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Two weeks ago, public health nursing didn’t sound very interesting to Taylor Schoenborn. The 22-year-old student admitted she wasn’t even sure what public health nurses did. She learned quickly, however.

Launch SlideshowMarquard coaxes 4-year-old Deon Sanders into saying “ah” during a community health fair at Patrick Henry Downtown Academy attended by her public health students.

Schoenborn and her fellow students in the accelerated masters of nursing program participated in a health screening at an inner city elementary school. Schoenborn and her instructor, Samantha Marquard, B.S.N. (’04), M.S.N. (’09), M.P.H. (’09), A.P.R.N., F.N.P.-B.C., interviewed a little girl who appeared tired. With gentle prompting the girl revealed that she hadn’t had much sleep because her grandmother and cousin were arguing all night.

Marquard guided the nursing students as they asked the girl, as well as her classmates, a series of questions regarding home safety: Is there anything or anyone in the home that scares you? Are there weapons in the home?

“It was an eye-opening experience for me,” said Schoenborn, a native of Orange County, CA. “The level of violence the children are exposed to is breathtaking. Making children feel safe enough to tell you their stories is as important as getting their height and weight.

“Some children didn’t have enough food at home. Some needed winter coats. One girl was wearing shoes that were too small and we were able to get her a new pair,” she said. “These things aren’t a big deal to me but to them, it’s the world.”

Clinical Exposure 

Marquard said a large part of introducing students to public health nursing is getting them to step outside their comfort zones.

“Asking students to go into a school or into someone’s home where they might see things they’ve never see before – poverty, the lack of resources, unclean – can be overwhelming,” said Marquard. “Fortunately, many of our students have been on mission trips and are mission driven so they do beautifully. They thrive, actually.”

After her experience at the elementary school, Schoenborn said she might consider a career as a public health nurse. According to the Bureau of Labor Statistics, she shouldn’t have trouble finding a job. Employment opportunities for public health practitioners, especially nurses, are projected to grow by 13 percent over the next decade.

Due to the predicted overall shortage of one million nurses by 2020, the Institute of Medicine, in its Future of Nursing report, stressed the importance of "attracting and retaining well-prepared nurses in multiple care settings," including those in public health. The training of public health nurses is made more critical by the increased emphasis on preventive care; growing rates of chronic conditions, such as diabetes and obesity; demand for health care services from the baby-boom population; and new emerging infections.

Yet even with an optimistic job outlook, a literature review in the International Journal of Nursing Studies (2016) on nurses’ perceptions of different areas of nursing practice found that public health/community care nursing is not seen as an attractive line of work.

“Students begin their education wanting to practice the kind of nursing that’s been modeled in the media,” said Marquard. “They want to be in the hospital at the bedside taking care of really sick people. They imagine the bleeding-out-on-the-floor experience or performing CPR on top of somebody’s chest. They want access to the cool technology available in hospitals. Our goal is to change perceptions of public health – to show students that the work can be just as challenging and meaningful.”

Care Out There 

Both Marquard, who teaches students in the accelerated option programs and Devita Stallings, Ph.D. (’12), an assistant professor who teaches students in the traditional option program, use specific curricular content and clinical placements to change minds and possibly career paths.

Their students spend clinical hours working with underserved and vulnerable populations in the St. Louis area. Students learn the roles of public health nurses by participating in various clinical experiences that include:

• Working with patients at health clinics and home health care agencies.
• Caring for children in school settings, inmates in correctional facilities, older adults in assisted living and adult day care centers, and homeless populations to name a few.
• Promoting health by planning and/or participating in health fairs at schools and churches.
• Promoting cardiovascular health by conducting heart health screenings for at-risk populations throughout St. Louis and Hands-Only CPR training for elementary and high school students in St. Louis.
• Holding dance therapy classes at adult day care centers.
• Providing blood pressure checks and medication education at area food pantries.
• Offering flu shots at nursing homes and in St. Louis Housing Authority developments.

“We take our students to where the people are,” said Stallings. “People don’t spend the bulk of their time in hospitals. They live outside hospitals and if they can’t be healthy outside of the acute care setting, they’re going to keep coming back.”

Stallings experienced this firsthand. She was an ER nurse in Memphis when she had her public health epiphany. She saw the same patients returning to the ER every week.

Stallings noted several reasons for patients’ repeat visits to the ER.

“Many didn’t have the money to get their medications,” she said. “Many weren’t compliant with treatment. Some didn’t have transportation. Some didn’t understand their illness. There was a break in the chain of care, which compromised the patient’s quality of life. Providing health care is more than seeing patients when they’re sick.”

Stallings returned to school, earned her master’s degree in community nursing and eventually her Ph.D. in nursing.

Present and Accountable 

Stallings shares her passion for public health with students but she also advises them to work in acute care initially to hone their technical skills and learn to prioritize care.

This is the path Andra Morris intends to follow. The 21-year-old junior from the Chicago area wants to work in pediatrics in an acute care setting after graduation but said she “definitely” can see herself working with older adults in a public health care setting after that.

Morris took Stallings’ public health course last semester. She spent some of her clinical hours engaged in a dance therapy program with older adults at Cardinal Ritter Senior Services.

“I’m much more open minded than I was before,” she said. “Instead of passing judgment or making assumptions you get to know your patients. You become their ally and do everything you can to help them prevent illness and live their lives to the fullest. I also like the idea of giving back to my community.”

Morris became so interested in public health that she working with one of her professors on a research project measuring enjoyment levels in seniors who participate in ballroom dancing exercises.

Even if students do not choose a career in public health, Stallings and Marquard hope they plant a seed and students choose to volunteer in their communities after graduation, as Stallings does with the American Heart Association.

Marquard hopes students never lose the skills they’ve learned in her course.

“Our students develop amazing communication skills when they’re interacting with patients in the community,” said Marquard. “They learn to be present. They explore a patient’s environment, their culture, their spirituality. They see the patient as a person who is loved and has a family who loves them. So, whether the patient is in the ICU or in a community setting, they know how to treat the whole person. This enriches the treatment process.”