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Population Health for Nurses

3.2 Public/Community Health Nursing Scope of Practice, Core Competencies, and Function

Population Health for Nurses3.2 Public/Community Health Nursing Scope of Practice, Core Competencies, and Function

Learning Outcomes

By the end of this section, you should be able to:

  • 3.2.1 Describe the scope and standards of practice of public/community health nursing.
  • 3.2.2 Describe community/public health nursing core competencies.
  • 3.2.3 Discuss the knowledge, skills, and attitudes associated with community/public health nursing practice.
  • 3.2.4 Identify behaviors reflective of the Quad Council Coalition’s community/public health competencies in caring for communities and populations.

Public/community health nursing is a specialty that focuses on improving the health of communities and populations through health promotion, disease prevention, risk reduction, community education, outbreak and epidemic management, and other initiatives. Nurses work in interprofessional teams with clinicians, community members, community partners, and policymakers to support ameliorating health disparities and injustices and ensure equitable access to a healthy life (Figure 3.5).

U S Representative Lauren Underwood stands behind a podium that says FMLA. At left is a larger banner with the words FMLA and a picture of a child with two adults as well as a flag with the seal of the United States.
Figure 3.5 Public/community health nurses can impact health in many ways. Here, U.S. Representative Lauren Underwood speaks at an event celebrating the anniversary of the Family and Medical Leave Act. Underwood is a registered nurse elected to represent Illinois’ 14th District in 2019. As such, she has been uniquely positioned to promote public health through national policy and legislation. She has created or supported bills on many health topics, such as mandating the removal of shackles to pregnant incarcerated individuals, ending preventable maternal mortality, climate change, and support for working families. (credit: Alyson Fligg/Department of Labor/Flickr, CC BY 2.0)

Scope of Practice and Practice Standards

The American Nurses Association (ANA) provides a scope of practice and practice standards that guide the current, evidence-based, ethical work of public/community health nurses. Across nursing specialties, such documents or guides are called “scope and standards.” Scope of practice refers to the professional activities involved in a particular role. Defining a scope of practice helps nurses work within and to their level of qualification, expertise, and competence. Standards of practice are the principles and guidelines to which professionals must adhere. Standards of practice support nurses’ decision-making and delivery of care. Standards can change with the dynamics of the nursing profession and depend on specific contextual factors like clinical situations and circumstances. Nurses across specialties and care settings are expected to be familiar with and adhere to the scope and standards relevant to their professional role.

The ANA identified the following nine core concepts of practice based on the dynamic and complex work of public health nursing:

  1. Social determinants of health
  2. Community collaboration
  3. Population health
  4. Ecological model of health: Micro- to macro-levels
  5. Culturally congruent practice: Respectful, equitable, and inclusionary
  6. Levels of prevention
  7. Ethics
  8. Social justice
  9. Health equity (ANA, 2022)

These principles provide a framework to guide public/community health nurses in practice and support their work in addressing the population’s needs and collaborating with varied parties.

Additionally, the ANA (2022) developed 18 standards of practice and professional performance for public health nursing. The standards for public/community health nursing follow standards set for nurses of any discipline or specialty by the ANA, which describe the who, what, where, when, why, and how of professional nursing practice (ANA, 2023). The standards of professional public health nursing practice are:

  • Assessment: Collects comprehensive data pertinent to the health status of populations.
  • Diagnosis: Analyzes the assessment data to determine actual or potential diagnoses, problems, and issues related to health and well-being.
  • Outcomes identification: Identifies expected outcomes for a plan specific to the health status of the population or situation.
  • Planning: Develops a plan that prescribes strategies to attain optimal health and well-being.
  • Implementation: Implements identified plans.
    • Coordination of care: Coordinates care delivery.
    • Health teaching and health promotion: Employs multiple strategies to promote health and safety.
    • Consultation: Provides consultation to enhance the abilities of diverse people to create and effect change.
    • Policy and regulatory activities: Participates in policy and regulatory activities related to health.
  • Evaluation: Evaluates progress toward the attainment of goals and outcomes.
  • Ethics: Practices ethically.
  • Respectful and equitable practice: Practices with cultural sensitivity, humility, and safety in a manner that is congruent with principles of cultural diversity, inclusion, and equity.
  • Communication: Communicates effectively in a variety of formats in all areas of practice.
  • Collaboration: Collaborates with the population and others in the conduct of nursing practice.
  • Leadership: Leads within the professional practice setting and the profession.
  • Education: Seeks knowledge and competence that reflect current nursing practice and promote futuristic thinking.
  • Evidence-based practice and research: Integrates evidence and research findings into practice.
  • Quality of practice: Contributes to quality nursing practice.
  • Professional practice appraisal: Evaluates personal nursing practice in relation to professional practice standards, guidelines, and relevant law.
  • Resource utilization: Uses appropriate resources to plan and provide nursing and public health services that are safe, effective, and financially responsible.
  • Environmental health, planetary health, and environmental justice: Practices in an environmentally safe, fair, and just manner (ANA, 2022).

Using this scope and these standards, public health nurses can help create healthier environments, foster partnerships that promote and protect health, and advocate for justice and health equity in practice.

Core Competencies

Public/community health nurses must possess certain knowledge, skills, and attitudes to effectively fulfill their professional role and successfully meet the community’s health needs. In general, nurses need knowledge of epidemiology, environmental health, social determinants of health, statistics, evidence-based practice, health promotion, and factors that impact health. Public/community health nurses need strong communication and relationship-building skills to effectively engage with the community. Attitudes in alignment with social justice, health equity, and advancing health, as well as cultural humility and respect for all community members, are
needed to fulfil the roles and responsibilities. Concepts and content related to these professional attitudes are threaded throughout chapters in this text. However, please see Structural Racism and Systemic Inequities, Designing Culturally and Linguistically Appropriate Programs, Managing the Dynamics of Difference, and Advocating for Population Health for in-depth information. The term competencies refers to the foundational knowledge, skills, and attitudes that nurses need to meet their clients’ needs. Competencies represent technical skills, personal qualities, and professional behaviors that support successful work in a certain area. In public/community health nursing, four leading nursing organizations formed the Quad Council Coalition in 1988 and collaboratively developed the Community/Public Health Nursing Competencies in 2018. The Quad Council member organizations include the Alliance of Nurses for Healthy Environments, the Association of Community Health Nurses, the Association of Public Health Nurses, and the American Public Health Association-Public Health Nursing Section (Quad Council Coalition Competency Review Task Force, 2018).

The competencies include major domains and leveled competencies for public/community health nurses to follow based on their role. Tier 1 competencies apply to nurse generalists who are not in management positions, while tier 2 and 3 competencies are for public/community health nurses who are managers and supervisors or executives, respectively. Applying the domains and competencies of public/community health nursing in professional practice is critical. Public/community health nurses might be the only clinician or care provider some community members have reliable access to, see regularly, or are comfortable talking with. Nurses in community health have a duty to stay abreast of evidence and clinical guidelines that could impact the health and care of the community. Table 3.1 displays the domains, select generalist competencies, and sample public/community health nursing applications to practice associated with each. Please note the table is not exhaustive; see the full Quad Council Coalition document linked above for a comprehensive listing.

Domain Generalist Competencies Examples of Nursing Actions
Assessment and Analytic Skills
Focus on identifying and understanding data, turning data into information for action, assessing needs and assets to address community health needs, developing community health assessments, and using evidence for decision-making
  • Use a data collection plan that incorporates valid and reliable methods and instruments for the collection of qualitative and quantitative data to inform the service for individuals, families, and a community.
  • Use information technology effectively to collect, analyze, store, and retrieve data related to public health nursing services for individuals, families, and groups.
Assess for postpartum depression during home visits for new parents using the validated Edinburgh Postnatal Depression Scale. Enter collected data into a secure computer file for analysis.
Policy Development/Program Planning Skills
Focus on determining needed policies and programs; advocating for policies and programs; planning, implementing, and evaluating policies and programs; developing and implementing strategies for continuous quality improvement; and developing and implementing community health improvement plans and strategic plans
  • Demonstrate knowledge of laws and regulations relevant to public health nursing services.
  • Comply with organizational procedures and policies.
Review the local nurse practice act, public health nursing scope and standards of practice, job description, and relevant employer policies regularly.
Communication Skills
Focus on assessing and addressing population literacy; soliciting and using community input; communicating data and information; facilitating communications; and communicating the roles of government, health care, and others
  • Apply critical thinking and cultural awareness to all communication modes (i.e., verbal, nonverbal, written, and electronic) with individuals, the community, and other parties.
  • Use various methods to disseminate public health information to individuals, families, and groups within a population.
  • Listen attentively to community member reports of health and demonstrate empathy and compassion in conversation.
  • Prepare health information for distribution via printed flyers, website posting, and email blasts.
Cultural Competency Skills
Focus on understanding and responding to diverse needs, assessing organizational cultural diversity and competence, assessing effects of policies and programs on different populations, and taking action to support a diverse public health workforce
  • Deliver culturally responsive public health nursing services for individuals, families, and groups.
  • Explain the benefits of a diverse public health workforce that supports a just and civil culture.
  • Ensure health recommendations and suggestions for community participation align with cultural needs; for example, avoid suggesting attending community events that occur during religious holidays.
  • Support the hiring of colleagues that ensures the characteristics and demographics of the workforce approximate the community.
Community Dimensions of Practice Skills
Focus on evaluating and developing linkages and relationships within the community, maintaining and advancing partnerships and community involvement, negotiating for the use of community assets, defending public health policies and programs, and evaluating & improving the effectiveness of community engagement
  • Assist individuals, families, and groups in identifying and accessing necessary community resources or services through the referral and follow-up process.
  • Build preferences into public health services.
  • Remain aware of all community agencies, events, programs, and opportunities for social prescribing.
  • Evaluate client, family, and community comfort level and agreement with participating in selected activities.
Public Health Sciences Skills
Focus on understanding the foundation and prominent events of public health, applying public sciences to practice, critiquing and developing research, using evidence when developing policies and programs, and establishing academic partnerships
  • Assess hazards and threats to individuals, families, and populations and reduce their risk of exposure and injury in natural and built environments (i.e., chemicals and products).
  • Model public health science skills when working with individuals, families, and groups.
  • Observe for methods of cleaning products and other household chemical storage during a pediatric home visit.
  • Guide practices with evidence-based resources obtained from the scholarly literature and guidelines of reputable organizations.
Financial Planning, Evaluation, and Management Skills
Focus on engaging other government agencies that can address community health needs, leveraging public health and health care funding mechanisms, developing and defending budgets, motivating personnel, evaluating and improving program and organization performance, and establishing and using performance management systems to improve organization performance
  • Interpret the impact of budget constraints on the delivery of public health nursing services to individuals, families, and groups.
  • Organize public health nursing services and programs for individuals, families, and groups within budgetary guidelines.
  • Periodically review the out-of-pocket cost and health plan coverage of interventions suggested to clients and families.
  • Prioritize free or low-cost recommendations for health promotion and risk reduction activities.
Leadership and Systems Thinking Skills
Focus on incorporating ethical standards into the organization; creating opportunities for collaboration among public health, health care, and other organizations; mentoring personnel; adjusting practice to address changing needs and environment; ensuring continuous quality improvement; managing organizational change; and advocating for the role of governmental public health
  • Apply systems thinking to public health nursing practice with individuals, families, and groups.
  • Model personal commitment to lifelong learning, professional development, and advocacy.
  • Recognize the role and utility of health services across the care continuum.
  • Engage in continuing education opportunities relevant to the needs of the community served.
Table 3.1 Community Health Nursing Competencies

Public/community health nurses have a vital role in meeting the health needs of a community. Their expertise in epidemiology, environmental health, social determinants, statistics, evidence-based practices, and health promotion impacts the communities they serve and the greater population. These nurses build relationships with community members and local agencies to make appropriate connections and referrals in support of health. Nurses in this area must guide their professional practices with a social justice lens, recognizing that health disparities and inequities in communities exist and influence health. The Community/Public Health Nursing Competencies provide a framework for nurses in community health to follow to meet the needs of the community holistically.

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