By Christina Hernandez Sherwood
Despite Julianna Manske’s years as a nurse educator and acute care outpatient oncology nurse, she was overwhelmed in 2016 when she became a frontline public health nurse in suburban Milwaukee. The local health department, Manske, MSN, RN, OCN, quickly learned, is where residents turn for answers to all manner of health-related questions, ranging from how to avoid the stomach bug circulating the schools to how to handle a dog bite to the risks of long-term radon exposure.
“Every time I answered the phone, I was googling the answers or asking my colleagues,” says Manske. “There’s a huge amount of education and knowledge that’s needed from that frontline workforce.”
Not only was there so much for public health nurses to learn but the education they needed was not organized well. Because of this gap, Manske and others she met that year at a state orientation for public health workers were not confident they could meet the needs of their communities. “We could do better,” she says.
Within a year, Manske and a small group of other incoming public health nurses had laid the groundwork for what they envisioned as a first-of-its-kind public health nurse residency program. Following an established framework outlining the responsibilities of public health departments, the team created a six-month, in-person residency program that combined education and networking to help better prepare nurses in southeastern Wisconsin for their public health roles.
Today, what began as a nurse-focused grassroots effort in one corner of the state has become a yearlong virtual residency program open to all early-career public health professionals working in governmental public health organizations across the country. Housed at the University of Wisconsin–Madison School of Nursing, the New to Public Health Residency Program is a partnership between the School of Nursing, the UW–Madison School of Medicine and Public Health, and the Wisconsin Department of Health Services.
“The overall goal is to help people entering public health practice be successful by improving their knowledge and skills and increasing their job satisfaction,” says Susan Zahner, DrPH, RN, FAAN, associate dean for faculty affairs and Vilas Distinguished Achievement Professor at the School of Nursing. “We want people to enjoy public health and stay in it because we need public health workers.”
Zahner, whose work focuses on improving public health practice through research and development, had long believed in the need for a public health residency for nurses to help bridge the transition between school and practice. Then she met Manske, who was ready to expand the new program beyond southeastern Wisconsin. “The timing and passion aligned,” Manske says. The two teamed up, secured grant funding, and brought on Hannah Hayes ’16, Cert’16, MPH, RN, to rework the Southeast Wisconsin Public Health Nurse Residency Program to a broader audience. The original residency program, which lasted six months and focused solely on nurses, was adapted to all public health professionals.
“In any public health department, there are multiple different professionals working together: nurses, epidemiologists, nutritionists, social workers, animal control officers, and so on,” Zahner says. “We wanted to encourage the concept that public health is an interdisciplinary field, and that nurses and people in many other disciplines work together.”
The expanded program was set to pilot a cohort in northern Wisconsin when the COVID-19 pandemic brought in-person learning to a sudden halt in early 2020. With another year to further adapt the residency, Manske, Zahner, and Hayes decided to make the program fully virtual, combining a robust online course with complementary synchronous aspects to increase overall accessibility, and adding mentorship and project development components. The first cohort of this reimagined program, made up of 24 participants from Wisconsin and Virginia, launched in September 2021.
The New to Public Health Residency Program consists of 12 online learning sessions, as well as a synchronous “community of practice” component, which includes about 90 minutes per month of live discussion. Each resident is also matched with a public health mentor based on their personal and professional preferences, and graduates are given the opportunity to become mentors.
“Having an opportunity to share resources and break down silos was one of the original goals of the New to Public Health residency program,” says Manske, who is now a residency program manager and facilitator. “Now, we are bringing people together so we can have productive, open dialogue. We’re not just doing the same things the way they’ve always been done. It’s about challenging each other to work at the top of scale and be the public health leaders the public needs.”
The program’s content — provided by more than 70 public health experts who volunteered to develop educational content about their specialties — is framed around five foundational areas and capabilities of public health as described in the Foundational Public Health Services Model: environmental public health, communicable disease control, chronic disease and injury prevention, maternal, child and family health, and access to and linkage with critical care. In a module on environmental public health, for instance, residents might learn about lead, radon, and other human health hazards via a voiceover PowerPoint presentation, then use an example from a real-life, de-identified case study to discuss applying the lessons in their own communities.
At the end of the program, each resident presents an evidence-based practice project that is applicable to their public health work. One recent project, which focused on lactation support in the workplace, involved educating local business leaders about the benefits of breastfeeding. Another involved training several hundred community members to administer the opioid overdose treatment Narcan.
Though the assignment is to plan a project — not necessarily to implement it — most residents eventually bring their ideas to fruition. “It’s really rewarding to see everyone come together and share in that accomplishment,” says Hayes, a residency program coordinator and facilitator. “It’s a reminder of why I do the job, too.”
The residency’s first graduates — some 30 public health professionals from two cohorts — reported a nearly 37 percent increase in their public health core competencies after completing the residency, according to a post-program survey. A full 87 percent of graduates said the program increased their confidence in how they perform their public health duties.
“I lead a [team]… that has implemented an entire training for next generations of [public health] professionals,” one participant wrote, “and used what I learned to reach out to another jurisdiction to co-write requests that turned into us becoming the first two Narcan vending pilots in the state.”
Four more cohorts totaling nearly 100 residents kicked off throughout 2022. These included the first state-specific co-facilitated model, a cohort of Alaska public health nurses that maintained the core components of the program but adapted synchronous discussions to suit the needs of their state. At least three more state-specific cohorts are expected to launch in 2023.
“The end goal is to be a service that supports public health,” Manske says, “so that the workforce can thrive and continue to grow.”