Your BSN and the public

By Jennifer E. Shearer | 08/04/2014

If you are a hospital nurse, you are a public health nurse.

Patient with nurse

The 2010 Institute of Medicine (IOM) study, “The Future of Nursing: Leading Change, Advancing Health,” calls for nurses to practice to the fullest extent of their education and training. Why does this have to be limited to advanced practice nurses?

Your BSN degree certifies that you have been educated and trained to assess and care for populations, but nurses who work in hospitals often do not practice to the full extent of their education. Many hospital nurses think that community or public health nursing is a course required to graduate, to be used only if they work as public health nurses. But hospital nurses also take care of the public.
Jennifer ShearerMore public than you think
“Public health” has been characterized inaccurately. Every day, “the public” arrives in our hospitals sicker and sicker, because formalized public health budget cuts make it difficult to effectively prevent disease. BSN-prepared nurses need to recognize that their patients are “the public”—that public health interventions are a nursing prerogative. If you have a BSN education and work in a hospital, you are a “public health” nurse.

The story has been around in public health circles for many years: A doctor is fishing in a stream when he sees a man drowning. Naturally, he jumps in to rescue him but, before getting him to shore, hears a call for help and realizes another man is drowning. Quickly depositing the first man on the shore, he jumps in to rescue the second. And just as he brings him in, more cries for help tell him another person is drowning. He wonders, “Who is upstream, pushing people in?”
The same thing happens in health care. To streamline the rescue operation and get people to hospitals more quickly, we send helicopters, rescue boats, and teams of specialists, but we wonder, “Who is pushing them in?” We have a downstream perspective, but we need an upstream viewpoint that goes to the source and stops the problem.
We know health is determined by social and environmental factors—where we live and what we do—but we prescribe and treat patients as if only drugs and therapy effect better health. After rescuing patients, we send them home and wonder why they return to the hospital, their health unimproved. Let’s look upstream, where our patients spend most of their lives.
Going public
If you’re a hospital nurse, you may see them only when they need rescuing, but what if you became involved in preventing disease and promoting health before your patients start to “drown?” BSN-prepared nurses need to remember their capabilities. As a hospital nurse, if you practice to the full extent of your capability, what does it look like? Who is your patient—your “public”?
In the hospital, we advocate, collaborate, coordinate, manage care, and educate, while applying research at the bedside. But every BSN graduate has also learned to screen and follow up, assess communities, build coalitions, investigate disease, provide surveillance, and contribute to policy development. To focus on prevention and improve health care delivery, these latter competencies need to be practiced.
Consider patients admitted to your unit as representing the public, a group, a population that may live in the area or beyond your hospital’s community. What are you doing to know and meet their needs? Look again at functions you already perform—teaching, advocacy, and case management, to name three. Below are some ways those roles can be made more effective from a public health perspective.
Teaching: Include family members in patient education. Make education available to larger audiences by providing classes. Address culture and literacy barriers through hospital-wide media.
Advocacy: Affirm your patients. Respect human dignity by speaking out when needed and by providing resource information when patients are discharged.
Case management: Is there someone on your unit with special expertise who could become a primary resource—case manager—for a particular population? The population could be based on diagnosis or residential location, such as rural areas, inner city, low-income neighborhoods, or underserved communities. Referral is not a stand-alone intervention. It requires follow-up. Is there someone who could take that on? Make it a quality-improvement task. When referrals are not completed, find out why and plan an intervention with a population focus.
Start with awareness of upstream factors. Build relationships and learn about your patients by listening to them and really hearing what affects their health. Follow up surgical discharges with a phone call. Ask “upstream” questions and collect the data.
As nurses, we want patients to assume self-management, but we may not be aware of educational barriers that stand in the way of self-management. Use your BSN training to plan and implement intervention programs on your unit. To solve a problem, you collect data. Before planning care, you assess. Remember those community assessments you did in nursing school? Those were not just academic exercises. Under the Affordable Care Act, U.S. nonprofit hospitals are now required to do community needs assessments to receive federal funds (New requirements, 2016). Those failing to do so will be fined by the Internal Revenue Service.
Remember who you are
You can help. Researching data on your unit’s population may uncover some needs and service gaps in your community. Identify barriers and be part of the solution by taking part in outreach. Every day, nurses teach to increase knowledge and change patient attitudes and behaviors. You can help families in crisis by participating in conferences or home visits. Include community nurses in those conferences.
Transportation is a barrier for some rural populations. Advocate for change by soliciting support from your hospital. And don’t forget your place in developing policy. As nurses, we have power because of the trust the public puts in us. A well-written letter to the editor can promote your cause as well as the profession.
The IOM study states that health care transformation requires that nurses take on new roles and become a linchpin (the hub, the essential piece) for health reform. We can do that. We are almost 3 million strong. But we have to change the way we view the system and get out of our silos. The populations we see—those who are elderly, those who have diabetes or heart disease—are comprised of individuals. But let’s not look at them only as individuals; let’s also look at them as representing populations. Already, advanced practice nurses are claiming their place in primary care. BSN nurses can also move up to their full potential and care for their groups of patients by assessing group needs, implementing programs, evaluating successes (and failures), and improving what they do.
Practice to your full potential. As a BSN-prepared nurse, you are fully equipped to promote health and help protect the public, right where you are. By being creative and inspired, you can help the nursing profession be the linchpin for health reform it was meant to be.
Jennifer E. Shearer, PhD, RN, CNE, is assistant professor, Medical University of South Carolina College of Nursing, Charleston, South Carolina, USA.
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from
New requirements for 501(c) (3) hospitals under the Affordable Care Act. (2016, July 29). Retrieved from

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