Nursing professor finds true calling in ‘working upstream’

A few years into her nursing career, Susan Zahner realized that her professional future lay in “working upstream from where people generally see nurses,” she says. “Most people don’t see us until they are already sick. In my first nursing job in a hospital, I always wondered what led to people getting sick. I also wondered what happened to the patients when they left the hospital. I wanted my career to be about prevention and about helping people where they live, in their communities and homes.”

Zahner took up that quest working as a public health nurse in a small rural county in Minnesota.

“I loved it because it allowed me to help people help themselves while in their own environments. I have continued to work in the field of public health ever since. Public health is often in the shadows, not obvious to many students or even to many health care providers,” Zahner says. She also developed an interest in teaching — she received a Distinguished Teaching Award last year.

However, public health services, provided by local or county government agencies, provide several pronounced challenges for its champions. Wisconsin, like the rest of the country, faces an acute nursing shortage in all specialties. Zahner says that the field of public health nursing has been experiencing a more difficult time than other nursing disciplines. “Research that I published in 2004 indicated that public health agencies in Wisconsin are finding that their nursing positions are taking longer to fill and that, in some cases, less-qualified people are hired or services are reduced,” she says.

The pay scale in Wisconsin is typically lower for public health nurses than for their colleagues at hospitals nationwide. Zahner says that average hourly pay rates for intensive care nurses nationally were $26.60 in 2003. In Wisconsin, hourly pay for public health nurses ranged from $14.31 to $26.19 in 2004, according to a state survey of local public health departments.

Demographics present other concerns:

“Public health nurses are ‘aging.’ The 2001 Wisconsin Registered Nurse Workforce Survey showed that the average age of public/community health nurses was 47.1, exceeding the overall mean age of nurses in Wisconsin,” Zahner says. “Experienced public health nurses will be retiring soon.”

Further muddying the statistical waters is the fact that public health nurses work in communities, “many of which are facing changes in demographics and economics. That results in greater or changing health needs,” she says. “We need to recruit nurses of all racial and ethnic backgrounds into the field, as well as provide more education in public health nursing practice.”

Finally, there’s the behind-the-scenes image of the public health nurse.

“It’s a real challenge for me to promote understanding of and appreciation for public health perspectives in students who have grown up watching ‘ER’ on television and expect to work in high-tech/critical- care positions,” Zahner says. “However, when students are exposed to the concepts and practices — and to skilled nurses working in public health settings — most come away with a strong appreciation for the importance of public health nursing, whatever the setting.”

One critical way that Zahner is giving students a real-world look at public health community care and providing effective continuing education for experienced public health nurses is through her Linking Education and Practice for Excellence in Public Health Nursing (LEAP) project, newly funded by a three-year grant from the federal Department of Health and Human Services/Health Resources and Services Administration.

Zahner describes LEAP as a statewide collaborative public health work force development project.

“One of our primary objectives is to improve education for practice by faculty development and to link faculty and practitioners to improve field education opportunities for students,” she says. “A second key objective is to improve orientation to public health practice for nurses entering the field. A third objective is to improve continuing education for public nurses currently practicing in Wisconsin.”

LEAP’s academic partners include all of the baccalaureate schools of nursing in Wisconsin. Participation by the Wisconsin Division of Public Health and local health departments across the state also is important to the project.

“There are many reasons to make these links,” Zahner says. “Linking education and practice helps assure that that educators know what’s needed in the workplace regarding skills and knowledge. Practice settings need competent workers and can benefit from relationships with academic programs that can support the transition from research findings to day-to-day practice. As Goethe said, ‘Knowing is not enough; we must apply. Willing is not enough; we must do.’”

The links that LEAP is establishing with public health agencies across the state also may give practicing nurses a taste for teaching. Zahner says that because there is a shortage of nurses, there is a corresponding shortfall of nursing instructors. “These partnerships can stimulate the interest of working nurses in teaching roles or even in faculty roles,” she says.

Indeed, Zahner has instituted online and in-person continuing education courses that show practicing community health nurses how to work more effectively with student nurses.

However, she adds that what these links actively illustrate to both nurses-in-training and experienced hands is that the workplace is a living entity, something at which the formal classroom can only hint.

“The work environment is dynamic, and new crises arise every day,” she says. “The expectation that academic programs alone can produce competent staff is almost obsolete in this kind of environment.

“New skills are needed today, not tomorrow. Continual, lifelong learning is required.”