American Public Health Association
800 I Street, NW • Washington, DC 20001-3710
(202) 777-APHA • Fax: (202) 777-2534 •

Public Health Nursing
Section Newsletter
Spring 2005


The work of the Public Health Nursing Section is even more visible than I had understood when I came into this role as Chair. The position has larger responsibilities than I previously thought. I am representing the Section on the Quad Council of Public Health Nursing Organizations, in APHA, at conferences, and to the occasional reporter. I have tried to be bold. Being bold has not necessarily come naturally to me, but our distinguished foremothers in public health nursing were bold, and we should and can be, too. My inspirations in public health nursing have been those who have challenged me to exercise leadership in acting on things that were “wrong,” in collaborating with unique and under-recognized partners and in using my expertise to join others in creating change. Now, more than ever, I feel called to abandon my comfort zone and be true to these inspirational mentors, thereby, reflecting our Section’s distinguished past as well as advancing our work into the future.

I am not alone in this. In recent years the Section Leadership has committed itself to a handful of topical areas in which our efforts predominate and will advance public health nursing’s legacy of bold reform. These areas include social justice, health disparities, environmental health and public health nursing infrastructure. These endeavors include investments of time, collaborations with other Sections, compromise and sometimes discomfort!

Some of our work, such as national discussions regarding the Community/Public Health Nursing Certification, seem more mundane, but this is something I have found to have a profound relationship with our profession and the populations we serve. It seems that examinations for this credential could soon no longer be provided (despite our serious efforts to the contrary). It is clear to me now that the Section needs to have a role in examining the implications of credentialing and the fragile pipeline of new nurses that we (and our communities) depend on in public health. Public health practice also has a great deal to learn from our experience with credentialing, as the broader public health community considers the issue of creating a credential for the general public health worker. The Section has more at stake in this discussion than many of us had previously realized. We can use this challenge to provide leadership to create new solutions for public health nursing education, advancement, and service to our communities.

(NOTE--In the short run, PLEASE consider taking the Community/Public Health Nursing Certification exam held in October by the American Nurses Credentialing Center. See the report from Pamela Kulbock in this newsletter.)



Council on Linkages (COL): The Council on Linkages Between Academia and Public Health Practice is comprised of leaders from national organizations representing the public health practice and academic communities. The Council (1992) grew out of the Public Health Faculty/Agency Forum (1990), which developed recommendations for improving the relevance of public health education to the demands of public health in the practice sector. The need for this improvement, and for public health professionals to place a higher value on practice-specific training and research, were documented by the Institute of Medicine report, The Future of Public Health (1988). The Council is a Public Health Foundation project supported under a cooperative agreement from the Health Resources and Services Administration.

The Council's Mission: To improve public health practice and education by refining and implementing recommendations of the Public Health Faculty/Agency Forum, establishing links between academia and the agencies of the public health community, and creating a process for continuing public health education throughout one's career.

Member Organizations:
American Association of Health Plans
American College of Preventive Medicine
American Public Health Association
Association of Schools of Public Health
Association of State and Territorial Health Officials
Association of Teachers of Preventive Medicine
Association of University Programs in Health Administration
Centers for Disease Control and Prevention
Health Resources and Services Administration
National Association of County and City Health Officials
National Association of Local Boards of Health
National Environmental Health Association
QUAD Council of Public Health Nursing Organizations
Society for Public Health Education

APHA Past President William Keckis the Chair of this group, and a quarterly bulletin “The Link” is published at <>.

The “Core Competencies for Public Health Professionals” was published in April, 2001. The competencies are divided into the following eight domains: Analytic Assessment Skills, Basic Public Health Sciences Skills, Cultural Competency Skills, Communication Skills, Community Dimensions of Practice Skills, Financial Planning and Management Skills, Leadership and Systems Thinking Skills, Policy Development/Program Planning Skills. Skills and knowledge levels are listed first within each domain, followed by important attitudes relevant to the practice of public health. While attitudes may be more difficult to measure, they can be part of what is taught and should be included in curriculum and content development efforts.

The QUAD Council and you, some of our Public Health Nursing Section leaders, especially Diane Downing, were instrumental in developing and refining these competencies. The core competencies represent a set of skills, knowledge, and attitudes necessary for the broad practice of public health. They transcend the boundaries of the specific disciplines within public health and help to unify the profession. However, because the list only captures the cross-cutting competencies for public health practice, it does not contain competencies that are specific to certain disciplines within the field. Discipline-specific competencies are necessary for specialized roles within public health (such as public health nurses). Moreover, because this list is meant to represent the core, it may not contain many skills that are necessary for the performance of certain jobs within certain practice settings. Individuals, employers, educators, and trainers are encouraged to use this list as a starting point for developing a modified list of competencies that matches their institutional needs.

In a recent COL e-mail message, we were informed that CDC has committed funding to republish the “Core Competencies for Public Health Professionals” booklets. These will contain some updated language, including a list of resources available to help practice and academic organizations use the Competencies. For more information on the Core Competencies, please see the Public Health Foundation Web site: <>.

Today, the Council is working with member organizations to convene a national forum to discuss evidence on effective efforts to address worker shortages and to learn what other fields have done to combat this problem. A toolkit highlighting worker recruitment and retention efforts that have documented evidence about their level of success is being developed. The need to identify an adequately staffed, skilled and competent public health workforce -- the focus of a recent COL meeting agenda -- is being considered as a research topic for one of the Agency for Health Care Research and Quality’s evidence-based practice centers. A comprehensive list of potential strategies for addressing the public health worker shortages, with corresponding sample projects, research, and other resources can be found at <>.

You might be interested in knowing that while APHA is actively focusing on and supporting the National Public Health Performance Standards Project and working with NACCHO on Mobilizing for Action through Planning and Partnerships (MAPP), during various sessions at the Annual Meeting, it is also using the CE Institutes for public health worker education. APHA continues to develop individuals' skills through the Continuing Education Institutes, which help prepare non-MPH workers for public health work, and working with CDC to strengthen the training capacity of Public Health Leadership Institutes. One of the recent recommendations to COL was to review the final report of the Sullivan Commission on diversity in the Healthcare Workforce, “Missing Persons: Minorities in the Health Professions.”

Colleen Hughes
(775) 225-5015 (Cell...leave message)



The Quad Council of Public Health Nursing Organizations is composed of representatives from the American Public Health Association, Public Health Nursing Section (APHA), the Association of State and Territorial Directors of Nursing (ASTDN), the Association of Community Health Nursing Educators (ACHNE), and the American Nurses Association (ANA). It was decided at the Public Health Nursing mid-year meeting to include a report about the initiatives and projects of the QUAD Council (Council) and its members in the Section Newsletter.

The following are reports from each of the Council members:

American Nurses Association: Reported by Rita Munley Gallagher, PhD, RN;

Since the 2004 ASTDN meeting, among other activities, the ANA Congress on Nursing Practice and Economics:

  • Acknowledged the scope of practice statements and approved the standards of practice of Pain Management Nursing and School Nursing.

  • Discussed the American Association of Colleges of Nursing (AACN) Clinical Nurse Leader, Nursing Doctorate, and advanced practice issues and the interest of the organizational affiliates in the policy and practice work of the organization.

  • Published the Utilization Guide for the ANA Principles for Nurse Staffing.

  • Recommended that the ANA Board of Directors -

  • i. Adopt the resolutions of the Transforming the Work Environment workgroup concerning fatigue;
    ii. Consider developing informational opportunities to classify the role of regulators and professional organization in supporting the advanced nursing practice;
    iii. Continue to oppose regulatory barriers to advanced nursing practice such as APRN second licensure and the recent activity of the Texas Board of Nurse Examiners to limit the number of nursing specialties recognized for practice;
    iv. Endorse the Acute Care Nurse Practitioner Competencies;
    v. Endorse the National Heart Attack Alert Program (NHAAP) Coordinating Committee paper, Prehospital 12-Lead Electrocardiography—A Call for Implementation in Emergency Medical Services Systems Providing Advanced Life Support;
    vi. Endorse, the Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes;
    vii. Have all the associations involved in nursing education investigate the concerns related to the increase in offshore education for licensed nurses;
    viii. Request the ANCC work with ANA on further refinement and application of the forces of magnetism especially in home health and long term settings;
    ix. Support the NY State Board for Nursing proposal regarding baccalaureate education as a requirement for continued licensure to practice professional nursing; and,
    x. Take the position that ANA neither oppose nor approve the initiative to establish the Clinical Nurse Leader and/or Practice Doctorate until a series of concerns/questions formulated by CNPE are addressed.

  • Revised Nursing’s Agenda for Health Care Reform.

  • Projects/Issues Pending:

    The draft Population-Focused Nursing: Scope and Standards of Practice document is approximately two-thirds completed, and spirited discussions still remain the hallmark of the group's work process, reflecting the members' dedication and commitment to create a truly valuable document. The scope of practice statement reflects contemporary models and frameworks, including public health competencies and IOM directives. The standards of practice and professional performance and accompanying measurement criteria model the template language of Nursing: Scope and Standards of Practice but have necessarily been modified to encompass the specialty's population-focus. This document replaces the 1986 community health and 1999 public health nursing scope and standards documents and will be posted for public comment as part of the review and revision process. Joy F. Reed, EdD, RN is serving as chairperson of the workgroup empanelled by the Committee for Nursing Standards and Guidelines. Other members of the workgroup include: M. Beth Benedict, DrPH, JD; Betty Bekemeier, MSN, MPH, RN; Kaye Bender, PhD, RN, FAAN; Ellen L. Bridge, BS, MT, RN; Stephanie Chalupka, EdD, APRN,BC; Karen W. Connelly, BSN, MPA, RN; Mary Pat Couig, MPH, RN, FAAN; Philip A. Greiner, DNSc, RN; Glenda Kelly, MSN, RN; Pamela A. Kulbok, DNSc; Deborah S. Martz, BSN, RN.

    Association of State and Territorial Directors of Nursing reported by Joy Reed, EdD, RN; Joy. Reed

    Mentoring: ASTN has been working with the University of Massachusetts at Amherst to connect ASTDN members as mentors for students enrolled in their distance learning MS/MPH dual degree program. A matching process was used to unite mentors and mentees for the first cohort. Having a mentor with no connection to the program gives the students an individual with whom they can discuss ideas and assignments and how the theory they are learning works in the real world, as well as providing a “sounding board” for the student. For ASTDN members, this is one way we attempt to assure the future of our specific role as the State level as well as the future of our specialty.

    Role of PHNs in Disasters: The Saturday workday at the ASTDN’s annual meeting was devoted to looking at this issue in a comprehensive way, facilitated by Dr. Kristine Gebbie. “To do’s” resulting from that session include developing a “white paper” on the delineation of roles of various organizations and partners, including addressing the problematic issue of Special Needs Shelters. We will also be developing a guidance document for the top public health nurse in the state. A project to clarify the education for all levels of PHNs on preparedness has also been initiated.

    On a related issue and in preparation for a presentation at the Public Health Law Conference in June, ASTDN is conducting a survey of states on changes to the nursing scope of practice (as defined in nurse practice acts) or the addition of public health and/or preparedness specific laws which expand nursing scope of practice in times of disaster.

    Data on the PHN Workforce: Almost two years ago, with CDC assistance, ASTDN worked with the North Carolina Institute for Public Health to complete a survey on the role of the “top” nurse in each state, as well as to collect some data specifically about the governmental public health nursing workforce (since the HRSA data groups us with many other nurses). With the support of Betsy Weiner of Vanderbilt, ASDN is working on revising that survey to initiate annual collection of data, which will allow us to track trends.

    Ratio of PHNs to Population: One new issue that ASTDN will be reviewing this year is attempting to determine an appropriate ratio of PHNs to population or at least developing an instrument or method for measurement. We hope that some of the researchers in our partner organizations will want to work with this group to be led by Margaret Schmelzer of Wisconsin.

    Association of Community Health Nursing Educators reported by Pamela A. Kulbok, DNSc, RN;

    Annual meeting: ACHNE’s annual meeting, Evidence-Based Practice in Community/Public Health Nursing, was held from June 2-4, 2005 in Hartford, Conn. There were more than 50 paper and poster presentations on education, practice and research. The following three awards were presented: (1) Outstanding Graduate Student in the Field of Community/Public Health-Susan Breakwell, DNP, RN, Assistant Professor, Rush University College of Nursing; (2) Outstanding Contributions to Community/Public Health Nursing Research-JoEllen Wilbur, PhD. RN, CS, FAAN, Professor and Associate Dean for Research Services and Administration, University of Illinois at Chicago, College of Nursing; and (3) Outstanding Contributions to Community/Public Health Nursing Education-Patty Hale, PhD, FNP, RN, Professor, Lynchburg College School of Health Sciences and Human Performance Nursing Program.

    American Nurses Credentialing Center: Quad Council members have been actively participating in a series of conference calls with leaders of the American Nurses Credentialing Center (ANCC) to problem-solve regarding the future of the Community/Public Health Nursing Basic and Clinical Nurse Specialist (CNS) examinations. On the recent May 2005 testing date, only 10 PHNs took the basic examination, and 46 PHNs took the CNS examination. The examinations will be offered again in October 2005. Individuals must apply either for Oct. 15, 2005 or Aug. 5, 2005. The future of these exams remains uncertain. However, the number of PHNs taking the CNS exam has increased, and more test takers in October will allow ANCC to better evaluate the validity of the test. Please consider taking these exams!


The IHRC has scheduled four scientific sessions for the APHA Annual Meeting in New Orleans on topics related to human rights, ethics, and public health. The sessions are: 1) Torture and the Human Rights of Prisoners; 2) Human Rights and Cloning; 3) the Human Right to Health; and 4) The Human Rights of Vulnerable Populations. An Open Forum will once again be held for attendees at the APHA meeting to share their thoughts, concerns, and ideas with the IHRC. Progress continues on the globalization white paper and securing names for the emergency action mechanism that was voted on and accepted at the 2004 annual meeting. Thank you to PHN Section members who have helped with both endeavors.

Louise Ivanov is the PHN Deployment Representative to the IHRC, and can be reached at


Rita Gallagher

At the mid-year meeting, permission was given for development of a PUBLIC HEALTH NURSING SECTION LOGO. We want everyone in the Section to have the opportunity to create a dynamic, unique, artistic, stylish, chic, smart, incomparable, and/or ingenious production.

You are encouraged to review what other sections are currently using. Section logos can be found on the APHA Web site at <>.

Submission Requirements:

Medium: All media are acceptable
Dimensions: No larger than 8.5 x 11
Deadline: August 31, 2005
Submit to: Rita Munley Gallagher, PhD, RN
Senior Policy Fellow
American Nurses Association
8515 Georgia Avenue
Silver Spring, MD 20910

The winning LOGO will be selected by Section Leadership at the first PHN Section meeting during the Annual meeting in New Orleans. The selected LOGO will be unveiled at the PHN Celebration Luncheon and the creator will be recognized.

The LOGO will be used on Section letterhead and on Section promotional items.

Please DO NOT miss this opportunity to become a very visible part of the PHN Section.


The International Nursing Coalition for Mass Casualty Education (INCMCE) has met for the past few years at Vanderbilt University, Nashville, Tenn. The INCMCE consists of organizational representatives of schools of nursing, nursing accrediting bodies, nursing specialty organizations and governmental agencies interested in promoting mass casualty education for nurses. This project has been funded by the U.S. Department of Health and Human Services, Office of Public Health Emergency Preparedness ( to assure a competent nurse workforce to respond to mass casualty incidents. As part of the international community’s overall plan for emergency preparedness in mass casualty incidents (MCI), nurses worldwide must have a minimum level of knowledge and skill to appropriately respond to a mass casualty incident.

In August, 2003, this group published a document outlining educational competencies that apply to all professional nurse roles and practice settings such as: acute care facilities, clinics, schools, homes, and other community venues for registered nurses responding to mass casualty incidents. It is true that not all nurses can or should be prepared as first responders, however, every nurse should have sufficient knowledge and skill to recognize the potential for a MCI, identify when such an event may have occurred, know how to protect oneself, know how to provide immediate care for those individuals involved, recognize their own role and limitations, and know where to seek additional information and resources. The potential roles of nurses in a MCI may vary extensively due to diverse educational background, experiences, and practice settings within the community and health care system.

The Center for Health Policy at Columbia University School of Nursing has published a set of “Core Public Health Worker Competencies for Emergency Preparedness and Response.” It is interesting to note that several state Boards of Nursing have opted to add a short course on bioterrorism to the requirements of licensure and licensure renewal applications. I discovered an excellent free continuing education course from the University of Albany that more than adequately met our state’s rigid requirements for licensure renewal, and I highly recommend this course to you: “UAlbany Center for Public Health Preparedness," <>.

I have a question for you….what courses are required courses for your state’s licensure renewal? Perhaps some of these required professional education courses can and should be taught during APHA’s Annual Meetings. Do you agree? It is my understanding from the recent APHA Education Board meeting that for a minimal additional fee, CEs will be awarded for nearly every session.

National Public Health Performance Standards (NPHPSP)
Since Sept. 11, public health and its leaders have been in the spotlight with the concept of strengthening public health systems and organizations being an enterprise of unprecedented interest. The National Public Health Performance Standards (NPHPSP) is a way to assess and improve the ways we deliver public health services in our states and out communities.

The NPHPSP were developed through a collaborative effort between the Centers for Disease Control and Prevention(CDC), the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), the National Association of Local Boards of Health (NALBOH), and the Public Health Foundation (PHF). The National Network of Public Health Institutes (NNPHI) is a new member group. The NPHPSP is designed to measure public health practice at the state and local levels. The performance standards have been developed using the 10 Essential Public Health Services as a framework. The NPHPSP includes state, local, and governance instruments, as well as an international instrument. Various products and resources are available to assist you in learning about the value and quality improvement aspect of using the NPHPSP at <>.

Mobilizing for Action through Planning and Partnerships (MAPP) is a community-wide strategic planning tool for improving community health. Facilitated by public health leadership, this tool helps communities prioritize public health issues and identify resources for addressing them. There are four MAPP Assessments that are designed to provide critical insights into the challenges and opportunities throughout the community: community themes and strengths assessment; Local public health system assessment; community health status assessment; and forces of change assessment. Using the results of these assessments, participants identify strategic issues and then formulate goals and strategies for addressing each issue to ultimately lead to community health.

Compellingly designed to provide useful and practical guidance, while at the same time offering enough flexibility to be adaptable to any community, each section of the MAPP tool includes guidance, tools, case vignettes and references and resources. This tool is a natural augment to the NPHPSP and is available through <>.

I really encourage you to become acquainted with the NPHPSP and MAPP processes and encourage their use. These are not designed to grade the public health departments, but rather to look at public health being delivered throughout the community by all sorts of groups including the governmental public health entities.


At the mid-year meeting, Chair Betty Bekemeier asked the Section members to jot down a few thoughts about what membership meant to them. Here are some of the responses:

This is my second family - my booster shot for PHNing

The PHN Section has a leadership role for public health nurses nationally & globally. This role cannot be fulfilled unless public health nurses participate. I am here to participate!
I am inspired by the tremendous volunteerism, energy and dedication of the people I am surrounded by here and in the legacy that comes before.

While I’d like to say that I come to serve the section, the truth is I have too much to learn - so I come to learn. Thanks.

I come because I am lucky enough to belong and on behalf of those who can’t.

Professional commitment, professional growth, collegiality, super friends to work with.

Finding out what’s happening in Public Health around the country… not to mention hanging out with people who awe me with their energy, accomplishments & vision.

Love for Public Health & Public Health Nursing

This is a group of people with whom I share a common language, vision and commitment

Enjoy working with dynamite people.

I’m crazed - it’s a productive use of energy

Being on the front line of work I care deeply about; working with folks who are masterful at making things happen.

Agree with the mission - it’s in my soul.

Fellowship with others who love Public Health Nursing

I wanted to join APHA since I became a PHN in 1974, and it only took me 30 years to do so - finally.

Please consider sharing these responses with some of your friends, colleagues or professional partners who might also benefit from Section membership.


The Global Health Committee is busy planning a solicited session for the APHA Annual Meeting in New Orleans. The session will be "Beijing Plus 10: Global Policy Changes for Women." This session will focus on global women’s health issues and progress toward improving health for women since the International Conference on Women 10 years ago in Beijing. Speakers will address women’s ongoing struggles at the United Nations against forces of conservatism, human trafficking of women, and women’s health in China. This session will provide public health nurses with information on women’s health issues that can be used in education and practice with women of various cultures. We look forward to seeing all of you at the conference.

--Louise Ivanov

Louise is the Chair of the Global Health Committee and can be reached at <>.


The Administration on Aging encourages You Can! partners to join in celebrating ways for older adults to be active and healthy this September. Holding a local You Can! Celebration can help you spread the word about the importance of healthier lifestyles, and it can be fun!

During any seven-day period in September, AoA invites You Can! partners to create You Can! activities. These are activities where participants can make a pledge and engage in healthier lifestyle activities. If they see how easy and enjoyable it can be, hopefully they will continue the nutrition and physical activity behaviors and help others to improve their health, too.

All community partners that sign up and complete the contest entry form have a chance to receive awards. The contest will culminate with a ceremony in the Washington, D.C., metro area in October, where the best entries in leadership categories will be recognized.

For more information visit:

If your organization wants to participate and is not yet a You Can! Partner, you can enroll at <>.

Kay Loughrey
Aging Program Specialist
U.S. Administration on Aging
(202) 357-0142