Idaho Public Health Nursing Study

Public health nursing represents the foundation of the U.S. public health system, particularly in predominantly rural and frontier states. Increasing attention has recently been paid to strengthening the public health infrastructure and workforce in response to disaster preparedness concerns. Major concerns regarding the current and future shortage of public health nurses have been raised at the national and state levels (The Quad Council of Public Health Nursing Organizations, 2006; Health Resources Services Administration, 2005; Gehrke, 2007). Factors contributing to the shortage include the aging nursing workforce, inadequate funding and salaries, lack of qualified applicants, and ineffective recruitment and retention. In some states vacancy rates for public health nurses reach 20 percent with turnover rates up to 14 percent (Association of State and Territorial Health Officials, 2005). Unfortunately there is limited current research information regarding the state of public health nursing in Idaho as well as other, predominantly rural and frontier areas. The purpose of the Idaho Public Health Nursing Study, which was conducted in the spring of 2007, was to describe the current status of public health nursing in Idaho

Civic Engagement and Nursing Education

Significant declines in indicators of civic behavior identify Americans’ decreased connectedness to each other, their communities, and participation in the process of government and solving problems together. Universities across the United States are working to revitalize college students’ involvement in the processes of democracy. This move to increase students’ engagement in their communities and nation has implications for nursing education and the profession. Nurse educators are advised to use experiential learning to teach skills of civic engagement, political advocacy, and policymaking and to be role models and mentors to foster the growth of nurse citizens in the profession

Public Health Nursing Competency in a Rural/Frontier State

Objectives: To assess the self-reported levels of competency among public health nurses (PHNs) in Idaho. Design and Sample: A cross-sectional descriptive design was used. The sample consisted of 124 PHNs, including 30 in leadership roles, currently practicing in Idaho\u27s official public health agencies. Measures: Structured interviews were conducted with participants who provided self-ratings in the 8 domains of public health competency as developed by the Council on Linkages Between Academia and Public Health Practice and the Quad Council of Public Health Nursing Organizations. Results: The findings indicated that the overall level of competency was most strongly associated with the duration of professional experience. No major differences in the competency levels were found in relation to nurses\u27 level of education or licensure. Nurses in leadership positions reported the highest levels of competency. Rurality, as measured by district population density, was not significantly correlated with competency levels, except in relation to community dimensions of practice skills. Conclusions: The findings suggest that PHNs\u27 self-perceived levels of competence are most strongly influenced by their years of professional experience, particularly in leadership roles. Professional development efforts should focus on the domains with the lowest perceived competency: policy development/program planning skills, analytic assessment skills, and financial planning/management skills

Public Health Nurses in Rural/Frontier One-Nurse Offices

Introduction: Public health nursing is the foundation of the United States’ (US) public health system, particularly in rural and remote areas. Recent increasing interest in public health in the USA has highlighted that there is limited information available about public health nursing in the most isolated areas, particularly in the US. The purposes of this study were to: (1) describe the characteristics, competency levels, and practice patterns of public health nurses (PHNs) working in remote one-nurse offices; and (2) compare PHNs working in one-nurse offices with nurses working in multi-nurse offices in Idaho, in relation to their demographic characteristics, practice patterns and competency levels. Methods: Using a cross-sectional descriptive design, a statewide sample of 124 PHNs in Idaho, including 15 working in one-nurse satellite offices, were assessed in relation to their demographic characteristics, experience, educational background, job satisfaction, practice characteristics, and competency levels in March to May 2007. Results: The solo (nurses working in one-nurse offices) PHNs were based in 15 different counties, 10 frontier (population density of less than 7 persons/1.6 km2; 7 persons/mile2) and 5 rural. The counties ranged in population from 2781 to 28 114 (mean = 11 013), with population densities ranging from 0.9 to 29.4 persons/1.6 km2 (mean = 8.6; 0.9 to 29.4 persons/mile2). The distance from their offices to the district main office ranged from 25.8 to 241.4 km (mean = 104 km; 16 to 150 miles, mean = 64.6 miles). All the solo PHNs were Caucasian females, with a mean age of 46.9 years and a mean of 22.5 years’ nursing experience. Educationally, 7 (47%) held a bachelor degree in nursing, 6 (40%) had associates degrees, 1 (7%) had a diploma in nursing, and 1 (7%) was a licensed practical nurse (LPN). These solo PHNs provided a wide array of services with support from other nurses in the district, including epidemiology, family planning/sexually transmitted disease clinics, immunization clinics, communicable disease surveillance, and school nursing. They expressed strong job satisfaction, citing the benefits of autonomy, variety, and close community ties, but also voiced some frustrations related to isolation. Their self-rated levels of competency were highest in the areas of communication, cultural competency, community dimensions of care, and leadership/systems thinking skills; and lowest in the areas of financial management, analytical assessment, policy development/program planning, and basic public health sciences skills. When the solo PHNs were compared with PHNs based in multi-nurse offices, there were no statistically significant differences between the solo and non-solo PHNs in demographics or competency levels, except in the competency area of community dimensions of practice skills. The mean self-rating for solo PHNs in relation to community dimensions of practice skills was significantly higher (3.9) than non-solo PHNs (3.2) (t = 3.547, p = .002). Conclusions: These findings suggest that US PHNs practicing in isolated one-nurse offices in rural and remote communities are comparable to PHNs working in less isolated settings; however, solo nurses may have stronger community dimensions of practice skills. Their practice is more generalized than other PHNs and they express high levels of job satisfaction. The study was limited in that it was conducted in only one state and data were collected only by self-report. Further research is indicated to describe this unique subset of PHNs, particularly in terms of factors promoting recruitment and retention. Additional study into the conceptual aspect of isolation is also indicated in relation to public health practice in rural and remote areas