Way back in the not-so-groovy 1980s when I graduated from nursing school, all of my nursing instructors told me I would have to work in a hospital setting for several years before being able to work in community/public health, which is what drew me to nursing to begin with. Thankfully, I did not listen to them and went straight into my first nursing job as Hypertension Nurse Coordinator for the Richmond Health Department. This is a photo of me wearing my requisite navy blue public health nursing duds and shaking hands with then Virginia Governor Chuck Robb. I was in his office that day with the Richmond Urban League staff with whom I worked on community-based hypertension control projects in churches. I loved my first job as a public health nurse and I have continued to love all my subsequent community/public health nursing jobs since then. I would have made a miserable hospital nurse and most likely would have left nursing altogether if forced to work in a hospital. To be clear, I have nothing against hospital nurses (and indeed they have saved my life in the past!), but the community is where my passion lies.
Why are nursing instructors still telling nursing students that they have to work in a hospital setting upon graduation? Is it because this is what they were told and they don’t question it? Where in the world do they get this silly and completely outdated notion that hospital nursing experience is the only experience that makes for a ‘real nurse?’ Why would a nurse with hospital experience make for a better community/public health nurse? And why are we still educating nurses almost exclusively in acute care/tertiary care hospital settings?
In a 1961 New England Journal of Medicine article “The Ecology of Medical Care,” Kerr White wrote about how serious questions could be raised about medical and nursing students’ clinical experiences in academic medical center hospitals–giving them a limited and biased view of the health care needs of a community. “Medical, nursing, and other students of the health professions cannot fail to receive unrealistic impressions of medicine’s task in contemporary Western society” (as quoted in Thomas Bodenheimer and Kevin Grumbach’s Understanding Health Policy: A Clinical Approach, McGraw-Hill, 2012). Surely in ‘modern’ nursing education we could easily find more community-based clinical rotation sites in areas like pediatrics, OB/GYN, psych, and chronic disease and transition care. The 2010 Institute of Medicine’s Future of Nursing report admonished us to do that; four years later I see no concrete improvements in this area.
I’ve written about this topic before and refer you to the still relevant blog post from 2012, Dear Grads: Please Go Directly Into Community/Public Health Nursing. Along with the advice and links to resources I gave in this previous post, I add the following:
- We need to make it easier (and preferable) for pre-nursing students to gain volunteer experience in outpatient and community settings and not simply send them to the closest hospital to be modern-day Candy Stripers. Here in Seattle some rewarding (based on student feedback) community-based health care volunteer opportunities are with the 45th Street Homeless Youth Clinic, Bailey-Boushay House (HIV AIDS and hospice care), and Needle Exchange programs.
- Nursing students can add to their community/public health toolkit (and hence, boost their employment opportunities) by seeking out extra trainings in community/public health-related topics. For instance, the Institute for Healthcare Improvement’s Open School Professional online course “Introduction to Population Health” is an excellent resource (and is free when your school is a member). Another great (local) resource I use in my teaching is the free online certificate trainings offered through the University of Washington’s Northwest Center for Public Health Practice.
- In addition, I highly recommend that nursing students (and all nurses) attend an Undoing Institutional Racism workshop by the People’s Institute Northwest. The People’s Institute for Survival and Beyond is a national program with headquarters in New Orleans. If you don’t live in the Seattle area check out their website for links to upcoming trainings in your area. Our school uses their Undoing Racism workshop as a required diversity course since it is so powerful and professionally done.
- Learn another language if you don’t already know one! Take a medical Spanish course. Participate in a travel immersion course or experience, especially if it focuses on some aspect of community health or social well-being.
- Go straight into community/public health nursing if that is where your heart is!
Excellent advice…for all health professions students.
Graduated from nursing school in 2012- went directly into community health nursing. Zero regrets.
But how? How can I get a job in public health? I try and apply but I am told that I need experience in acute care and I hate the hospital setting. Please help.
Hi Stacy,
It does take perseverance sometimes, especially if you happen to be living in a more shall we say ‘unenlightened’ area of the country where people are still stuck in the outdated thinking that all nurses have to cut their teeth in acute care settings. Consider widening your search and notion of public/community health thinking to include home hospice, school nursing, or some of the newer hospital-community linkage programs aimed to keep people from bouncing back into the hospital. Hope this helps!
They say they are one of a handful of such community cafes in the world of this specific model, but I know there are many variations on the theme.
Thank you, thank you, THANK YOU for this!! I am currently a nursing student and am often discouraged because my program and clinicals are all hospital-based (mostly Med-Surg with a smattering of OB/Peds and OR), which is just not my cup of tea. I also seem to be the only student in my class that isn’t entranced by the idea of a hospital job, so it gets a little lonely. Going into this career, I knew my heart was in community/public health nursing. But I, too, have been told over and over that foregoing Med-Surg experience right out of school is career suicide. I’m rebellious by nature, so I’m not taking that “advice” to heart. However, I do have occasional moments of panic, wondering if they’re actually right…You have provided me with hope and optimism at a time when I desperately needed it. Thank you again, I am deeply grateful to you for sharing your experience and perspective.
Thank you, thank you, THANK YOU for this!! I am currently a nursing student and am often discouraged because my program and clinicals are all hospital-based (mostly Med-Surg with a smattering of OB/Peds and OR), which is just not my cup of tea. I also seem to be the only student in my class that isn’t entranced by the idea of a hospital job, so it gets a little lonely. Going into this career, I knew my heart was in community/public health nursing. But I, too, have been told over and over that foregoing Med-Surg experience right out of school is career suicide. I’m rebellious by nature, so I’m not taking that “advice” to heart. However, I do have occasional moments of panic, wondering if they’re actually right…You have provided me with hope and optimism at a time when I desperately needed it. Thank you again, I am deeply grateful to you for sharing your experience and perspective.
Follow your passion in nursing and I do not think you will be disappointed, nor will you be throwing your career away. Thanks you for your note and for the reminder for me to write some follow-up posts on this topic. I know of so many more recent nursing graduates who have gone directly into community/public health nursing and are thriving and happy.