Many nurse practitioners and NP students imagine that a majority of their working lives will be spent inside of hospitals or clinics, treating patients in contained environments and being on-call; however, not all of these healthcare professionals suffer the stress of rushing through multiple patients every hour in these settings. In fact, one largely overlooked career path for NPs is in public health nursing.
Public health nurse practitioners address the health needs of their communities through wellness clinics, home visits, and developing relationships that can help to stop serious health problems before they start, exacting positive change in the lives of patients and communities.
According to the Association of Public Health Nurses (APHN), "public health nurses comprise the largest segment of the professional public health workforce" and can work in a variety of settings, including:
The sheer range of possible work environments make this an attractive career to nurses of all types who want to work closely with their patients and dislike the idea of being stuck exclusively in a hospital. Notably, as healthcare costs in the U.S. continue to climb and the population of Baby Boomers ages, the need for public health nurse practitioners is expected to grow.
Public health NPs can work in many different environments. Some work for agencies and programs that are specifically designed to provide services for underserved and low-income communities. It is rare to find a public health nurse who spends all of his or her time in an office or in one specific clinic; on the contrary, it’s common for these professionals to travel around the community, offering wellness trainings, drop-in clinics, educational seminars, immunizations, and other services in a variety of settings. Some public health nurses offer in-home care—particularly to low-income seniors or breastfeeding mothers; others may plan group meetings with isolated community members. For the most part, public health nurses do not work only in hospitals or acute care clinics.
Public health NPs can work with patients at any point in their lifespans, from newborn infants to older adults. Many of the patients a public health NP encounters may come from disadvantaged or low-income families and from a variety of backgrounds, underscoring the need for providers skilled in culturally-competent care.
In terms of clinical assessments, public health nurses deal with healthy people—aiming to encourage good habits and disease prevention—as well as those who are managing chronic illness. Public health NPs can act as an important line of defense for the chronically ill, teaching them how to manage their illness and care for themselves before their situation becomes dire.
As with virtually any nurse, the daily responsibilities of public health NPs vary wildly from day to day; however, one of the most important and attractive features of public health nursing is the nurse's ability to spend a lot more time with his or her patients. Rather than rush through each clinical round at a hospital, public health nurses can take the time to talk with their patients and their families. They not only examine the root of an illness, but also strive to educate and motivate these patients to work toward better health.
Many public health nurses are mobile for at least part of the day, tending to in-home visits, wellness clinics, community centers, or schools; consequently, commuting is typically necessary in this NP subfield.
The clinical procedures of public health NPs vary greatly depending on the population with which he or she works and can vary from day to day. For instance, a public health NP that provides in-home care to low income seniors will face drastically different tasks than one who works mainly in pediatrics, offering counseling and support to new mothers and their babies.
Some of the most common clinical procedures include:
Public health nurses also must pay thought to the the health of the community as a whole. One way this manifests is through the prevention of disease outbreaks, particularly for nurses who work with high-risk populations. It is the duty of a public health nurse to identify those risks and provide treatment and education to prevent disease from spreading as best they can.
Finally, public health nurses may be part of a first response team that offers services in the event of a natural disaster or violence. For most public health NPs, this is not a daily occurrence, but can prove a rewarding opportunity to serve others through this particular career path.
Public health nurse practitioners play a pivotal role in the healthcare of their patients. While they may consult with physicians or other nurses, in many cases, public health NPs are not closely supervised and practice relatively autonomously. In many settings, they’re allowed to rely on their own knowledge and creative problem solving skills to offer treatment and education to their patients each day. That said, order to promote community health, public health NPs will need to communicate effectively with the physicians and offices to which they refer patients for follow up treatment.
The administrative work required of a public health nurse will depend largely on his or her employer. Some public health nurses are employed by government agencies—thick bureaucracies which typically require more paperwork than private agencies.
Also, because they are on the front lines of community health, public health nurses can find themselves involved in the legislative process, advocating for new laws, regulations, or funding to support their community health efforts.
There is no legal certification requirement for public health NPs; however, the American Nurses Credentialing Center (ANCC) offers the Advanced Public Health Nursing-Board Certified (APHN-BC) credential for experienced public health nurses.
In order to be eligible for board certification as a public health nurse, the individual must:
Nurses who are eligible also must submit a nursing portfolio to ANCC. Full details on eligibility and portfolio requirements are available from the ANCC website.
In order to maintain certification, nurses must maintain a license in good standing and complete the required continuing education credits every five years.
Finally, the emotional demands on a public health nurse practitioner are going to be different from those of an acute care NP and depend largely on the type of work (or population) the public health NP chooses. For example, some public health NPs may work in hospice care, which can be emotionally demanding, albeit important and rewarding work.
In general, public health nurses should be comfortable with and eager to develop close relationships with their patients. While this can make the nursing job more painful in the case of prolonged illness or death, it is these relationships that public health NPs report being among the most fulfilling and appealing parts of the job.