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Advanced Practice Nursing in Public Health: Survey of California - - PowerPoint PPT Presentation
Advanced Practice Nursing in Public Health: Survey of California - - PowerPoint PPT Presentation
Advanced Practice Nursing in Public Health: Survey of California Public Health Department Directors of Nursing Karin L. Lightfoot, MSN PHN RN-BC Kristine D. Warner, PhD MPH RN California State University, Chico Presenter Disclosures: Karin L.
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Objectives
Upon completion of the presentation, attendees will be able to:
Describe the issues threatening the future of
the public health nurse as an advanced practitioner.
Recognize the current and future roles of
advanced practice nurses in the public health arena.
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Historical Background
Lillian Wald paved the way for Advanced Practice Nursing
Current disputes threaten PHN AP role:
Eliminate Community Health Nursing certification exams
Eliminate CNS as APRN role
Population health management not considered APRN practice
Input not sought from PHN leaders
Outcomes:
APRN Model Act approved by National Council on State Boards of Nursing in 2008
Clinical Nurse Specialist Public/Community Health Nursing certification changed to Advanced Public Health Nurse (APHN-BC)
(ACHNE, 2007; ANCC, 2009; ANCC, 2006; Dunphy, et al., 2004; Levin et al., 2008; NCSBN, 2006; Robertson, 2004)
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Research Design
Design
Quantitative exploratory descriptive design study using survey methodology
Setting
Work emails at local public health agencies in California
Sample
Directors of public health nursing within the California Conference of Local Health Department Nursing Directors organization.
N=30 (representing 49% of California’s public health agencies)
Protection of Human Subjects
IRB approval, informed consent, anonymous
Research Instrument
New research instrument was developed
Data Collection/Analysis
Nominal & ordinal data collected through on-line survey, categorical and grouped frequency distributions, means and modes, and rankings
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Nurses Employed in Advanced Practice Roles
18 directors (60%) reported they currently
employed nurses who function in the advanced practice public health nurse role
A total of 179 nurse FTEs Represents 28% of the PHN staff at those
agencies
17 counted their own position as APN role
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Advanced Practice Job Descriptions
Of the 18 agencies with AP roles, only 8 had actual job
descriptions
Job description titles wide-ranged:
Manager, Director of Nursing, Supervising Public Health
Nurse, Public Health Nurse I to PHN III, and Nurse Practitioner
More master’s prepared directors had AP roles than did
the BSN-level directors
76% of directors w/ Master’s degree had nurses in AP roles 42% of directors w/ BSN degree had nurses in AP roles
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Nurses Certified by ANCC
Of the ~1221 PHNs represented, seven were
certified by ANCC
<1% of PHNs represented in survey Certified Nurse Practitioners: 6 Clinical Nurse Specialist: 1
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Public Health Agencies with No Advanced Practice Roles
12 directors reported no nurses employed in
AP roles
Reasons:
Too costly (3) No qualified applicants (2) Agency does not see as valuable (2) Additional reasons: limited time & resources (1),
not needed (2), not current practice (2), considering the position (3), and minimal guidance from national practice (1).
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Requirements for Advanced Practice Nurse Positions at Agencies with Job Descriptions
1 2 3 4 5 6 7 Master-Level Education Experience Certification Required for Some
- r All Positions
Not Required for Any Positions
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Nurses with Master’s Education
Of the ~1221 public health nurses
represented:
145 were master’s prepared. Represents 12% of the public health nursing
workforce at the agencies involved in the study.
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Education/Certifications of Subjects
60% of the nursing directors had post-
graduate degrees
17 were masters prepared 1 had a doctorate degree
Only 1 nursing director was certified by the
ANCC (certified nurse practitioner)
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Degree Preferences for Advanced Practice Public Health Nurses
Degree Preference For Advanced Practice PHNs All Subjects N=30 Percentage of All Subjects Subjects with Advanced Degree n=18 Percentage of Subjects with Advanced Degree BSN 6 20 2 11 MSN 11 37 10 56 MPH 6 20 5 28 Other 1
(not specific)
3 No Preference 4 13 1 5 No Answer 2 7
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Ranking of Advanced Practice Public Health Nurse Characteristics
Ranking Characteristic 1 Practice is evidence-based 2 Takes leadership role in practice 3 Engages in population-level health care 4 Identifies gaps in public health knowledge, practice, and systems 5 Uses an interdisciplinary approach to partnership/collaboration 6 Develops strategies to promote systems improvement 7 Analyzes programs/system outcomes 8 Practice uses and ecological approach 9 Participates in research to develop new knowledge and improve practice
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Future Roles
Will be a use for advanced practice PHN at
- ur agency in the future: More than 75% agreed
Prescriptive authority should be required of all
advanced practice nurses: 73% disagreed
Direct patient care should be required of all
advanced practice nurses: 80% disagreed
Need new designation for APPHN: 80%
agreed
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Subject’s Involvement in Quad Council
Quad Council Organization Directors of Nursing Membership American Public Health Association- Public Health Nursing section 10 Association of Community Health Nurse Educators American Nurses Association Council on Nursing Practice and Economics Association of State and Territorial Directors
- f Nursing
5
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Summary of Findings
Great divide between theoretical expectations and actual practice in the field of public health nursing.
Role Stress/Role Strain
Ambiguous advanced practice role for public health nurses evident.
Wide range of job titles, qualifications, expectations.
Entire AP role in jeopardy.
Standardization of role is needed.
Future roles promising:
United in recognizing value of role.
Most directors of nursing agreed there is a need to have a separate category for advanced practice public health nurses.
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References
American Nurses Credentialing Center. (2006). Update on Public/Community Health Nursing certification exams. Retrieved October 7, 2006, from http://nursingworld.org/ancc/cert/PCHN update.html
American Nurses Credentialing Center. (2009). Advanced public health nurse (formally known as clinical nurse specialist in public/community health). Retrieved February 7, 2009, from http://www.nursecredentialing.org/NurseSpecialties/PublicHealthNurse.aspx
Association of Community Health Nursing Educators. (2007). Graduate education for Advanced Practice Public Health Nursing: At the crossroads. Retrieved February 5, 2008 from http://achne.org/files/public/GraduateEducationDocument.pdf
Dunphy, L. M., Youngkin, E. Q., & Smith, N. K. (2004). Advanced practice nursing: Doing what had to be done- radicals, renegades, and rebels. In L. A. Joel (Ed.), Advancedpractice nursing: Essentials for role development (pp. 3-30). Philadelphia: F.
- A. Davis Company.
Levin, P. A., Cary, A. H., Kulbok, P. Leffers, J., Molle, M., and Polivka, B. J. (2008). Graduate education for advanced practice public health nursing: At the crossroads. Public Health Nursing, 25(2), 176-193.
National Council of State Boards of Nursing. (2006). Draft vision paper: The future regulation of advanced practice nursing. Retrieved January 27, 2007 from https://www.ncsbn.org/Draft_APRN_Vision_Paper.pdf
Robertson, J. F. (2004). Does advanced community/public health nursing practice have a future? Public Health Nursing, 21, 495-500.
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