INTRODUCTION
Public health nursing is defined by the American Public Health Association’s Public
Health Nursing Section as:
“the practice of promoting and protecting the health of populations suing
knowledge from nursing, social and public health sciences.”(1996)
This definition was used as the basis for the Quad Council of Public Health Nursing
Organizations first Scope and Standards of Public Health Nursing Practice in 1999 and
for the American Nurses Association’s update of that document, Public Health Nursing:
Scope and Standards of Practice, in 2007. The latter document identifies 8 principles
that, when taken together, distinguish public health nursing from other nursing
specialties:
 The client or unit of care is the population.
 The primary obligation is to achieve the greatest good for the greatest number.
 The processes used by public health nurses include working with the client as an
equal partner.
 Primary prevention is the priority in selecting appropriate activities.
 Public health nursing focuses on strategies that create healthy environmental,
social and economic conditions in which populations may thrive.
 A public health nurse is obligated to actively identify and reach out to all who
might benefit from a specific activity or service.
 Optimal use of resources to assure the best overall improvement in the health of
the population is a key element of the practice.
 Collaboration with a variety of other professions, populations, organizations and
other stakeholder groups is the most effective way to promote and protect the
health of the people.
In 2010, the North Carolina Association of Public Health Nurse Administrators updated
its recruitment brochure on Public Health Nursing entitled “North Carolina Public Health
Nurses: Making a Difference. That brochure describes the role of public health nurses,
the opportunities to impact the health of the population, and some of the exciting work
done by PHNs in North Carolina. A copy of the brochure is found on this website under
“Recruitment and Retention/Recruitment Tools.
EDUCATION AND CERTIFICATION
EDUCATION
Educational Requirement for PHN Roles in North Carolina
The educational requirement for public health nurses is specified by Administrative Rule.
Under North Carolina Administrative Code, 10A NCAC 46, Section .0300 – Local
Health Department Staff, Rule .0301 identifies “Minimum Standard Health
Department Staffing.” Item (2) under that rule states:
(2)
All local health department nurses shall either:
(a)
Have a nursing degree from a baccalaureate school accredited by
the National League for Nursing or the Commission on Collegiate
Nursing Education; or
(b)
Complete within one year of employment with the health
department an introductory course in principles and practices of
public health and public health nursing sponsored by the
Department. The curriculum for the course shall be developed by
the Department with input from local health departments and
schools of nursing.
NOTE several key phrases from this rule:
 “All local health department nurses” – the rule does not make exceptions for
nurses who work only in clinics or in a specific program (such as Home Health )
within the Department;
 “a nursing degree from a baccalaureate school…” – a baccalaureate degree in
another field does not meet this requirement;
 “Complete” – successfully complete, including attaining a passing grade; and
 “within one year of employment” – due to timing of these courses, this has been
interpreted to mean that the PHN must at least be in the process of taking the
course when the first anniversary of his/her employment date in public health
nursing arrives.
This course, Introduction to Principles and Practices of Public Health Nursing, is offered
in collaboration with the North Carolina Institute for Public Health’s Office of
Continuing Education. Although required for all non-baccalaureate prepared registered
nurses hired by local health departments, it is open to any baccalaureate-prepared nurse
who wishes to participate.
Course dates and enrollment information are available at
www.sph.unc.edu/nciph/training .
Other Educational Requirements
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those identified in Division Agreement Addenda as programmatic requirements
(e.g., STD Nurse Clinician);
those identified by the State Medicaid Agency or other agencies/organizations
that provide reimbursement as mandatory criteria for staff performing
reimbursable services (e.g., Enhanced Role Nurses);
those identified by individual agencies, nursing directors/supervisors or individual
PHNs based on an assessment of the knowledge base and skills of an individual
PHN and the requirements of the position.
NOTE that continuing education may be a part of the individual RNs continued
competency plan that is required by the North Carolina Board of Nursing for renewal of
the nurse’s license to practice.
Dispensing by Public Health Nurses
In order for public health nurses to dispense drugs and devices on the approved formulary
in a local health department, the following things needs to occur:
- the agency must have a pharmacy permit;
- the individual who serves as the trainer for all PHNs who will dispense must be a
Registered Pharmacist; that pharmacist may also have a PHN from the agency
participate as a trainer IF that nurse has been trained by the Division of Public
Health’s Pharmacist, Denise Perry;
- the training must utilize the materials that have been approved by the NC Board
of Pharmacy: Dispensing of Drugs by Public Health Nurses Part 1 and Dispensing
of Drugs by Public Health Nurses Part II.
Once the training is completed, the agency should send a list of all those trained on the __
form to the Public Health Nursing and Professional Development Unit so that certificates
can be sent to the agency to go in the individual personnel files or a central file in order
for the agency to provide documentation of approved training during accreditation or
audit/visit by the Board of Pharmacy.
Continuing Education/Inservice Topics available from Public Health Nursing &
Professional Development Nurse Consultants
Coding and Billing
Confidentiality
Customer Service
Documentation
Interviewing Clients
Policies and Procedures
Triage
Providing Local Continuing Education Which Offers Continuing Education Credit
The Public Health Nursing & Professional Development (PHNPD) Unit has been granted
approval as a Provider of nursing continuing education by the North Carolina Nurses
Association which is accredited by the American Nurses Credentialing Center’s (ANCC)
Commission on Accreditation. The Unit can, therefore, provide or co-provide continuing
educational activities which award contact hours.
A local health department wishing to co-provide such an educational activity must
contact the Unit (919-707-5132) prior to beginning to plan the educational activity so that
a member of the Continuing Education Committee can be appointed to help with
planning the activity; this is an ANCC requirement. It will be the role of that individual
to:
- assure that the appropriate forms are completed and sent to the PHNPD Unit; and
- assure that ANCC criteria are utilized in planning the activity.
Continuing with Formal Education
Because of the complexity of and changes in the health care environment and the
challenges facing public health, higher levels of formal education are increasingly
necessary or preferred by employers. In addition, colleges and universities have made
great strides in making programs more accessible geographically and more flexible for
students who must continue to work while pursuing additional education.
The following baccalaureate nursing programs are available in North Carolina:
Appalachian State University, Boone
Barton College, Wilson
Duke University, Durham
East Carolina University, Greenville
Fayetteville State University
Gardner-Webb University, Boiling Springs
Lenoir-Rhyne College, Hickory
Methodist University, Fayetteville
NC A&T State University, Greensboro
NC Central University, Durham
Pfeiffer College, Misenheimer
Presbyterian School of Nursing at Queens University, Charlotte
UNC at Chapel Hill
UNC at Charlotte
UNC at Greensboro
UNC at Pembroke
UNC at Wilmington
Western Carolina University
Winston-Salem State University
The following masters and/or doctoral nursing programs are available in North Carolina:
Duke University, Durham
East Carolina University, Greenville
Gardner Webb University, Boiling Springs
UNC at Chapel Hill
UNC at Charlotte
UNC at Greensboro
UNC at Wilmington
Vail Program of Nursing at Queens University, Charlotte
Western Carolina University
Winston-Salem State University
CERTIFICATION
Advanced Public Health Nursing
Only 1 certification exam is currently offered in public health nursing; that is for
Advanced Public Health Nursing. There are 3 options to qualify for this exam:
Option A: applicant must hold a current, active RN license and must hold a graduate
degree in public and/or community health nursing from a program accredited by the
Commission for Collegiate Nursing Education or the National League for Nursing
Accrediting Commission. Credential: APHN–BC or (with specific coursework at
master’s level, PHCNS-BC.
Option B: applicant must hold a current, active RN license and hold a baccalaureate or
higher degree in nursing and hold a master’s in public health (MPH) degree. Credential:
APHN-BC.
Option C: applicant must hold a current, active RN license and hold a graduate degree in
nursing or a related field (if master’s is not in nursing, then baccalaureate degree must be
in nursing) and complete a minimum of 2000 practice hours in advanced
public/community health nursing within the last 3 years. Credential: APHN-BC.
This option is valid only through 12/31/15.
COMPETENCIES AND ORIENTATION
Agency leaders are responsible for creating an environment which fosters selfdevelopment and continued learning by staff in order to support the agency’s mission.
They are also responsible for assessing and promoting the competence of individual staff
members to do the job for which they have been hired; this applies to all staff, not just
nurses.
Initial assessment of the individual’s competency is done by reviewing the applicant’s
abilities and qualifications for the position for which he/she is being considered. Then
specific competencies must be confirmed as a part of the orientation process. In addition,
assessment of the individual employee’s competence should be a part of the evaluation of
that individual’s on-going ability to perform assigned duties and tasks.
The agency should have processes for:
- defining the qualifications and competencies needed by staff to do the job
responsibilities required of each position;
- selecting employees whose qualifications are aligned with those job
responsibilities; and
- assessing on a ongoing basis to assure that staff maintain or enhance their
competence for job responsibilities.