Oregon Public Health Association: Nursing Section Late Fall/Early Winter 2015

STAND TOGETHER

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Pursuing Public Health: A Rarity Amongst New Nursing Grads? by Taylor Killen

“Wow – you’re so young!” is a remark that I have been receiving a lot lately, having graduated nursing school last summer and now beginning my first nursing job at the age of 22.

Did I always know I wanted to be a nurse? No. Did I have some major event in my life that made me want to pursue this career? I could make that argument, but in reality, no. To be honest, I wasn’t even sure that I wanted to continue pursuing nursing during the fourth semester of my five-semester-long nursing program. It sounds rash, but I was ready to take off and spend a year (or more) in Australia immediately after school to reevaluate my plans and consider other options. I was yearning for something more than what I was finding during my acute care clinical rotations.

So why was I feeling this dissatisfaction – this itch in my bones to do something other than implement nursing interventions in the acute care setting? I would soon find out during my final senior clinical rotation with the Multnomah County Health Department. With this first experience of true public health nursing, I realized that I was missing the proactivity that makes the nurse/patient relationship so unique. I was missing out on minimizing health disparities and taking part in the upstream interventions aimed at preventing the issues that land patients in the acute care setting in the first place. I was missing the relationships that I could form with clients who I get to work with on a continuum of care. I was missing an array of factors that happen to fall suitably under the umbrella of public health nursing.——————Thinking about the opening remark regarding my age as a nurse, I was struck with the thought that perhaps I am hearing this so often (despite the fact that Portland alone receives hundreds of new nursing grads age 20-30 each year) because I am unusually young to be choosing public health nursing as my takeoff point. I am not meaning to make a blanket statement about all new nursing grads, but please allow me to generalize what I’ve learned from my own experience a little bit here…

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Features

1 Pursuing Public Health: A Rarity Amongst New Nursing Grads? 2 Chair’s Corner 3 Addressing Alcohol Misuse in Public Health Settings 6 Meet your newly-elected executive team members

Oregon Public Health Association: Nursing Section Late Fall/Early Winter 2015

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Chair’s Corner The Oregon Action Coalition will receive a Robert Wood Johnson Foundation grant as part of the Future of Nursing Program. This grant will be used to prepare and encourage nurse to take leadership roles by participating on health care boards. Visit Oregon Center for Nursing to learn more.

This is a good time to remind ourselves of the 2010 Institute of Medicine report: The Future of Nursing: Leading Change, Advancing Health and the eight recommendations. We should think of what we can be doing concerning all of the recommendations.

Recommendation 1: Remove scope-of-practice barriers. Are nurses in my organization practicing at the full extent of their license? Are there protocols, administrative guides, standard operating procedures, and the like that effectively limit the practice of nursing? Am I practicing at

the full extent of my license?

Recommendation 2: Expand opportunities for nurses to lead and diffuse collaborative improvement efforts. Does my organization fully embrace the concept that nurses are members of the various teams planning, delivering, and evaluating services? Am I comfortable with those collaborative roles?

Recommendation 3: Implement nurse residency programs. At one point we were all students. At one point we were all brand new and knew very little. Someone helped us learn and mentored us. Does my organization provide opportunities for students and does it have programming for new nurses that gives both time and knowledge for the new nurse to become competent?

Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020. Oregon has nice work to provide academic pathways for nurses entering Associate Degree programs to commit to a bachelor degree. Most of the AD programs participate. However, it is up to us to provide opportunities for nurses without a bachelor degree to achieve that goal. On line programs, and programs with a portion of the program on site, have removed distance and timing as a barrier. The private sector is moving well on this standard both with hiring standards and support of continuing education. Public health nursing must do the same.

Recommendation 5: Double the number of nurses with a doctorate by 2020. We need to support nurses who want to continue their education and support programs that offer these degrees with placements

Recommendation 6: Ensure that nurses engage in lifelong learning. Does my organization support continuing education opportunities? Even if it does not, do I accept the idea that it is my responsibility as a professional to keep up my learning and education? It is my responsibility. This responsibility belongs to me not someone else. Do I a lot sufficient time? We also need to advocate for nursing education organizations to not forget the working nurse and provide opportunities for continuing education. I find more and more common when talking with a young newly education nurse that I say something like – well that wasn’t invented when I was in school.

Recommendation 7: Prepare and enable nurses to lead change to advance health. As you know each Gallup poll affirms that nursing is the most trusted profession. The IOM report calls out that trust, the public expectation of nursing participation, and the absence of nursing from leadership positions. The above mentions RWJ Foundation program is one strategy. We have a couple obligations. First we must advocate for, and prepare ourselves and nurses for leadership positions. Second we must provide the content so decision making bodies actually know what advances health. We need to ask ourselves – am I prepared tackle both those obligations? One of my roles with this recommendation is to remind those around the table that the second part of this recommendation [advance health] is as important as the first [lead change].

Recommendation 8: Build an infrastructure for the collection and analysis of interprofessional health care workforce data. Those of you interested in the workforce data end of things I encourage to contact Jana Bitton at the Oregon Center for Nursing. They can always use help and thinking. A short version of the recommendations can be found here.

I encourage all of us to periodically revisit the recommendations and ask ourselves – Am I doing what I can for my profession and its role to lead change and advance health? Public health nursing is uniquely positioned and educated for participation in this effort. Those who are interested in statewide efforts contact Jan through the above mentioned OCN link.

be well. te

Oregon Public Health Association: Nursing Section Late Fall/Early Winter 2015

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Addressing Alcohol Misuse in Public Health Settings by Becky Porter

Alcohol misuse, including binge drinking, is a costly health issue that contributes to diseases, accidents, injuries, violence, and unintended pregnancies1-2. In my early career as a health educator, I spent eight years working alongside public health nurses in a family health clinic that was part of an urban-based local health department. I saw a variety of people requesting anonymous or confidential HIV and STI testing. We addressed substance use through harm reduction techniques with the idea that doing so would help to decrease a person’s risk for infectious diseases. Although I do believe many individuals were able to change behaviors and reduce risks, some of the more challenging conversations involved talking to people about changing their drinking patterns. Discussing alcohol was more difficult in many ways than discussing other substances, given that it was legal for adults and was accompanied by a host of societal, cultural, and environmental dynamics that contributed to an individual’s pattern of use and perception of risk. Back then, I found it difficult to believe that I could influence people who were seeking care to change their drinking patterns. I thought that a being a specialist from a substance abuse treatment program was really what was needed to be effective. Much has been learned over the years about drinking behavior and the potential of health providers to address risky drinking. My current career path, ironically, now includes helping health care providers play an important role in identifying and addressing their patients’ at-risk alcohol use, and particularly reaching out to public health nurses to encourage their adoption of universal alcohol screening and brief intervention as an effective clinical preventive service.

Almost 30% of adults in the U.S. consume alcohol in a way that compromises health, however, only a small proportion of these, about 4%, are considered dependent on alcohol.3 Historically, alcohol and substance abuse has been seen as a problem that is treated through specialty care, and for that 4% who are dependent, a referral to treatment services is important. But what about the 25% of non-dependent drinkers who may be putting their own health and the health of others at risk, even though they are not considered clinically severe?4 For example, alcohol use during pregnancy increases risk of miscarriage, stillbirth, and fetal alcohol spectrum disorders (FASDs).5-6 Even moderate or occasional heavy drinking may impact health and increase societal issues. Patients who fall into this category of non-dependent drinkers may be unaware of their risks. Since these patients present for care in public health and primary care clinics, providers have an opportunity to address their drinking in the context of their overall health.

Alcohol screening and brief intervention (SBI) is a clinical preventive service that has proven effectiveness at reducing risky drinking with patients who are drinking too much but may not be experiencing a severe alcohol use disorder.7 To date, the practice has not been widely integrated into clinical care. Although many public health and primary care practice settings ask patients something about alcohol use, alcohol SBI begins with a validated set of standardized screening questions that can be easily scored to understand three important points: 1) Does my patient drink too much (i.e., is this person exceeding the nationally recommended limits for his or her sex, age, and health condition); 2) Has my patient already experienced alcohol-related problems (i.e., does his or her alcohol use connect to a chief complaint or other chronic medical concern), and; 3) How severe is my patient’s reliance on alcohol? For most positive cases, the brief intervention is a short and personalized conversation used to raise patient’s awareness about his or her risks and to enhance motivation toward behavior change. A follow-up visit produces greater drinking reductions, thus it is ideal to discuss alcohol use again in four to six weeks. Alcohol SBI can be done in a few minutes during the patient encounter and may be reimbursed by third-party payers.8

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Oregon Public Health Association: Nursing Section Late Fall/Early Winter 2015

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From Addressing Alcohol Misuse in Public Health SettingsAdopting Alcohol SBI in Nursing Practice In 2014 CDC funded the University of Alaska Anchorage (UAA) and the University of California San Diego (UCSD) to establish two of six national FASD Practice and Implementation Centers (FASD PICs). Concurrently, CDC funded the University of Pittsburgh School of Nursing (Pitt SoN) to provide leadership and coordination across a number of nursing national partner groups, including public health nurses. Together, we are working to promote nurses’ adoption of universal alcohol SBI as a means to routinely address alcohol misuse among all patients, including women of reproductive age, in order to prevent alcohol-related harms as well as to prevent alcohol exposed pregnancies and cases of FASDs. Additional FASD-PICs and National Partners were funded to focus on other health disciplines including, medical assistants; physicians practicing in OB-GYN, pediatrics, and family medicine; and social workers. Collectively, we are working within and across professional disciplines to develop the most current professional training, clinical resources, and technical assistance for implementing practice change.

A focus of our nursing outreach is to provide public health nurses and practice settings the following resources: 1) clinical training from experienced nurses offered as part of conference presentations, in-services, webinars, trainings, workshops, and/or seminars; 2) facilitated practice-based implementation, technical assistance, and evaluation for healthcare systems to integrate alcohol SBI into routine practice; 3) development of organizational documents including position statements, issue briefs, practice guidelines, and white papers promoting routine alcohol SBI, and; 4) centralized web-based training and resources specific to practicing nurses. Finally, we are seeking public health nurse champions who are interested in collaborating with us and take an active role in promoting alcohol SBI education and practice change. Training and staff support are provided as necessary.

Alcohol SBI is a cost-effective public health approach used to identify and intervene with people who drink too much. Many who receive alcohol SBI respond positively and will reduce risks over time. We hope that public health nurses across the country will avail themselves of these resources, and join in the effort to address this serious health issue as a part of routine clinical practice. Doing so can enhance practice competence, personal confidence, and the ability to effectively address patient alcohol use in order to improve health outcomes.

For more information on how to access alcohol SBI resources or to inquire about alcohol SBI nurse champion opportunities, contact Becky Porter at rrporter2@uaa.alaska.edu. 1 Centers for Disease Control and Prevention. Vital Signs: Communication between health professionals and their patients about alcohol use – 44 States and the District of Columbia. MMWR Morb Mortal Wkly Rep. 2014; 63(01):16-22.2 Rehm J. The risks associated with alcohol use and alcoholism. Alcohol Res Health 2011; 34(2): 135-43.3 Grant BF, et al. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002. Drug

Alcohol Depend. 2004 Jun 10(74):223-2344 Dawson DA, et al. Toward the attainment of low-risk drinking goals: a 10-year progress report. Alcohol Clin Exp Res 2004 Sep;28:1371-1378.5 Bailey BA, Sokol RJ. Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. Alcohol Res Health. 2011; 34(1):86-91.6 Sokol RJ, Delaney-Black V, Nordstrom B. Fetal alcohol spectrum disorder. JAMA. 2003; 290(22):2996-2999.7 Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. U.S. Preventive Services Task Force. Behavioral counseling intervention in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004 Apr 6; 140:557-68.8 Centers for Disease Control and Prevention. Planning & Implementing Screening and Brief Interventions for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices. Atlanta, GA: Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 2014.Becky Porter, MS, LPC is both a research staff member for the Center for Behavioral Health Research

at the University of Alaska Anchorage (UAA) and a mental health provider at the UAA Student Health Center. Becky manages the UAA FASD Practice and Implementation Center, emphasizing nurse

training to adopt and implement universal alcohol screening and brief intervention practices. Some of UAA’s work with Alaska public health nurses is featured on CDC’s website and can be found at this

link: http://www.cdc.gov/features/alcohol-alaska/ 

Oregon Public Health Association: Nursing Section Late Fall/Early Winter 2015

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From Pursuing Public Health: A Rarity Amongst New Nursing Grads?As new nursing grads, most of us come out of the chute wide-eyed and ready to save every living thing in our midst. We have the knowledge, we have the energy, and we are ready to do it all. Most of my classmates graduated nursing school with their eyes on hospital positions – Med/Surg, Cardiac, OR, ICU, ED, you name it. Perhaps this was solely due to our young adrenaline-inducing preferences, but perhaps it was also due to the lack of awareness about what public health nursing really is among young nurses. “Public Health” can be a vague term and nursing in this field is often overlooked by students for this reason. Students simply don’t know enough about what they could expect in a career as a public health nurse. When I realized that working in the hospital was not for me, I had to dig for information about what public health opportunities existed for nurses. This took a significant amount of investigation for me. So why is there this cloudy abyss looming over the public health nursing field for new nurses? I don’t think it’s the fault of any one organization or person. I think it may be due to a lack of focus and specificity regarding public health in many nursing programs, as well as a lack of recruitment efforts for new nurses made by major public health employers/organizations. I think it also may be due to the attitudes of this generation of nursing grads. I received many remarks from classmates about how “great” it was that I was interested in preventative health because of how needed it is, but most of my counterparts did not feel that it was “exciting” enough for them.

Regardless of why our city sees only a small percentage of new nursing grads trickle into the public health sector, I believe that more measures need to be taken to raise awareness of this specialty. In order for the public health nursing sector to maintain diversity in the age of it’s work force, students should be made aware of what public health nursing has to offer new grads, how vital public health nursing is to the health of a community, and what public health nursing opportunities are present for new nursing grads. There might be other nurses out there who would love public health as much as I do, but just don’t know where to start.

Looking back I am thankful that I took the initiative to become familiar with public health nursing. I have the amazing opportunity to work with clients each day as they take steps in eliminating disparities and increasing health equity. Going forward in my career, I hope to help make this field more understood by and connected to the new nursing population.

I don’t believe that there is any one area of nursing intervention that is more important than another. But having the opportunity to help a client move from a state of not knowing how to improve their diagnosis, or not even knowing what their diagnosis means, to making huge strides in improving their health status and taking initiative in their own health management? I think that’s pretty incredible.

Taylor Killen is a recent BSN grad from the University of Portland School of Nursing. She earned her RN last August and began working for the Multnomah County Health Department at the East County Health Center in October 2015. In her spare time, Taylor enjoys learning about new advances in Maternal/Child health, discovering new music, spending too much time at the gym, and eating good food with friends.

Oregon Public Health Association: Nursing Section Late Fall/Early Winter 2015

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Meet your newly-elected executive team members

Carol Easter: Chair Elect Carol is a Public Health Nurse Consultant in Oregon Health Authority (OHA) and has recently transferred to work in Reproductive Health after having worked in other areas of OHA, and Department of Human Services (DHS) sections, culminating a 15 year career, as of June 2016, with the State of Oregon. Prior to this she worked in CCU/ICU/Trauma, L&D, Occupational Health, Clinical Instructor in Nursing, and more for 15 plus years. She graduated from Walla Walla University School of Nursing before embarking on and more than 30 year nursing career. She looks forward to the next year of serving on the OPHA Nursing Section.

Kala Mayer: Secretary Kala Mayer is a registered nurse and assistant professor at the University of Portland in Portland, Oregon. Her major teaching and research interests are in population health nursing, community-driven participatory research, food and nutrition, and the social determinants of health. Her research and pedagogy frames food-health work as a site of interdisciplinary, integrated inquiry that encourages critical understanding of the determinants of food and health. Since fall 2014, Kala has served as a faculty member at the University of Portland where she teaches population health nursing and population health nursing clinical to undergraduate nursing students. In spring 2015, Kala entered into an action research partnership between the University of Portland School of Nursing and Home Forward that seeks to both explore and improve community health outcomes within housing sites over time. Kala is looking forward to furthering the field of population health nursing through her active involvement in OPHA Nursing.

Layla Garrigues: Board Representative I am honored to be the new Nursing Section Representative for OPHA. I am a Clinical Assistant Professor at Oregon Health and Science University, School of Nursing. My research interests include quality health care, patient safety, health disparities, and wound prevention (pressure ulcers and incontinence associated dermatitis). I have a background in community health education and have worked as a nurse in clinics, hospitals, home care, as well as internationally.

Oregon Public Health Association: Nursing Section Late Fall/Early Winter 2015

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Nursing Section

Want to submit an article for the newsletter? We’re happy to review it and add it to our next newsletter. Deadline for Winter Newsletter submission is February 15th. If you have any questions on the newsletter or want to guidelines for writing an article, email: opha.nursing@gmail.com.

In the News Place Matters Oregon

Place Matters Oregon is an effort of the Oregon Health Authority, Public Health Division that seeks to foster conversations about how place influences our individual and collective health. - Find out more about how where we live, work, play, and learn matters to our physical, mental, and emotional health. See more at: http://placemattersoregon.com/about-us/#sthash.yDdOAUIl.dpuf.

New Study: Sociodemographic Predictors of Vaccination Exemptions on the Basis of Personal Belief in California

A new study by Y. Tony Yang et al. examined “the variability in the percentage of students with personal belief exemptions from mandatory vaccinations in California schools and communities.” Read More: http://ajph.aphapublications.org/doi/10.2105/AJPH.2015.302926.

According to the CDC:“More than one-third of adults and 17% of youth in the United States were obese in 2011–2014. The prevalence of obesity was higher among women than among men overall and higher among non-Hispanic black and Hispanic adults compared with other racial and Hispanic origin groups. Among youth, no difference in obesity prevalence was seen between males and females, except among non-Hispanic Asian youth.” For more information visit: http://www.cdc.gov/nchs/data/databriefs/db219.htm.

Challenge your Health IQChallenge your Health IQ in this fun and educational health trivia app from the CDC. Available in GooglePlay http://bit.ly/1FrAifv and iTunes http://apple.co/1V8easC.