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 Where in the world do they get this silly and completely outdated notion that hospital nursing experience is the only experience that makes for a ‘real nurse?’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!