The last time you got a flu shot, had your school nurse examine your child’s vision, or had questions about an elderly parents’ care, did you thank your public health nurse?
If you didn’t, it’s OK.
Public health nurses are behind-the-scenes types, used to enacting policy, directing change and promoting health in quiet discussions together, in the field and with clients in the community. They’re largely happy to remain on the ground — staffing rural health clinics; talking to high-schoolers about the dangers of tobacco and sexually transmitted diseases; offering counsel to pregnant teens; screening schoolchildren for hearing deficiencies; studying what programs work, why and how to best evaluate their effectiveness, and conducting research to stave off illness before it starts.
It’s a critical, well-respected but largely unheralded job. And really, that’s the way public health nurses like it.
But with the advent of the Affordable Care Act and the seismic change it will bring, the profession in particular is poised to play an even larger role in making sure the well stay that way — and that those likely to become ill are helped quickly, competently and purposefully.
As we shift away from an “illness care” system to one focused on health promotion and prevention, we need more public health nurse generalists and advanced practice public health nurses prepared to understand and lead healthcare reform. To attract more bodies, we need to get louder about what public health nurses do, why it’s important, how it’s both fulfilling as a profession and critical to this country’s future — and why cuts to public health programs should not be tolerated.
Because public health nurses often work quietly, they’re often first in line on the chopping block.
Even with the Affordable Care Act’s push for disease prevention and expanding preventive care for all, financing health promotion and disease prevention is tricky often because isn’t sexy. It is painstaking, important work lacking the drama of TV hospital dramas, the chirping monitors, the chest compressions and cries of “stat!”
But drama in health care sells. In 2012, one study found that just 3 percent of our health care dollars were spent preventing disease. But dealing with the aftereffects of preventable chronic illness costs our country $7,900 for every American with a chronic disease. That translates into more than $1.050 trillion to cover the 133 million Americans suffering from a chronic disease. Per year.
Even an investment in just $10 per person per year could save just shy of $3 billion in health care costs in just one to two years, and more than $18 billion a year in 10 to 20 years.
The thing is, public health programs are often first in line for budget cuts precisely because wellness lacks the drama of illness. One report found that the number of RNs employed in public and community health settings — places like schools, worksites and health departments — was chopped nearly in half between 2004 and 2008.
But oh, how important public health nurses are.
I had the good fortune to co-chair the group that revised the American Nurse Association’s “Public Health Nursing: Scope and Standards of Practice,” the seminal volume that guides nurses work and focuses their efforts. The new working document — 71 pages of revised standards of practice and professional performance thoughtfully and purposefully arranged — will inform how public health nursing moves forward and keeps our population well.
Public health nurses must become better self-promoters, giving our jobs a shout-out, because keeping well is the very simple answer to health care reform.
So next time you see one of us, just nod and smile. You don’t have to say thanks; your health and wellness are more than thanks enough.
Pamela Kulbok is the Theresa A. Thomas Professor of Primary Care Nursing and chair of the Department of Family, Community and Mental Health Systems at the University of Virginia School of Nursing. A Robert Wood Johnson Executive Nurse Fellow, she studies tobacco cessation programs for the young and was inducted as a Fellow of the American Academy of Nursing in 2010.