Certification is defined in the nursing literature in several ways; no one consistent definition of certification exists. Nursing specialty certification programs are intended for consumer protection. Certification protects the public by enabling consumers to identify competent people more readily. However, benefits for stakeholders other than patients and families are also described in the literature. This article describes the value of specialty certification from the perspective of the patient and family, nurse, and employer.

Recognizing the public's health is the outcome of dynamic, adaptive, and complex systems of agencies; infrastructure, relationships, and interactions that dictate how to improve health outcomes; and reducing health risks in a population based on systems thinking and evidence. New methods such as network analysis and public health practice-based research networks demonstrate the potential for new insight to our understanding of how systems and infrastructure influence population health. We examine advances in public health systems research since 1988 and discuss the relevance of this type of research to public health practice. We assess the current infrastructure for conducting public health systems research, suggest how the research infrastructure can be improved, and conclude with a discussion of how health reform in the United States will require research focused on understanding the adaptive complexity inherent in public health and health care systems and strengthening the systems research infrastructure. Expected final online publication date for the Annual Review of Public Health Volume 31 is March 17, 2010. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.

Recent evidence suggests that specialty nurse education and certification may improve the quality of patient care. Specialty nurse certification also may improve nurses' job satisfaction and sense of empowerment, as well as positively affect collaboration with other health care team members. Despite the evidence that there are intrinsic rewards for specialty certification, the lack of extrinsic value to nurses makes it unlikely that greater numbers of nurses will be attracted to certification unless health care administrators increase opportunities for recognition and greater compensation. AORN J 89 (January 2009) 183-192.(c) AORN, Inc, 2009.

CONTEXT Public health leaders are making difficult decisions about how to maximize the effectiveness of public health services with diminishing funds. Quality improvement (QI) interventions seek to improve the efficiency and effectiveness of public health programs, services, or organizations. The purpose of this study was to review the literature to describe public health system QI interventions and their impact on public health practices and health outcomes. EVIDENCE ACQUISITION A systematic review was conducted using PRISMA guidelines. Three databases were searched for peer-reviewed articles that included public health quality improvement-related terms in their abstracts. Articles published in 1990-2010 that described results from QI interventions conducted within the U.S. public health system were included. EVIDENCE SYNTHESIS Fifteen studies were identified, reporting on 18 separate QI interventions. Studies fell naturally into three functional categories: organization-wide QI, program- or service-specific QI, and administrative or management function QI. Few of the studies linked their improvements directly to a health outcome or predictors of health outcomes. Studies generally were implemented in state-level or large local public health departments. CONCLUSIONS Formally published QI interventions may not be representative of typical, smaller-scale QI activities. Collection and distribution of QI results associated with proven, effective public health interventions and that quantify the benefits of QI practices in public health should be a goal. More research is needed to definitively "connect the dots" between QI efforts, resulting practice improvements, and actual (or predictors of) health outcome improvements. Future studies should examine QI in diverse public health systems.

OBJECTIVES : The American Nurses' Association (ANA) 2007 Public Health Nursing: Scope and Standards of Practice along with the Quad Council's PHN competencies frame the practice of public health nurses (PHNs). The preface for ANA's PHN Scope and Standards encourages using the standards as the basis of PHN job descriptions. This study sought to assess the extent to which PHN job descriptions are aligned with the ANA's PHN Scope and Standards and the Quad Council competencies. DESIGN : We obtained PHN job descriptions from 3 local health departments in Illinois and 3 in Washington. Statements from the job descriptions were content analyzed, categorizing statements into the 16 ANA PHN Scope and Standards and using Quad Council competencies as additional definitions of each category. To code all job statements related to PHN practice, 2 categories were added which were MPH competencies from the Associations of Schools of Public Health. Interrater reliability was established. RESULTS : All 18 PHN job descriptions had statements related to Standard 5 Implementation, followed by 94% of the job descriptions having statements related to assessment, planning, coordination of services, health education/health promotion, and collaboration. The least frequently (22%) included standard was outcome identification. CONCLUSIONS : Attention to human resource management is necessary to align job descriptions with current professional scope and standards for basic and advanced PHN practice. The lack of statements regarding Outcome Identification has serious implications for PHN involvement in quality improvement and health planning.

OBJECTIVE The activities that local health departments (LHDs) conduct and their workforce characteristics change over time. We know little, however, about how changes among the services LHDs conduct are associated with the nature of LHD leadership and how these factors impact health. This study investigated changes in LHD services and leadership and how these changes are associated with mortality disparities. DESIGN We conducted regression analyses of secondary data using an exploratory panel time series design. MEASURES We used secondary data to investigate changes in LHD services and leadership and how these changes were associated with each other and with 1993 to 2005 changes in black-white mortality disparities. Local health department services were examined relative to change in breadth of services within each of 10 program domains between 1993 and 2005. LHD leadership was examined for discipline of the lead executive in 1993 and 2005. STUDY POPULATION Our sample included 558 county or multicounty "common local areas," representing county-level data for LHDs and their jurisdictions. RESULTS Significant beneficial relationships exist between having a clinician as lead executive in an LHD and reductions in black-white mortality disparities. Local health departments with a clinician (usually a nurse or physician) as their lead executive in 1993 and/or 2005 experienced a significant decrease in black-white mortality disparities for young adults (age 15-44 years) in their jurisdictions from 1993 to 2005 when compared with LHDs with nonclinician leaders. CONCLUSIONS The discipline of an LHD's lead executive as a clinician appears to have a significant relationship with the impact of LHD practice on reducing black-white mortality disparities. This study suggests that the discipline of an LHD's leadership may be an important factor to consider in relation to local public health capacity to impact health disparities. Further research related to the mechanisms at play in these relationships is warranted.

To identify which MCH services delivered by local health departments (LHD) appear associated with reducing differences in Black-White mortality. We used a time-trend design to investigate relationships between change in MCH activities provided by LHDs in 1993 and in 2005 and changes in 1993-2005 Black-White mortality disparities. Secondary data were analyzed for 558 US counties and multi-county districts. Independent variables included the six MCH services provided by LHDs and captured in the 1993 and 2005 NACCHO Profile of Local Public Health Departments surveys. MCH service variables represented change in each service from 1993 to 2005. Control variables included selected LHD characteristics and county-level socioeconomic, demographic, and health provider resource data. Absolute change in Black and White mortality rates and changes in the mortality disparity "gap" between these rates in 1993 and 2005 were examined as dependent variables. Among the MCH services examined, prenatal care had a significant beneficial relationship with Black all-age mortality change and with reducing the mortality "gap." Family planning services had a beneficial relationship with reducing the mortality "gap" for females in the jurisdictions in the study sample. WIC services indicated the most consistently beneficial relationship with both Black mortality and White mortality change, but these changes did not influence the mortality "gap" during the study period. LHD delivery of family planning and prenatal care by LHDs appears related to reductions in Black-White mortality disparities. Implications of this study suggest the importance of certain MCH services for reducing Black-White mortality disparities.

The United States is facing a severe shortage of well-trained public health workers, and public health nursing is the discipline with the greatest shortage. A local public health agency's (LPHA's) staffing and leadership characteristics are critical in determining its programs, performance, and capacity. A better understanding of the relationship between specific staffing and leadership characteristics and public health programs is needed to address this capacity challenge. METHOD: Data from the 2005 National Profile of Local Health Departments, were examined to identify associations between an LPHA's nursing workforce and the specific activities performed by LPHAs. RESULTS: LPHAs with a nurse as senior executive had a greater breadth of immunization, maternal/child health, and prevention activities than their nonnurse-led counterpart LPHAs, particularly in rural areas. Nurse-led LPHAs were less likely, however, to have a broad level of environmental health and regulation activities or to have recently conducted community assessment and planning activities. CONCLUSIONS: Both LPHA nurse leaders and nursing staff play an important role in the provision of LPHA services, and a shortage of LPHA nursing leaders and staff, particularly in rural areas, will likely have a major impact on certain LPHA programs unless steps are taken to address these challenges.

Objectives. I explored the underutilization of the community/public health nursing (C/PHN) credential by examining the individual characteristics of public health nurses, the value these nurses perceive for certification, the barriers they perceive to obtaining or maintaining a C/PHN credential, and their credential status. Methods. I surveyed a national sample of 655 public health nurses regarding this more than 20-year-old credential. I analyzed variables related to perceived value, barriers, and characteristics of public health nurses. Results. The perceived value of credentialing did not differ among public health nurses relative to whether they had ever had a C/PHN credential. The C/PHN credential, however, was obtained significantly more often by public health nurses in academic settings than by those working in practice settings. Conclusions. The C/PHN credential appears to be disproportionately underutilized and unknown to public health nurses in the practice community. Findings suggest, however, that utilization could be improved by increasing the credential's visibility outside of academic environments and by establishing system level changes that provide external recognition, such as salary increases and career advancement, for specialty credentials.

Leveraging funds to sustain the efforts of a grant-funded initiative is often an explicit, or implicit, expectation in philanthropy. However, the magnitude of funds leveraged and the factors that facilitate success in leveraging are rarely researched. An example of one of these grant-funded initiatives is the National Turning Point Initiative. Twenty-one states received funding from The Robert Wood Johnson Foundation as part of this initiative to establish and implement strategic goals for achieving significant statewide public health system improvement through diverse, cross-sector partnerships. Leaders from 17 of these 21 states participated in a two-phased study regarding the leveraging of additional funds for their public health infrastructure improvement activities. This article reports on the second phase of the study. In this phase, key informant interviews were conducted to examine how leveraging of resources occurred as part of this large national initiative. Findings indicate that the combination of a comprehensive planning process and a broad-based partnership was crucial in securing resources to expand their efforts. The ability to strategically respond to unexpected events and opportunities also helped states use their plans and partnerships to "make the case" for additional resources to improve their public health infrastructure.

Reforming the public health infrastructure requires substantial system changes at the state level; state health agencies, however, often lack the resources and support for strategic planning and systemwide improvement. The Turning Point Initiative provided support for states to focus on large-scale system changes that resulted in increased funding for public health capacity and infrastructure development. Turning Point provides a test case for obtaining financial and institutional resources focused on systems change and infrastructure development-areas for which it has been historically difficult to obtain long-term support. The purpose of this exploratory, descriptive survey research was to enumerate the actual resources leveraged toward public health system improvement through the partnerships, planning, and implementation activities funded by the Robert Wood Johnson Foundation as a part of the Turning Point Initiative.

A critical review of the American Nurses Association Code of Ethics for Nurses with Interpretive Statements, Nursing's Social Policy Statement, and Nursing: Scope and Standards of Practice provides evidence that these documents present an inconsistent, ambiguous, and superficial conceptualization of social justice, and do not offer an adequate framework for nurses to address underlying issues that affect health outcomes. Despite expansive references to the historic role of nursing in social reform, the documents implicitly reinforce nursing practice directed toward the individual nurse-patient relationship and give short shrift to nursing models that endorse broad systems change intended to improve health.

Objectives. I explored the underutilization of the community/public health nursing (C/PHN) credential by examining the individual characteristics of public health nurses, the value these nurses perceive for certification, the barriers they perceive to obtaining or maintaining a C/PHN credential, and their credential status. Methods. I surveyed a national sample of 655 public health nurses regarding this more than 20-year-old credential. I analyzed variables related to perceived value, barriers, and characteristics of public health nurses. Results. The perceived value of credentialing did not differ among public health nurses relative to whether they had ever had a C/PHN credential. The C/PHN credential, however, was obtained significantly more often by public health nurses in academic settings than by those working in practice settings. Conclusions. The C/PHN credential appears to be disproportionately underutilized and unknown to public health nurses in the practice community. Findings suggest, however, that utilization could be improved by increasing the credential's visibility outside of academic environments and by establishing system level changes that provide external recognition, such as salary increases and career advancement, for specialty credentials.

Recent national and regional public health workforce development efforts have been conducted through a framework of public health services research. Public health nurses (PHNs) are the single largest professional group in the formal public health system, and thus have the greatest potential for positively impacting our community health systems. Effective public health workforce development is contingent on examination of how PHNs themselves make meaning of their practice. This paper suggests that a nursing perspective should be used from which to conduct research surrounding PHN practice. Literature describing PHN practice and recent workforce assessment efforts are reviewed. Assumptions are identified regarding the nature of nursing knowledge, and a theoretical perspective for inquiry about PHN praxis is developed. Finally, a model is offered to illustrate the reciprocal influence of nursing science and public health nursing practice.

The purpose of this study was to explore community healthcare competency of public health nurses (PHNs) and related factors in Taiwan. A cross-sectional research design was adopted to collect data. A community healthcare competency scale for PHNs was developed by the researchers based on a review of the literature to measure PHN competency (self-assessed) and task frequency rates. The instrument earned a content validity index score of .90, Cronbach's a of .97, split-half reliability of .95, and test-retest reliability of .97. The questionnaire was sent to 369 head nurses, who distributed copies to PHNs. A total of 2,956 questionnaires were sent out, with a return rate of 67.03%. Results indicate that (1) the PHNs scored high in cooperation with community-based healthcare services, community resources integration, and operation of community group and low on the ability to apply biostatistics, community health promotion activities initiation, and application of epidemiology;(2) implemented task frequency, years of work as a PHN, job position, education level and health station location were all significantly related to respondent competency scores. Results suggest that further examination is needed in the areas of years of work and training courses for incoming personnel and that further investigation of on-the-job training given by various locations of health stations is necessary in order to devise a training model for PHNs.

OBJECTIVES: Following the introduction of hospital early postpartum discharge (EPD), public health nurses (PHNs) have provided large-scale in-home follow-up to promote the safety and well-being of mothers and babies. Given high numbers of births per year, this program has affected PHNs' practice. This descriptive qualitative study aimed to explore PHNs' perceptions of EPD and its effects on their practice. METHODS: Data were collected in focus groups (n = 24) consisting of PHNs in four community health areas (CHAs) in the Winnipeg Regional Health Authority (WRHA). Audiotaped data were transcribed, entered into Microsoft Word XP, and analyzed using constant comparison. RESULTS: The female participants had a mean of 10 years of PHN experience. Three main themes and 10 subthemes were identified. The main themes were: passion for the PHN role, influence of EPD on practice, and building a PHN future. The subthemes included: valuing public health nursing, building capacity and developing relationships, changes in practice, erosion of health promotion, a new role, proper tools, continuity of care, relationships with community partners, and resources to support public health programs. CONCLUSION: The PHNs indicated the introduction of EPD altered their practice by reducing their role in community-level intervention and health promotion activities. Although they identified benefits from undertaking EPD activities, they wanted resources and funding shifted into the public health system to better support PHNs' increase in scope of practice and historical roles in promoting the health of individuals, families and communities.

Generic preparedness education and training for the public health workforce has increased in availability over the past 5 years. Registered Nurses also have more opportunities available for participation in emergency and disaster preparedness curricula. Discipline- and specialty-specific training and education for public health nurses (PHNs) incorporating their population-based practice, however, remains a largely unexplored area that is not accessible except for sporadic local venues. The Public Health Nursing Surge Curriculum provides 50 hr of nursing continuing education and activity-based aggregate focused learning experiences that are completed within a 12-month period, including an in-classroom seminar. The Public Health Nursing Surge Curriculum was developed on a foundation of 25 competencies linking PHNs and their population-based practice to surge capability. The curriculum was built in partnership with statewide public health directors of nursing over a 12-month period and is evaluated by a 3-level process to include self-rated confidence in performance. The curriculum's use of a blended learning methodology enables staff-level PHNs to master individual competencies toward surge capability within the public health response system.

PURPOSE: Public health nurses (PHNs) need to develop new projects to solve community health problems as an active strategy. The purpose of this study was to clarify how many Japanese PHNs actually have experience of project development process, and to examine related factors. METHOD: By using random-sampling, we chose 374 municipalities from a total of 1,871 that would not consolidate with their neighbours in 2005, and obtained cooperation from 305. In collaboration with the Association of Japanese Public Health Nurses, questionnaires mailed to 2306 Japanese PHNs working in the municipalities in 2005. The self-administered questionnaire included items on; 1) municipal and organizational variables; 2) PHN-related factors; 3) whether the PHNs had experience of project-development processes. We performed logistic regression analysis to examine the relationship between experience and these parameters. RESULTS: Among the 1,270 respondents, PHNs who did not recognize the necessity of creating a new project accounted for 481 (37.9%); those who recognized the need to create a new project but did not propose any practical means numbered 324 (25.5%); those who proposed a new project but did not implement it were 66 (5.2%); and those who provided a new project for their residents were 399 (31.4%). The logistic regression analysis revealed that PHNs who had experience of developing new services by themselves and read health, medical and welfare journals were significantly more likely to provide new projects for their residents. CONCLUSION: PHNs have the capability to create new projects and individuals in all municipalities and organizations need to acquire active experience of developing projects.

Aim. The aim of the study was to explore factors which impact on quality nursing care in the community from the Public Health Nurse's (PHN) perspective. Background. Public Health Nursing has significantly evolved over the past few years with the delivery of quality nursing being a focus point. This study explores factors that impact upon the delivery of quality care in Public Health Nursing in Ireland. The findings provide an opportunity for an additional perspective to be included in the existing international findings and act as a starting point from which further research can be built. Method. A qualitative method using semi-structured interviews were conducted. Interviews were taped and content analysed. Findings. Four main categories emefrged from the data, namely role change, components of quality nursing care, barriers to quality nursing care and the factors that facilitate the delivery of quality nursing care in the community. PHNs strive for evidence-based practice; they acknowledged their inability to achieve this and referred to factors that inhibited them from reaching their goal. Conclusion. Enhanced education for PHNs will equip them in the delivery of a quality service and have a positive impact on patient care. Better communication is required between PHNs, line managers and the multidisciplinary team. The delivery of community services need to be reviewed and developed further in accordance with the health strategy policy. Relevance to clinical practice. This study has identified the evolution in clinical practice associated with the changing role and scope of Public Health Nursing. Clinical practice has evolved over time to incorporate societal change, technological advances and the delivery of an evidence-based service responsive to identified need. This study identified the presence of an increase in the specialist clinical work being undertaken as a result of new technological advances entering the community working environment.

It is important for nursing administrators to understand the migration and credentialing process as they integrate foreign-educated nurses into United States health care systems. Issues and considerations related to migration and credentialing of foreign-educated nurses are summarized.

The purpose of this study was to describe the experiences of public health nurses (PHNs) who screen for woman abuse within their clinical practice. Semi-structured, in-depth interviews were conducted with 11 PHNs. There was a great deal of variability in participants' level of experience in working with abused women.The results reveal that nurse readiness is an important factor in screening for woman abuse. The authors describe a number of steps participants appeared to grapple with in order to become comfortable working with abused women, including coming to terms with abuse, asking the question, bearing witness, and "walking with" the client. As the PHN became increasingly comfortable working with abused women, she came to redefine success. Her client's personal growth over time, rather than the single act of leaving an abusive relationship, now defined a successful client interaction.The authors also discuss implications for practice that arise from these accounts.