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Education plays a big role in the job of nurse epidemiologists in hospitals. Joan Golden, RN, CIC, supervises infection control at three hospitals in Provo, Utah. Don Ray is a staff member at Utah Valley Regional Medical Center.

Kirsten Ernst, RN, MSN, MPH, FNP, had been on the job at the national Centers for Disease Control and Prevention only four days when her pager rang on a Friday night in August 2000. The next morning, she found herself on a plane to Jackson, Miss., off to track down the West Nile virus.

As an epidemic intelligence service officer at the CDC, Ernst helps local officials tackle diseases that are often deadly and mysterious. Mississippi had been especially hard hit by West Nile that summer, and it took investigators six weeks to conclude the source of the disease as well as create a plan to combat it.

Not all nurse epidemiologists find themselves on a plane at a moment’s notice, but all are detectives tracking diseases—both infectious and noninfectious—assessing trends, looking for causes, and developing interventions on a primary and secondary level.

Although physician epidemiologists may focus on the pathology of a disease, nurse epidemiologists investigate the community’s habits to see how it spreads and how it can be contained.

Epidemiologists such as Maria Teran-Maciver, RN, MSN, a community involvement specialist at the CDC, study demographics and the dynamics of a community: Does the community meet in churches? How much local cable do its people watch?

“In the South, you never have a public meeting on Wednesday because that’s church night,” she said.

Nurse epidemiologists assess and treat communities in the same way they once helped individual patients, said Ann Kurth, RN, PhD, CNM, an assistant professor in biobehavioral nursing and health systems at the University of Washington in Seattle.

“It’s such a natural fit for a nurse to do epidemiology,” she said. “It’s part of what we do in our day-to-day care. But now the population is your patient.”

Most epidemiologists train by getting a master’s degree in public health with a focus on epidemiology or by getting a doctorate in epidemiology, Kurth said. They enter into one of the overlapping subfields of epidemiology: chronic disease, environmental, occupational, infectious disease, or social and behavioral. Some work to control infectious outbreaks in hospitals, others work in state public health departments.

Specific numbers of nurses working as epidemiologists are hard to find, but of the country’s 2.2 million working nurses, about 12.8% work in community and public health, and 1.7% work in occupational health. A small percentage of those are nurse epidemiologists.

As an environmental epidemiologist, Ernst has studied the effects of a range of events, from air quality in New York after the collapse of the World Trade Center to the effects of the smallpox vaccine.

“The environment affects everything,” she said. “There’s a lot of overlap.”

In Mississippi, she and her colleagues identified patients with West Nile, tested them, and reviewed the data. Next, they sought a “control” group that had not been infected. Comparisons between the groups confirmed that mosquito bites spread the disease. The next step was to educate the public about preventing bites and reducing the mosquito population through spraying.

Caring for communities

Identifying and solving a problem within a community involves coordination among many disciplines.

“You’re working at a federal, state, and local level, with the EPA, environmentalists, physicians, community concerns groups, microbiologists,” Ernst said. “And you’re meeting one-on-one with citizens.”

Each group brings its own strengths to the team. Nurses bring trust with the public, Ernst said. “You’ve got a foot in the door,” she said.