August 2000
WASHINGTON, D.C. - The frontline can serve as a bastion against disease or a surreptitious spot for retreat. Health care providers holding the position are on the cutting edge, and that exposed, forward momentum is new, fresh, frightening and sometimes painful, said Carolyn Mazzella, RN, MS, MPA, assistant surgeon general, Chief Nurse Officer.
"The position carries risk and responsibility to yourself and those you lead," Mazzella said here at the 34th National Immunization Conference.
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| Challenges for Frontline Nurses |
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Individuals on the frontline face growing challenges such as the complacency of colleagues over immunization issues, complex vaccine schedules, rapid emergence of new knowledge, drug resistance and self diagnosis, to name a few.
Nurses are caught up in the demand for greater efficiency and effectiveness and more specialization. "We've become fractured," said Mazzella. "We have the immunization nurse, the family planning nurse, the school nurse. I think we need to monitor that trend to avoid fracturing our services as we seek comprehensive and knowledgeable care.
"I haven't counted how many backyard consultations, grocery aisle referrals or poolside counseling sessions I've given. The public sees nurses as honest, accessible, knowledgeable and trustworthy. It's in our interest to maintain that. We do so not only by being advocates and accessible, but by being knowledgeable, being the honest broker of information we've always been. It's an awesome responsibility - one that can buttress our frontline role or send us into retreat."
"Frontliners" face their own challenges. The complacency of a public that does not see disease as a threat; health care workers who see vaccinations as numbers, not good public health; and colleagues who don't understand what's required of an immunization program and who hold the attitude that "it's just a shot," Mazzella said.
According to Mazzella, conflict resolution, negotiation and cultural confidence should be a part of the makeup of someone holding the frontline. Being an advocate for patients, the system and the final outcome calls for cooperation and coordination with partners in the community, businesses, schools and government, said Mazzella, adding that if the business of the 21st century is knowledge, then practitioners must distribute it to remain plausible and effective.
Another challenge facing nurses are patients making self diagnoses, then coming into a doctor's office and requesting certain drugs. Just flip through almost any magazine on any store shelf and one will encounter big bucks advertising for prescription drugs.
"It's become akin to one of the newest sections of the Physician's Desk Reference being printed in the TV Guide. If you've looked at some recent magazines, you'll find lots of drug ads there and folks are wandering in and saying, `this sounds just like what I've got, why don't you give me this?'" said Mazzella.
Her point? In the age of the Web, Mazzella said patients are finding information that sounds right and wandering into doctor's offices armed with the information like Moses with the Ten Commandments. "But where are they getting it, how solid is it, how good is it? We need that skepticism as we evaluate and deal with information," she said.
Along those lines, the American public has become increasingly reliant on technology, Mazzella noted. In the health sector, it's played out by a confidence in a cure for ending all diseases, and a subsequent minimization of prevention and personal responsibility.
"We're seeing an increase in HIV/AIDS in California. The suggestion is that because we now have pills and cures, we don't need to engage in safe sex. As health professionals, we have a great responsibility to understand what this research means for health and how personal choice impacts health. There is no magic cure, we know the magic is in healthy living, prevention and the hard work of health promotion."
Other challenges Mazzella noted include elements of the workforce, not just numbers or diversity, but the rapid emergence of new knowledge, the explosion of information sources, the diversity of communication strategies and the vast array and types of media.
"All contribute to information clutter. It is the health professional's responsibility to be knowledgeable and to help communities and patients sort through the clutter to find value and meaningful data to use in decision making," said Mazzella.
She said contributing to and compounding the information clutter is pseudoscience, best illustrated by the vast amount of information available on the Internet. "The old adage about not everything you read in the newspaper being true certainly carries over into computer sources," said Mazzella.
According to Mazzella, successes in public health were historically built upon four factors, including: critical changes in the public health infrastructure with the early integration of health education and biomedical advances, the identification of risk factors and the initiation of community action; the monitoring and surveillance of disease states based upon quantitative analytic techniques with epidemiologic focus and data collection; public health training; and partnerships with both governmental and nongovernmental organizations.
"But perhaps the most important factor, unheralded and unnamed in this list, but critical in these achievements, is the health care worker and often the public health nurse," said Mazzella. "Today's challenges lie in the appearance of HIV/AIDS and the reemergence of tuberculosis (TB) and multidrug-resistant TB. Infectious disease mortality has begun an insidious increase, especially globally."
According to Mazzella, while vaccines are often cited as one of the great achievements in medical science, challenges still remain, including the increasing complexity of vaccine schedules, new vaccines on the horizon, parental resistance fueled by misunderstanding or lack of knowledge and issues of supply and financing.
For more information:
- Mazzella C. Frontline experience: Clinical and nursing issues. Plenary session: Special issues: Strategies for success. Presented at the 34th National Immunization Conference. July 5-8, 2000. Washington, D.C.
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