SPECIAL FEATURES: EDUCATION

The Henry Street ConsortiumPopulation-Based Competenciesfor Educating Public HealthNursing StudentsMarjorie A. Scha¡er, SharonCross, LindaO. Keller, PamelaNelson, PatriciaM. Schoon, and Pat Henton

ABSTRACT The Henry Street Consortium, a collaboration of nurse educators from universities and col-leges and public health nurses (PHNs) from government, school, and community agencies, developed 11population-based competencies for educating nursing students and the novice PHN. Although many orga-nizations have developed competency lists for experts, the Consortium developed a set of competencies thatclearly define expectations for the beginning PHN. The competencies are utilized by both education andpractice. They guide nurse educators and PHNs in the creation of learning experiences that developpopulation-based knowledge and skills for baccalaureate nursing students. Public health nursingleaders use the competencies to frame their expectations and orientations for nurses who are new to publichealth nursing. This paper explains the meaning of each of the 11 population-based competencies and pro-vides examples of student projects that demonstrate competency development. Strategies are suggested fornurse educators and PHNs to promote effective population-based student projects in public health agencies.

Key words: collaboration, partnerships, population-based nursing, public health nursing compe-tencies, public health nursing education.

The Henry Street Consortium, established in 2001, is agroup of five baccalaureate schools of nursing and the13 local health departments in the state of Minnesotathat developed a model for collaboration between pub-lic health nursing education and practice. One of theirmost important outcomes was the development of theEntry Level Population-Based Public Health NursingCompetencies (Minnesota Department of Health,2004), a set of entry-level competencies that met theneeds of both education and practice, and was easilyunderstood by students and novice nurses in publichealth nursing. The overarching goal of the Consortiumwas to redesign clinical experiences to be population-based, which meant that they: (1) focused on entirepopulations, (2) were guided by assessment of thecommunity’s health, (3) incorporated the determinantsof health, (4) addressed all levels of prevention, and (5)included all levels of practice (Keller, Strohschein, Lia-Hoagberg, & Schaffer, 2004) (Table 1).

Existing competency sets defined competenciesfor expert public health nurses (PHNs). The complexity

Marjorie A. Scha¡er, Ph.D., R.N., is Professor, BethelUniversity, St. Paul, Minnesota. Sharon Cross, M.S.P.H.,B.S.N., is PublicHealthNurse Clinician, Department ofPublicHealth,St. Paul RamseyCounty,St. Paul,Minne-sota. Linda O. Keller, D.N.P., R.N., F.A.A.N., is ClinicalAssociate Professor, School of Nursing, University ofMinnesota, St. Paul, Minnesota. Pamela Nelson, M.S.,R.N., is Assistant Professor, Bethel University, St. Paul,Minnesota. PatriciaM.Schoon,M.P.H., R.N., P.H.N., Re-tired, Maternal Child Health, Family Health, ChisagoCounty Public Health Department, St. Catherine Uni-versity, St. Paul, Minnesota and Distance Clinical In-structor, University of Wisconsin, Oshkosh,Wisconsin.Pat Henton, R.N., P.H.N., MaternalChild Health, Fam-ilyHealth,Chisago County Public Health Department,North Branch, Minnesota.Correspondence to:Marjorie A. Scha¡er, Bethel University, 3900 BethelDrive, St. Paul, MN 55112. E-mail: m-scha¡er@bethel.edu

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Public Health Nursing Vol. 28 No. 1, pp. 78–900737-1209/r 2010 Wiley Periodicals, Inc.doi: 10.1111/j.1525-1446.2010.00900.x

and detail of these competency sets created a barrierfor nursing students in understanding the fundamen-tals of public health nursing. The Henry Street Con-sortium was challenged to translate abstractcompetencies into specific, achievable goals for un-dergraduate nursing students. The Henry Street Con-sortium competencies are clear, action-oriented, andintegrate important values and attitudes needed topromote the health of populations. These competen-cies engage nursing students and novice PHNs inlearning the essential expectations for public healthnursing practice.

Background on ExistingCompetencies, Essentials,and Standards

Competencies are expectations that guide public healthnursing practice (Carter, Kaiser, O’Hare, & Callister,2006). They integrate the skills, knowledge, and atti-tudes needed by a PHN for effective practice (Council onLinkages Between Academia and Public Health Practice,2001). The Quad Council of Public Health Nursing Or-ganizations (2004) adopted the Core Competencies forPublic Health Professionals developed by the Council onLinkages Between Academia and Public Health Practicein 2001 and revised in 2009 (Public Health Foundation,2009). The Core Competencies provide a structure forthe training needs of public health professionals, devel-opment of job descriptions and performance review cri-teria, and assessment of knowledge gaps. The QuadCouncil (American Nurses Association [ANA], AmericanPublic Health Association, Association of CommunityHealth Nursing Educators [ACHNE], and the Associa-

tion of State and Territorial Directors of Nursing) iden-tified the applicability of the competencies to generalistand expert PHNs (Association of State and TerritorialDirectors of Nursing, 2003). While this competencyframework is effective in guiding the work of expert pub-lic health professionals, many of the competencies arebeyond the basic knowledge and skills expected of un-dergraduate nursing students.

Several educational organizations have estab-lished essentials for baccalaureate education that de-fine the foundational knowledge and skills necessaryfor the education of nurses. The Essentials of Bacca-laureate Education for Professional Nursing Prac-tice, developed by the American Association ofColleges of Nursing (AACN) (2008), identifies ‘‘thecurricular elements and framework for building thebaccalaureate nursing curriculum for the 21st cen-tury’’ (p. 3). One of these elements focuses on clinicalprevention and population health.

The ACHNE developed educational essentialsthat many academic programs use for developing cur-ricula and teaching-learning strategies to preparePHNs (2000). Although both the AACN Baccalaure-ate Essentials and the ACHNE Core Knowledge areasare very useful guides for determining the content toinclude in the public health nursing curriculum, theiruse is not easily translated for either practicing PHNsin the field or public health nursing students in theirclinical experiences.

ANA (1999, 2007) developed standards of practicefor public health nursing that outline ‘‘the expectations ofthe professional role within which all public health reg-istered nurses should practice’’ (2007, p. vii). Importantpublic health nursing concepts include determinants ofhealth, epidemiology, partnership, policy development,

TABLE 1. Entry-Level Public Health Nursing Competencies

1. Applies the public health nursing process to communities, systems, individuals and families2. Utilizes basic epidemiological principles (the incidence, distribution, and control of disease in a population) in public health

nursing practice3. Utilizes collaboration to achieve public health goals4. Works within the responsibility and authority of the governmental public health system5. Practices public health nursing within the auspices of the nurse practice act6. Effectively communicates with communities, systems, individuals, families, and colleagues7. Establishes and maintains caring relationships with communities, systems, individuals, and families8. Shows evidence of commitment to social justice, the greater good, and the public health principles9. Demonstrates nonjudgmental and unconditional acceptance of people different from self10. Incorporates mental, physical, emotional, social, spiritual, and environmental aspects of health into assessment, planning,

implementation, and evaluation11. Demonstrates leadership

Schaffer et al.: Population-Based Public Health Nursing Competencies 79

population, and social justice. The Public Health Nurs-ing Scope and Standards of Practice incorporates rec-ommendations from Institute ofMedicine (IOM) reportsfor educating the public health workforce (IOM, 1988,1995, 2003a, 2003b). Several of these reports emphasize‘‘the linkages and relationships among multiple factors(or determinants) affecting health’’ (ANA, 2007, p. 42).Although these important standards provide a frame-work for public health nursing practice, they do notclearly identify the activities that PHNs routinely per-form or the basic skills that public health nursing stu-dents are expected to master.

Development of Competencies

Consortium members reviewed existing sets of publichealth nursing competencies and other sources thatreflected public health nursing activities (ACHNE,2000; Allegrante, 2001; ANA, 1999; Core PublicHealth Functions Steering Committee, 1994; Councilon Linkages Between Academia and Public HealthPractice, 2001; Cross, Block, & Josten, 2003; Deiman,1988; Gebbie, n.d.; Knox, 1985; Missouri Departmentof Health Council of Public Health Nursing, n.d.;North Dakota State University, n.d.; U.S. Departmentof Health and Human Services, 1997). Additionalsources included public health nursing position de-scriptions from counties represented in the Consor-tium, public health nursing course syllabi, andMinnesota law related to public health nursing. Arti-cles written by public health nursing experts were alsoreviewed for the skills, knowledge, and attitudes thatunderlie public health nursing practice (Gebbie &Hwang, 2000; Kaiser & Rudolph, 1996; Kenyon, Smith,Hefty, Bell, & Martaus, 1990; Nickel, 1995; Snow,Hefty, Kenyon, Bell, & Martaus, 1992; Zerwekh, 1990).

Consortium members divided into four work-groups consisting of equal numbers of public healthnursing educators and public health nursing staff. Thegroups analyzed the following practice frameworks forthe skills, knowledge, and attitudes needed by PHNs:

� Core Competencies for Public Health Professionals(Council on Linkages BetweenAcademia and Practice,2001),

� Essentials of Baccalaureate Nursing Education forEntry Level Community/Public Health Nursing(ACHNE, 2000),

� Scope and Standards of Public Health NursingPractice (ANA, 1999), and

� Essential Public Health Services (Core PublicHealth Functions Steering Committee, 1994).

In order to meet the needs of both practice andeducation, existing documents were reviewed throughdual lenses. From the practice perspective, the work-groups analyzed health department job descriptions,performance evaluations, interview questions, and jobadvertisements and compared them with the skill,knowledge, and attitudes identified from the existingframeworks. From the education perspective, theworkgroups examined public health nursing coursesyllabi, clinical student performance evaluation tools,learning activities, and assignment guidelines andconducted a similar analysis.

The resulting competency lists from each of thefour workgroups were compiled and synthesized tocreate a single list of competencies. The entire mem-bership reviewed numerous iterations and refine-ments of the list, ultimately yielding the desired setof competencies that represented both practice andeducation. Table 2 provides a comparison of theHenry Street Consortium competencies with compe-tency and three other practice frameworks in use atthe time of competency development.

Competency Use by Educators andPublic Health Nurses

Public health nursing educators have used the HenryStreet Competencies to both frame learning and as-sess baccalaureate nursing students’ accomplishmentof the population-based public health nursing compe-tencies. Public health nursing educators at one uni-versity in the Consortium developed a portfolioassignment that asked students to reflect on learningexperiences consistent with the competencies, iden-tify relevant population-based public health concepts,and evaluate their growth and preparation for futurenursing practice (Schaffer, Nelson, & Litt, 2005). Thecompetencies also provide a clear and straightforwardguide for PHN managers and supervisors in healthdepartments to frame expectations for entry-levelperformance for the beginning PHN. In partnershipwith educators, PHNs use the competencies as a guideto create student-learning experiences that are con-sistent with key expectations of both nursing facultyand health department staff. This article explains theessence of each competency and presents student pro-

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TABLE 2. Comparison of Henry Street Entry-Level PHN Competencies to Other Public Health Practice Frameworks

Entry-Level Population-Based PHN CompetenciesHenry Street Consortium,2003 11 competencies

Core Competencies for PublicHealth Professionals Council onLinkages, 2001; Quad Council[ANA, APHA, ACHNE, ASTDN]competencies, 2003 18 domains

Scope and Standards of PublicHealth Nursing AmericanNurses Association, 1999 6

standards of care; 8 standardsof professional performance

Essential Public HealthServices Core Public Health

Functions Steering Committee(1994) 10 core functions

#1 Applies the public healthnursing process tocommunities, systems,individuals and families

Analytic/assessment skillsPolicy development and program

planning skillsCultural competency skillsCommunity dimensions of

practice skills

Standards of careAssessment; diagnosis;outcome identification;planning; assurance;evaluation

Monitor healthDiagnose and investigateInform, educate, andempowerLink to/provide careEvaluateSystem management andresearch

#2 Utilizes basicepidemiologicalprinciples (theincidence, distribution,and control of disease ina population) in publichealth nursing practice

Analytic/assessment skillsCommunity dimensions of

practice skillsBasic public health sciences skills

Standards of careAssessment; diagnosis;outcome identification;planning; assurance;evaluation

Diagnose and investigate

#3 Utilizes collaboration toachieve public healthgoals

Communication skillsLeadership and systems thinking

skills

CollaborationCollegiality

Mobilize communitypartnerships

Link to/provide care#4 Works within the

responsibility andauthority of thegovernmental publichealth system

Policy development and programplanning skills

Cultural competency skillsCommunity dimensions of

practice skillsFinancial planning and

management skillsLeadership and systems thinking

skills

Quality of carePerformance appraisalResource utilization

Develop policesEnforce laws

#5 Practices public healthnursing within theauspices of the nursepractice act

Analytic/assessment skillsPolicy development and program

planning skillsCommunity dimensions of

practice skills

Standards of careAssessment; diagnosis;outcome identification;planning; assurance;evaluation

Assure competent workforce

#6 Effectivelycommunicates withcommunities, systems,individuals, families,and colleagues

Communication skillsCultural competency skillsFinancial planning and

management skills

Education Link to/provide care

#7 Establishes andmaintains caringrelationships withcommunities, systems,individuals, and families

Communication skillsCultural competency skillLeadership and systems thinking

skills

Quality of careEducationEthics

Inform, educate, andempower

Mobilize communitypartnerships

Link to/provide care#8 Shows evidence of

commitment to socialjustice, the greater good,and the public healthprinciples

Analytic/assessment skillsCommunication skillsLeadership and systems thinking

skills

Quality of careEthics

Inform, educate, andempower

Mobilize communitypartnerships

Develop polices#9 Demonstrates

nonjudgmental andunconditionalacceptance of peopledifferent from self

Communication skillsCultural competency skillsLeadership and systems thinking

skills

Ethics Inform, educate, andempower

Mobilize communitypartnerships

Schaffer et al.: Population-Based Public Health Nursing Competencies 81

jects that illustrate learning experiences for buildingskill in and understanding each competency.

Evidence for Population-BasedStudent Projects

Henry Street Consortium members from health de-partments submitted written descriptions of collabo-rative projects. All of the projects were population-based and engaged public health nursing students inaspects of assessment, planning, implementation, orevaluation. Traditional undergraduate students oftenworked on projects in groups, while R.N. to B.S.N.students generally worked one on one with a precep-tor or staff team. Although a specific project isascribed for each competency, the projects oftenrepresented more than one competency.

All population-based student projects aregrounded in actual community assessments and com-munity plans completed by public health staff in localhealth departments. Brownson (2003) declares thatevidence-based public health must include data andscientific evidence, input from community members,input from other stakeholders, and professional expe-rience. The community health plans are based onpublic health data that health department staff ana-lyze to determine priority health needs. The decisions

about priority needs are influenced by input or pref-erences from community members and leaders. Localhealth departments then develop an action plan to re-spond to the identified needs (Minnesota Departmentof Health, 2009). They use published research whenavailable and expert opinion developed from profes-sional practice experience to determine the actionplan. Local health department staff used communityhealth data and priorities from the community healthplans to select and guide student projects.

In addition, the interventions featured in the pro-ject are supported by the Public Health InterventionWheel (Keller et al., 2004), a practice-based, evi-dence-supported model. In 2001, the evidence baseof the Wheel was validated by a rigorous critique byhundreds of regional and national PHN experts. The‘‘Wheel’’ depicts how PHNs improve populationhealth through interventions with communities, iden-tified individuals within communities, and the sys-tems that impact health. It includes 17 interventions:surveillance, disease and other health threat investi-gation, outreach, screening, case-finding, referral andfollow-up, case management, delegated functions,health teaching, counseling, consultation, coalitionbuilding, collaboration, community organizing, advo-cacy, social marketing, and policy development andenforcement (see Table 3).

TABLE 2. Continued.

Entry-Level Population-Based PHN CompetenciesHenry Street Consortium,2003 11 competencies

Core Competencies for PublicHealth Professionals Council onLinkages, 2001; Quad Council[ANA, APHA, ACHNE, ASTDN]competencies, 2003 18 domains

Scope and Standards of PublicHealth Nursing AmericanNurses Association, 1999 6

standards of care; 8 standardsof professional performance

Essential Public HealthServices Core Public Health

Functions Steering Committee(1994) 10 core functions

#10 Incorporates mental,physical, emotional,social, spiritual, andenvironmental aspectsof health intoassessment, planning,implementation, andevaluation

Analytic/assessment skillsCultural competency skills

Standards of careAssessment; diagnosis;outcome identification;planning; assurance;evaluation

Inform, educate, andempower

Link to/provide care

#11 Demonstratesleadership

Policy development and programplanning skills

Communication skillsCommunity dimensions of

practice skillsFinancial planning and

management skillsLeadership and systems thinking

skills

Quality of carePerformance appraisalEducationCollegialityEthicsCollaborationResource utilization

Mobilize communitypartnerships

Develop policesAssure competent workforce

82 Public Health Nursing Volume 28 Number 1 January/February 2011

Entry level population-based public healthnursing competencies

Competency 1: Applies the public healthnursing process. This competency addresses PHNuse of the nursing process in their work in publichealth settings. PHNs expand the nursing process toapply to communities and systems in addition to in-dividuals and families. One of the most importantskills for this competency is conducting a communityassessment and determining community priorities.Assessment of populations includes analysis of thehealth determinants that contribute to the health sta-tus of populations. Determinants of health include thesocial, economic, perinatal, nutritional, behavioral,and environmental factors that influence the healthstatus of population groups (Novick & Mays, 2001).Health statistics and health program evaluation dataare analyzed to help determine priority populationhealth needs. PHNs use existing partnerships and de-velop new partnerships in planning evidence-basedinterventions that have the greatest potential for im-proving the health of the population. PHNs, in part-nership with others, select all applicable levels ofpractice (community, systems, and individual/family)and all relevant levels of prevention (primary, second-ary, and tertiary). The Public Health InterventionWheel (Keller et al., 2004) provides a framework forselecting population-based public health interven-tions. The evaluation step of the nursing process in-volves measuring the outcomes of public healthnursing interventions and documenting both processand outcome.

An R.N. to B.S.N. degree student applied the pub-lic health nursing process when working on the devel-opment of an asthma tool kit. Together with healthdepartment staff, the student contributed to assessingthe need for education about asthma, planning theproject, and creating the tool kit for parish nurses touse in faith-based communities. The student searchedthe Internet, reviewed existing resources for informa-tion about asthma and asthma tool kits, and devel-oped and assembled a comprehensive tool kit, whichincluded the symptoms, triggers, and management ofasthma. The tool kit was tailored for faith-based com-munities and represents a community-level interven-tion for the asthma population in faith-based settings.

Competency 2: Utilizes basic epidemiolog-ical principles. This competency focuses on PHNsutilization of the science of epidemiology to identify

TABLE 3. Evidence Supporting Student Projects

All of these student projects were based in actual communityneed and contributed to meeting the health improvement goalsof the local health departments

ProjectPublic health interventions

and practice level

Asthma tool kit for parish nursesand faith-based communities

Health teaching(community)

Best practices for head licemanagement

Consultation (communityand systems)

Policy development andenforcement(community)

Teen labor and delivery classes Collaboration (community)Health teaching

(community)Natural disaster preparedness Community organizing

(community)Outreach (community)Policy development

(systems)Dental health screening Health teaching

(individual)Outreach (community)Policy development

(systems)Screening (community)Surveillance (community)

Teen program satisfaction survey Collaboration (community)Policy development

(systems)Surveillance (community)

Revision of pregnancy free clubsurvey

Advocacy (community)Collaboration (community)Counseling (individual)

Latino health survey Advocacy (community)Collaboration (community)Health teaching

(community)Outreach (community)Surveillance (community)

Early childhood screeningoutreach

Collaboration (community)Outreach (community)Screening (community)

Walkability project Community organizing(community)

Policy development(systems)

Social marketing(community)

Analysis of state survey onstudents

Outreach (community)Policy development

(systems)Surveillance (community)

Source: Keller et al. (2004).

Schaffer et al.: Population-Based Public Health Nursing Competencies 83

and control health problems in populations. Throughapplication of the epidemiological process, publichealth nursing programs and services respond tohealth concerns identified in the community assess-ment. PHNs use epidemiological evidence to identifyinterventions that increase protective factors forhealth and reduce risk factors that contribute to dis-ease, illness, and injury. Application of epidemiologi-cal principles requires knowledge about the incidenceand distribution of disease in a population and strat-egies for reducing disease. Analysis of the interactionsof the host, agent, and environment (the epidemiolog-ical triangle) is necessary to plan interventions forprotecting health and reducing the risk factors thatcontribute to the incidence of disease.

A student group used the epidemiological processto respond to a growing head lice problem in a com-munity; they surveyed clinics, school nurses, andpharmacies to determine community norms for headlice treatment. Health department staff used the sur-vey findings to develop pediculosis treatment and pre-vention guidelines based on best practices. Studentsdisseminated the guidelines to community providers;many providers changed their recommendations forthe treatment of pediculosis. The health departmentbecame known as a helpful and reputable source forinformation and the community benefited through in-creased knowledge of tools for safe and effective headlice treatment (Monsen & Keller, 2002). The practicechange in head lice treatment focused on both com-munity- and systems-level interventions for popula-tions affected by pediculosis.

Competency 3: Utilizes collaboration. Anessential skill for PHNs is the ability to collaboratewith colleagues, community organizations, and clientsto deliver effective public health services. PHNs col-laborate with interdisciplinary community partners toachieve common public health goals for individuals,families, and communities. Individuals representing abroad range of disciplines, organizations, and servicescollectively come together for joint action to respondto community needs and enhance community assets.The ability to initiate and maintain partnerships is es-sential to the effective practice of population-basedpublic health nursing.

Nursing students partnered with a health depart-ment, school district, childbirth educators, and facultyto provide labor and delivery classes for a teen popu-lation. A group of students met with health depart-

ment staff and community partners to discussexpectations for program content. Students developedclass outlines and lesson plans, facilitated five laborand delivery classes, engaged and interacted withteens, and presented the project to public health staffat the end of the practicum. The student-developedcurriculum was integrated into the school district pro-gram. This population-based, community-focusedproject assisted the health department to meet itscommunity health priority of reducing the risk of pre-mature births and low-birth-weight babies.

Competency 4: Works within the govern-mental public health system. PHNs who work inofficial health departments must consider the govern-mental scope of their work. PHNs understand the re-lationship among the federal, state, and local levels ofthe public health system and identify their organiza-tion’s responsibilities within the context of the Essen-tial Public Health Services and Core Functions(assessment, policy development, and assurance).Critical to PHN practice is the nurse’s understandingof the independent public health nursing role as de-scribed in the Scope and Standards of Public HealthNursing (ANA, 2007) and legal issues such as publichealth nuisance, quarantine, commitment laws, dataprivacy, and mandated reporting. Additionally, thePHN must be knowledgeable and adept at using mul-tiple funding sources and community resources.

A student learned about the organization and re-sponsibilities of governmental systems though work-ing on an emergency preparedness project. Thestudent developed a resource manual that includedstate health department emergency preparedness re-sources, natural weather disaster risk maps, commonweather-related trauma and injury risks, and mentalhealth resources. The student’s work culminated inthe Disaster Event Injury and Needs AssessmentTool. This tool was used to document the needs, inju-ries, client complaints, and plan of care for evacuees.When Hurricane Katrina evacuees moved into thecounty, the tool was used to assess the needs of thispopulation. The project addressed community-focused interventions and assisted health departmentstaff to efficiently and effectively assume their govern-mental responsibility to meet the needs of a relocatedpopulation following a natural disaster.

Competency 5: Practices within the nursepractice act. This competency addresses the legalrequirements for the practice of public health nursing.

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All PHNs practice under the provisions of the nursepractice act in their individual states. PHNs distin-guish between actions delegated to them, such as giv-ing immunizations or distributing contraceptives, andmany of the independent functions identified on thePublic Health Intervention Wheel, such as healthteaching, counseling, and community organizing(Keller et al., 2004). Their scope of practice requiresensuring confidentiality for all clients and meeting theethical, legal, and professional requirements outlinedin the nursing practice act. The establishment of pro-fessional boundaries is particularly important in acommunity environment in which the boundaries be-tween professional and personal relationships can bemore easily blurred. For those states that have PHNcertification or registration, the PHN also needs tounderstand the requirements and scope of practicespecific to that state.

Students learned about independent publichealth nursing functions that are covered in the statenurse practice act through their work on an oralhealth project (focusing on the interventions of sur-veillance, outreach, screening, health teaching, andpolicy development). They collaborated with PHNswho had the goal of increasing the detection of andinterventions for poor oral health of pregnant teensserved by the health department. Students completedan assessment through key informant interviews andan analysis of health determinants, developed an oralassessment tool for PHNs to use in their practice, andcreated a brochure about oral health practices forpregnant teens. The PHNs now routinely include as-sessment questions on dental health for pregnantteens and the oral assessment tool has been modifiedfor use with all family health client populations. Thisproject is consistent with a community-level interven-tion and resulted in a systems change in the oralhealth assessment for families.

Competency 6: Effectively communicateswith communities, systems, and individuals.Public health nursing practice requires excellent com-munication skills, not only to work with individualsand families but with multiple community partnersand organizations. PHNs are required to disseminatehealth messages on numerous topics to diverse popu-lations. They work with the entire community, includ-ing clients, county board members, legislators,educators, social workers, environmental healthexperts, health educators, nutritionists, researchers,

physicians, and many others. This competency re-quires the ability to effectively communicate demo-graphic, statistical, programmatic, and scientificinformation in an understandable, professional, re-spectful, culturally sensitive, and accurate mannerthat promotes desired outcomes. PHNs must alsodemonstrate competence in utilizing computerizeddocumentation systems and programs for data analy-sis and reporting.

Students learned to effectively communicate eval-uation data to decision makers in a project thatinvolved reporting data from a high-risk teen popula-tion, which was a resurvey of teen satisfaction with thechanges in the services offered. Health departmentstaff, school faculty, and PHNs met with studentsto review previous survey questions and revise themto address program changes. Nursing students con-ducted 86 random phone interviews, analyzed andreported data to staff, and recommended programchanges. The teen data were combined with other pro-gram evaluation data for submission to the countyboard of commissioners and other program funders.The report provided valuable insights into the factorsthat influence pregnant and parenting teen behaviorand implications for public health nursing practice,contributing to the design of effective community andsystems-level interventions.

Competency 7: Establishes and maintainscaring relationships. Similar to all nurses, PHNsdevelop relationships with individuals and families.However, PHNs must also be skilled in establishingcaring relationships with communities and systems.Important components of a caring relationship includethe demonstration of trust, respect, and empathy ininteractions. Maintaining effective relationships withcommunity partners and organizations requires fol-lowing through with commitments and being tactfuland diplomatic in all communication.

Nursing students learned about the importanceof building caring relationships with teen mothers inan alternative school that serves pregnant and parent-ing teens. Teen mothers in the school have the optionof participating in the Pregnancy Free Club, whichfocuses on delaying a repeat pregnancy while inschool (Schaffer, Jost, Pederson, & Lair, 2008). Focusgroups revealed that the teen mothers felt that someof the program survey questions were intrusive. Incollaboration with PHNs, four nursing studentsworked together to revise the questionnaire based on

Schaffer et al.: Population-Based Public Health Nursing Competencies 85

focus group feedback. This is an individual-levelintervention for an adolescent parent population.Through their interactions with the teen mothers, thenursing students were able to establish empatheticand respectful relationships with the teen mothers.

Competency 8: Shows evidence of commit-ment to social justice. PHNs seek health equity foreveryone in their communities. PHNs diligently workto reduce the many health disparities that exist. Socialjustice and respect for the worth of all people, espe-cially the vulnerable, are core values in public healthnursing. For this competency, PHNs differentiate be-tween social justice and market justice and are acutelyaware of the impact of market justice on health. Theypromote social justice in all of their interactions, withthe goal of contributing to the well-being of popula-tions and ultimately to the greater good. A key publichealth nursing skill for this competency is advocatingfor those who do not have a strong voice in makingtheir health needs known.

Students addressed health disparities in a Latinopopulation by seeking out the perspectives of the pop-ulation group. Latino immigrants in a suburban com-munity attended a Catholic Church and soughtservices from a Latino resource center. The initialgroup of senior nursing students worked with a pub-lic nursing supervisor and resource center staff to de-velop a culturally sensitive health survey in Spanish.The resource center staff reviewed the translation forquality and accuracy and the health department com-munication specialist formatted the survey using aculturally appealing design. The survey was adminis-tered to the Latino population after church services.In the following semester, a student group from adifferent school of nursing analyzed the survey andcreated a report. Later student groups created posterdisplays that addressed important health needs iden-tified in the survey, including appropriate disciplinefor children and dental health. Interventions involvedcommunity-level assessment and planning educa-tional presentations that targeted the Latino popula-tion to increase their access to health care and healtheducation.

Competency 9: Demonstrates nonjudg-mental/unconditional acceptance of people.PHNs respect other cultures and ways of thinking.Population-based public health nursing practice re-quires nurses to explore the influence of cultural, so-cial, spiritual, religious, and behavioral factors in all

their interactions. PHNs consider and integrate di-verse opinions and perspectives into their practice.They interact sensitively and respectfully with popu-lations that are different from self, including differ-ences in culture, socioeconomic status, education,race, ethnicity, gender, sexual orientation, religiousbackground, or age.

Nursing students had the opportunity to respectthe perspectives and experiences of African Americanparents in a program improvement project for a childhealth program. School staff had identified a need toincrease the participation of African American familiesin early childhood screening. In collaboration with thestudent wellness administrator, nursing studentsstudied state law, reviewed program information, andanalyzed community data. They observed the earlychildhood screening process, surveyed parents, andconducted key informant interviews with the parents.Findings indicated a variety of ways in which parentsaccessed the program. Students recommended out-reach methods to increase parent knowledge andparticipation in the program, a community-level inter-vention. As a result of the student recommendations,an additional 15 families enrolled in the program.

Competency 10: Incorporates the mental,physical, emotional, social, spiritual, andenvironmental aspects of health. PHNs inte-grate the mental, physical, emotional, social, spiritual,and environmental aspects of health into their assess-ment, planning, implementation, and evaluation. In-tegrating this holistic approach to health is especiallyimportant in PHNs’ work with community neighbor-hoods and family environments. Strategies for im-proving health through addressing environmentalissues are particularly applicable to communities andsystems.

Nursing students completed a project that con-sidered the holistic nature of health in a communitythrough increasing safe and pleasant walking oppor-tunities for community residents. Students collabo-rated with health promotion staff and their nursinginstructor to complete an analysis of walking paths ina city surrounded by rural countryside. A studentgroup divided the city into walking routes of 1.5–2miles; they rated and scored each route using a check-list and also took photos. Students compiled the data,organized photos, and presented their findings tohealth department and city officials. Residents andcity officials became more aware of safe walking

86 Public Health Nursing Volume 28 Number 1 January/February 2011

opportunities. As a result, the town received a grant toimprove walking paths as part of the Safe Routes toSchool Program. The project resulted in a communitylevel change for community residents at risk for a sed-entary lifestyle.

Competency 11: Demonstrates leadership.PHN leaders look for leadership opportunities to ini-tiate strategies that improve the health status of com-munities. They both engage and build the capacity ofothers to contribute knowledge and expertise toaccomplish needed change. PHN leaders meld theirability to work collaboratively and in partnership withothers with their independent and autonomouspractice in unstructured environments. PHNs dem-onstrate leadership when they identify a population-based issue and seek community solutions to theissue. The effective PHN leader tolerates ambiguity,adapts to change, and maintains flexibility whileassuring quality standards.

An important leadership strategy for PHNs is cre-ating opportunities to communicate information tokey decision makers for the allocation of public healthdollars. Students worked with the adolescent healthcoordinator and a local health department to identify10 key youth risk-taking behaviors in the MinnesotaStudent Health Survey. They examined school districtdata and compared the results with other county andstate data. The students then graphed the compara-tive data and wrote a summary report. The health de-partment incorporated the report into the communityassessment they were conducting. The report was alsoused to inform staff about specific youth risk-takingbehavior and assist in establishing adolescent pro-gram priorities. The project resulted in community-and systems-focused change.

Summary of Henry Street Entry-LevelPopulation-Based Competencies

The Henry Street Competencies provide a clearframework for preparing nursing students and novicePHNs for public health nursing practice. The compe-tencies are grounded in the essential content of exist-ing public health nursing competency sets andstandards. The Henry Street Competencies provide arefined, focused, and simplified competency list thatwas developed in partnership between faculty andPHNs from local health departments who actuallyhire new PHNs. The competencies provide a balanced

set of expectations and common language for faculty,students, and PHNs in the practice community. Theopportunity for students to share their assessmentsand projects with professionals, community leaders,and legislators gives them a unique insight into theirfuture professional role. The students demonstrateleadership and receive recognition for real work thatcontributes to promoting the health and well-being ofpopulations.

Strategies for Effective NursingStudent Projects

Henry Street members have learned to identify rele-vant student projects that meet the service-learning re-quests from local health departments, interests of thestudents, and educational goals. Although the projectsdescribed in this article represent collaboration be-tween schools of nursing and local health departments,many of the projects could be adapted and imple-mented in nonofficial agencies. Henry Street Consor-tium members disseminate innovative project ideasand lessons learned at their consortium meetings.

Promoting effective student projects requiredrole clarification and a willingness to discuss tensionsand conflicts. Through ongoing dialogue, local healthdepartments realized that they are partners in design-ing effective student-learning experiences. Facultymembers became skilled in negotiating projects thatare feasible in scope for student learning and alsomeet the expectations of health departments.

‘‘Behind the scenes’’ actions contributed to assur-ing effective student projects. The educator must beinvolved in all stages of projects, beginning with initialcontact of PHNs to identify potential projects 2months or more ahead of time. Student groups versusa single student broaden the scope of feasible projectsand provide the opportunity to learn collaborationskills. In areas where there are multiple schools ofnursing that utilize health departments for clinicalsites, projects may be divided into components andshared between schools. This allows schools to take onlong-term projects based on priority health needs ofthe community. For example, a student group fromone school of nursing can conduct the assessment, astudent group from another school of nursing canprovide the intervention in the following semester,and a third student group can evaluate the effective-ness of the project. Frequent communication betweenfaculty and nurses in the health department who

Schaffer et al.: Population-Based Public Health Nursing Competencies 87

TABLE4.Stra

tegiesforPromotingEffective

NursingStuden

tProjectsin

PublicHea

lthAgen

cies

Publichealthnursehealthdep

artm

entaction

sNursingfacu

ltyaction

s

Becom

efamiliarwithstuden

ted

ucation

allevela

ndcourse

objectives

Exp

lain

projectsaredetermined

bycommunityan

dhealth

dep

artm

entneeds

Com

municatevaluean

dusefulnessof

paststuden

tprojects

Appointaconsisten

tstaffliaisonwithavailability

andcontact

inform

ation

Exp

lain

connection

ofproject

goalsto

publichealthou

tcom

esRefl

ectwithstuden

tson

application

ofpublichealthnursing

concepts

duringproject

planningan

d/orim

plemen

tation

Facilitatestuden

tpresentation

ofprojects

Publicizestuden

tinvo

lvem

entin

publichealthof

community

through

localm

edia

Emphasizepop

ulation

focu

sof

project

versusindividual

focu

s

Match

projectsto

needsof

healthdep

artm

entan

dstuden

tlearningneeds

Begin

collab

orationwithhealthdep

artm

entstaffearlyforad

equatedevelop

men

ttimeforproject

ideasan

dplanninglogistics

Clarify

project

goalsan

dhealthdep

artm

entstaffan

dfacu

ltyexpectation

sforou

tcom

esof

project

andcontribution

topublichealth

Providehealthdep

artm

entstaffan

dstuden

tswithneeded

contact

inform

ation

Providedirection

andconsultationto

studen

tsforproject

develop

men

tan

dim

plemen

tation

Com

municateregu

larlywithhealthdep

artm

entstaffab

outan

yconcernsan

dstuden

tprogress

Provideinform

ationab

outrelevantresources

relatedto

project

such

asWeb

sitesor

community

agen

cies

88 Public Health Nursing Volume 28 Number 1 January/February 2011

coordinate student experiences is essential. For ex-ample, faculty should make the course syllabus avail-able to nurses who precept students. In addition,nursing faculty should arrange to meet with healthdepartment staff following the completion of the clin-ical to evaluate projects.

Both PHNs and faculty members should seek op-portunities to help students reflect on how their activ-ities are population-based. Students are oftengrounded in a world of acute care to individuals; pub-lic health experiences can spur their growth in sys-tems thinking. Finally, celebrate the success ofstudent projects. Publishing the activities in localnewsletters and newspapers validates the importanceof student work to the public. See Table 4 for a de-tailed list of suggested strategies that health depart-ment staff and nursing faculty members canimplement to ensure greater success in collaborativeprojects.

The Henry Street Consortium members, repre-senting nursing practice and education, collaboratedto develop the Henry Street Public Health NursingCompetencies. The competencies have been instru-mental along with the Public Health InterventionWheel in guiding nursing students’ learning experi-ences. The competencies provide a concise and con-crete framework that has engaged nursing students inlearning the expectations for public health nursingpractice.

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