Bernice Boafowaah has to wake her daughter, Lynda Nyanor, which does not make the little girl too happy. Although Lynda, who turned 1 on Sept. 10, does not cry, she isn't going to be cooperative either.
Amanda Hodges, a public health nurse with the Fairfax County Health Department, is trying to check on Lynda's developing motor skills.
Hodges sits on the floor with Lynda, who weighed only 3 pounds when she was born six-weeks premature, trying to prompt the sleepy girl to either pick up blocks, move across the floor or do something so Hodges can see if there has been any improvements since her last visit. Lynda is having none of it.
So instead, Hodges talks to Boafowaah, originally from Ghana, about Lynda's food, makes sure the mother is keeping up with her doctor's appointments, does a general check of the apartment, asks if there are any problems with work and home. Boafowaah says Lynda can do all the things is she refusing to do for Hodges. And just to prove her mom is right, Lynda picks up one of the blocks as Hodges starts to pack everything up. Now the little girl can get back to her nap.
Fairfax County employs 170 part-time and full-time public health nurses who work in the health department's clinics, in the field and at the public schools. The nurses, who go through the same training as their colleagues working in hospitals or doctor's offices, focus mostly on preventative medicine and education, but also provide supportive care for high-risk patients.
As of Sept. 4, of the 170 positions, eight were vacant and due to a nationwide nursing shortage, the county is seeing less qualified applicants.
"Typically with a vacant position, I'd have 20 to 30 resumes with public-health nursing experience," said Sandy Graumann, assistant director of patient care services. "With these eight vacancies, I have eight to 10 resumes and none with public- health nursing experience."
GRAUMANN said one of the reasons previous experience is important is because of the nature of the work.
"The difficulty with public-health nursing — it's really pretty independent and the nurses are making a lot of independent decisions," Graumann said. "It's interesting to see some of the nurses come straight out of school and feel comfortable being so independent."
She said hospital experience is not required, however, many nursing programs have the students do rotations in the various nursing fields. In addition to having a nursing degree from a National League for Nursing accredited college or university or an equivalent program, and a current license to practice as a registered nurse in Virginia, the county's public health nurses go through a six-month orientation program before receiving their first assignment.
"People in the public-health nursing field like it and generally are not moving on to other things," Graumann said.
THAT IS TRUE of Monica Gagliano. She has been a public health nurse for almost six years and works at the clinic in the Health Department's Springfield District Office.
"I think what I like the most is I get to teach. I was a teacher in another life," Gagliano said. "I like to talk to people about how to be healthy. There's so much diversity [in the job] it's never boring."
Clinical nurses mostly focus on preventive medicines such as giving children their immunization shots before school starts, providing pregnancy testing, doing preliminary screening for refugees, providing required shots for international travel and monitoring of pregnancies up to six months. In addition, the clinical nurses provide prophylactic treatment of tuberculosis.
"We do a lot of troubleshooting," Gagliano said. "People come to us not knowing what they need or want. We serve as a resource."
The walk-in clinics have busy cycles, such as just before school. During the last week in August, the Springfield clinic was seeing up to 120 patients a day. Even with so many clients, Gagliano said the nurses do develop a rapport with their patients.
"When you click with a family, they come back to you. They give you pictures of their babies," Gagliano said. "They remember your name and ask for you when they come."
DEVELOPING A RAPPORT is important for Hodges as a field nurse out of the Mount Vernon District Office because in some cases she will be following the same case for up to two years. The field nurses see a variety of people in their homes, including tuberculosis, high-risk maternity and high-risk infant patients. Some field nurses also provide long-term care for older adults.
Hodges said she typically has 20 cases at any given time consisting of maternity and tuberculosis patients. Usually the patients she sees have their own primary-care physicians and she is brought in as support. The field nurses also work closely with the Centers for Disease Control, monitoring and reporting on communicable diseases.
"Our main purpose is protecting the health of the community," Hodges said.
She has been a nurse for five years, but became a public health nurse three years ago. Hodges said she has been with the county long enough to begin seeing some of the families she helped with high-risk pregnancies having other children.
It's nice to develop lasting relationships," Hodges said. "[With tuberculosis cases] it's sometimes tricky to gain their trust. They don't always want us there. Others want help and invite us into their homes."
SANDY LANIER does not have to go into people's homes, but she is responsible for the health of about 5,000 to 6,000 students. The 16-year public-health nursing veteran travels back and forth between five schools. She visits each of her schools at least once a week and supervises the clinic-room aide that is at the schools on a daily basis. Lanier oversees the 35-hours of training the aides go through. She also acts as a consultant to the school in developing a health-care plan.
Before the start of school, Lanier was busy collecting records for the students and creating "flag lists" highlighting medical concerns. She also provides some training to the school staff in how to deal with medical emergencies such as diabetes.
"We provide less than basic First-Aid. As we say, it's the ice and water and Band-Aid brigade. If it's a serious issue, we call 911," Lanier said. "We're limited in the type of care because we don't have the nurses. I think it would be beneficial to have a nurse in every school."
In fact, the ratio of school nurses to students in the county is approximately 1-to-3,200, which Graumann said is higher than a lot of neighboring jurisdictions. The school system supports 132 elementary schools, 19 middle schools, three secondary schools made up of grades seven through 12, 21 high schools, 26 special services centers and 35 alternative schools.
Lanier said the clinic room is used to provide medications to students who have a written prescription and bring the medications from home. The aides are not permitted to hand out aspirin unless it is provided by the family.