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Laurie Calderhead, RN, PHN, with children at Nunamiut School in Anaktuvuk Pass, Alaska, after she gave the children TB skin tests and immunizations.

Cindy, a mother of three on Alaska's Kenai Peninsula, had an abscessed molar and recurring tooth pain. But she wasn't able to see a dentist. Those in her area either didn't take Medicaid patients or took only patients who could pay a certain amount up front. The nearest dentist who took Medicaid patients was 150 miles away, and Cindy (not her real name) didn't have a car reliable enough to make the trip.

This year, however, she finally was able to receive treatment when a new dental clinic opened in Kenai. Various community members launched the Aspen Dental Center for residents who have no access to dental care.

The clinic is the brainchild of JoAnn Hagen, MS, RN, PHN, public health nurse manager for the Kenai Peninsula, and her fellow Healthy Communities/Healthy People task force members. Although the clinic didn't make headlines, it was "one of the most exciting things I've done in a long time," Hagen said.

As a public health nurse, Hagen often participates in projects that reach far and wide. She focuses on populations, rather than individuals, and aims to prevent diseases rather than to treat them.

Strength in numbers

Public health nurses' influence is only continuing to grow as more and more nurses are choosing the specialty.

Registered nurses employed in public and community health settings increased by 155 percent between 1980 and 2000, while the overall RN population increased by 62.2 percent in the same time period, according to the Health Resources and Service Administration's 2000 National Sample Survey of Registered Nurses.

Also, public health nurses make up the second-largest group of working registered nurses at 18.1 percent, or 402,000 individuals, the report said. Hospital nurses make up the largest group of working RNs at 59.1 percent.

Public health nurses don't usually focus on performing or assisting with medical procedures. Instead, they focus on educating clients and examining community trends to prevent diseases. However, they can give immunizations, provide medications for communicable diseases, run health screening clinics and refer clients for medical follow-up.

Jennifer Schmidt, RN, PHN, had worked in hospitals and taught nursing throughout Alaska for about a decade before she moved to Fairbanks, where the public health nurse manager at the state-run Fairbanks Regional Public Health Center asked her to apply for a public health nursing position.

"I had always enjoyed looking at the big picture and looking at ways that problems could be avoided, so it fit," Schmidt said.

She has covered the Fairbanks North Star Borough since 1982. She visits clients in their homes in order to provide information and help families stay healthy. Schmidt spends a lot of time directly serving clients, such as administering pregnancy tests and running new-parent clinics. Clients can be referred by hospitals, doctors or agencies. Sometimes, they even refer themselves.

Public health nurses prefer home visits because they can get a better picture of individuals' or families' resources and health needs, Schmidt said.

"I love the variety in public health nursing," Schmidt said. "I like working with clients and families, and going beyond the individual problem and seeing what else is going on."

Family-centered care

Candace House, PHN, a public health nurse with the Kitsap County Health District in Washington state, used to work in med/surg and rehabilitation until she began to work in home health. She enjoyed working with families so much that she switched to public health nursing.

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