• Assurance of effective public health nursing leadership, through the position of the state nursing director, who has influence on state and local public health nursing priorities.
• Assurance of competent public health nurses and public health nurse leaders.
• Articulation of public health nurses’ role in implementation and support of public health and CDC-funded programs.
• Presence of an adequate number of public health nurses.
• Development of an evidence-base for public health nursing practice.

1. Focus Area:  Assurance of effective public health nursing leadership, through the position of state nursing director, who has influence on state and local public health nursing priorities.

• Review, reassess and interpret data from the 2003 ASTDN survey.
  Utilized 2003 data from 2003 ASTDN survey to develop outline for “State of Public Health Nursing Leadership”
• Solicit stories that describe the role of the public health nurse leader
• Describe the impact that the absence of a public health nurse leader has on public health  and articulate the benefits of the presence of a public health nurse leader
  Solicited stories that describe the role of the public health nurse leader via ASTDN list serve, personal email and phone calls but had very poor response. Changed strategy to “profiles” that highlight background and contributions of state public health nursing director.
• Solicit testimonials from State Health Officials who support public health nurse leaders.
  Obtained testimonials from State Health Officials who support public health nursing
• Solicit supporting statements from ASTHO and NACCHO.
  Sent letters requesting supporting statements from ASTHO and NACCHO.

• Identify leadership competencies through examining known competency sets, e.g., other nursing specialties, other public health leadership positions, senior executive (business) models, etc.
• Integrate measurable leadership competencies from the Quad Council’s Public Health Nursing Competencies into the state public health nursing director role
  Identified leadership competencies from six major public health and nursing competency sets (see “Leadership Competencies” document):
  •   Robert Wood Johnson Executive Nurse Fellows Program
  • Quad Council Core Competencies for Turning Point
  • The National Public Health Leadership Institute
  • Scope and Standards for Nurse Administrators (American Nurses Association)
  • Organization of Nurse Executives
• Develop a model position description for state public health nursing director using existing state nursing director and large local health department nursing director position descriptions.
• Develop a template, then solicit and compile examples of how selected leadership competencies are incorporated into practice by current ASTDN members to be used in developing model position description. 
  Developed model position description that incorporates leadership competencies
• Requested position descriptions from state nursing directors and large local health department directors (23 received).
• Developed a framework to analyze the composite position descriptions for public health nursing director functions and knowledge, skill, abilities, and values, and then compared the results with the ASTDN survey completed in 1993
• Using the results of the analysis, designed a template of state public health nursing director functions and a separate template of required knowledge, skills, abilities, and values. See documents: “State Public Health Nursing Director Functions” “State Public Health Nursing Director Knowledge, Skills, Abilities and Values” 
• Integrated the leadership competencies from the competency sets into the “State Public Health Nursing Executive Functions” template and into the “State Public Health Nursing Executive Knowledge, Skills, Abilities and Values” template
• Conduct a survey of ASTDN members, based on the 2003 ASTDN survey, and compare results from this current survey with the 2003 ASTDN survey results to identify changes since the 2003 survey.
• Document trends in practice by developing a “State of PHN Leadership and Workforce” report.
  Developed State of Public Health Nursing Leadership” Report that identifies:
• Number of states with a public health nurse leader within the state health department
• Various types of public health positions designated as “chief nurse” for ASTDN representation
• Numbers of states with no public health nursing leader within the state health department
• States that have reinstated PHN Director Position in past decade
• Turnovers and changes in State PHN Directors
• States that require baccalaureate preparation for PHN
• Coordinate with ACHNE and seek support for impact on curriculum of the findings on leadership.
  Presented an overview of “Enhancing the Capacity of Public Health Nursing through Partnerships the Cooperative Agreement” at ACHNE’s Annual Meeting on June 1, 2006 in Pasadena California

• Develop talking points about the role of public health nurses; test the message with representative from key audiences.
• Develop a categorical program matrix with examples of how public health nurses contribute locally, using current position descriptions of public health nurses functioning in various program roles.
  Completed matrix of public health nursing activities in the areas of immunization, tuberculosis prevention and control, and STD prevention and control
• Perform visits with key CDC staff to establish partnerships and make the case for public health nurse impact.
  • Steering Committee and invited partners met with key Centers for Disease Control officials in Atlanta on July 18th, 2006 to establish partnerships and discuss the capacity of public health nursing in the United States.
• Identify and make contact with key CDC partners (e.g., ASTHO, NACCHO, and other national groups) which influence CDC and public health decision-makers.
  • Maintained regular ongoing contact with NACCHO, ASTHO and the US Public Health Service;
  • Presented an overview of the Cooperative Agreement at the Public Health Nursing Leadership Work Group convened by the Association of Schools of Public Health (ASPH) and HRSA in Washington DC, on May 25, 2006.
  • Presented on project at the American Public Health Association in Boston, November 7, 2006

• Revise and update the public health nurse shortage statement through use of data from the 2003 ASTDN survey, the current ASTDN survey, and the 2003 ASTHO Public Health Worker Shortage Report that verifies a continued public health nurse workforce shortage.
  Contributed to the revised public health nurse shortage statement developed by Quad Council
• Perform a literature review for existing methodologies on other public health and healthcare discipline ratios.
• Design an outline for a plan and methodology for establishing a public health nurse: population ratio.
  Developed a plan for establishing a public health nurse/ population ratio. The evidence for a public health nurse/ population ratio will be established though a task analysis that quantifies the work of public health nurses. The task analysis will be conducted through a Delphi method.  The task analysis project will be modeled after the Delphi project that established the national recommended staffing ratio for infection control practitioners.
• Forty staff level public health nurses from around the nation will be solicited for the Delphi process. (Participants will have baccalaureate preparation in nursing and at least five years of experience as staff public health nurse in a local health department or local health office of state health department. The Delphi will include public health nurses who specialize in disease prevention and control, maternal child/health, community health promotion, and emergency preparedness.
• Developed solicitation letters and consent forms
• Submitted proposal for Delphi to Institutional Review Board.
• Received funding for a proposal to Robert Wood Johnson Executive Nurse Fellows Alumni Association for funding to support Delphi
• Performed a literature and Internet review for existing methodologies to determine public health and healthcare discipline ratios. (Most sources identified existing ratios, not recommended ratios, and did not specify methodology.)
• Write a series of compelling stories describing the value of public health nurses and articulate the impact of the public health nurse shortage.
  Developed a set of public health nursing stories that describe the value of public health nurses and articulate the contributions of public health nursing to achieving CDC’s goals.
• Story topics include Katrina response, the mumps outbreak, immunization, tuberculosis control, infectious disease prevention and control, emergency preparedness, diabetes control, obesity prevention, HIV/STD control, health disparities, and other public health nursing areas
• Develop an inventory of public health nurse recruitment resources and identify resource gaps.
• Profile human resource practices and systems that are “public health nurse friendly” or “public health friendly”.
  Developed an inventory of public health nurse recruitment and retention resources
• Describe the “value-added” public health impact which results when public health nurses, rather than other disciplines, perform certain activities.
  Performed an extensive review of the literature and Internet on the unique role of public health nurses. Solicited documents from the broader public health nursing community. Developed concepts for “value-added” paper describing the unique contributions of public health nursing.

• Describe the relationship between evidence-based best practices to measuring outcomes and impact of public health nursing practice.
• Review the existing resources for evidence-based best practices for other nursing specialties or other disciplines
  Performed an extensive review of the literature and Internet for evidence-based public health nursing practice and evidence that supports public health nursing practice and PHN programs and activities.  Developed list of resources for evidence-based public health nursing practice.
• Develop an outline for the process of establishing a research agenda.
  Contacted ACHNE and the Public Health Nursing Section of APHA for their research agendas for public health nursing. Acquired ACHNE’s research agenda; Section of Public Health Nursing’s research agenda not currently available. Collaborated on the Special Session on “Setting a Research Agenda for Public Health Nursing” sponsored by Section at the American Public Health Association Annual Meeting in November 7, 200

The Steering Committee and other partners met with officials from the Centers for Disease Control (CDC) in Atlanta on July 18th, 2006 to discuss the capacity of public health nursing in the United States. The Centers that participated in that meeting included representatives from the

• Coordinating Center for Health Information and Service (CoCHIS)
• Coordinating Office for Terrorism and Emergency Preparedness (COTPER)
• Coordinating Center for Infectious Disease (CCID)
• National Center for HIV, Viral Hepatitis, STDs, and Tuberculosis Prevention (NCHHSTP)
• Coordinating Center for Infectious Disease (CCID)
• National Center for Infectious Diseases (NCID)
• Coordinating Center for Infectious Disease (CCID)
• National Center for Immunization and Viral Respiratory Diseases (NCIVRD)
• Office of Chief of Public Health Practice (OCPHP)
• Office of Workforce and Career Development (OWCD)

• Rear Admiral (RADM) Carol A. Romano, Chief Nurse Officer, Public Health Service (PHS), Office of the Surgeon General
• Frances Sadden, BSN, MA, Director Siouxland District Health Department, Sioux City, IA
• Mary Ann Cooney, RN, MS, Director, Division of Public Health Services, New Hampshire Department of Health & Human Services

• Linda Olson Keller, Project Director, presented an overview of “Enhancing the Capacity of Public Health Nursing through Partnerships the Cooperative Agreement” at ACHNE’s Annual Meeting on June 1 st in Pasadena California. Several ACHNE members expressed interest in participating in the project.
• Linda Olson Keller, Karen O’Brien, Joy Reed and Pat Drehobl submitted an abstract on the project for the American Public Health Association. The abstract was accepted and will be presented on Tuesday, November 7 at the Annual Public Health Association meeting in Boston.
• The “template” of state public health nursing leader functions is almost completed. It is currently under review by several current and retired state public health nursing directors. Please contact Linda if you are interested in reviewing this document.

612-626-5144 (phone)
612-626-2359 (fax)