Running head: NURSINGS LEADERSHIP ROLE IN POPULATION BASED

Nursings Leadership Role in Population Based Issues

Valrey Llewlaka
Ferris State University

NURSINGS LEADERSHIP ROLE IN POPULATION BASED

Abstract
This paper is written to give the reader insight into the roles of a direct care public health nurse
and that of a leader/manager public health nurse during times of community emergency. These
two roles will be presented in light of potential responsibilities that each could entail.
Additionally, the writers insight into how these roles may fit the personality and experience of
said nurse will be explored. The focus is to define the similarities and differences of two aspects
of nursing roles that share a common goal, the health of the community served.

NURSINGS LEADERSHIP ROLE IN POPULATION BASED

Nursings Leadership Role in Population Based Issues
Nursing describes an extensive array of functions. The public tends to perceive of
nursing as caring for patients in the hospital setting. This writer believes that much work is
required on the part of the profession to widen the publics view of what nursing encompasses.
Nursing roles, inside and outside the hospital, include nurses who provide hands-on care of
patients; and those who become leaders in their area of expertise. One of the many areas where
nursing has the ability to impact lives is through the public health nurse role in emergency
preparedness.
The Direct Contact Nurse
According to the American Nurses Association (ANA) every nurse has the responsibility
to be involved with and prepare for disasters. Regardless of what specialty or position a nurse
holds, each must be prepared to make appropriate healthcare decisions in the face of emergency
conditions (American Nurses Association [ANA], 2008, p. 10). This statement indicates that
nurses should anticipate and prepare for loss of essential services (ANA, 2008, p. 13)
including interruption in the delivery of supplies and loss of running water. In some cases,
nurses may be called from their usual patient care roles into that of performing triage or assisting
in moving patients and equipment to alternate locations.
The public health nurse with the insight to gain knowledge and skill in emergency
preparedness may find that he or she is in a position that the Association of State & Territorial
Directors of Nursing (ASTDN) describes as competent public health nurses and public health
nurse leaders (2010). This leadership role was included in a five focus areas (ASTDN, 2010,
p. 8) identified by the ASTDN and CDC. The Enhancing the Capacity of Public Health
Nursing Through Partnerships (ASTDN, 2010) project looked at ways that nursing could

NURSINGS LEADERSHIP ROLE IN POPULATION BASED

support public health infrastructure [and] demonstrate the critical value of adequate public
health nursing (p. 8) by sharing information that impacts patient care from the unique view of
the professional nurse.
Characteristics of the public health nurse in a disaster includes recognition of the role his
or her particular agency plays, as well as that of his or her specific role in an emergency
(Harkness & DeMarco, 2012, p. 387). It is important for the disaster prepared nurse to
understand that deviations from the norm may be required in order to provide appropriate care
to the population affected (Harkness & DeMarco, 2012). The safety of all patients and
responders, triage of victims, and manag[ing] behavioral responses (Harkness & DeMarco,
2012) are areas that fall under the realm of public health nurses during times of disaster.
The American Nurses Association (ANA) offers professional standards for nurses that
are relevant to the role a direct contact nurse would play in the event of an emergency or disaster.
This includes the first standard, that of Assessment (American Nurses Association [ANA],
2010). With this standard, the nurse would collect data pertinent to the [patients] health
and/or the situation (ANA, 2010). Additionally, the public health nurse would be in a position
to implement the plan identified during disaster planning (ANA, 2010).
The Leader/Manager Nurse
A public health nurse leader can be found in any agency or organization that provides
nursing services to the public. Although responders such as police, firefighters and Emergency
Medical Service providers have taken the lead role in disaster preparedness, public health nurses
have the ability to play a crucial role in all phases of disaster management (Harkness &
DeMarco, 2012). Nursing leaders may be found in local health departments, hospitals, or private
care facilities. All it takes is for a nurse to apply his or her diverse knowledge base, []

NURSINGS LEADERSHIP ROLE IN POPULATION BASED

clinical skills, [] and commitment to public welfare [to the] disaster management process
(Harkness & DeMarco, 2012).
Public health nurses can become advocates at the state and local level of disaster planning
by translat[ing] and interpret[ing] information about [his or her] communities to
policymakers (ASTDN Committee on Eliminating Health Disparities, 2008) that relates the
needs of the local population. An effective leader commits to life-long learning [and]
collaborative leadership (Reyes, Bekemeier, & Issel, 2013) in order to contribute to the health
of the population he or she serves. Olson Keller, Strohschein, & Schaffer (2011) list the
cornerstones of public health nursing (p. 252) as focus on the health priorities and needs
[] of [the] entire population (p. 252). Being knowledgeable in these social determinants of
health [in the population he or she serves can help the nurse provide information to policy
leaders that can help reduce] the outcomes of risk (ASTDN Committee on Eliminating Health
Disparities, 2008). The public health nurse who demonstrates an understanding of the needs of
the community he or she serves reveals the characteristic of social justice and respect for the
worth of all people, especially the vulnerable (Olson Keller, Strohschein, & Schaffer, 2011).
Public health nurses in the role of collaborative disaster manager could be seen as having
the opportunity to demonstrate several of the ANA Standards of Professional Practice (2010).
Identifying the outcomes of a plan meets standard 3 and involves the ability to differentiate
between process interventions [and] system-level interventions (ANA, 2012). Being aware
of interventions necessary at the level of the overall system can be seen as indicating a nurse who
is prepared beyond the undergraduate level. Planning ahead for disasters falls under standard 4
(2012) of the ANA standards. Disaster planning can be enhanced when the public health nurse
knows the community he or she serves. Public health nurse leaders contribute in the

NURSINGS LEADERSHIP ROLE IN POPULATION BASED

development and continuous improvement of systems that support the planning process (ANA,
2010). Standard 5B addresses teaching and health promotion (ANA, 2010), two important
components of public health nurses. Taking the initiative to teach the community members
about how to prepare before disasters can reduce potential risk to the public during a disaster.
Analysis
The role of the public health contact nurse and that of the leader/manager are very similar
in that both are expected to know the unique needs of community he or she serves. The roles are
different in that the direct care nurse would be responsible for delivery of the planned care to the
best of his or her ability. During the delivery of care, the public health contact nurse may
perform rapid needs assessments of communities impacted by the incident (Stanley, Cole,
McGill, Millet, & Morse, 2013). This could include triage, patient care, and working in shelters
(Stanley, et. al., 2013). Nurse leaders can promote continuity of care by providing insight to
interdisciplinary teams, through collaborating with public and private partnerships (Norlander,
2011) during management of the disaster.
The roles of direct care public health nurses and leader/managers have the opportunity to
improve disaster management through build[ing] stronger relationships (Norlander, 2011)
between the members of the interdisciplinary teams. This can be done by address[ing] policy
issues that create barriers (Norlander, 2011) at the local, state, and federal level. Direct care
nurses could be seen to best support the community through providing appropriate care given the
circumstances of the disaster. A leader/manager public health nurse could make himself or
herself available to the disaster managers to provide guidance in areas that affect the health of the
community.

NURSINGS LEADERSHIP ROLE IN POPULATION BASED

Reflection
When this writer considers the skillset necessary for the role of direct care public health
nurse, it is found that the writers background is well suited to the task of patient care during a
disaster. This nurse has over twenty years as a paramedic working with diverse populations in a
number of settings. Performing triage and patient care with the threat of limited supplies would
be a routine task. The role of a nurse leader/manager would be more of a challenge due to
having more limited experience as a manager. To take on the public health nurse leader/manager
role in a disaster would require this nurse to obtain more education related to the role of a
manager. It is the desire of this writer to obtain that education by enrolling in the Disaster
Nursing-Emergency Preparedness course of Ferris State University. This nurse believes that
participating in that particular course would improve how the health and challenges of the overall
community would be affected during times of emergency.

NURSINGS LEADERSHIP ROLE IN POPULATION BASED

References
American Nurses Association (ANA). (2010). Nursing: Scope and standards of practice.
Silver Springs, Maryland: Author.
American Nurses Association (ANA). (2008). Adapting standards of care under extreme
conditions: Guidance for professionals during disasters, pandemics, and other extreme
emergencies. Silver Springs, Maryland: Author.
Association of State & Territorial Directors of Nursing (ASTDN). (2010). From a diamond in
the rough to the beauty of a gem: ASTDN celebrates 75 years, 1935-2010. Author.
ASTDN Committee on Eliminating Health Disparities. (2008). The public health nurses role in
achieving health equity: Eliminating inequalities in health. Association of State and
Territorial Directors of Nursing (ASTDN).
Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing: Evidence for
practice. Philadelphia, Pennsylvania, Wolters Kluwer Health | Lippincott Williams &
Wilkins.
Norlander, L. (Ed.). (2011). Transformational models of nursing across different care settings.
The future of nursing: Leading change, advancing health [Appendix G], 401-441.
Institute of Medicine.
Reyes, David J., Bekemeier, B., & Issel, L. M. (2013). Challenges faced by public health
nursing leaders in hyperturbulent times. Public Health Nursing. doi: 10.1111/phn.12078
Stanley, S. A. R., Cole, S., McGill, J., Millet, C., & Morse, D. (2013). The role of the public
health nurse in disaster preparedness, response, and recovery: A position paper.
Association of Public Health Nurses (APHN).