12/19/96 L1120

COMMUNITY HEALTH NURSE 1

DEFINITION: This is professional nursing with primary orientation in the promotion and maintenance of the physical and psychosocial health of individuals and families within the community.*

An employee in this class performs as a staff nurse* within a state health center* by providing a variety of community health services. The employee performs all the activities* associated with community health nursing through the direct delivery of nursing services according to the practice of professional nursing by providing nursing diagnosis and treatment to individuals and families within the community with actual or potential health problems. Employees are normally assigned responsibility for a specific territory within a community health service area* where activities are performed through home visit services, clinic services, community services, and liaison services; however, clinic and community service responsibilities may be performed outside the employee's assigned territory. Liaison activities typically involve representing the agency in the provision of community health information to local organizations. Employes practice within a variety of settings in the health care delivery system. Work involves the development and implementation of a nursing care plan, utilizing a family centered approach*, by integrating all components of nursing care, both independently and through non-professional nursing personnel. This involves identifying and assessing the physical and psychosocial needs and health status of individuals and families; selecting, implementing, and evaluating those therapeutic measures essential to the effective execution of a nursing regimen or prescribed medical regimen; and conferring with other disciplines in the community. The staff nurse utilizes independent judgment, many times without the availability of other health care resources, in the assessment and prioritization of immediate needs of individuals and families and in the resolution of unpredictable health problems within the community. Work assignments vary and increase in complexity as the employe demonstrates increased proficiency in professional community health nursing skills.

Employees participate in staff development programs and provide ongoing orientation and on-the-job education to non-professional nursing personnel. Work is received in the form of oral or written instructions and is reviewed while in progress and upon completion by a professional nursing supervisor for the attainment and application of established nursing standards, skills, and competence levels.

EXAMPLES OF WORK: Performs the activities associated with Community Health Nursing by utilizing the nursing process, i.e., assessment, diagnosis, treatment, and evaluation in order to maximize the health status of individuals and families.

Provides a variety of community health services through the direct delivery of nursing services which involves home visit, clinic, community, and liaison services.

Develops, implements, reviews and modifies nursing care plans, utilizing a family centered approach, for individuals and families.

Observes, interprets, records and reports those signs, symptoms, and processes which indicate the responses of individuals within the family to actual or potential health problems.

Directs or conducts clinic service activities such as patient intake, patient interview, provision of services, and determination of follow-up services.

Provides direct nursing services to individuals and families within the home

and determines the necessary follow-up.

Conducts nursing case conferences with professional and non-professional personnel within the health center or clinic to insure the continuity of nursing care.

Provides health promotion and maintenance through teaching, guidance and counseling to individuals, families and groups within the community.

Observes, interprets, records and reports the effects of pharmacological agents and therapeutic treatments; and provides the necessary health teaching and counseling in relationship to the treatment.

Assesses community health needs and available resources and recommends necessary health care services.

Develops collaborative and cooperative relationships with other community agencies and groups engaged in the planning and implementation of health services.

Initiates nursing services based on referrals from individuals, families and other community resources.

Explains to individuals, families and groups the policies, rules and regulations, procedures and objectives as they relate to the health care system.

Participates in the planning for community follow-up of individuals and families referred from various health care resources.

Provides orientation and on-the-job health care education to non-professional personnel engaged in direct care.

Demonstrates community health nursing practices affiliate nursing students by providing observational experiences.

Identifies actual and potential safety and health hazards within the health center, clinic, and the home and takes appropriate action to eliminate them.

Directs the work of non-professional nursing personnel engaged in the direct care and treatment of individuals.

Participates in epidemiological surveys, health research activities, and special studies and projects.

Prepares and submits records and reports as required in accordance with rules and regulations.

Participates in a formal staff development program and continuing education programs to enhance professional competence.

Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES: Knowledge of the theories and practices of professional nursing.

Knowledge of the theories and practices of professional community health nursing.

Skill in applying basic nursing practices and methodology.

Ability to develop skill in the application of professional community health nursing.

Ability to apply basic community health nursing concepts techniques, and procedures.

Ability to develop and apply the techniques utilized in interviewing, observing, recording and reporting signs and symptoms of individual's and family's actual or potential health status.

Ability to develop and maintain effective working relationships with other employes.

Ability to maintain records and prepare reports, i.e., nursing care plans, individual and family records.

Ability to establish and maintain effective communications with individuals families and other members of the health care system.

Ability to provide guidance to individuals and families in health promotion and maintenance.

Ability to give, understand, and follow oral and written instructions.

Ability to instruct and direct non-professional nursing personnel in the care and treatment of individuals.

Ability to identify actual or potential health and safety hazards.

Ability to acquire new knowledges, skills and techniques required to maintain currentness in community health nursing practices.

Ability to develop the capacity to make independent judgments in relation to nursing care of individuals and families.

Ability to express ideas clearly and concisely, both orally and in writing.

Ability to recognize the limitations of one's capabilities and to seek help and/or guidance when necessary.

Ability to learn the purpose and functions of other health care and social organizations in the community.

MINIMUM EXPERIENCE AND TRAINING: A bachelor’s degree in nursing from a baccalaureate program accredited by the National League for Nursing.

or

Any equivalent combination of experience and training.

NECESSARY SPECIAL REQUIREMENT: Possession of a current license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing; or possession of a non-renewable temporary practice permit issued by the Pennsylvania State Board of Nursing.

CONDITION OF EMPLOYMENT: Employes possessing non-renewable temporary practice permits must obtain licensure as a Registered Nurse within the one (1) year period as defined by the Pennsylvania State Board of Nursing.

 

Allocation Terms (COMMUNITY HEALTH NURSING)

1 Community: Any particular geographical area where nursing services are provided to individuals, families, and groups where referrals and collaboration occur with health care organizations; and where coordination and cooperation exists with social and other organizational disciplines and resources.

2 Community Health Service Area (CHSA): An assigned territorial jurisdiction that is a small county (50,000 - 200,000 pop.) or an equivalent major sub-division of a county, where nursing services are delivered in the community to individuals, families, and groups with actual or potential health problems.

The assigned territorial jurisdiction (CHSA) varies depending upon the identified and anticipated health needs of the community; demographic characteristics; availability of health care resources; and the philosophy, goals, and objectives of the nursing services and the agency.

Since there are such great variances in geographical size and population density, the information provided is only a relative measure of scope for jobs in Community Health Nursing.

Examples of CHSA Structures:

1 - Inter-city urban area with a high population density and availability of many health care resources.

2 - Remote rural area with a sparce population and availability of few health care resources.

3 State Health Center: A facility located in the local community (county) where a variety of health services are coordinated and provided either directly or by prompt referral within the particular geographical area. The primary objective of the State Health Center is to promote the highest standards of health care services, by preventing health problems and teaching health promotion within the community.

The state Health Center serves as the headquarters within the community for the local administration of State Community Health Services.

4 Clinic: An organized health service directed to a group of individuals for a specifically identified health care need which is conducted in a variety of settings; generally following the pattern of patient intake, patient interview, provision of services (assessment, diagnosis, treatment (i.e. teaching, counseling, guidance and physical care), and evaluation) and determination of necessary follow-up activities.

5 Home Visit: Direct nursing services provided to individuals within the home by utilizing a family centered approach in the assessment, diagnosis, treatment, and evaluation, and determination of necessary follow-up activities.

6 Community Services: Health services conducted within the community that are directed to a group of individuals with a specifically identified health care need. Such health services primarily include planned educational activities and participation on community advisory boards and committees.

7 Family Centered Approach (Nursing Care): The provision of community health nursing services (i.e. teaching, counseling, guidance, and physical care) to an individual(s) who is recognized and cared for, not as a single entity, but as part of a family unity by performing family evaluation, providing family orientation, and coordinating family assistance.

8 Program: Any of the major component services that are authorized by the Department of Health for administration within the State Community Health Centers (i.e. Child Health, Adult Health, Crippled Children, Communicable Disease, Chronic Respiratory).

9 Program Services: Encompasses all of the following:

1 . Clinic services for diagnosis, treatment, health education, and referral.

2. Home visit services for diagnosis, treatment, health education, and referral.

3. Community services for group health education.

4. Liaison services with community groups for the purpose of health care continuity.

10 Activities: The component elements of each program service (health service and/or direct nursing service).

Examples

Clinic Services Activities - interviewing patients; observing patients; assisting physicians; documenting patient records; administering medications; administering immunizations; counseling patients and families; initiating referrals; directing ancillary personnel.

Home Visit Services Activities - interviewing patients; observing patients; assessing total family health status; documenting patient records; developing nursing care plans; administering treatment; teaching and counseling patients and families; demonstrating and instructing physical care methods; initiating referrals.

Community Services Activities - conducting health educational programs to community groups (speaking before groups and presenting audio-visuals and literature); explaining inter-agency cooperative methods (e.g. referrals) to other organizations; interpreting state community health services to community organizations, professional groups, and community leaders.

Liaison Services Activities - communicating and consulting with health care, social, educational, and religious organizations to promote health care continuity and planned follow-up care; cooperating with state and local agencies on surveys and emergencies; participating in community projects, activities, and meetings; representing the agency on local health screening programs; encouraging other organizations to make appropriate referrals to the state health center.

11 Staff Nurse: A professional nurse who has the responsibility for the delivery of nursing services to individuals and families within the community, focusing on prevention of disease and promotion and maintenance of health.

Clinic Staff Nurse - A role of the professional staff nurse when designated to perform specific nursing services and record maintenance functions within a clinic.

Clinic Charge Nurse - A role of the professional staff nurse when designated as nurse in charge on the onsite organized delivery of health services within a clinic.

12 Area Nurse Coordinator: A professional nurse who has the responsibility for the delivery of all the nursing services within a community health service area. This nurse has limited-scale program responsibility that involves the entrustment of the operational aspects  of the programs within the assigned geographical area (CHSA) which encompasses the following component function: 

Program Implementation

(a) Implement Program Services by Performing:

- Staff Orientation

- Staff Scheduling

- Site Preparation

- Supply Requisitioning (Availability)

- Community Resource Contacts

- Media Contacts

- Program Service Administration

(b) Evaluate Activities of Each Program Service by Utilizing:

- Observation

- Data Collection

- Data and Operational Assessment

- Documentation Review

- Problem Resolution

- Coordinative Communication

- Reporting (Documentation of Data and Findings)

13 Program Nurse Coordinator: A Professional nurse who has the responsibility for the comprehensive coordination of one or more programs within multiple community health service areas. In jobs that involve the responsibility for only one program, the program must be of a major  magnitude encompassing the following intensity within the program services:

1 . Prioritization, direction, and evaluation of two or more clinic sessions conducted per month for the same health service (e.g. Child Health Conference); or two or more clinic sessions conducted per month for different health care services (i.e. Orthopedic Clinic, Cardiac Clinic, Cleft Palate Clinic). 

2. Prioritization, ordination, evaluation, and identification of available resources for all home visit services which originate from families; clinic sessions; educational sessions; and health care, social, and other organizations; that identify needs for numerous or varied health care services.

3. Prioritization, ordination, presentation, evaluation, and identification of available resources for all group health education sessions, averaging one session per month, which originate from need determination; families; clinic sessions; and health care, social, and other organizations; that identify educational needs on numerous or varied health care topics.

4. Prioritization, ordination, and evaluation of liaison services with numerous or varied community groups. 

In jobs that involve the responsibility for more than one program, the programs may of a minor magnitude encompassing the following intensity within the program services:

1. Direction and evaluation of one or more clinic sessions conducted per month for the same health care service (e.g. Child Health Conference).

2. Prioritization, coordination, evaluation, and identification of available resources for all home visit services which originate from families; clinic sessions; educational sessions; and health care, social, and other organizations; that identify needs for limited and similar health care services.

3. Presentation, evaluation, and identification of available resources for group health education sessions, averaging four sessions per year, which originate from need determination; families; clinic sessions; and health care, social, and other organizations; that identify educational needs limited and similar health care topics.

4. Provision and evaluation of liaison services with community groups on a limited basis. 

The program nurse coordinator has full-scale program responsibility that involves the entrustment of the evaluative, planning, and coordinative aspects of a program(s) at the local level (county(s)) which encompass the following component functions: 

Program Need Evaluation

(a) Observation

(b) Data Collection

(c) Assessment (Feasibility/Benefits/Results)

(d) Need Identification

(e) Recommend Findings (Modifications)

Program Plan Development

(a) Define and/or Apply Goals

(b) Determine Program Services

(c) Determine Program Service Composition (Activities)

(d) Determine Appropriate Utilization of Budgetary Resources

(e) Determine Site Location (s)

(f) Identify Media Sources

(g) Seek and Coordinate Community Resource Cooperation

(h) Maintain and Evaluate Records

(i) Determine Staff Development

Needs/Objectives/Methods

Program Implementation

(a) Implement Program Services by Performing:

- Staff Orientation

- Staff Scheduling

- Site Preparation

- Supply Requisitioning (Availability)

- Community Resource Contacts

- Media Contacts

- Program Service Administration

(b) Evaluation Activities of Each Program Service by Utilizing:

- Observation

- Data Collection

- Data and Operational Assessment

- Documentation Review

- Problem Resolution

- Coordinative Communication

- Reporting (Documentation of Data and Findings)

Program Continuity

(a) Coordinate Program Services and Professional Nursing Staff by Performing

- Continuity Planning

- Coordinative Communication

- Documentation Review

- Problem Resolution

- Combined Program Service Assessment

 

Commonwealth Equivalent PSG ST08