Inquiry for PH listserve

[Sullivan, Susan]

I have interest in talking to PHNs at local health departments re the
structure of their reporting and supervision.  I have noticed within the
agency I work that some issues seem to arise because of non nurse leadership
of programs.... although our agency has over 450 nurses employed, we are
fragmented and working in diverse  programs with no centralized nursing
leadership....so many PH nurses and nurses in PH clinic settings are being
managed by non-nurse supervisors....I am wondering about the legality of
this (in CA especially) and from a practical standpoint how do other
community health nurses deal with such a reporting structure., especially
when they are put in situations where they may feel that in the interest of
the patient  "things should be handled differently" based on their nurse
instincts, experiences, understanding of community practice standards and
nurse practice acts, as well as knowledge of legal issues. But there is no
central nursing authority to notify or consult.
Have others experienced such environments and survived?  Thoughts? Comments?
Susan S. PHN