Transformation of public health nurse competencies to support an integrated health care practice model

The historical tenets of public health nursing were developed to support the delivery of preventive care within the context of the social and environmental aspects of the individual and the population. Traditionally, public health nurses developed long-term trusted relationship with the population, usually within economically disadvantaged neighborhoods. The nurses were known for taking on health issues and breaking barriers to resolve the problem. Today, loss of traditional funding streams and expansion of public financing of medical care as well as emphasis on a primary care physician practice model urges the transformation of public health nurse competencies without compromising the foundations of social connectedness, tenacity of follow through, and comprehensive health education. Bexar County Hospital District, Texas recently acquired 8 traditional public health clinics with vibrant long-established maternal child health programs. The district consists of a large teaching hospital with a robust specialty outpatient clinic network closely aligned with University of Texas Health Science Center (UTHSCSA). In addition, the district operates 4 large primary care health centers employing over 70 physicians with an objective of providing medical care for uninsured residents of the County. The acquisition of the traditional public health clinics provided an opportunity to realign services between the public health clinics and the primary care health centers maximizing the professional abilities of both settings. The leadership set an agenda to adapt an integrated health care model of practice maximizing the various members of the health care team and the infrastructure of the agency to meet the multiple needs of the patient population. UTHSCSA School of Nursing was consulted to provide expertise to facilitate the new competency development for the public health nurses, both expanding maternal and child health knowledge and refreshing acute and chronic disease based interventions. This presentation will outline the process of setting up such a model of practice and discuss the preliminary outcomes from the first months of operation.