Nurse practitioners as public health leaders

Some time ago, when my daughter was younger, I stumbled across a website that introduced the concept of life-goal mapping. Aptly named “43 Things,” the website functions like a bucket list—a place to house all the goals, aspirations, and dreams of a lifetime. Rather than fill it with my own “to-do’s,” I chose to use it as a catalog of all of the experiences I wanted my daughter to have and the life skills and competencies I wanted to pass on. The list was one part basic, two parts “womanly” personal, including such things as learning how to swim, having (and using) a passport, traveling abroad, knowing how to change the oil in her car, rotate the tires, and balance her checkbook. Back then, I thought of these life skills only in the context in which they existed—equally attainable by anyone who had the mindset to achieve them.

Over time, I came to realize that my list was not as unique as I thought it was. Through sleepover parties and swim classes, I met other parents who—regardless of race, ethnicity, or demographic background—had goals for their children that almost mirrored mine. I recognized, but at the time did not give much consideration to, the shared underlying premise: These were lessons and skills we considered a necessary part of a healthy childhood that would lead, we hoped, to a healthy adulthood. Fifteen years would elapse before I thought of that list again. And then came a local news report of a fatal accident and a tragic national news story.

In early July, news outlets in my area carried a story about a group of teenage campers caught in a violent and rapidly moving storm. According to the report, the day had unfolded as normally as any other. The young campers had participated in their usual activities and, later that day, “sang songs, read stories and prayed in open-air pavilions,” just as they did every evening at the camp. At some point, when signs of an impending storm became evident, the camp leaders decided to cut the evening’s activities short. As the sky darkened and the wind picked up, they led the children on a wooden path, single file, to a nearby shelter, but already trees had fallen and power lines were strewn about. Eight children were injured, and one—a 12-year old—died.

A week later, while commuting to work, I tuned into a radio news report about the growing number of children crossing the southern U.S. border, seeking to escape violence in their Central American countries. With only coins in their pockets and the clothes on their backs, children as young as 5 years old had traveled across Mexico clinging to the rusted bars of freight trains, “risking death, rape, or abuse” by the hands of drug lords on one side and arrest and deportation by border agents on the other. Children carrying children had crossed muddy, snake-ridden rivers on inner tubes and ridden dusty roads on stolen bicycles. Many of those who survived and were lucky enough to make it to a migrant shelter or federal holding center have well documented stories of lives they left behind: unemployed parents, prostitution, rape, sex trafficking, poverty, closed schools, illiteracy, and whole communities left to their own devices for the most basic of health needs. According to some statistics, more than 70,000 unaccompanied minor-age children are expected to cross the border this year, double the number who came across in fiscal year 2013.

It would be easy to label this an immigration issue and leave it to the high court of the land to figure out, but in any part of the world where there is heightened danger, political instability, and mass numbers of individuals risking lives to cross borders to escape abuse, rape, murder, prostitution, ethnic cleansing, human trafficking, famine, or any other inhumane set of conditions, we call them what they are—refugees—and we call the situation what it is—a humanitarian crisis.

Conditions at migrant shelters and holding facilities in U.S. border states are a far cry from optimal. Makeshift warehouses are overcrowded with detainees lying on chilly concrete floors or wall-to-wall mattresses. Language barriers make it nearly impossible for the most basic communication. Amidst the tangled web of legal procedures involved in processing unaccompanied minor children—whether locating U.S. relatives or placing them in the juvenile foster-care system—a significant number of health needs go unaddressed. Many children lack basic immunizations and routine preventive care. Pregnant teenage girls, often housed in separate facilities, wait days for prenatal exams. Worst of all, given the language barriers, there are significant mental health issues, such as depression, panic disorder, and PTSD—either directly or indirectly related to the refugee experience—that we can ill afford to ignore.

Strangely absent from the larger media are the voices of nurses. Where are our work groups and think tanks? Who are our public health leaders? What do we know about overcrowded living conditions, mental illness, teenage pregnancy, and poor prenatal care? In this crisis, what can we, as nurses, do that we’ve done before?

Whether it is a rural migrant health center, a busy inner-city ER, or a campground clinic in our own backyard, nurses are in a key position to shape discussion about population health and implementation of safe public-health practices. Nurses, by far, are the single largest body of health care providers nationwide and, more often than not, are the first point of contact in a health-related encounter. As of 2011, more than 2.7 million registered nurses were employed in the United States, and the number continues to grow. As of 2013, according to the American Association of Nurse Practitioners, more than 192,000 nurses in the United States are nurse practitioners.

Given provisions in the Patient Protection and Affordable Care Act, there is greater potential than ever before for nurse practitioners to lead policy development that strengthens public health practice and networks, improves availability of primary care, and eliminates disparities and inequities in the health care delivery system. From nurse practitioner-led clinics to community-based disease prevention programs, nurse practitioners have the skill and competencies needed to advance care, expand delivery, and improve health outcomes at all levels of our society—especially, and most importantly, at our own borders, where there is a humanitarian crisis.

Looking back on the list I compiled a decade and a half ago, I’m reminded of its basic underlying premise and the hope that unites every parent, regardless of race, ethnicity, or nationality—the desire for opportunities, experiences, and competencies that make for a healthy childhood and healthier adulthood. These are not just bucket-list ideas, and they are not universally attainable by all—yet.

Nurses, regardless of political affiliation, have a moral and ethical responsibility to make opportunities for health available to all. The loss of a child’s life—whether through accidental death or otherwise—is a matter of public health. Ensuring emergency preparedness and safety in our communities, providing care for those who are medically underserved, and figuring out ways to care for those who are “not our own” are matters of public health. We can do better than turn our backs, nod our heads, and fall silent. And nurse practitioners are well prepared to lead the charge.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.