Developing public health nursing identity and competencies in local health: Jump started by H1N1 response

Shortly before H1N1 emerged, our leadership team prioritized the need to strengthen public health nursing identity/culture among our local health department nurses by developing competencies that aligned with four priority public health needs in our Community Health Action Plan: immunization, communicable disease surveillance, high risk infant follow up, and lead case management. Our nurse competency development 80/20 plan was designed to assure that all nurses could demonstrate competencies to address our four priorities. By committing at least 20% of each nurse's time to these priorities and offering education and quality improvement support, we planned to strengthen nursing competencies overall and build a cohesive nursing team. Immunization intervention presented a challenge in the 80/20 plan since few nurses could demonstrate competency in this priority area and resistance was high. Change readiness for the new public health nursing competencies was low due to growing staff shortages stemming from a recent 10% staff lay off and subsequent, ongoing hiring freeze. Our leadership team capitalized on the rapid onset of the H1N1 threat to accelerate adaptation to change. The urgent community need for H1N1 actually jumpstarted the immunization competency process for our nurses, while drawing the entire department staff into a development cycle that centered on immunization delivery, a communication plan for the public, and response to H1N1 immunization issues raised by thousands of residents in clinic settings, emails, and telephone calls. Rallying around the need to vaccinate large masses of children and adults, our small team of public health nurses delivered immunizations and mentored student and contract nurses in the delivery of over 20,000 vaccinations in a sixty day period. As H1N1 activity is diminishing, our public health nurses, drawing on their initial success with immunization competency development, are developing competencies in the other three priority areas, and are gaining experience at the population and public health system levels as they work in community partnerships and existing networks. This session will discuss both our lessons learned and our findings about how a public health emergency response triggered readiness for change and facilitated the development of public health nursing identity and competencies.