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Martha W. Moon, PhD, RN, MPH, JoAnne K. Henry, EdD, RN, MPH, Karen Connelly, RN, MPA and Phyllis Kirsch, MS, MPH

Martha W. Moon, JoAnne K. Henry, and Phyllis Kirsch are with the Virginia Commonwealth University School of Nursing, Richmond. At the time of this project, Karen Connelly was with the Virginia Department of Health, Richmond.

Correspondence: Requests for reprints should be sent to Martha W. Moon, RN, PhD, MPH, Virginia Commonwealth University School of Nursing, PO Box 980567, Richmond, VA 23298-0567 (e-mail: mwmoon{at}vcu.edu).

	ABSTRACT

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A shift in the role of public health practice in the United States to population-focused care, together with demographic shifts increasing the diversity and age of the population, has created a need for a public health workforce more highly skilled in community and population-based practices. Despite this need, few changes have been made in the pattern of field placements for nursing students, in part because many public health nurses in population-focused roles are unfamiliar with models of successful student fieldwork in their areas.

We describe the Public Health Nurses for Virginia’s Future project, a successful project undertaken by nurse educators and public health leaders to increase the number of highly qualified graduates working in state and local health departments.

	INTRODUCTION

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BACCALAUREATE EDUCATION in nursing includes preparation in community- and population-focused care as well as individual-focused care, all of which are essential for today’s public health practice.^1,2 Less than 50% of the public health nursing workforce in Virginia has this baccalaureate-level preparation. In an effort to increase the number of nurses choosing to enter the public health field, and to prepare them with the required skills needed to successfully fill roles in the emerging public health system, the Virginia Commonwealth University (VCU) School of Nursing and the Virginia State Department of Health established a partnership entitled "Public Health Nurses for Virginia’s Future," funded by the Division of Nursing of the US Health Resources and Services Administration. The lead community health faculty member at VCU provided leadership for this project, as did the director of public health nursing for the Virginia State Department of Health and the director of the VCU Community Nursing Organization; support was provided by the school’s community health clinical coordinator.

The project’s goal was to increase the number of nursing students choosing a career in public health nursing. Specific objectives were as follows:

• To provide experience in public health department settings for a minimum of 76 bachelor of science (BS) students per year, compared with 32 at baseline
  
• To increase by 50% the number of students who report upon graduation that they will consider a career in public health nursing
  
• To increase by more than threefold the involvement of state and local health department public health nurses in the Community and Public Health Nursing course
  

	NEED FOR THE PROGRAM

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At VCU, students are required to take a community and public health nursing course in their senior year. The course employs an epidemiological approach to population-focused nursing through community health status assessment and evaluation of the effects of contemporary issues and health policy on the public’s health. Despite this class, the school had not been able to place many students in population-focused public health settings for clinical experience. Nurses in these community settings reported difficulty identifying appropriate clinical placements for students. Many of these nurses had received no training in population-focused care in their own basic nursing education or more traditional public health clinical training, and they were unfamiliar with models of successful student placement in their current fields. They reported not having time in their work to figure out how best to use students. Through this project, we hoped to increase the number of population-focused placements and preceptors available to students, thus improving the preparation of future public health nurses, helping Virginia’s Public Health System better meet current needs, and preparing for the public health challenges of the next 2 decades.

	METHODS

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The project employed the following 3 strategies to achieve its objectives:

• Public Health Nursing Advisory Group. The project team developed a Public Health Nursing Advisory Group to guide changes in the course and to identify health department mentors for students. This group comprised public health nurse managers from local health departments and state health department nurses. They provided suggestions for the seminar content and for project implementation.
  
• Outreach to public health nurse managers. The team conducted telephone outreach and face-to-face meetings with public health nurse managers in the State Health Department and throughout the state to increase the number of field placement sites and preceptors for baccalaureate nursing students. Through these meetings, the team clarified the roles and responsibilities of the preceptors and the students; gave concrete examples of service learning projects that would increase the students’ knowledge of public health nursing and contribute to improving the health of the community; and assured the preceptors that clinical faculty would maintain ongoing communication and provide help supervising appropriate and productive clinical placements for students.
  
• Public health topical seminars. The project team provided quarterly seminars that focused on targeted community assessment and were open to students, public health nurses, and faculty, a need identified by the Public Health Nursing Advisory Group. The seminars were broadcast live to local health departments through a new statewide video-conferencing system at the State Health Department. The sessions were recorded and distributed to local health departments for those who were unable to participate in the live telecasts.
  

	EVALUATION

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The project exceeded 2 of the 3 specific objectives and made excellent progress toward meeting the third. To determine if the project’s objectives were attained, the number of students placed in population-focused settings (data recorded by clinical faculty for baseline and project period) was counted; the percentage of students reporting that they would consider a career in public health (data recorded on anonymous course evaluation forms completed by students) was calculated; and the number of public health nurses willing to serve as preceptors (data recorded by clinical faculty for baseline and project period) was counted. Figure 1 graphically illustrates the relative success of the 3 objectives.

View larger version (13K): [in this window] [in a new window]   FIGURE 1—— Relative success of the Public Health Nurses for Virginia’s Future project.

	RESULTS

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MODELS OF SUCCESSFUL STUDENT FIELDWORK ARISING FROM THIS PROJECT Educating new teen mothers about child development. Two students conducted a project to mitigate an identified knowledge deficiency regarding child development among teen mothers. The students developed a booklet with information about developmental milestones, that included information on when the milestones should be achieved, sources of delays in achieving those milestones, when to seek professional care because of those delays, suggestions for stimulating the child in areas where the child was lagging, and check boxes to mark as the child achieves each milestone. The students produced the booklet with a magnetized backing so that the young mothers could keep it on their refrigerators and refer to it regularly. The students also developed and presented a seminar to a group of teen mothers and fathers, during which the developmental milestones were explained, the booklet was reviewed, and the parents were shown how to use the booklet. The public health nurses in the health department plan to continue using the booklet and the seminar in their Resource Mothers Program. Designing and conducting fire safety education. A local public health department identified a need for fire safety education for children. A student worked with 150 kindergartners in a county school, using the Freddie Fire Safety Curriculum from South Carolina (accessible at http://www.llr.state.sc.us/freddie.asp). This curriculum teaches children to identify items that can get hot, to recognize the sound of a smoke detector, to go to an adult if they find matches or a lighter, to "stop, drop, and roll" if their clothes catch on fire, to crawl low to the ground if they encounter a smoke-filled room, and to recognize a firefighter in protective gear. The student gave the children educational kits with a "homework assignment" to construct or review fire escape routes with their parents. Two weeks later, she conducted a follow-up session in which she reinforced the lessons and reviewed the fire escape plans the children and their parents had prepared. Conducting targeted community assessment. One student conducted a targeted community assessment to determine a city health department’s need for tuberculosis control and prevention activities. The city was considering a new program to provide chest x-rays for postpartum mothers with a particular risk profile. While tuberculosis is a significant problem in some Virginia localities, the data revealed that tuberculosis is not a significant problem in the city she studied. This analysis helped the local health department better target resources to more pressing public health needs in that locality. Updating child health resource book. Two students worked with a county health department to provide the child health division with a comprehensive, up-to-date resource book that would be used by public health nurses and outreach workers to refer clients to community resources. The current version had not been updated for 9 years. Using the current version as a starting point, the students called all listed resources to update information. They surveyed health department personnel to find out what information the staff needed in the resource book and to identify additional resources. They used the Internet, telephone directory, and other sources to find more local service providers. The final listings contained detailed information about each service provider, including whether Medicaid was accepted and whether various languages were known in order to attend to monolingual clients.

 

Objective 2
In the school year 2002–2003, only 2 students stated that they would consider a career in public health nursing. In the following school year, a question was added to the student evaluation forms for community health nursing that asked, "Would you consider a career in public health nursing?" (Answer options were yes, no, and unsure.) Fifty-seven students, or 40% of the students surveyed, responded yes.

Objective 3
With the assistance of the Public Health Nursing Advisory Group and outreach to public health nurses, the team increased the number of public health nurses who served or agreed to serve in the future as preceptors for baccalaureate nursing students, from 25 in 2002–2003 to 77 in 2003–2004. A serendipitous benefit is that many of the preceptors gained an appreciation of the BS degree in nursing and indicated an interest in returning to school for their BS degrees.

The seminar series helped to better prepare current and prospective preceptors for their roles by familiarizing them with community assessment as currently taught to students. Participating public health nurses found the content useful not only for their roles as preceptors but also for their continuing education. The first seminar had viewers at 26 sites throughout the state. Follow-up phone calls and inquiries regarding the series evidenced a pressing need for additional sessions on the topic. Offering continuing education units for the seminars provided an additional incentive for nurses, even though these units are not required for nurses in Virginia.

	DISCUSSION

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KEY FINDINGS Face-to-face discussions with public health nurses who had never worked with students about the opportunities for working with students, as well as examples of appropriate student projects, encouraged many nurses to become preceptors. Face-to-face discussions also helped experienced preceptors better use their student trainees. Public health nurses and epidemiologists working in the field were enthusiastic about the seminar series, which provided relevant information to their work and helped familiarize them with the methods being taught to community and public health nursing students. Adequate focus on public health nursing in the curriculum, and well-planned and well-managed field experiences, can dramatically increase students’ interest in public health nursing careers.

 

This project demonstrated how to take a straightforward approach in solving a public health problem. In the first step of the project, the project team assessed the problem and identified the problem’s primary barriers to resolution. In this case, the problem was identified as an insufficient number of students choosing to enter the public health workforce, as well as inadequate preparation for those students who did enter the public health workforce. The greatest barrier to ensuring appropriate public health preparation for these students was finding preceptors who were willing and able to provide meaningful practical experience for the students. For the next step of the project, the project team involved key stakeholders (the Public Health Nursing Advisory Group), in the design and implementation of the solution. Members of the advisory group understood firsthand the problems facing public health nurses in Virginia and appreciated the opportunity to work with VCU to help shape the educational experience of their future colleagues. Having helped design a solution, they were invested in the project’s success.

The third step was to plan and implement an intervention to confront the problem and its associated barriers. The intervention incorporated multiple methods, from face-to-face meetings to statewide educational broadcasts. It focused on opening 2-way lines of communication between faculty and nurses, providing nurses in the field with the information and tools they need to be effective preceptors for public health nursing students, and providing counsel to the course faculty to ensure that the curriculum remained relevant and current. Finally, indicators of program success were measured at baseline and at the conclusion of the intervention.

The collaborative relationship that developed between the school of nursing and state and local public health organizations was a key to the success of the project. The school’s service contract with the Virginia Department of Health covered all public health departments throughout the state, greatly facilitating entry to new public health settings once a willing preceptor was identified. The state public health leadership’s unequivocal support encouraged local public health nursing officials to invest the necessary time to benefit from the seminars, the interaction with the school of nursing, and student placements.

	NEXT STEPS

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The project was accomplished with funding for 10 hours per week of faculty time over the course of one year. This time was used to plan the project, develop the Public Health Nursing Advisory Group, organize meetings for the advisory board, conduct outreach to health department personnel, develop and present the seminars, attend telephone and in-person grantee meetings, and conduct the evaluation and reporting of results. With the infrastructure in place—most notably the leadership advisory group and the outreach presentations for potential preceptors—the program can be continued with moderate effort and no additional funding.

The success of the program will build on itself. For example, the team now has additional examples of successful student projects that can help new preceptors identify similar projects within their settings (box page 1105). Some of the outreach functions can be delegated to clinical faculty, who can perform outreach duties during the course of their normal contact with potential and current preceptors. The leadership advisory group can be convened annually to review the curriculum, plan for the following year’s seminars, collect additional suggestions, and review placement recommendations. Through these efforts, the school of nursing faculty will maintain ongoing communication with public health nurses in leadership roles, management, and field settings, simultaneously improving the quality of the course content and clinical experiences for student nurses. With improved preparation and positive field experiences, it is our expectation that more students will choose to enter public health nursing careers.

	Acknowledgments

 
This project was funded by the Division of Nursing of the US Health Resources and Services Administration from July 1, 2003, through June 30, 2004 (grant D52HP00583). The Virginia Department of Health provided substantial in-kind support through the use of its statewide video-conferencing system.

	Footnotes

 
Peer Reviewed

Contributors
M. W. Moon and J. K. Henry originated the idea for the project, secured funding, provided leadership, and conducted the seminar series. M. W. Moon drafted the article. K. Connelly was instrumental in convening the Public Health Nursing Advisory Group and gaining the support of public health nurses throughout the state. P. Kirsch provided clinical coordination. All authors reviewed subsequent drafts of the article.

Accepted for publication January 22, 2005.

	References

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1. Gebbie KM, Hwang I. Preparing currently employed public health nurses for changes in the health system. Am J Public Health. 2000;90:716–721.[Abstract/Free Full Text]

2. Reed J, Moffatt S, King M, et al. The impact of the nursing shortage on public health nursing by the Quad Council of Public Health Nursing Organizations, July 2001. Available at: http://www.astdn.org/publication_impact_nursing_shortage.htm. Accessed May 5, 2005.

This Article Abstract Figures Only Full Text (PDF) Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Moon, M. W. Articles by Kirsch, P. Search for Related Content PubMed PubMed Citation Articles by Moon, M. W. Articles by Kirsch, P. Related Collections Community Health Public Health Practice