Health Protection Nursing

What: Kay Crawford

Who: Health Protection Nurse

Background: First registered as an SRN yes, I’m that old! in 1983 in Manchester. Worked in infectious disease ward for a few years then went in to a rotational post through ICU/CCU/Cardiac Rehab ward which was a step down from CCU and provided patients and their families with lots of health promotion advice re lifestyle post MI. This was a nurse lead initiative which the ward Sister and I lead. In 1988 I took up my Ward Sister post back in the ID unit and while there set up a first of its kind renal unit for people who were hepatitis B positive.

We also had a four bed high dependency unit and a hyperbaric chamber in the ward. From here to my first teaching post as a Clinical Teacher in the North East where I stayed in Nurses Teaching until 1995 when I left as a Senior Lecturer in Nursing Studies at the University of Teesside. Off to Norfolk as a Practice development lead for a couple of years and then to Bedford as the Senior Nurse Manager for the surgical specialities.

A secondment for a year to the Education and Training Consortium and then the big shift to health protection nursing, a specialised element of Public Health Nursing, where I remain today. Along the way I completed a degree in Health Studies with the Open University and a Cert Ed in adult teaching. Lots of CPD and most recently a certificate in work place mediation.

Health Protection Nursing – A Typical Day

Like all other Nursing specialities to use the term ‘typical day’ is a misnomer. There really isn’t one. There are some things we’ll do routinely but even those things might be addressing the same infection, outbreak, incident or chemical event in a different part of the patch, with different members of the public, different partners and a different skill mix or it might be something we do alone. It’s fascinating work and it’s interesting to know that you’re contributing to peoples health on a range of levels from individual to groups to the population as a whole.

So, we ‘do’ our work in a Health Protection Team within a Public Health England Centre. Public Health England (PHE), as you can imagine, addresses a huge range of important matters relating to the health of the population. Our mission is to protect and improve the nation’s health and wellbeing and reduce health inequalities; our directorate is Health Protection.

We are made up of teams of health protection specialists throughout England coordinating services at a local level, a nationally organised integrated epidemiology service and an emergency response department. We deliver health protection services that maintain and deliver best practice to leading international standards, are a source of expert advice and operational support and contribute actively to policy making and implementation in partnership with other PHE divisions and the Department of Health and externally with the National Health Service, local authorities and other agencies.

Nurses are office based but spend time out in the patch working with our multi agency partners: Environmental Health and Public Health partners in Local Authorities, Emergency services including the Coast Guard, the armed forces, NHS in acute and community settings, NHSE colleagues, Care Homes, voluntary bodies, schools, colleges and universities, industry and the public – this isn’t an exhaustive list! And we work in a proactive way with partners on service responses , design and change as well as on reactive matters which are described in more detail below.

That last paragraph begins to give you a flavour of what Nurses might find themselves involved with on any typical day. In local Health Protection teams we use a case management system called HPZone to help us keep track of and manage new and ongoing cases, outbreaks and incidents. It also assists and guides with decision making and action planning and has links to national guidance that we use frequently to assist in making decisions and judgements about our responses, it’s also our electronic record keeping system.

There are a range of AfC Bands in a team and with an eye on professional development the Nurse with the appropriate skills and experience will act within her scope, this may be from advising on an appropriate vaccination for a new entrant or leading a large scale incident dependant on role, skill set and banding.

A day often starts with a review of HPZone which will show the situations, cases and enquiries and the actions required associated with them. Many of these will require phone calls to local or national laboratories to seek information or confirm results for individuals who may then need prophylactic medication or vaccinations arranged via GP’s.

There will be follow ups calls to care homes who may have outbreaks of Norovirus or seasonal influenza and we’ll advise on control measures and coordination of medication provision; schools with a case of meningitis with all the advise and reassurance that entails, we’ll provide a letter for the school to share to reassure parents and advise on signs and symptoms, we’ll also monitor for further cases with a view to further intervention.

We may speak a member of the public who has Legionnaire’s disease to try to identify a possible source in order that preventative measures can be implemented thus preventing others becoming ill. We’ll liaise with our medical and surveillance colleagues regarding clusters of cases and might participate or lead an incident or outbreak control meeting.

While that’s ongoing calls will be coming in seeking advice on immunisation queries from clinical staff and the public or notifying us of two new cases of E coli 0157 associated with a food outlet, a fire in a large industrial site with a request regarding what might be found in the smoke that could be hazardous to health, or that asbestos has been found on the site of the fire. Nurses dealing with the calls will manage many of the responses autonomously and seek advice from or pass on some to senior colleagues.

When required we’ll go out to visit people in hospital to gather information from them or to care homes where there is an outbreak of influenza like illness that may require treatment or prophylaxsis with antiviral medication. We’ll then coordinate the prescribing of medication via General Practices and advise on outbreak control measure. Another day we could attend a poultry farm where avian influenza has been identified and play a part in coordinating the response. While some of the nurses are doing this reactive work others will be at meetings, delivering training in Universities or working with partner agencies on their health protection agendas. There’s heaps more I could tell you about had I space.

Oh, we provide an out of hours service too, we’re a 24/7 365 days per year service and we offer the same service out of hours as in. It’s never dull!