USPHS Nursing: Mission, Responsibilities, and Challenge

Nurses in the PHS:

The PHS employs approximately 6,000 civil service and approximately 1,300 are commissioned corps nurse officers. PHS nurses provide health care services in specialties ranging from the hospital-based staff nurse to a doctoral-prepared nurse researcher overseeing international public health studies. Serving in virtually all of the PHS Operating Divisions (OpDivs) and agencies, nurses are involved in all aspects of PHS activities, operating independently and in concert with other professional disciplines. PHS nurses also serve in assignments with other government agencies such as the Bureau of Prisons, the Environmental Protection Agency, the Immigration and Naturalization Service, the U.S. Coast Guard and the National Oceanic and Atmospheric Administration.

For more than 200 years, the PHS has met its responsibilities to improve the health of our nation. The Assistant Secretary for Health (ASH) serves as the Department of Health and Human Services (DHHS or Department) Secretary’s principle advisor and assistant on national health policy and on all health related activities in the Department. The ASH directs the activities of the Office of Public Health and Science, which serves as the focal point for leadership and coordination across the Department in public health and science.

The Surgeon General of the U.S. Public Health Service is “the nation’s family doctor” and supports the DHHS programs to improve the health of all Americans. The Surgeon General directs the activities of the Office of the Surgeon General within OPHS and leads the commissioned corps of the PHS, an all-officer cadre of mobile health professionals. As one of the seven uniformed services of the United States, the commissioned corps is a specialized career system designed to attract, retain and develop health professionals. These professionals are assigned to federal, state or local agencies, or to international organizations, to accomplish the mission of the PHS.

Mission of PHS Nurses:

PHS nurses play a vital role in the overall PHS mission to protect and advance the health of the nation. PHS nurses function in all the following roles:

• Provide direct patient care to patients through the Indian Health Service, National Health Service Corps, National Institutes of Health, Immigration and Naturalization Service, and Federal Bureau of Prisons.
• Provide supervisory and consultative nursing expertise to various federal, state, and local government agencies such as the Health Services and Resources Administration, the Centers for Disease Control and Prevention, the Center for Medicare and Medicaid Services, and the Food and Drug Administration.
• Use nursing skills to research and identify solutions to the many health-related problems that face our nation through PHS Agencies such as the National Institutes of Health and the National Institute of Nursing Research.
• Perform vital administrative and staff support roles representing the unique perspective of nursing throughout the OpDivs of the PHS and other federal, state, and local government agencies.

The Role of the Professional Nurse in the PHS:

As with the role of nursing in society, the role of PHS nurses has continued to expand and grow in complexity, scope and professionalism to meet the ever-changing health care needs of the American people.

PHS Nursing – Then and Now:

Since the inception of the PHS in 1788 to serve the Marine Hospital System under President John Adams, nurses have been a vital component to the provision of health care to the American people. Long before official recognition of their professional status, the earliest PHS nurses were contract civilian nurses or civil service nurses. Throughout the 19th century, the number and range of services of PHS nurses continued to grow in direct response to the pioneering efforts of Florence Nightingale, Clara Barton and Dorothea Dix to bring professionalism and recognition to nursing.

As technology and social change accelerated in the 20th century, the role of the PHS nurse became increasingly complex and demanding. The need for nursing specialties beyond hospital-based and home-based direct patient care expanded to include public health nurse specialists of all kinds to combat epidemics such as tuberculosis, venereal disease and diphtheria. PHS nurses continue to be at the forefront of social and scientific revolutions in all fields of health care in America. To appreciate the depth of commitment and courage put forth by PHS nurses in the history of their service to our nation, the book Plagues and Politics, the Story of the United States Public Health Service by RADM Fitzhugh Mullan is suggested reading for all PHS nurses. A more detailed history of nursing in the PHS is located in Chapter 2.

Today the PHS uses the skills and expertise of virtually every recognized nursing specialty. Nurses make up one of the largest components of the PHS and their influence on the development and provision of health care in the United States and in the larger community of nations is eminently recognized.

What does the future hold for PHS nurses?

Clearly, the need for the technical expertise and professional skill of nurses will continue to grow as more complex health problems face our nation and the world community. Based on a proud history of service the PHS nurse can expect to play a major role in addressing the health care problems of our nation and our world.

Chapter 3 provides a detailed description of the varied nursing specialties within specific agencies.

Responsibilities of the PHS Nurse:

As a PHS nurse, you have certain responsibilities to yourself, your employer, your profession, and the public.

The primary responsibility of the PHS nurse is to ensure and promote the public health and safety of the American people. The nurse must make certain that his or her professional actions and decisions are consistent with this public trust. This means ensuring that all actions, nursing decisions or personal behavior, have the highest degree of professional integrity. Never perform any nursing function that is outside your own professional competence. Be sure to maintain open and clear channels of communication with your supervisors. Be aware of temptations to compromise public trust.

Federal employees are bound to follow the “Standards of Ethical Conduct for Employees of the Executive Branch” which is published in 57 Federal Register 35006-35067. Additionally, as a nurse, you must practice within the guidelines and constraints of the nurse practice act of the state in which you are licensed. Commissioned officers abide to the Standards of Conduct for commissioned officers. These standards are found in INSTRUCTION 1, Subchapter CC26.1, Commissioned Corps Personnel Manual.

Your professional development as a PHS nurse is primarily your own responsibility. There are many accredited continuing education opportunities available to you. It is your responsibility to take advantage of them in order to maintain professional excellence and a current professional license.

PHS nurses achieve Professional support through membership in various professional organizations such as the American Nurses Association, specialty-nursing associations, and the USPHS Commissioned Officers Association. Membership and participation in such organizations is encouraged. (See Appendix C for a listing of such organizations.)

The Challenge to Excel:

The mission, roles and responsibilities of PHS nurses at all levels and in all areas of expertise translate into a personal challenge to excel in your PHS career. A PHS nurse can progress through a series of work experiences that ultimately lead to attainment of his or her career goals. To facilitate the achievement of professional goals:

• Define your goals early in your career while still maintaining flexibility and openness to different and challenging assignments. As your professional expertise and experience grows, your professional goals may change and be further redefined. Several different career tracks are available in detail in Chapter 4.
• Career planning for obtaining those skills and assignments that will assist you to move forward toward achieving your career goals is the nurse officer’s responsibility. Job changes in the PHS are primarily self-generated. Help in developing an appropriate career plan are available from professional colleagues, supervisors, personnel advisors, career development centers and, in the case of commissioned officers, from commissioned corps staffing officers. Although there are many resources available to assist PHS nurses with their career development, each individual must take the lead in charting his or her own future.
• Networking with other PHS nurses is encouraged. The representatives to the Nursing Professional Advisory Committee (N-PAC) and nurse mentors as resources for career development

The Office of the Chief Nurse and the N-PAC welcomes you to a career as a professional nurse in the PHS. A force of competent and satisfied nurses accomplish the mission of the Public Health Service. This handbook provides basic career planning information to help PHS nurses fulfill their responsibilities, excel in their profession and achieve complete career satisfaction through service in the United States Public Health Service.

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