Guide to a Generalized Public Health Nursing Program

Foundational area and foundational capability: Assessment and Surveillance

Wisconsin Admin. Code § DHS 140.04(1)(a) addresses surveillance and investigation.

• Collect and analyze public health data to do all of the following:
  • Identify health problems, environmental public health hazards, and social and economic risks that affect the public's health.
  • Guide public health planning and decision making at the local level.
  • Develop recommendations regarding public health policy, processes, programs, or interventions, including the community health improvement plan.
• Conduct timely investigations of health problems and environmental public health hazards in coordination with other governmental agencies and stakeholders.
• Establish written protocols for obtaining laboratory services at all times.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Participate in basic data collection from regular interactions with the community.
• Participate in collection of data from community health assessment (CHA) and other data sources.
• Participate in data (trends) discussions to address population level public health issues.
• Maintain continued knowledge and/or awareness of ongoing disease and illness, current practice, and targeted assessments.
• Investigate health problems and environmental public health hazards according to policy and procedure.
• Participate in the development of evidence-informed policies and procedures surrounding lab-related services.

Potential activities

• Collect and assess data to track trends and provide a nursing perspective when developing comprehensive public health strategies, such as with:
  • Safe sleep.
  • Intentional and unintentional injuries.
  • Chronic illness.
  • Child death reviews.
  • Overdose fatality reviews.
• Use Wisconsin Immunization Registry (WIR) benchmark data.
• Use national data resources, such as County Health Rankings & Roadmaps.
• Use state resources, such as Wisconsin Electronic Disease Surveillance System (WEDSS), WIR, and the Office of Health Informatics data.

Foundational area: Communicable Disease Control

Wisconsin Admin. Code § DHS 140.04(1)(b) addresses communicable disease control.

• Conduct activities required of local health departments under Wis. Admin. Code ch. DHS 144, relating to immunization of students.
• Comply with the requirements of Wis. Admin. Code ch. DHS 145, relating to prevention, monitoring, conducting epidemiological investigations, and control of communicable diseases, including outbreaks.
• Improve public recognition and awareness of communicable diseases and other illnesses of public health importance.
• Provide or facilitate community-based initiatives to prevent communicable diseases.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Maintain or ensure access to a vaccination program.
• Work with schools to ensure accurate immunization records.
• Teach about preventing communicable disease and outbreaks.
• Complete disease follow up with community members and primary health care partners.
• Provide public health nursing expertise on communicable disease case management and investigation of categorical disease investigations using the WEDSS.
• Use the assistance of Wisconsin DHS and/or Division of Public Health communicable disease subject matter experts and epidemiologists as needed (for example, infrequent and/or new diseases or outbreaks).

Potential activities

• Implement evidence-informed programs that could include walk-in, on-site, and in-home immunization efforts; tuberculosis (TB) testing and care coordination; communicable disease, and animal bite follow-up.
• Assist with mass clinic planning, such as drive-thru immunizations.
• Conduct smaller mass clinics to provide access to immunizations throughout the community. For example, employers and businesses, schools, and senior centers.
• Use the school and licensed childcare immunization audits to find lower vaccination rates and work to increase the rates.
• Present communicable disease education, cases, and lessons learned at community events, conferences, and to specific partners.
• Provide technical expertise within DHS to ensure policies and procedures align with state and national guidelines on communicable disease control.

Foundational area: Chronic Disease and Injury Prevention

Wisconsin Admin. Code § DHS 140.04(1)(c) addresses other disease prevention.

• Develop and implement interventions intended to reduce the incidence, prevalence or onset of chronic diseases or to prevent or ameliorate injuries that are the leading causes of disability and premature death in the LHD's jurisdiction, as identified in the community health assessment or the most recent state public health agenda.
• Link individuals to needed personal health services.
• Identify and implement strategies to improve access to health services.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Continuously assess, develop, and review chronic disease and injury prevention data and programs.
• Participate in multidisciplinary teams to address chronic disease-injury prevention, family health, and access and linkages to care. Examples include school or jail nursing, commercial tobacco control, lead prevention, or access to health and dental care.
• Ensure access to equitable and accessible health care programming with community partners.
• Connect partners and clients to resources in the community.
• Educate the public on prevention topics to help reduce injury rates or poor health outcomes.

Potential activities

• Promote screening for Chronic Disease and Injury Prevention based on the demographics and identified needs of the community.
• Educate on human services, health care, and public health services at community activities.
• Collaborate with community partners to plan and provide Chronic Disease and Injury Prevention programming.
• Use innovative ideas to promote access to care, such as providing reproductive health supplies after regular office hours.
• Use the local and statewide resource centers to link individuals and families with resources.

Foundational area: Emergency Preparedness and Response

Wisconsin Admin. Code § DHS 140.04(1)(d) addresses emergency preparedness and response.

• Participate in the development of response strategies and plans in accordance with local, state, and national guidelines to address public health emergencies as defined in Wis. Stat. § 323.02 (16).
• Participate in public health preparedness exercises.
• Communicate and coordinate with health care providers, emergency service providers, and other agencies and organizations that respond to a disaster, outbreak or emergency.
• Define the role of public health personnel in responding to a disaster, outbreak, or emergency, and activate these personnel during any such occurrence.
• Maintain and execute an agency plan for providing continuity of operations during a disaster, outbreak, or emergency, including a plan for accessing resources necessary for response or recovery.
• Issue and enforce emergency health orders, as permitted by law.
• Establish processes to ensure the LHD is immediately notified of an actual or potential disaster, outbreak, or emergency.
• Implement strategies intended to protect the health of vulnerable populations during a disaster, outbreak, or emergency.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Use the ecological model and public health nursing perspective to LHD’s emergency preparedness programs and plans.
• Participate in the jurisdiction emergency preparedness planning, deployment, and recovery, such as coordination and enforcement of emergency health orders.
• Participate in planning and implementation of preparedness exercises.
• Provide nursing and medical expertise as part of coordinating messaging for clinical partners for disaster response.
• Provide public health and nursing expertise in areas that require medical expertise and communication with clinical partners. Examples include medical countermeasure dispensing; nonpharmacological interventions; responder physical and mental safety; personal protective equipment management; public health messaging; volunteer training; and communication with health care partners.
• Assist with identifying vulnerable populations.

Potential activities

• Participate in preparedness exercises and events:
  • After-action reports.
  • Mass immunization clinics.
  • Incident Command System (ICS) trainings.
• Gather partner contact information. Examples of partners include local infection preventionists and long-term care, and schools.
• Provide technical expertise to colleagues on changing national and state communicable disease guidance.
• Help with planning and implementation of emergency shelter requirements, particularly for the medically vulnerable.

Foundational capability: Communications

Wisconsin. Admin. Code § DHS 140.04(1)(e) addresses health promotion.

• Develop and implement interventions, policies, and systems to promote practices that support positive public health outcomes and resilient communities.
• Disseminate relevant, accurate information and evidence-informed prevention guidance to the public health system and community.
• Use a variety of accessible, transparent, and inclusive methods of communication to convey and to receive information from the public and stakeholders.
• Provide accurate, timely, and understandable information, recommendations, and instructions to the public during a disaster, outbreak, or emergency.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Use the ecological model and public health nursing perspective to support healthy and adaptable communities.
• Apply public health nursing expertise to translate evidence-informed prevention guidance into culturally appropriate plain language to distribute to clinical partners and the broader community.
• Communicate with community members in a way they understand, using plain language, oral and written communications, and interpretation as needed

Potential activities

• Use trusted relationships with diverse populations to distribute public health information.
• Create health messaging for different medias, such as social media posts or newsletters.
• Work with public health colleagues to develop targeted educational materials.
• Teach about health topics to community members at various community locations.
• Share official state and/or national communication on critical public health issues.

Foundational area: Environmental Public Health

Wisconsin. Admin. Code § DHS 140.04(1)(f) addresses human health hazard control.

• Assist in the conduct of activities authorized under Wis. Stat. § 251.06 (3)(f) and Wis. Stat. § 254.59.
• Declare dilapidated, unsafe or unsanitary housing to be a human health hazard, when permitted under Wis. Stat. § 254.593.
• Identify public health hazards through laboratory testing, inspections, reporting, and investigation for the purpose of preventing further incidence of occupational disease, environmental disease, and human health hazard exposure.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Offer public health nursing perspective to investigations of sanitary conditions in the community.
• Provide case management during health hazard investigations.
• Use public health nursing expertise when developing policies for human health hazards and the health impact of unsafe and unsanitary conditions.

Potential activities

• Provide and/or coordinate childhood lead poisoning case management, including working with social services and pediatric and hospital providers.
• Partner with environmental health staff to ensure health education, including clinical implications of radon and water quality results.

Foundational capability: Policy Development and Support

Wisconsin Admin. Code § DHS 140.04(1)(g) addresses policy and planning.

• Coordinate planning and serve as a source of information and expertise in the development and implementation of policies affecting public health.
• Foster and support community involvement and partnerships in development, adoption, and implementation of policies affecting public health, including engagement of diverse populations and consideration of adversely impacted populations.
• Conduct a community health assessment resulting in a community health improvement plan at least every five years.
• Develop a written community health improvement plan at least every five years, by assessing applicable data, developing measurable health objectives, and partnering with persons, agencies, and organizations to cultivate community ownership throughout the entire development and implementation of the plan.
• Engage members of the community in assessment, implementation, monitoring, evaluation, and modification of community health planning.
• Promote land use planning and sustainable development activities to create positive health outcomes.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Provide public health nursing perspective about laws, regulations, and policies that impact public health.
• Review and update internal policies and procedures.
• Involve affected communities in policy development.
• Apply nursing ethics to issues involving patient privacy, social justice, and the application of evidence-based practice to policy development.
• Provide an ecological and public health nursing perspective to the CHA and community health improvement plan (CHIP) processes, including alignment with the State Health Assessment and Improvement Plan.
• Participate in or lead coalitions and committees.

Potential activities

• Identify emerging community health needs using feedback, observation, and qualitative and quantitative data.
• Use community health data to adapt program planning to meet the identified community needs.
• Include public health nursing perspectives into the CHA-CHIP.

Foundational capability: Organizational Competencies

Wisconsin Admin. Code § DHS 140.04(1)(h) addresses leadership and organizational competencies.

• Establish and sustain relationships with governmental and nongovernmental partners and stakeholders.
• Engage stakeholders in the development and implementation of the local health department's organizational goals.
• Use principles of public health law, including local and state laws, in the planning, implementation, and enforcement of public health initiatives.
• Promote and monitor progress towards achieving organizational goals, objectives identified in community health improvement plan, and identifying areas for improvement.
• Implement processes within public health programs that create health equity.
• Maintain a competent and diverse workforce intended to ensure the effective and equitable provision of public health services.
• Provide continuing education and other training opportunities necessary to maintain a competent workforce.
• Implement and maintain the technology needed to support public health operations while simultaneously protecting personally identifiable information and other confidential health information, pursuant to Wis. Stat. § 19.21 and Wis. Stat. § 146.82.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Develop and maintain relationships with a variety of partners that provide clinical, community-based health care and other community partners.
• Engage community stakeholders in the development of the LHD’s goals.
• Advise on the impact of policy decisions on the social determinants of health (SDoH) to promote public health programs that advance health equity.
• Advise on the health impacts of planning, implementing, and enforcing public health initiatives.
• Monitor progress and outcomes of organizational goals and objectives.
• Identify and work on individual training needs to continue growing as a competent public health nurse.
• Maintain knowledge and competency in technology used in public health operations.
• Ensure the confidentiality of all personally identifiable information (PII) as part of health department operations.
• Help develop Health Insurance Portability and Accountability Act (HIPAA) and PII policy and procedures.

Potential activities

• Reach out to clinics, hospitals, and long-term and other medical providers in the community.
• Subscribe to listservs or newsletters for ongoing education.
• Join public health nursing-focused associations.
• Seek out training opportunities to continue growing skills as a public health nurse.

Wisconsin Admin. Code § DHS 140.05(1)(a) addresses communicable disease control, chronic disease and injury prevention, environmental public health, family health, and access and linkage to health services, in addition to services already provided under Wis. Admin. Code § DHS 140.04, by doing all of the following:

• Identifying and promoting either a community need that has not already been selected as a local priority by the local health department in its most recent community health improvement plan or an objective specified in DHS's most recent state public health agenda, developed pursuant to Wis. Stat. § 250.07.
• Providing support to implement services through leadership, resources, and engagement of the public health system.
• Using evidence-informed resources and practices to provide services.
• Evaluating the additional services and reporting to the community and local board of health on progress and performance.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Apply clinical expertise and ecological model to community-based data to address emerging community needs.
• Implement population level public health services that are inclusive and responsive to community needs.
• Act as a content expert on evidence-informed practices to provide services.
• Provide public health nursing-related content on progress and performance.

Potential activities

• Identify unmet needs while providing public health programming and link to resources.
• Lead or provide public health nursing expertise on fatality or mortality review teams.
• Advocate for and implement harm reduction strategies, like bringing public health vending machines into the community.
• Apply nursing and public health principles in coalitions.
• Implement evidenced-based programs across the life span based on the community-identified needs.

Foundational capability: Equity; Organizational Competencies

Wisconsin Admin. Code § DHS 140.05(1)(b) addresses developing and maintaining a plan to employ qualified public health professionals and ensure a competent public health workforce by doing all of the following:

• Including core public health competencies and credentialing requirements in all department job descriptions, unless prohibited by local governing body.
• Assessing staff core public health competencies every two years to identify department training needs.
• Completing annual performance evaluations and personal development plans, unless prohibited by local governing body.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Become familiar with and apply the Public Health Nursing: Scope and Standards of Practice to all aspects of professional nursing practice.
• Collaborate with public health professionals on all programs and plans, including workforce development.
• Seek out individual, team, and organizational learning opportunities for personal and professional development as a public health nurse.
• Keep records of trainings.

Potential activities

• Work with supervisors to integrate the basic public health nursing core competencies into individual development plans.
• Partner with academia to host student nursing clinicals to help develop well-trained public health nurses.
• Attend public health-focused conferences to be lifelong learners.
• Present at conferences to share lessons learned and successes.
• Join committees and networks to expand public health nursing knowledge.
• Obtain additional certifications, such as certified car seat technician and certified lactation consultant.

Foundational capability: Accountability and Performance Management

Wisconsin Admin. Code § DHS 140.05(1)(c) addresses conducting quality improvement.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Discuss QI efforts, policy and procedures, and staff training needs using feedback from programs.
• Participate in QI teams.
• Contribute to the evaluation plan for public health nursing services.

Potential activities

• Evaluate completion rates for WEDSS documentation.
• Review immunization rates to develop improvement strategies.
• Update TB case management process.
• Analyze three-month follow up testing rates for sexually transmitted disease (STD) cases.
• Adapt policy and procedures to improve immunization clinical outcomes.

Foundational capability: Accountability and Performance Management

Wisconsin Admin. Code § DHS 140.05(1)(d) addresses providing training and resources related to quality improvement to local health department staff and the local governing body.

Nursing implications

• Attend QI trainings.
• Provide QI training and resources to new public health nursing staff.

Potential activities

Use lessons learned to develop public health nursing-focused QI projects.

Foundational capability: Accountability and Performance Management

Wisconsin Admin. Code § DHS 140.05(1)(e) addresses establishing explicit organizational performance measures for the LHD's mission, vision, values, and strategic goals.

Nursing implications

Apply nursing processes and work as part of a collaborative team to:

• Collaborate on all parts of the health department's programs and plans.
• Participate in the organization’s PM system.
• Nurses should use follow procedures when working with public health programs and services.

Potential activities

• Identify emerging needs that may impact the health department’s strategic activities.
• Develop performance measures to measure impact of work.

Foundational capability: Assessment and Surveillance

Wisconsin Admin. Code § DHS 140.06(1) addresses leading the collection of data to guide public health planning and decision-making at the local level in alignment with the most recent state public health agenda.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Lead data collection processes from daily interactions with the community.
• Provide public health nursing program data for the CHA.
• Help with data analysis to identify trends and gaps, then develop interventions to address population level public health issues.
• Partner with other public health professionals and the broader communities to identify local needs and implement strategies to address needs.

Potential activities

• Collect and generalize data from community interviews and provide an overview of health care needs for the CHA.
• Build local coalitions by leveraging role as a trusted partner.
• Apply public health nursing knowledge to identify vulnerable populations for preparedness planning.
• Align CHIP and public health nursing programs with the State Health Plan.

Foundational capability: Communications

Wisconsin Admin. Code § DHS 140.06(2) addresses providing public health expertise within the jurisdiction to elected officials, stakeholders, and community partners, including data and research.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Promote public health policies.
• Provide technical assistance on integrating recommendations from state and national experts.
• Communicate and connect with clinical partners.
• Provide expert testimony to advance public health policy.

Potential activities

• Present public health information at the board of health (BOH), county board, or city council meetings.
• Present at civic organization meetings and to other community partners.
• Participate in Nurses Day at the Capitol to advocate for public health nursing.

Foundational capabilities: All

Wisconsin Admin. Code § DHS 140.06(3) covers identifying and addressing factors impacting population health by implementing evidence-informed and emerging practices.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Research evidence-informed and best practices.
• Implement evidenced-informed programs and education in the community.

Potential activities

• Implement evidence-informed programs like Living Well with Chronic Conditions, Stepping On, Grapevine Cafés, and Nurse Family Partnership.
• Share evidence-informed and emerging practices to the community, coalitions, and at BOH meetings and events.

Foundational capabilities: Policy Development and Support; Community Partnership Development

Wisconsin Admin. Code § DHS 140.06(4) addresses developing, advocating, adopting, and implementing policies or strategies to improve the physical, environmental, social, and economic conditions affecting health.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Engage with community stakeholders in assessing, developing, and implementing strategies that address socio-economic factors.
• Build relationships with local leaders and elders to identify ways to reach populations with public health initiatives, education, and health department decision making.

Potential activities

• Build a relationship with underserved populations and listen to their community’s concerns—such as Plain communities, older adults, Latinx, and rural farmers—and share health information with them.
• Collaborate in identifying and implementing population level access needs; for example, an accessible trail chair.
• Participate on internal or external health equity teams.

Foundational area and foundational capabilities: All

Wisconsin Admin. Code § DHS 140.06(5) addresses establishing and implementing an environmental health program as directed by the local BOH or other local governing body by doing all of the following:

• Participating and providing environmental health expertise in the development of community plans.
• Providing or arranging for the availability of services authorized under Wis. Stat. ch. 254, such as for toxic substances, indoor air quality, animal borne or vector borne disease, and human health hazards.
• Collecting, reviewing, and analyzing environmental and community health data, and managing, controlling, and preventing environmental factors that may adversely affect the health, safety, or well-being of individuals or the community.
• Implementing agreements established with state agencies to provide or arrange for environmental health services.
• Administering regulations of the BOH or other local governing body.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Help to develop environmental public health programming for individuals, families, and the community.
• Provide case finding and management to individuals and families impacted by environmental health hazards.
• Collect environmental and human health hazard data from individuals, families, and community to determine potential effects to health, including lead, nitrates, hoarding, mold, and air quality.
• Research best practices to advocate for local ordinance and other policy change or community-driven and collective action.

Potential activities

• Collect environmental health data.
• Help to develop safe housing policies to reduce environmental health risks.
• Research health impacts of environmental health concerns (for example, vaping on lung health) and help to develop policy, system, and environmental changes to minimize health risks.
• Advocate for policy changes at all levels that impact your jurisdiction.
• Participate in committees that focus on land use.

Foundational capability: Assessment and Surveillance

Wisconsin Admin. Code § DHS 140.06(6) addresses providing or arrange for other services that the local health department determines appropriately address objectives or services in the most recent state public health agenda.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Apply data from the State Health Plan to identify needs not addressed in CHIP.
• Work with partners to identify local needs, then implement community strategies to address needs.

Potential activities

• Participate in local committees focused on affordable childcare.
• Advocate for broadband to assist in the expansion of telehealth services.
• Identify alignment between local CHIP priorities and the State Health Plan.

Foundational capability: Accountability and Performance Management

Wisconsin Admin. Code § DHS 140.06(7) addresses developing and implementing methods to collect performance data, evaluate goals, conduct quality improvement, and report progress to advise organizational decisions.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Identify improvement strategies using performance measures.
• Implement multiple collaborative performance and QI action plans.
• Lead the process for PM and QI for public health nursing programs.
• Work with the community to evaluation services, then communicate outcomes.

Potential activities

• Collect immunization rates to evaluate outreach efforts, develop a plan to address them, and report on progress.
• Develop a plan to decrease throughput time for immunization preparedness clinics.
• Use a Plan-Do-Study-Act process to improve rabies investigations.

Foundational capability: Accountability and Performance Management

Wisconsin Admin. Code § DHS 140.06(8) addresses developing and implementing a plan that integrates quality improvement at the individual, team, and organization levels.

Nursing implications

Apply nursing process and work as part of a collaborative team to:

• Identify improvement areas that impact the entire department, particularly those that impact public health nursing practice.
• Develop plans and document progress toward identified improvements.
• Identify organizational initiatives that provide opportunities to improve the quality of public health nursing practice.

Potential activities

• Lead organizational QI project to ensure policies and procedures are regularly updated.
• Participate in the QI team at the health department.