Inquiry for PH listserve

[Sullivan, Susan]

Thank you for your prompt insightful remarks...I think  your comments
identify what is missing, i.e., a professional nurse leader in a position of
authority who can be a resource and intervene in matters related to many
areas including professional nursing standards.  There is no central nursing
leadership here. Instead nurses work within several divisions which are
headed by non nurses, many of whom have no licensure or clinical
expertise...and there may or may not be a "nursing supervisor" in the
program, it is a different experience for most nurses to find themselves in,
and when issues arise there is no resource to resolve some concerns...For
instance, nurses in some programs had  been instructed to "just call 911 and
wait for paramedics to arrive" when someone needs CPR. And their concerns re
their responsibility as licensed professionals were not really
understood....Again I appreciate your comments, and look forward to hearing
from others. Thanks. 
Susan Sullivan, RN, MSN
(714) 834-8309  FAX  834-8526
SSullivan at hca.co.orange.ca.us


----Original Message-----
From: Kristine Gebbie [mailto:kmg24 at columbia.edu]
Sent: Friday, August 16, 2002 9:42 AM
To: Public Health Nursing Discussion and Information 
Subject: Re: Inquiry for PH listserve


In considering this question, please bear in mind that it is extremely
important
to separate organizational line reporting structures from professional
standard
setting and quality oversight.  Public health is by its very nature
interdisciplinary, and nurses are among the valuable contributors to the
mission, doing so in interdisciplinary teams of all sorts.  Any insistence
that
'nurses can only report to a nurse' does a disservice to the professionalism
of
every nurse, but a disservice to the public health process.  On the other
hand,
it is important that all professionals within public health have access to
professional leaders in their own disciplines for purposes of establishing
or
improving standards of practice, clarifying questions that arise, and making
quality improvement.  In larger agencies, there may be an entire office of
professional standards, with leadership for medicine, nursing, dentistry,
health
education, environmental health.  In smaller agencies, one or more senior
members of each profession may fill this role, formally or informally.  In
the
US Public Health Service (and I think in the military branches as well) the
role
of senior professional is a term appointment, for someone rotated out of
other
duties.  Hope this helps--

"Sullivan, Susan" wrote:


> 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