Being a real nurse: A secondary qualitative analysis of how public health nurses rework their work identities

Abstract

The Latin expression nihil sub sole novum-'there is nothing new under the sun'-applies to today's groundswell of renewed interest in the concept of population health (Neve, Hothersall, & Rodrigues, 2019). Population health is concerned with 'interrelated conditions and factors that influence the health of populations, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and well-being of those populations' (Government of Canada, 2013). Renewed interest is evident in Canada, where a 'population health approach' is being used to reduce health inequities (Cohen et al., 2014), and in the United Kingdom (UK), where the Nursing and Midwifery Council recently revised its competencies to include population health (Lasater, Atherton, & Kyle, 2020). In Australia, the Victorian Department of Health and Human Services collaborated with the University of Melbourne to increase the number of population health course offerings (Naccarella, Butterworth, & Moore, 2016), while in the United States, the American Association of Colleges of Nursing (AACN) (2019) integrated population health concepts into its vision for nursing education. What has not been considered in exhortations to focus on population health is the role of professional or work identity and the accompanying tension created in trying to move nurse actions to the population health level. Since work identity is critical in determining the 'purpose and worth' of nursing (Willetts & Clarke, 2014, p. 165), it also may be useful in understanding nursing's uptake of population health. The analysis reported here arose from an earlier study whose purpose was to explore factors influencing public health nurses' decisions to obtain a graduate degree (Drevdahl & Canales, 2018). Data were gathered through semi-structured interviews with 30 U.S. nurses working in public health. During the interviews, study participants often discussed how they understood their role as public health nurses. Although these data

Emotional Labor and Burnout of Public Health Nurses during the COVID-19 Pandemic: Mediating Effects of Perceived Health Status and Perceived Organizational Support

“…During the COVID-19 pandemic, PHNs were initially mobilized for infection control and quarantine, while actively adapting to constantly changing policies and guidelines. They felt pressure from still being responsible for the regular role of providing health promotion and public health services, such as smoking cessation education and vaccination [ 1 ] while facing additional COVID-19-related work [ 35 ]. In this study, over 50% of PHNs had a heavy work burden, having performed ≥ 4 h of COVID-19-related work (50.7%), ≥2 h of complaint response work (63.8%), and ≥2 h of overtime work (59.9%) in the past one week.…”

“…As the pandemic has lingered on and expanded to communities, the public health policies of the government and health authorities are changing constantly. Public health centers are basic but core institutions within the public healthcare network, while public health nurses (PHNs) provide primary healthcare services to community residents for disease prevention and health promotion [ 1 ]. However, during the global pandemic crisis, PHNs have faced a sharp increase in their workload for infection control and dealing with complaints [ 2 ], screening [ 3 ], as well as added work for cohort isolation, contact tracing, and self-isolation training; vaccination; and follow-up actions for adverse symptoms after vaccination [ 4 ].…”

Towards abandoning the master’s tools: The politics of a universal nursing identity

“…The horizontal violence so broadly acknowledged in nursing can be understood as a consequence of the struggle for symbolic capital in an arbitrarily unjust system, and the obvious success of some nurses over others at attaining it, such as managers and advanced practice nurses (Anderson et al., 2020). As Drevdahl and Canales (2020) found, the legitimacy of a nursing identity is judged in terms of its proximity to medicalized acute nursing care. In terms of repressed or diverse identities, it could be theorized that in the work to mimic the valued oppressor, which requires abiding by established norms and which in Canadian healthcare contexts could mean white, middle class, male, heterosexual and medical, that nursing has subconsciously avoided making room for alternate identities in fear of losing opportunities to gain status.…”

“…The dominant discourses of nursing identity do shape nursing identity research, and as such, this type of research may not get results about the inner negotiation of both cultural and social influences but rather produce a reflection of how nurses measure up to the construct. Further, if the legitimacy of a nursing identity relies amongst nurses on its proximity to acute care due to a disciplinary marginalization of non-acute, or population-based specialties (Drevdahl & Canales, 2020), then social and structural determinants of health, such as systemic racism, may not be considered a nurse's work. This centring of work that is most valued in the doxa of the healthcare field may thus contribute to a lack of attention and commitment to significant social processes that tragically impact the lives of countless people.…”

Primary healthcare professionals’ perspectives on patient help-seeking for lung cancer warning signs and symptoms: a qualitative study

“…Patient education was highlighted as key to early LC referral and diagnosis, particularly among PHNs who emphasised the importance of educating high-risk patients (e.g., smokers) about LC before symptoms occur. This nding is not surprising since health promotion and risk screening is at the heart of the PHN role [24]. Another strategy to raise patients' awareness of LC and engage them in early detection and referral was recommended by CPs who spoke about the importance of stressing LC symptoms rather than smoking per se.…”