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”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

Triage

Bus

Off-site

Level 1 Screener

Treatment Center

(First Aid)

MDH Adjusted Standards of Mass Dispensing Matrix- Antibiotics

Tier 1 (Example: BDS) Tier 2 (faster) 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.

Screening and

Dispensing

StaffingIn order of preference

Under direction of MD or Pharmacist Level 2: Pharmacist, MD, RNLevel 1: Pharmacist, MD, RNExpress: 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 professionalsLevel 1: RN, health care related professionalsExpress: RN, health care professionals, trained non-health care volunteers

Process

Screening and documentation with standard flow, form, and protocols

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.

Form Retained as record. Same as tier 1 Client retains form.

Bottle Labeling

NDC# or lot # LabelPt. name

Record on form Labeled by dispenser - name and pre-printed labels put on bottles

Same as tier 1 No recordDispenser or assistant puts name of client on Cipro bottle

Pediatrics Suspension for 2 year olds and underCipro < 6 mo. olds (if available)Dispenser writes dosage on bottle

Suspension for 2 year olds and underCipro < 6 mo. olds (if available)Dispenser writes dosage on bottle

Suspension for 2 year olds and underCipro < 6 mo. olds Dispenser determines number of bottlesParent determines dose w/ chart.

Data Compilation

Clients MIIC, manual tabulations Same as tier 1 Inventory count

Drugs Inventory management system, manual counting

Same as tier 1

Education - One-on-one with written instruction. Written w/one-on-one for brief reinforcements only w/handouts

Handouts, signs, media

Tier 1 (Example: BDS)

Tier 2 (faster) Tier 3 (fastest)

Screening and

DispensingProcess

Screening and documentation with standard flow, form, and protocols

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.

MDH Adjusted Standards of Mass Dispensing Matrix- Antibiotics

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’sMn Micropolitan – 12.4% of all RN’s Rural – 7.9%

Median AgeMn 47 years oldMicropolitan and rural – 49 years

% of all Nurses between 55 years and 65+Mn Micropolitan – 27.6% Rural – 28.5%

PHN’sMn – 2.9% of all RN’s Micropolitan – 5.3%

Rural – 7.5%

Challenges

- salary

- multicultural communities

- limited learning opportunities for students

- aging workforce

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