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Career development: becoming a specialist community public health nurse

Janine Ellul Bsc(Hons) PGDip RGN
Specialist Community Public Health Nurse (Health Visitor)
Newham Community Health Services
East London Foundation Trust

A specialist community public health course can provide a greater understanding of the context in which you work and increase confidence in applying research to a practical setting

Nursing and Midwifery Council (NMC) guidelines give explicit standards that public health nurses must meet before they are placed upon the third part of the register.1 The NMC indicates that the educational level of nurses on this part of the register must be to at least degree level. As a result, nurses may feel they wish to reach a higher level of study to broaden their career path.

The specialist public health nursing course (postgraduate diploma in public health) at Queen Mary University comprises a variety of core modules and one optional module, which is common to most degree and postgraduate programmes. It involves completing nine modules in one year, demanding a good level of commitment and time.

The core modules of any programme are meant to equip the student with the principles of that discipline. Due to the nature of the programme and the fact that it prepares the student for a vocational role, the core modules seek to outline the NMC professional standards for public health practice, which include: stimulating an awareness of health needs; facilitating health enhancing activities; searching for health needs; and influencing policies on health.
The modules are:

  • Research methods.
  • Epidemiology and statistics.
  • Philosophy and politics of primary care.
  • Health promotion.
  • Integrated public health.
  • Innovations in healthcare leadership and management.
  • Community empowerment and education.

Key skills gained from the programme include:

  • An ability to interpret and understand large amounts of data around health and health interventions. The aim is to increase confidence in applying interventions and research to the practical setting.
  • A greater understanding of the political and historical context of primary care and public health, as well as policy decisions and the power relationships in this setting on macro, meso and micro levels, and how to respond to these to ensure the best care for patients.
  • An understanding of public health practice in relation to the NMC professional standards. Public health is often described as the art and science of promoting health and within this is embedded the importance of the population aspect of health.2 An insight into the impact of poverty, social exclusion and lack of education on health outcomes enables a better understanding of what holistic health really means and how this can be applied to practice.3
  • How to lead change in an effective way by being an agent for change and conducting change in a way that is sustainable and supportive to the work setting. This is increasingly important in the current political climate with the implementation of the coalition's white paper and proposed changes to working conditions for all staff.4 Public health and community nurses have a unique understanding of their communities and their needs, and this needs to be harnessed for any change to be successful.5

Another vital component of the course is the practice-based module. This is a core module where the theory learned can be put into practice, and any gaps clearly exposed. Many of
the assessments for the diploma involve implementation in practice or recognising a need, such as leading a change management project or formulating a health promotion project
for the local area.

The course involves study with students from a broad range of disciplines, giving access to a wider range of views and opinions. Reflection on practice is an important part of the course, and it introduces new ways of reflecting, such as storytelling and using objects to stimulate discussion, all of which provide students with a more detailed and greater understanding of themselves and their work.

The course is challenging in terms of the amount of academic work and practice that need to be completed. At master's level understanding becomes critical analysis, where students' own ideas gained from a thorough understanding of the literature and current trends become important. It may also be challenging on a personal level. Students may need to prioritise assignments over family and many weekends can be spent studying rather than socialising. However, for many people this can be liberating, opening up a whole new and interesting career pathway.

Public health nursing is of great importance to the community and has the potential to be a varied and interesting job using a wide range of skills.5,6 Current issues in public health nursing, namely the vacancy rates and high workloads, mean that this may not be the case at the moment; but if targets for more health visitors and school nurses are met then one day it may be.6

Changes in the NHS, specifically commissioning, mean that nurses in the community need to be highly skilled and confident to be part of developing and leading on population-based services. Successfully completing this course can help nurses to become highly skilled and confident practitioners who are able to actualise the health needs of clients and communities and put them at the heart of everyday practice.

References
1.     Nursing and Midwifery Council (NMC). Standards of proficiency for specialist public health nurses. London: NMC; 2004.
2.     Acheson D. Independent Inquiry into Inequalities in Health. London: Stationery Office; 1998. Available from: www.archive.official-documents.co.uk/document/doh/ih/ih.htm
3.     Marmot M. Social determinants of health inequalities. Lancet 2005;365:1099-104.
4.     Department of Health (DH). Equity and Excellence: Liberating the NHS. London: DH; 2010.
5.     Department of Health (DH). Healthy Child Programme:pregnancy and the first five years of life. London: DH; 2009.
6.     Department of Health (DH). Health visitor implementation plan 2011-2015: a call for action. London: DH; 2011.

Resources
NHS Careers: Health Visiting
www.nhscareers.nhs.uk/details/default.aspx?id=807

Nursing and Midwifery Council
Specialist community public health nursing
www.nmc-uk.org/Nurses-and-midwives/Specialist-Community-Public
Health-Nursing/