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Public Health and Immunisation Nursing
I have been nursing for over 38 years – starting as a pupil enrolled nurse in 1984 (Nurse Grade 2) and I am now a Nurse Practitioner (Nurse Grade 8). Along the way I also trained as a midwife and child health nurse, and have spent all of my career in South East Queensland. My specialty area is infectious diseases/public health, with a focus on vaccine preventable diseases, mainly in adults. Fun fact: I can speak French and play piano, although I’ve never tried to do both at once!
What is a Vaccine Preventable Diseases Nurse?
My nursing practice involves using primary, secondary and tertiary interventions to prevent or limit the progress of vaccine preventable diseases (VPD). So primary prevention includes administering vaccines, immunoglobulins or other medications to prevent contracting a VPD; secondary prevention would involve pathology screening and diagnostic imaging to detect VPD infection/immunity status; and tertiary prevention consists of interventions to limit VPD progression such as antibiotic or antiviral treatments.
What does your current role involve you doing?
I currently work in a specialist immunisation service, so my role is quite varied, and includes comprehensive health assessment and screening for special risk vaccination groups; prescribing and administering vaccines, immunoglobulins, antibiotics etc; skin prick testing and graded vaccine challenges; ordering and interpreting serology to assess immunity status or non-susceptibility to a VPD; consultation with and referral to other health professionals; plus research, education and leadership activities of course!
What considerations should people make before considering becoming a Nurse Practitioner?
Firstly – do your research – the ACNP website is a great place to start. Make sure that you meet the minimum entry requirements – at least two years of advanced practice nursing within the past 6 years and have completed a post graduate specialist qualification. And finally – talk to any NPs you can find, especially if they are in the same clinical specialty – they are usually very happy to have a chat to future aspiring NPs!
What is the unique benefit that NPs add in your field?
For me personally, I love having the practice scope to meet most of my patient’s needs in the same visit. For example, if I have a patient who has had their spleen removed, I can administer their vaccines, write a prescription for their daily and emergency antibiotics, and provide them with relevant education on their condition and when to seek medical attention. Prior to becoming an NP, as a nurse immuniser I could have administered the vaccines, but I would not have been able to write a prescription for the antibiotics and would have had to refer the patient to a medical officer – which sometimes meant sending them to their GP for a separate appointment, which can be inconvenient – and I often then didn’t know whether or not the patient had actually done this.
What is Public Health nursing all about?
Public Health Nursing mainly involves communicable disease control and immunisation, usually within a specific geographic area that your Public Health Unit (PHU) covers. The role can include contact tracing of persons with a communicable disease, providing telephone advice to health care providers, managing vaccine cold chain breaches, educating health professionals on current public health issues (e.g. monkeypox, Japanese Encephalitis), assisting aged care facilities with outbreak management etc.
As well as nurses, PHUs also employ administration, medical, environmental health and health promotion officers. It’s a very interesting area to work in as you deal with all sorts of health care providers in your allocated area – GPs, community health, hospitals, local government vaccination programs, correctional facilities, Indigenous Health Services, Refugee Health Clinics etc.
Can you tell us what you love about your area of nursing?
I love that my role is preventative, and that most of the time I am dealing with healthy people. I also enjoy the challenge of exploring all options to keep high risk patients protected against VPD, whether that be by vaccines, immunoglobulins or other medications. Immunisation has provided me with many opportunities to work in a variety of areas – hospital, community health, school based vaccination program, Indigenous home vaccination program, refugee health service, public health unit etc. I have also had the opportunity to be a member of several national immunisation groups (e.g. ATAGI, ACV) and have even travelled overseas to represent Australia on immunisation issues!
What have you learned about vaccine hesitancy?
There is definitely a continuum of vaccine hesitancy, from “fence sitters” to “selective vaccinators” to outright “refusers”, so you need to tailor your approach according to what level the person sits at. Always ask permission to discuss concerns, and acknowledge and accept these, don’t dismiss them. Spend plenty of time with the person and offer another appointment or a referral to a specialist immunisation service if required. There are many excellent resources out there, but a few that I find really useful are Sharing Knowledge About Immunisation (SKAI), MumBubVax and the COVID-19 vaccine decision aids.
What are some common misconceptions about your area of nursing?
I think the most common is that administering vaccines is just like any other injection – but there is a lot more that goes into it – ensuring the correct route, minimum intervals between doses, assessing contraindications and precautions, calculating catch up schedules based on the persons’ health/age/lifestyle/occupation etc. I am a tutor for one of the accredited nurse immuniser programs and the course requires 120 hours of study so it is definitely not just like giving any other injection!
What would a common career path look like for those wanting to get into public health or immunisation?
A good place to start for immunisation would be completing an accredited nurse immuniser program. For public health, undertaking a tertiary level program which includes epidemiology, biostatistics, health promotion and environmental health would be very beneficial. Look for short term secondments in the area first so you can see if this is a specialty you would like to pursue!
What advice do you wish you could give yourself back when you started nursing in 1984?
Never be afraid to ask for help or advice; treat your patients and colleagues as you would want yourself or a family member to be treated; and look after yourself so you can continue to look after others. Most importantly believe in yourself – you can do it! At one stage in my career I was working full time, studying part time, and was a single parent with 5 teenagers in the house – and I survived!
Any final lessons learnt or pearls you would like to share?
Be ambitious, dream big, don’t be afraid to change plans if you need to – you are the author of your career story, reach for the stars and enjoy every minute of it!
