Describing the Contribution and Value of Public Health Nurses to Health System Outcomes

Given that nurses are the largest group within the public health workforce, more effective use of PHNs would optimize the associated financial investment by improving the upstream prevention of illness and promotion of health (Meagher-Stewart, 2009). PHN roles have been vulnerable to cuts and replacement by other less expensive providers (National Advisory Council on Nurse Education and Practice, 2013). Building an effective Public Health Nurse (PHN) workforce requires an evidence base to articulate the contributions made by PHNs to the health outcomes of individuals and communities they serve (Underwood, 2010). Many aspects of PHN practice are invisible and need to be made explicit to the public and to administrators who manage public health programming and resources (Royal College of Nursing, 2016). The purpose of this study is to explore PHN and Nursing Leaders perspectives of their perceived value to health system outcomes.

The Nursing Role Effectiveness Model (Doran et al., 2002), based on systems theory, includes structural, process and outcome components that impact the quality of care. This framework will underpin the interview guide, as well as the identification of concepts relevant to PHN practice in relation to health outcomes. To understand outcomes unique to public health, the Ontario Public Health Standards (MOHLTC, 2008) will be used to reflect the five program areas (infectious diseases, family health, chronic disease management, environmental health and emergency preparedness).

 A qualitative design will be employed and data collected using individual telephone interviews (up to 60 minutes). Purposive sampling with maximum variation will be used to ensure representation by the five programmatic areas of public health practice, the five regions of public health across Ontario (Canada) and a balance of PHN roles. Participants will be recruited via email distributed through the membership of two provincial PHN professional groups representing direct practice and formal leadership roles. A sample of 20 practitioners and 10 nursing leaders are sought (or more until saturation achieved). Interviews will be recorded, transcribed verbatim with personal identifiers removed. NVIVO 10 will be used to assist with coding. Inductive content analysis will be used to identify themes. Themes derived from the interviews will be used to identify concepts relevant to PHN practice in relation to contributions, value to the system, and group/community outcomes. The findings will be used to inform a systematic review of the literature to identify PHN-sensitive outcomes that can be used by administrators and policy makers to plan appropriate health human resources required for a robust public health system.