Advanced Nursing Practice
While a DNP education prepares a nurse with advanced nursing knowledge and scientific skills, a hallmark of the program is mastery in a single specialty. Advanced practice nurses are able to systematically assess patients and communities, integrating approaches and interventions across the socio-ecological spectrum. These nurses are prepared to handle complex care needs at many levels, use excellent judgement in analyzing and choosing appropriate interventions, work with individuals across specialties, communities, cultures, and backgrounds, link theory and practice, and mentor other nurses in their own practice (AACN, 2006).
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My specialty, public health nursing, is one I have practiced in for over 18 years. I became board certified as an advanced practice public health nurse in 2017 (attached). I currently hold a director-level position and have the profound honor of serving over 80 nurses under me. In my years as a public health nurse, I have learned to care not just for the individual, but for entire communities and populations of people who experience poverty, isolation, racism, and other factors that negatively influence their individual and collective health. As indicated in the narrative below, written the summer of Summer 2019 in the Advanced Public Health Nursing course, I believe one of my greatest responsibilities as a public health nurse leader is to use my voice to mobilize other nurses to action around population health and policy change.
I've also included a link to a podcast I was featured in through the Midwestern Public Health Training Center, discussing public health nursing leadership. The interview was done at the Association of Public Health Nurses annual conference in April of 2019, just prior to my transition to past president.
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American Academy of Colleges of Nursing (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf
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APHN Practice; DNP, MPH Education
NURS6633, Summer 2019
"Advanced nursing practice is defined by its ability to influence health, manage care, administer organizations, and develop and implement health policy (AACN, 2006, pg 4). While this is true in its summary of all advanced nursing roles, it does not approach the depth and breadth to which advanced public health nurses (APHNs) accomplish their work. One of the most striking qualities of APHNs is the degree to which our practice is characterized by constant expansion and responsive flexibility, while yet seeming to always remain, at the core, the same (Shamansky and Graham, 1992, referred to this as “dogged determination”). In many ways, our practice mirrors that of our foremother, Lillian Wald, who recognized that children’s health would benefit from safe play places and thus mobilized her community resources and political will to build a playground. Similarly, we assess our communities and find ways to respond to their needs by utilizing partnerships and policy. However, through education and necessity, our roles have bent and expanded. A quick look at the Quad Council Coalition website gives an interesting perspective on the development of public health nursing practice over years; in 1997, these organizations developed a one-page document that laid out a rough foundation of the function of public health nursing (QCC, 1997); Today, those tenets have expanded to core competencies across 3 functional tiers, with periodic updates to account for the ever-expanding roles of PHNs (QCC, 2018).
More than just interventionists, APHNs are characterized by broad, systemic action, as seen in the descriptors used by my peers: Facilitators. Diverse. Collaborators. Scholars. Proactive. Holistic. Leaders. Liaisons. More than prescribing a treatment for a population, APHNs are actors upon forces to shift entire systems toward health, and are fluent in each step of the process from assessment through evaluation. Developing fluency in systems-level work requires more than baccalaureate level education, and many APHNs pursue a Master of Public Health (MPH) degree to capture the breadth of field knowledge, and a PhD or DNP in nursing that requires significant public health clinical work to ensure competency at the APHN level (Swider, Levin, & Kulbok, 2015).
As I have interacted with national APHN leaders, I have also come to the conclusion that a vital role of APHNs is to be conscientious disruptors. The systems that APHNs work within often address population health at the mid-stream level, and the more upstream policy needs can be difficult to address without a great deal of multidisciplinary movement supporting change. This requires advocacy and disruption. To garner this level of support, APHNs need to have the skills and confidence necessary to look outside of normal partnerships and actions. For instance, the APHN can better address education as a social determinant of health by becoming involved with the local school board and lending his or her broad public health lens to the policy work that occurs in that arena, rather than only partnering with schools to implement programs in a strict public health partnership. APHNs can write expert opinion editorials that inform public opinion and inch cultural shifts in one direction or another (Myers, 2019). APHNs can and should be utilizing social media avenues as a way to promote, connect, mobilize, and empower partners and constituents around current issues that are impacting health (McLemore, May 2019). While these may not be traditional avenues for APHN work, they are necessary skills to impact positive change in the current environment and are platforms in which conscientious disruption is a viable intervention.
In summary, APHNs use advanced education and clinical experience to bravely, doggedly, and expertly apply data, social science, economics, politics, media mobilization, and any other tool we can creatively and effectively apply to ensure every single person in our communities can equitably experience health and wellbeing."
References
American Association of Colleges of Nursing (2006). The essentials of doctoral education for advanced nursing practice. http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf (Links to an external site.)
McLemore, M. (2019). Twitter for clinicians with Assistant Professor Monica McLemore. Retrieved from https://ucsf.app.box.com/s/3c2mcmoogecyyljndtxemkne0qlvdc0y (Links to an external site.).
Myers, C. (2019). Personal Communication, April 25th, 2019.
Shamansky, S., & Graham, K. (1992). Poewrful women: 100 years of public health nursing. Public Health Nursing, 9(4), p. 217.
Swider, S., Levin, P., Kulbok, P. (2019). Creating the future of public health nursing: A call to action. Public Health Nursing, 32(2), pp. 91-93.
Quad Council of Public Health Nursing Organizations (1997). Tenets of public health nursing.
Retrieved from http://www.quadcouncilphn.org/ (Links to an external site.).
Quad Council Coalition Competency Review Task Force. (2018). Community/Public Health Nursing Competencies. Retrieved from http://www.quadcouncilphn.org/documents-3/2018-qcc-competencies/ (Links to an external site.).
American Nurses Credentialing Center
Advanced Public Health Nursing
Board Certification
