12/27/06 Update
Association of State and Territorial Directors of Nursing (ASTDN)
Position on the National Nurse Proposal

The Association of State and Territorial Directors of Nursing (ASTDN), under its bylaws, promotes a program of national health protection, develops innovative and collaborative partnerships with governmental and voluntary agencies in programs aimed toward protecting the public’s health, articulates and advocates the role of public health nursing in health care, establishes guidelines for states and territories in setting standards for public health nursing services and recommends and advocates the effective and efficient use of public health nurses in the provision of preventive, health promotion and personal health services. In keeping with these purposes, the National Nurse proposal is of significant interest to the Association.

The National Nurse movement began with a guest opinion-editorial in the New York Times on May 20, 2005. The author, Ms. Teri Mills, RN, MS, ANP, an instructor at a community college in Oregon, proposed that a National Nurse be appointed. Under Ms. Mills construct, the National Nurse, occupying a position similar to the US Surgeon General, would conduct weekly health education sessions via radio and gather a cadre of local nurses who would volunteer in their communities to conduct health education activities.

Subsequently, a bill was introduced (HR 4903) by Representative Lois Capps, herself a registered nurse, to amend the Public Health Service Act to establish an office of the National Nurse. The bill has a number of co-sponsors, representing various states. (The bill may be viewed on-line at http://thomas.loc.gov/cgi-bin/query/a?c109:H.R.4903.) Should it become law, the National Nurse would perform activities that would encourage entry into the nursing profession, perform activities that would encourage nurses to teach nursing, promote public health (including encouraging nurses to volunteer in their communities to educate the public on better health), and conduct media campaigns and personal appearances for the purpose of achieving better health for the nation. The bill also provides for state coordinators, grants and nurse volunteers.

As nurses who are engaged in improving health in our states on a daily basis, we welcome the added attention to nursing as a profession and to the potential nurses have for improving the health of this nation through preventive and health promoting services. We welcome, as well, attention to the critical issue of shortages of nursing faculty.

However, there is a need for additional clarity with regard to some of the shortfalls of the proposal. First, it is not at all clear how this effort would articulate and build upon the current structures within the states and the national government. The proposal does not acknowledge the office of the Assistant Surgeon General, Chief Nurse Officer of the US Public Health Service, nor does the proposal offer clarity with regard to how the effort would fit with existing state and local health department initiatives. It is unclear how creating new state teams of volunteer nurses would lead to improved health outcomes. Beyond our current public health nursing workforce, it is also unclear whether there are an adequate number of nurses who would have the time to devote hours to volunteering and who have the skill sets necessary to effect changes in health behaviors within communities. There are currently a number of state and local agencies with vacancies who are endeavoring to attract and retain qualified staff.

Health education alone has not been shown to be effective in creating the behavioral changes that lead to lasting change in lifestyle. Simple health messages, even delivered as a topic of the month, as has been proposed, are unlikely to change knowledge, attitudes and behaviors across whole populations. Social marketing has been referenced with regard to this proposal, but it is not addressed in any meaningful way.

Concerns:

1. Creation of a National Nurse Office is redundant with existing public health systems, such as the U.S. Public Health Service Office of the Surgeon General. As outlined, the proposed role of the National Nurse is not unique and is a role filled by state and local public health throughout the country and territories. This creates confusion for the public when there are numerous entities providing a service.
2. Because there is no appropriation for a National Nurse Office, our concern is that policy makers may be inclined to pull funds from an already under-funded public health system in order to fund this proposal. This does a disservice to our current system and the public and does not create an atmosphere of collaboration. ASTDN recommends that funding for any national nursing initiatives will act in a way that strengthens the system as a whole and provides adequate infrastructure and linkages to effect long-lasting and effective change.
3. Efforts should emphasize partnering with and enhancing state public health nursing structures. The role of the public health nurses in the care of populations in preventing disease and promoting health needs to be recognized and honored. Public Health professionals have training and an understanding of population health. The majority of nurses have an individual health focus, which is a very different delivery model than delivering population-based health messages and programs. The workforce the National Nurse Office is proposing to carry these messages most likely will not have population health expertise, thereby diminishing their effectiveness.
4. The National Nurse Office proposal does not reflect the science of population-based interventions to impact the public’s health, such as the need for partnerships with populations and communities most at risk and social marketing concepts as a basis for effecting community-wide changes that support healthful behaviors. ASTDN recommends that population-based interventions be based on principles and actions that have been soundly tested and shown to be effective.

In review, our concerns are a National Nurse Office will create a redundant structure that does not serve a unique role, could jeopardize funding for other public health programs, does not honor the unique training and understanding of nursing professionals skilled in delivery of population health, and does not reflect an understanding of how to effectively impact the public’s health. Based on these concerns, ASTDN does not support the creation of a National Nurse Office as currently proposed. ASTDN would appreciate dialogue to discuss how the proposal could support the nation’s current public health structure in a way the benefits the current system and the public.

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