Challenges and Opportunities
for Public Health Nursing:
Present and Future
Lillian Wald
PHN in Emergency
Preparedness
Unique contributions of PHN
- focus on populations
“Worst Case Scenario”
- Affects the entire state of Minnesota
- Medications or vaccines dispensed to
every citizen in 5 days or less
- Clinics will operate 24/7
Spanish Influenza of 1918 - 1919
Unique contributions of PHN
- systematic planning approach
Process for MDS
Off-site
Triage
Level 1
Screener
Bus
Treatment
Center
(First Aid)
MDH Adjusted Standards of Mass Dispensing Matrix- Antibiotics
Tier 2 (faster)
Tier 1 (Example: BDS)
Tier 3 (fastest)
Triage
1) Screen w/triage protocol
2)
Form: “Triage Client Referral –
Contained Exposure”
3) Refer to individual’s provider as
indicated by algorithm.
Same as Tier 1.
Refer to pre-planned facility for true symptoms.
Form: “Triage Client Referral – Large Scale
Exposure”
Same as Tier 2 with emphasis on public
information “If ill, go to (preplanned
facility).”
Form: “Triage Client Referral – Large Scale
Exposure”
Meds
dispensed to
whom
Individual and their minor
dependents
Individual and 9 others (with their
acknowledgement and health data)
Individual and _?__ others (with their
acknowledgement and health data) Meds
may be dispensed without complete
information.
Under direction of MD or Pharmacist
Level 2: Pharmacist, MD, RN
Level 1: Pharmacist, MD, RN
Express: RNs, health care related
professionals, trained non-health
care volunteers
Same as tier 1
Under direction of MD or Pharmacist
Level 2: RN, health care related
professionals
Level 1: RN, health care related
professionals
Express: RN, health care professionals,
trained non-health care volunteers
Screening
and
Dispensing
Staffing
In order of
preference
Process
Same as tier 1
Families with no contraindications to or
complications with doxy, go directly to
Express – no form.
For all others - Staff uses form as screening
worksheet.
Screening and documentation with
standard flow, form, and protocols
Bottle
Labeling
Form
Retained as record.
Same as tier 1
Client retains form.
NDC# or lot
# Label
Pt. name
Record on form
Labeled by dispenser - name and preprinted labels put on bottles
Same as tier 1
No record
Dispenser or assistant puts name of client on
Cipro bottle
Suspension for 2 year olds and under
Cipro < 6 mo. olds (if available)
Dispenser writes dosage on bottle
Pediatrics
Data
Compilation
Education -
Suspension for 2 year olds and under
Cipro < 6 mo. olds (if available)
Dispenser writes dosage on bottle
Clients
MIIC, manual tabulations
Same as tier 1
Drugs
Inventory management system,
manual counting
Same as tier 1
One-on-one with written instruction.
Written w/one-on-one for brief reinforcements
only w/handouts
Suspension for 2 year olds and under
Cipro < 6 mo. olds
Dispenser determines number of bottles
Parent determines dose w/ chart.
Inventory count
Handouts, signs, media
MDH Adjusted Standards of Mass Dispensing
Matrix- Antibiotics
Tier 1 (Example:
BDS)
Screening
and
Dispensing
Process
Screening and
documentation with
standard flow, form,
and protocols
Tier 2 (faster)
Tier 3 (fastest)
Same as tier 1
Families with no
contraindications to or
complications with doxy,
go directly to Express – no
form.
For all others - Staff uses
form as screening
worksheet.
Unique contributions of PHN
- collaborate with community partners
Other unique contributions of PHN
- understand communicable or infectious
disease process
- work across “silos”
- experience and skill working with assistive
and volunteer personnel
PHN’s as Business People
South Country Health Alliance
Primewest Coverage Map
PHN’s in Quality
Improvement
Public Health Intervention Wheel
By the numbers…
Population
Mn Micropolitan – 14.7% of population
Rural – 12.8%
RN’s
Mn Micropolitan – 12.4% of all RN’s
Rural – 7.9%
Median Age
Mn 47 years old
Micropolitan and rural – 49 years
% of all Nurses between 55 years and 65+
Mn Micropolitan – 27.6%
Rural – 28.5%
PHN’s
Mn – 2.9% of all RN’s
Micropolitan – 5.3%
Rural – 7.5%
Challenges
- aging workforce
- salary
- multicultural communities
- limited learning opportunities for students
Opportunities
- Pay based on performance, outcome,
market standards
- new models for work
- new model for education
References
Columbia University School of Nursing Center for Health Policy. (November 2002)
Bioterrorism and Emergency Readiness Competencies for all Public Health
Workers.
From http://www.cumc.columbia.edu/dept/nursing/chphsr/pdf/btcomps.pdf
Delaney,C. (2007,May 29). Health First – Build a refocused health system on the
strengths of nurses [Letter to editor]. St.Paul Pioneer Press, p.B9.
Office of Rural Health and Primary Care, Minnesota Department of Health.
(July, 2006)
Minnesota Registered Nurses Facts and Data 2006
Retrieved August 23, 2007 from
http://www.health.state.mn.us/divs/chs/workforce/rn06.htm