Public Health Nurses Work Environment – A Challenge in Leadership

Step 1: Read the two (2) essay questions below and the key guiding questions. Write your responses following the directions above.

  1. MEDICAID WORK REQUIREMENT: A major component of the ACA was access to health insurance with subsidies through Medicaid for low-income persons. This has been challenged with the new proposal and the concept of work requirements for those on “welfare” to receive these benefits. On January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Director Letter providing new guidance for Section 1115 waiver proposals that would impose work requirements (referred to as community engagement) in Medicaid as a condition of eligibility.

Kentucky has already changed its eligibility requirements and South Dakota, Alabama, Louisiana, and South Carolina submitted formal requests. Based on your role of advocacy in the profession, address the following issues in response to this situation.  In addition to the resources identified in your previous readings, you may find this online article helpful:

The citation and the link:  Tipirneni R, Goold SD, & Ayanian JZ. (December 11, 2017). Employment status and health characteristics of adults with expanded Medicaid coverage in Michigan. JAMA Intern Med. doi:10.1001/jamainternmed.2017.7055

  1. According to this policy, which of your clients would not be required to work to receive these benefits?
  2. According to many groups, this concept may be detrimental to the health and wellness of some of your most vulnerable clients. Provide at least 4 reasons with explanation as to why this may be problematic.
  3. What would you propose to manage the challenge of cost for these low-income clients?
  4. As an advocate, design a letter to be written (do not send) defining your position (pro or con) for this requirement that could be sent to a state representative from you as a professional nurse.


  1. THE PUBLIC HEALTH NURSES WORK ENVIRONMENT, A CHALLENGE IN LEADERSHIP: The public health nurse is working in an agency that currently has 4 of its 8 nursing positions open.  There have been 3 nursing directors in the position over the last year. The work environment has not supported shared governance and independent decision-making. It is not unusual to hear insensitive comments or stereotypical statements.  There is no nursing staff diversity.  The population served by this clinic is a 5-mile radius in one of the poorest areas of Any City, Some State with a population of mixed minorities, low-income, single-parent homes, high unemployment, and poor health status and outcomes. Children attend a neighborhood school that is one of the poorer schools in the district and have even experienced lack of heat during the early part of the winter. When discussing the issues with her peers, her friends laughed at her decision to stay and recommended she leave the job immediately. The nurse has been offered the position as Director of Nursing under a new Health Care Administrator who is under a directive to correct the issues and improve the quality of care for the clients served in this community. Respond to the following questions from the perspective of a new Director hiring and employing a full nursing staff to support this agency.
  2. Explain the workforce ecosystem model.
  3. Using components of the model as the guiding activities in your plan, identify changes or actions that will be addressed in each component to alter this work environment as you move to full nurse staffing.
  4. What key ethical issues identified in the ANA Code of Ethics must be addressed as a part of your plan?
  5. Identify two types of training you would include in your orientation program for all staff. You may simply list and identify why you would include this component.

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