Relevant Challenges and Considerations for Public Health ... - Minnesota

Relevant Challenges and

Considerations for Public Health

Nursing Practice

MINNESOTA DEPARTMENT OF HEALTH

MINNESOTA PUBLIC HEALTH NURSING PRACTICE COUNCIL

MAY 2016

RELEVANT CHALLENGES AND CONSIDERATIONS FOR PUBLIC HEALTH NURSING PRACTICE

Relevant Challenges and Considerations for Public Health Nursing Practice

May 2016

Minnesota Department of Health

Center for Public Health Practice

Minnesota Public Health Nursing Practice Council

PO Box 64957 St. Paul, MN 55164-0975

Phone: 651-201-3880

Email: health.ophp@state.mn.us

Online: health.state.mn.us/divs/opi/

Contents

Purpose .......................................................................................................................................................................3

About the Minnesota PHN Practice Council ...............................................................................................................3

Introduction ................................................................................................................................................................3

A. Statutory Requirements for Public Health Nursing Certification ...........................................................................4

B. Definitions and Standards of Practice for Public Health Nursing ...........................................................................5

C. Challenges and Experiences of Public Health Nursing Practice .............................................................................7

D. Relevant Considerations of Public Health Nursing Practice...................................................................................8

E. Public Health Nursing Flowchart ............................................................................................................................9

Summary.................................................................................................................................................................. 11

References ............................................................................................................................................................... 12

Funding for this publication was made possible (in part) by the Centers for Disease Control and Prevention. The

views expressed do not necessarily reflect the official policies of the Department of Health and Human Services,

nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S.

Government.

Upon request, this material will be made available in an alternative format such as large print, Braille, or audio

recording. Printed on recycled paper.

MDH CENTER FOR PUBLIC HEALTH PRACTICE &

MINN. PUBLIC HEALTH NURSING PRACTICE COUNCIL

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MAY 2016

RELEVANT CHALLENGES AND CONSIDERATIONS FOR PUBLIC HEALTH NURSING PRACTICE

Purpose

Autonomy is the hallmark of the practice of public health nursing. Public health nurses find themselves working

in circumstances without professional nursing supervision. This document systematically identifies and explains

concepts relevant to public health nursing practice, and provides a step-by-step process for a public health nurse

to use when sorting through complex practice situations that have challenging nursing practice implications. This

paper aims to help public health nurses (1) follow American Nurses Association (ANA) Standards of Public Health

Nursing Practice (American Nurses Association, 2013); (2) protect client safety; and (3) respect organizational

lines of authority. When practicing without professional nursing supervision, this document will provide public

health nurses with guidance for working through a process in determining safe public health nursing practice.

Audience

While the primary audience for this document is public health nurses, another key audience includes non-nurse

supervisors of public health nurses. Professionals with other backgrounds do enhance the work of public health

nurses and can address administrative factors related to supervision, yet there is value in a nurse supervising a

nurse based on a common understanding of nursing practice issues and standards. In addition, non-nurse

supervisors should not provide direction to a public health nurse regarding nursing practice. Thus, a non-nurse

supervisor may be faced with the dilemma of how to continue supporting a public health nurse supervisee

without possessing the expertise acquired through nursing practice. This can be done by using the following

information as a guide in following important steps and considering appropriate resources.

Other audiences that will find this document helpful include, but are not limited to, nursing supervisors orienting new

nurses, nursing teams discussing a practice issue, and public health nursing faculty instructing nursing students.

Methods

Three sources of information were incorporated into development of this document: (1) a review of relevant

literature, (2) key informant interviews and (3) facilitated discussions of the Minnesota Public Health Nursing

(PHN) Practice Council.

About the Minnesota PHN Practice Council

The Minnesota Public Health Nursing Practice Council serves as a collaborative state-wide forum for public

health nurses from tribal and local health departments, The public health nurse consultants from the Minnesota

Department of Health and other public health nurse professionals who share a commitment in addressing

practice issues. The PHN Practice Council enhances and promotes the specialty of public health nursing.

Introduction

The concepts within this document have been identified by the PHN Practice Council as relevant to the nursing

practice of a public health nurse. While they have been separated into sections for clarity, the concepts are best

considered in unison when encountering a complex public health nursing practice situation. Section A identifies

the statute and rule requirements for public health nursing practice in Minnesota. Section B defines the practice

of public health nursing according to national standards. Section C describes experiences highlighting the

MDH CENTER FOR PUBLIC HEALTH PRACTICE &

MINN. PUBLIC HEALTH NURSING PRACTICE COUNCIL

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MAY 2016

RELEVANT CHALLENGES AND CONSIDERATIONS FOR PUBLIC HEALTH NURSING PRACTICE

challenges of autonomous public health nursing practice. This information was defined during early exploration

with the PHN Practice Council and key in identifying factors critical to the issue. Section D highlights relevant

considerations of nursing practice, including the autonomy of public health nursing practice and the importance

of collaboration. Lastly, Section E is the PHN Flowchart; this flowchart was designed as a process tool, for public

health nurse use when sorting out a complex nursing practice issue.

A. Statutory Requirements for Public Health

Nursing Certification

According to Minnesota statute ¡ì148.171, Subd. 15, the "practice of professional nursing" means the

performance, with or without compensation, of those services that incorporates caring for all patients in all

settings through nursing standards recognized by the board and includes, but is not limited to:

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)

providing a comprehensive assessment of the health status of a patient through the collection,

analysis, and synthesis of data used to establish a health status baseline and plan of care, and address

changes in a patient's condition;

collaborating with the health care team to develop and coordinate an integrated plan of care;

developing nursing interventions to be integrated with the plan of care;

implementing nursing care through the execution of independent nursing interventions;

implementing interventions that are delegated, ordered, or prescribed by a licensed health care provider;

delegating nursing tasks or assigning nursing activities to implement the plan of care;

providing safe and effective nursing care;

promoting a safe and therapeutic environment;

advocating for the best interests of individual patients;

evaluating responses to interventions and the effectiveness of the plan of care;

collaborating and coordinating with other health care professionals in the management and

implementation of care within and across care settings and communities;

providing health promotion, disease prevention, care coordination, and case finding;

designing and implementing teaching plans based on patient need, and evaluating their effectiveness;

participating in the development of health care policies, procedures, and systems;

managing, supervising, and evaluating the practice of nursing;

teaching the theory and practice of nursing; and

accountability for the quality of care delivered, recognizing the limits of knowledge and experience;

addressing situations beyond the nurse's competency; and performing to the level of education,

knowledge, and skill ordinarily expected of an individual who has completed an approved professional

nursing education program as described in section 148.211, subdivision 1.

Requirements for Certification as a Public Health Nurse

Minnesota (MN) statutes define a public health nurse means ¡°a registered nurse who meets the voluntary

registration requirements established by the board by rule¡± (Minn. Stat. ¡ì148.171, Subd. 18).

Minnesota rules require the following of applicants for registration as a public health nurse:

?

The applicant must have a baccalaureate degree or higher, with a major in nursing.

MDH CENTER FOR PUBLIC HEALTH PRACTICE &

MINN. PUBLIC HEALTH NURSING PRACTICE COUNCIL

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MAY 2016

RELEVANT CHALLENGES AND CONSIDERATIONS FOR PUBLIC HEALTH NURSING PRACTICE

?

?

The applicant¡¯s course work must have included theory and clinical practice in public health nursing. The

theory portion of the public health nursing education must have been at least 30 hours in length. The

public health nursing content in a hospital diploma or associate degree program does not qualify.

At a minimum, the public health nursing education must have prepared the nurse to:

o identify the incidence, distribution, and control of disease in a population, as well as the risk

factors and environmental factors related to communities;

o identify populations at high risk of illness, disability, premature death, or poor recovery;

o intervene within high-risk populations;

o evaluate the effect of interventions on the health status of a population; and

o use community services, institutional resources, and other health care providers.

(Minn. R. 6316.0100)

B. Definitions and Standards of Practice for

Public Health Nursing

Definition of Public Health Nursing Practice

According to the American Nurses Association (ANA),

¡°Public Health Nursing is the practice of promoting and protecting the health of populations using

knowledge from nursing, social, and public health sciences¡­ Public health nursing is a specialty practice

within nursing and public health. It focuses on improving population health by emphasizing prevention,

and attending to multiple determinants of health. Often used interchangeably with community health

nursing, this nursing practice includes advocacy, policy development, and planning, which addresses

issues of social justice. With a multi-level view of health, public health nursing action occurs through

community applications of theory, evidence, and a commitment to health equity.¡± (ANA, The Definition

and Practice of Public Health Nursing, 2013, pg. 2)

In addition to what is put forward in this definition, public health nursing practice is guided by the American

Nurses Association Public Health Nursing: Scope & Standards of Practice, 2nd Edition as identified below:

Standards of Practice for Public Health Nursing

Standard 1. Assessment

The public health nurse collects comprehensive data pertinent to the health status of populations.

Standard 2. Population Diagnosis and Priorities

The public health nurse analyzes the assessment data to determine the diagnoses or issues.

Standard 3. Outcomes Identification

The public health nurse identifies expected outcomes for a plan specific to the population or situation.

Standard 4. Planning

The public health nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes.

Standard 5. Implementation

The public health nurse implements the identified plan.

MDH CENTER FOR PUBLIC HEALTH PRACTICE &

MINN. PUBLIC HEALTH NURSING PRACTICE COUNCIL

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MAY 2016

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