An Exploratory Study of the Role of the Town Nurse

The Patient Protection and Affordable Care Act (PPACA) was designed to expand and refocus health care delivery to a more preventative mode as opposed to a curative one. Despite being a highly industrialized country, the United States of America (USA), ranks 37th in the world in a number of health outcomes including life expectancy, universal health coverage for core services, maternal outcomes and obesity rates among adults. Public health nursing is being called to respond to this need. What is missing from the literature is a description of the role of the Town Nurse. A descriptive, exploratory study of the role of the Town Nurse was conducted to explore the roles usefulness in meeting the goals of the Patient Protection and Affordable Care Act through the Community Transformation Grants; that of health promotion and disease prevention. There is little known about the role of the Town Nurse and its relationship to these goals. This study, including in-depth interviews with ten Town Nurses, was used to obtain a description of the Town Nurse role, identify barriers and facilitators for further role development and the impact of the role on the community. Ten female, Caucasian nurses who had been employed in the role between 6 months and 50 years in the New England region were interviewed at their places of work or a café in the community. Data were collected and analyzed using Schatzman and Strauss’ field notation system and included transcription of the audio taped interviews along with intra case and cross case analyses. Descriptions of the Town Nurse role included a core set of expectations: a population focus, the responsibility for identifying and meeting the health needs of the community, inclusion of needs across the lifespan, collaboration with others and performance of work within the context of a multi-level system. They met these expectations by being autonomous, being members of the community, being flexible and doing home visits. This required that the Town Nurse have a skill set that reflected clinical competency. Three sub-types of Town Nurses were identified, one with a focus on individuals, one with a blended focus and the last with a focus at the population level. Implications for theory include that the model will be useful for increasing understanding of the role. Research implications include the need for empirical testing of the outcomes for the Town Nurse in addressing the goals of the Patient Protection and Affordable Care Act (PPACA). There are also implications for education, including the need to incorporate the Town Nurse model into the current textbooks and literature. The role as compared with current competencies and standards in public health nursing is more wide ranging and perhaps novel. Official job descriptions and socialization into the role was generally lacking. Facilitators for the role were identified as the professional roles of the TN, the nurses’ autonomy, the PPACA, the location of the Town Nurse office, being a member of the community and the nurses’ own characteristics. Barriers included the nurses’ education level, difficulty communicating the role to community members, the location of services, the lack of opportunity for skill development, lack of resources and community preferences. In terms of future research, further identification and empirical testing of the outcomes for the Town Nurse are needed, especially in relation to the goals of the PPACA. Implications for education include the need to incorporate the Town Nurse model into the current textbooks and the nursing and public health literature. Practice implications include the need to evaluate a return to the blended role, consistent with historical models