The condition of public health in the United States has been a long time concern. Nurses make up the largest population of health care providers. Therefore, we are well positioned to provide leadership under health care reform. We are the front liners in health care and we see the condition of people in a more comprehensive way. Public health nurses or PHNs played a number of different roles within their respective public health systems and these roles often varied by work setting and location.
Direct patient services were more often than not provided by Public health nurses who worked in local health offices, at the same time as population-based services were provided by Public health nurses at local and, in some instances, district health offices. Program management was provided by Public health nurses in local, district, and State central offices. Some of the local and district health agencies in the case study States reported that funding cutbacks for programs have led to reductions in direct patient services at the local level provided by Public health nurses. Combining both, we have the power to inflict change and development in todays public health.
As of now, the role of Public health nurse regarding poverty primarily focuses only on supplementing the living of families who are in poverty to access suitable services rather than directing efforts at the policy level. Some of the factors connected with this limited participation are recognized.
Several nursing experts have leaned on for public health nurses to address the causes and penalty of poverty through policy encouragement. On the other hand, this role was less likely to be acknowledged in professional principles and competencies, and we found little pragmatic evidence documenting our Public health nurses efforts to take on in this role.
Scholars would suggest that the conceptual framework developed by Blackburn in the United Kingdom offers direction for a more fully developed public health nursing role.
Like what we have in child welfare agencies. Welfare agencies are developed to progress the health care and health outcomes of children in foster care. This new nursing role in health care administration offers nurses the chance to interface with the legal, political, and organizational world of foster care to sponsor for children in defending custody. The Public Health Nurses have joined the social workers in child welfare agencies to help meet the challenge of caring for children with critical physical and psychological problems.
Social workers are not adequately trained in the language or practice of health delivery and have to struggle in dealing with the extensive health concerns of foster children (Carlson, 1996; Simms, Freundlich, Battistelli, & Kaufman, 1999; Smart, Russell, & Custodio, 1998). Thus, the social worker is the legal case manager within the foster care system and the Public Health Nurse will provide care in terms of health counseling, referrals, and consultation to the foster caregivers, health care providers, and the social workers.
The federal and state government funded this role to lessen the difficulties in coordinating health care between the child welfare system and health care providers. Unofficial observations of the Public Health Nurse in a large metropolitan child welfare agency in California were categorized using the Minnesota Public Health Intervention Model. Nurses that are carrying out this role are part of a team, with social workers, to support the safety of children in foster care and to guarantee that health is part of a safe environment.
This just describes the strength for the new nursing role as a product of acknowledgment of the health problems of an increasing population of children in foster care, delineates the historical beginnings of the role in California, and summarizes informal observations of nurses in the role. The pediatric Public Health Nurses, also called foster care nurses, were observed performing their job functions within a large county child welfare organization in California. The Minnesota Public Health Nursing Intervention Model provided a framework for the observations.
The Public Health Nurses or foster care nurses have the probability to change the face of health care delivery to the foster care pediatric population, but must purpose within the confines of a case management role within non-healthcare setting, the child welfare agency. To work within the organizational context of the child welfare agencies has proven complicated for nurses because the organizational goal of safety does not constantly include health (Schneiderman, 2005).
The public and the public health system place a large, but often unwritten and unspoken, expectation on public health nurse leaders, but in recent years erosion has occurred in public health nursing in many states. Public health nursing is well positioned to provide leadership under health care reform. The challenge now facing public health nursing leaders is to maintain or create the infrastructure, as well as the organizational culture, to maximize these opportunities.
Thus, if given more organizational support and improved knowledge and skills, and more funding, public health nurses could be playing a better role in working with others to make child, family and even the community poverty history.