation. 2007.
Public Health Nursing Education Framework
Appendix 7: New Zealand Certificate in
Public Health
Current situation
Beginning in 2014, the level 5 (undergraduate)
national New Zealand Certificate in Public Health
is expected to be delivered by at least one tertiary
education provider. The certificate is based on
the Generic Public Health Competencies (GPHCs)
and is the baseline standard of public health
knowledge and skills for all people working in
public health environments. It is intended to be
both a first tertiary qualification and suitable for
those who already hold degrees.
The delivery modes proposed for the one-year PH
Certificate are block courses and online learning.
It is hoped this delivery mode will minimise time
away from work for students. Prior learning and
current competencies will be recognised, enabling
some students to complete the certificate more
quickly.
Discussion and summary of issues
While the GPHCs and the Certificate in Public
Health do not have a specific nursing focus, both
enable nurses to gain a foundation of generic
public health knowledge and skills relevant for
every PHN role.
Given that the Certificate in Public Health is an
undergraduate level 5 course, it may or may not
be the preferred study choice for PHNs. What
is important is that there are courses of study
available and different qualification levels for
those who wish to strengthen their public health
knowledge. The New Zealand Certificate in
Public Health offers access at lower levels of the
qualification spectrum.
Additionally, it is also important that all foundation
and orientation programmes for PHNs include a
solid foundation of public health knowledge and
skills. The GPHCs could provide this broad based
public health foundation content. Using the GPHCs
to inform the content of existing and new PHN
education and development courses could assist
PHNs to be equipped for practice in public health
environments.
PHNs are registered
nurses who use their
nursing expertise
alongside their
wider knowledge
of communities, to
promote health and
wellbeing.
Discussion Document – July 2013
37
Appendix 8: Public Health Leadership
Programme (PHLP)
What is the PHLP?
The PHLP is a residential leadership programme
designed specifically for public health leaders in
New Zealand. The programme is funded by the
Ministry of Health and run by Quigley and Watts,
and Catapult. The PHLP has been developed
following extensive consultation with the sector.
It builds competencies identified as important for
leaders in public health.
The PHLP allows participants to discover their
leadership potential and equip them with practical
and tested leadership tools and resources. The
programme will generate immediate and lasting
benefits for participants, those they lead, and for
public health.
The PHLP has a six-day residential leadership
component delivered as three two-day sessions.
Currently, there are two programmes per year.
Who is it for?
The PHLP is for leaders wanting to inspire, refresh
and create a powerful foundation for their
leadership development. It is not designed to
teach public health. Participants are expected
to have a good knowledge of public health
principles including an understanding of the social
determinants of health, inequalities in health, how
culture influences health, and the significance of
the Treaty of Waitangi in health.
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Why choose the PHLP?
The PHLP was designed to meet the leadership
challenges facing public health. It develops
leadership competencies identified as essential
for public health leaders. The programme is firmly
grounded within the reality of public health. Case
studies drawn from public health and practical
sessions will allow for application back to work.
The PHLP explores what is at the source
of powerful leadership. Participants gain
transformational insights into themselves and the
nature of leadership.
The PHLP is created specifically for New Zealand
public health leaders. The case studies and
examples used are based on the work Quigley
and Watts and Catapult have undertaken
with hundreds of New Zealand leaders and
organisations. This means the content will be
directly applicable to participants’ work.
Learn more: www.publichealthworkforce.org.nz.
Public Health Nursing Education Framework
Discussion Document – July 2013
39
Funded by: The Ministry of Health
Project managed and written by the Public Health Nursing Education Framework Working Group,
the Public Health Association of New Zealand and Head Strategic Limited
–
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Public Health Nursing Education Framework