Share Public Health Transcript: The Power of Perseverance in Public Health Nursing with Lorne Carroll

Lorne Carroll: I was recently in Denver for the American Public Health Association’s Expo. David Satcher, he closed with this phrase that I think couldn’t be more perfect. He said, “In order to eliminate disparities in health and achieve health equity, we need leaders who care enough, leaders who know enough, leaders of the courage to do enough, and leaders who will persevere until the job is done.”

Shirley Orr: Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast, connecting you to topics, issues, and colleagues throughout our region and the country that highlight what all we share in common in public health. Thank you for tuning in for this next installment in Share Public Health. I’m Shirley Orr. I am a partner in the work of the Midwestern Public Health Training Center. My work takes me in a few different directions. I serve as association executive director for the Association of Public Health Nurses, made up of nurses in public health practice at the local, state, tribal, and national levels. I also work with the Public Health Accreditation Board, where I serve as an education specialist and work to develop and implement some educational offerings that can hopefully advance the public health national standards and public health accreditation.

Lorne Carroll: My name’s Lorne Carroll. I’m a public health nurse III in the state of Alaska, and I’m working out of the Homer Public Health Center, which is positioned about 220 road miles south of Anchorage. As a public health nurse in Alaska, we focus on population health. Public health nurses in Alaska typically work at three levels, and that would be systems change, community level interventions, and individual client-based. But when I joined the section of public health nursing in the state of Alaska, and it was around 2012, a gal by the name of Rhonda Richtsmeier was the chief of our section, another public health nursing hero. You’ll pick up on a pattern here.
And Linda Worman at the time, I believe, was working in the Fairbanks Public Health Center, probably as a public health nurse IV or V, and then shortly thereafter, Linda advanced into I believe the deputy chief position. I might be wrong about that. But when I took on my Homer position, which is my current position, in April of 2014, Linda was the chief of the section at that time. One of Linda’s piece of her legacy was she created and guided the section of public health nursing through a communication work group, which we ended up calling it an internal communication work group, because it evolved after our work was done into an external communication work group.
But the communication work group itself was really designed to do a few things, but the main thing was to increase the proportion of section staff who agreed or strongly agreed that they’ve got a place to share their ideas, and a place to put their feedback in regards to their practice and employment in the section. And that whole process of creating an internal work group also kind set the stage for a number of our internal work groups that are structured to create and update our practice as public health nurses in the state.

Shirley Orr: Alaska, I would say it’s been really interesting in terms of the public health nursing leadership that has been present in Alaska. I know as far back as I can remember, when I first became aware really of the role through what was then the Association of State and Territorial Directors of Nursing, and is now the Association of Public Health Nurses, the public health nurse in Alaska, I think her name was Elfrida Nord, I want to say, who I didn’t have the privilege of knowing well, but I knew certainly of her work.
I knew of her as a phenomenal public health nursing leader for the state, and then the ones that Lorne has mentioned mentioned also. And I think I’m interested in hearing more today, Lorne, in our conversation just about public health nursing practice in Alaska. It’s very different and unique among the 50 states, I think. I know that they of various initiatives over time to help public health nurses be aware of the opportunities in Alaska. There was a campaign, I remember, a while back where there were a series of videos.

Lorne Carroll: Yeah. She’s a moving force, still. She was the section chief. I believe she began around 1984, and she worked through 1993, and 1993 is a special year for us because that’s when we celebrated 100 as public health nursing in some form or other in the state of Alaska. And Elfrida Nord, in my mind, I didn’t have the pleasure of meeting her either, but it’s my sense that she was not only a brilliant public health nurse, but also quite a historian as well. So she was kind of, I think, responsible for creating and following through with the 1993 100 years celebration of public health nursing in the state. She spearheaded several documents that are still around in my drawer today, and just pulled one out actually, earlier this morning, and read a quote.
And she said something about, “Public health nursing today, which was 1993, is very similar as it was in 1937.” And I was like, “Oh my gosh, here we go.” And she highlighted how fundamentally, we had the same approach in 1993 versus 1937. And I don’t know the significance of ’37 as opposed to say 1893, but she said, “It’s fundamentally the same, and the fundamental piece that’s the same is that we’re working at the local level, face-to-face with community members,” and that’s so true. And then flipping through the pages year after year, there’s these decades and decades of history that we have, and there’s pattern there.
One example might be in the 1940s, we really started to work a lot with tuberculosis, especially along the coast and up and down rivers, to gain access to these mobile chest x-ray machines in order to help fight tuberculosis. As it turns out today, we’re still working with tuberculosis. I’ve got about five cases in my inbox I need to catch up on today. And so the other examples too, measles campaign, looking to eradicate measles in the ’70s, and rubella, looking to eradicate polio at one time. And then today, you find our ourselves on the radio and on the telephones talking to folks and listening to their thoughts about COVID vaccine, especially for kiddos 5 to 11 years old.

Shirley Orr: It’s really interesting when we think back and reflect on some of our earlier leaders. I had the opportunity to be in New York City more than a year ago, because it was before COVID, with my son, and I went to visit the House on Henry Street, which was the center of operation for Lillian Wald, who is credited with having started or really launched public health nursing in the U.S. And I knew a bit about Lillian, obviously, already, but I learned so much more there. And just looking at the displays there at the house, which is still open and houses some active community outreach work, it was apparent to me that she was really, truly the champion of social determinants of health in that era.
They didn’t call them that, but her practice was for sure in the community, but it was focused on housing, and hygiene, and having access to healthy and nutritious foods. And she also, I think, was pretty groundbreaking for the time in terms of reaching out and establishing some cross-sector partnerships. I remember reading about her engagement with a company, it was an insurance company that donated significant amounts of funds for the improvement of the Henry Street settlement, which was where her public health nursing practice was centered, in the Lower East Side of New York City.
It’s so interesting, because I thought looking back, obviously there’s been a lot of things that have changed in that time since what was it, 1918, probably, but we’re returning to much of that now with a renewed focus, looking at causes beyond those that can be addressed. Causes of ill health that can be addressed or cannot be addressed through medicine or other kinds of interventions. So I think it’s fascinating too, to think about nursing practice, and where it’s come and where it is now, and where it’s headed. So I guess in that vein, maybe we could just talk a little bit out what you see, Lorne, through your lens about where the practice is headed. But I wonder, would you please, just to give us a little bit of background, tell us a little bit about your background, what drew you to public health, and maybe specifically, what drew you to public health practice in Alaska?

Lorne Carroll: Oh, yeah. Sure thing. Maybe I’ll just make one quick comment about Lillian Wald. I’m not a historian, I’m just now becoming interested in history at a very slow rate. But I think of us reading that Lillian Wald got her practice started in 1893, and we hold her up as not only a leader, but a leader of public health nursing, which is interesting because Miss Philippine King we hold up in Alaska as our first public health nurse who started her practice in 1893, the same year. So it leaves me thinking, these two leaders that were out there doing it in many ways, or from a particular lens, in the same way, that we do it today, I wonder if there were several women across the U.S. who also started around the same timeframe. What are the chances that Alaska, we had our started in the same year? Fascinating.

SShirley Orr: I think there’s a thesis or a dissertation in there somewhere. What do you think?

Lorne Carroll: Ooh, thanks for planting that seed. I just went back to school a year ago, and I got two years to go. I’ve yet to determine what my big project’s supposed to be. Let’s see. My start, well, let’s see. I wasn’t born or growing up with the sense of, “I want to care for people, and I’m going to be a nurse.” That was never me. I’m not wired like that. I don’t have that. I actually started professional healthcare in the late ’90s as a firefighter EMT, so I did structural firefighter in a big suburb that fits right next to Kansas City, Missouri, a big metropolis area. So I got to see a lot of fire, and codes and this type of thing pre-hospital work.
And I was a firefighter during 9/11, so I went through all that with our brothers and sisters, and that was a good time for learning and developing it as a young man in professional healthcare. But the big thing about for me for fire EMS was I felt stuck geographically. As to young man, I really wanted to see the world. I’d been to Mexico once, and I’d been to Guatemala two or three times, and I wanted to see more. I’d never been to Asia at that point. So I remember eating dinner with my crew in front of the TV, which was what we normally did on shift because you never know when you’re going to get a call, and I remember it hit me all at once.
I was like, “I should be a travel nurse so that I can travel, and maybe I can take these three month stints, and maybe I can get some help with housing.” It just seemed like a great idea. So my last two and a half out of five years of fire, I went back to school full-time and got my bachelor’s of science in nursing at Research College of Nursing in Kansas City, Missouri. So I got my nursing degree, I quit fire. I sold my house, cashed up my retirement, and started to travel through Central America, and I returned back to the house that I’ve been in several times for a couple service trips in Guatemala, and one afternoon I was sitting there with the man of the house in the afternoon, drinking a cup of coffee.
And Hector was telling me, he’s like, “I feel sorry for the rich and the middle class, because they’re so preoccupied with work.” And then, again, it hit me in this moment. I’m like, “Oh my gosh, I don’t want to work on the floor. I don’t want to do that.” I just wasn’t feeling it. I continued travel through Central America, then I traveled through China for a while, and ended up back in Kansas City where I started. Settled down for a couple years and worked on a house, and then I needed to get a job, because I ran out of money work working on remodeling this 100 year old house. And I pulled out an old email from a public health nurse who I did a one-day rotation on for a community health component of my program, and I said, “Hey Amy, are there any public health nursing positions open?”
And she’s like, “Yeah, there are a few. Check it out on this website.” And at that time, the Kansas City Health Department had an opening for a 0.5 FTE for a refugee health screening clinic, and they wanted the other half of the position to create and open and run an adult and travel immunizations clinic. And I was very interested in the position, because it was close to where I lived and the pay was good, and I really wanted weekends and holidays off. I didn’t want to work nights or weekends. That was really important to me, and still is. And I remember during the interview, they said, “Can you start a clinic?” And I said, “Yes.”
I had no idea what that entailed, but I did remember, I had a real hard time making it through physics in college. It took me two or three times. I got an F, and then I got a D, and then finally on my third pass through physics, I got through it. But I remembered my instructor was this Polish guy who was looking to get a job in the United States, and he told me this job, he was sitting in on an interview and they said, “Are you an expert on lasers?” And he said, “Yes,” and then he spent the entire next week living in the library, becoming an expert on lasers. And so that stuck in my head, and it just came out. So I worked there at Kansas City Health Department for about five or five-and-a-half years. That that was my entry point into public health nursing.

Shirley Orr: And then what about Alaska? How did you land there?

Lorne Carroll: Well, I guess the story continues. I was working public health nursing there for over a half decade, but I never really felt like I fit in Kansas City. I was gaining weight, and I felt like I was moody, and I didn’t like my neighbors, even though I did want to like them. I just was having a hard time for no particular set of reasons. Eventually, I handed off the adult and travel immunizations clinic to a new employee at the time. Her name is Lisa Susunaga, who I continued to work with her for years, and actually still do today in some capacity. But she came up to my office after I handed off the clinic to her, and she said, “Hey Lorne, can you cover my clinic? I’m going on vacation?” And I said, “Sure.” And she went to leave my office, and opened up the door and started to step out.
But then she turned back around and she said, “Lorne, I’m so nervous,” and I said, “How come, Lisa? I thought you were just going on vacation with your husband Iran.” And she said, “No, I’m actually flying up to Nome, Alaska, and I’m flying up there for a site visit in an interview for a public health nursing physician with the Native Corporation.” And I was like, “Wow. Have a good time.” So she flew up there, and she called me on the phone. This would’ve been 2009. She called me, and she’s like, “Oh my gosh, Lorne. You’ve got to get up here. Everyone looks just like you, and they talk just like you, and there’s another public health nursing position open.” And I had my resume ready to go, so I faxed it up there and they flew me up a week or two later for a site visit and interview.
And I remember flying into Anchorage and I was like, “Wow, this is beautiful.” And then I caught the flight from Anchorage to Nome, which is a bush flight, meaning that you go off of the road system and go out to a different area about 600 or 700 miles off the road system. And the plane itself was flying right past Denali, and I looked at the mountain covered in snow, and I was like, “Oh my gosh, I can’t. I’m going to take this position.” I knew there was a national shortage for nurses, and there still is, and I knew that they would offer me a position. So at that point, I pretty much decided I was going to accept the position. I had a window seat, but also, the guy next to me on the left started talking to me, and this to me seemed abnormal because when you’re flying around in the lower 48, people don’t talk to you when you’re sitting on the plane.
But when you get north of Seattle, it’s customary or cultural to talk to the people next to you. So this guy started chatting me up. “He’s like, “What are you doing in Nome?” And that was a very welcoming thing that I felt like I was looking for. So I hit the ground in Nome. They put me in a hotel, and I woke up the next morning, the day of the interview and a tour of the facility, and when I woke up, there was a blizzard that night, and some buildings on Front Street were literally buried in snow. So it was at that point I knew 100% I was going to accept the position, for which I had not yet interviewed. So that’s how I got to Alaska, and I guess I would say without a doubt, it’s been the best decade of my life.
But that first week in Nome was quite a week. I remember going to one of the three grocery stores, and I was standing in line, had eggs, and I had milk, the basics. My first or second time in the grocery store at that point. And the person behind me was like, “Are you Lorne, the new mandolin player in town?” And so the small town vibe, which I was used to from growing up outside of a town, was very much in Nome, Alaska, although it spread around quickly. So I had two people bump into me in the grocery store that already knew my name, and they knew I played or at least owned a mandolin. And so I played more music with other people my first week in Nome, Alaska than I had my entire life. I was off to a good start.

Shirley Orr: Wow. And that’s been about 10 years now, is that right, roughly that you’ve been there in Alaska?

Lorne Carroll: Yeah. I’ve got to use a calculator now. I guess it’s about 12 years or so.

Shirley Orr: Wow. It’s probably gone fast, because it sounds like it’s probably never a dull moment, or every day different than the one before. I guess along those lines, maybe, would you tell us a little bit about what your work is like as a public health nurse there?

Lorne Carroll: Oh, sure. Yeah. I was up in nom working for the corporation for about three years. One year of that was doing public health nursing as a TB, tuberculosis, good nurse consultant, because at that time, they were a grantee of public health nursing services, and had been since the mid ’80s. But then, Norton Sound Health Corporation decided to hand back that public health nursing responsibility back to the state after just over 25 years. I moved over to their critical care flight nursing program for almost a couple years, and then I came back to public health nursing. But at that point, the corporation and the state were right in the middle of the transition of handing those responsibilities back.
So as a public health nurse, guiding a small team of five or six folks to offer services in the same building. So these were actually tribal employees who quit and then got a job with the state, but now it was a different organization, so there were brand new charts, a new set service delivery, so this is a big transition. So beneficiaries or Alaska natives would walk in seeing the same faces, asking for services at the same place, but they were given in a different way. So I think the big example there was we have a fee-for-service, and so we would calculate the cost of service and ask them if they wanted to pay.
This was a big change for beneficiaries after not only their whole life, but their parents’ whole life, was to access services without having to pay out-of-pocket, or being asked to pay out-of-pocket. So I did that for about 15 months, went home for a year. Worked on a farm, caught up with my family, with the aim of coming back to Alaska, specifically Homer, Alaska, to get the same position in Homer that I had in Nome, which is a public health nurse III, or a what we call a team lead position. And then it opened up, so that’s how I back to Alaska, and how I got to Homer. That was April of 2014.
And the thing that’s different about public health nursing in Alaska than my experiences of working for Kansas City Health Department as a public health nurse is that we work at three different levels. As opposed to just focusing on individuals, we work with community level interventions, and also work with individuals for some safe to get services, which are usually surrounding communicable diseases. So what’s it look like and feel? For about the past 20 months, we’ve been working 90 to 95% with COVID. So that’s increasing access to vaccine, and a lot of public-facing work like radio, podcasts, that type of stuff, with the aim of empowering to continue with mitigation efforts until COVID calms down.

Shirley Orr: And Homer is where you remain today. You’re still in that role in Homer, is that right?

Lorne Carroll: Yeah.

Shirley Orr: I remember seeing a gorgeous photograph that you sent last year. I think it was of a gorgeous area, snow covered. It was just phenomenal.

Lorne Carroll: Oh, yeah. Yeah. I’ve been here in this position in place about seven and a half years. And Homer is positioned about 220 road miles south of Anchorage, in what we call South Central Alaska. And you know what we’ve done really good in Alaska, in terms of public health nursing, is recruiting folks from all over the nation who are excited about an adventure. I would say all of healthcare in Alaska has done a really great job of recruiting folks that are up for an adventure, but we’re still challenged to keep all these vacant positions filled, to say the least.

Shirley Orr: So in the time been there, Lorne, I’m wondering, and you’ve spoken a little bit about this already, but as you think about public health nursing practice, and then you think about the Public Health 3.0 framework, I’m wondering what changes, or transition, or I don’t know, evolution have you seen with regard to public health nursing, as far as Public Health 3.0-oriented practice?

Lorne Carroll: Oh, that’s a good question, Shirley. I guess one of the biggies that pops out to me is that the section of public health nursing hasn’t always been working at a population level in Alaska. That’s real evident, that a population focus is really a pretty new thing. So having our start in 1893, and then we didn’t achieve statehood or have statehood until 1959, and then we went through attempting to eradicate several vaccine preventable diseases, and then we geared up for HIV in the ’80s. And then fast forward pretty close to today, we didn’t start hearing the first news or criticisms about, “Hey, you public health nurses, you need to stop competing for individual client-based services,” because there are medical homes, and then in the outlying communities, there are community-based, village-based clinics that can offer primary care.
So we started to hear the first news of that around 2004, and then in 2009 or 2010, we made the official shift to population-focused healthcare. So when I showed up here, for example, in 2014, it was very much to clear public perception. And Homer, it’s about 5,000 people, about 15,000 people in area. It was very clear that the public thought that the Public Health Center is where you go to the public health and nurse give you a shot. And so people love to come to public health nursing or the Public Health Center to get a shot, because the public health nurses were very skilled at it and are, but also, they didn’t have to walk into a medical home or an ED, these places where maybe sick people go, and you have to wait in a lobby next to sick people in order to get your well child examination with immunizations.
So there was quite a need for a shift in the public perception, and that took a lot of work. Also, when thinking about all of our public health nurses in the ’80s and ’90s, they signed up for public health nursing because they love kids, and they love families, so maternal child health was really the heart and soul of public health nursing for a very long time. So what that meant was we had a significant proportion of our employees worked back in the day where that’s all we did, and that was their skill sets. And so not only that, but we have the infrastructure in place to teach new public health nurses who come to us on how to provide those services. But in regards to population-focused healthcare, we just don’t have the training capacity or experience as an organization to train folks like that.
So what it ends up looking and feeling can be look like a little bit exploring to discover or uncover what population focused health care is, so that’s a real challenge. But one of the main entry points into that has been our community, in line with federal IRS was like, “Hey, nonprofit hospitals, you need to do a community health needs assessment if you want to avert some taxes.” So our nonprofit hospital in 2008 asked the community, well, actually, they asked public health nurses, “How should we do this?” And the public health nurses said, “Well, let’s ask the community.” And they looked at several different frameworks for conducting community health needs assessments, and they chose an HO product called MAPP, and it’s simply a prescriptive framework for conducting a community health needs assessment. MAPP stands for Mobilizing Action through Planning and Partnerships.
Now, the thing about conducting a comprehensive community health needs assessment is it takes a lot of people, and it takes a lot of different kinds of people to mobilize and empower a community to assess their own health, so that in itself is where a lot of cross-sector collaboration is born. But also, it’s where a lot of existing cross-sector collaboration can be highlighted. So we’ve had mental health, and physical health, and mental health. All those folks have been cross-sector collaborating for years, but when thinking about a community health needs assessment, it can pull in other aspects of community health, like the built environment, economic wellness, and cultural wellness, things like that. So in regards to making that shift from public health nurses are the people to give shots to more of a systems and community-wide basis, the MAPP framework has been real key for us to make that shift.

Shirley Orr: So from that initial trial back in 2008, what do you see today in terms of were some of the things that were priorities, things that the community identified as being really important to them? Are there some of those things that are still important, that are still priorities there at Homer?

Lorne Carroll: Oh, yeah. Sure thing. I think that the framework we’ve been using has four major components or pieces to the community health needs assessment, and one of them is a perception survey, which really answers the question, “What do you, the people, feel like our major strengths and weaknesses are?” The thing that keeps popping up year, after year, after year, and you’ve seen it, Shirley, in a photo, is that the natural beauty is something that we see as one of our strengths. And so if you could imagine, and you should come up and try this, you wake up and look out the window, and when you see mountains and glaciers in a spruce forest, you get this feeling that you’re in vacation mode every day. That’s a great way to start the day, so that’s simplifying it.
But also, in terms of weakness or areas that we can improve, the past two or three community health needs assessments, the perception of substance misuse has risen to the top. So an example of cross-sector collaboration, and how we’ve looked at Public Health 3.0 or operationalizing it locally, is that the community health needs assessment feeds or informs a community health improvement plan, which we ask the community, “What do you folks want to do about this?” And our current community health improvement plan has two components. One is a resilience coalition, and the second one is an opioid task force , or All Things Addiction is what it’s called currently. And so these are folks that come from different areas, have different kinds of professional backgrounds, but they all are in alignment, and their goal to improve this really complex social issue.

Shirley Orr: That’s really very, very interesting to think about, that evolution and all of those things. Resiliency certainly has been, even though maybe when it was initially brought forward as an issue maybe for very, very different circumstances, certainly, I think with COVID and all that we’ve experienced, it’s certainly critical today. So it sounds like there have been some really long-term themes that have driven the work, and probably shaped some of the partnerships that you’re involved in too, I bet.

Lorne Carroll: Yeah, for sure. And we see some patterns too, like access to care is a really big one in our state. Texans, they feel, rightfully, that their state is big, and it is, but Alaska’s about three times bigger, and with much less of a population. So we’re about 730,000 people, which means we have about 1.2 miles per person. That means we got a lot of space, but it also means it’s a challenge to get to healthcare. The average Alaskan travels 150 miles to access healthcare, so that’s something that we see persists through time, and also pops up, obviously, during COVID 19. The other pattern we see is that health literacy is a challenge, and I think that this is something that’s not new, and I think that it’s something that is going to take us a long time time to find some creative, successful solutions to.
But when thinking about literacy, I didn’t know this, I recently discovered that more than half of the folks in the United States have literacy deficits. Literacy is tied very closely to health literacy, and I think that this is part of what we’re seeing with COVID-19. What’s everyone’s ability, or each individual and family’s ability, to seek out access information about health, but also be empowered to match and line that up with the health literacy to make the best decisions possible for an individual and family in such a way that it improves health, as opposed to deteriorate. So what’s that mean for us as public health nurse practitioners is I think we’re going to have to answer some really tough questions, like number one, what’s our role in promoting health literacy, and number two, how do we discover how to do that, and train employees in terms of public health nursing practice in the future?

Shirley Orr: I think that’s such an important point, Lorne. And I wonder about as far as accessing information about health, I think maybe an element of that now that’s been illuminated is accessing accurate information about health, because I think having the preparation and being able to know, should I trust this source? Is this a site or a source of health information that I can trust to help me make decisions for my own health, and for the health of my family? I think that’s perhaps aspect of that, that will become more and more important moving forward. Does that seem like a thing to you?

Lorne Carroll: Oh, yeah. I sure do. And I think that misinformation is something that we’re a little bit more familiar with, in comparison to disinformation. And disinformation goes a little bit deeper, and has a set of agendas of which I am not aware of, for the most part. So I think that some of the challenges with misinformation and disinformation are that it takes time to debunk. If it that were true, and it is, it takes time to debunk.
This is already occurring the need to debunk, or otherwise face these challenges when our public health workforce is already struggling in regards to funding streams, and also keeping vacancies filled. And so when you have a stressed public health workforce, like you’ll see consistently pops up the PH One’s survey, is that an already stressed workforce, it’s a real challenge to take in new employees and get them trained in the ways of public health nursing. So over the next few years, I think we really got our work cut out for us.

Shirley Orr: I’m thinking, too, that we can really learn a lot from Alaska, because it seems like you have been dealing with a workforce that’s had needs and opportunities. Always, I suspect that there are openings, and the need to recruit more and more for Alaska, so I think now, we’re really looking at that scenario more broadly just about everywhere. So I’m wondering one thing. I’d love to know a little bit more about how all this may impact or how it may fit with the work that you’re involved in. I don’t know a great deal about it, but I know that you’re currently involved with Johns Hopkins MPH Bloomberg Fellowship. So could you tell us a little bit about that, and how that might be shaping your work in the future?

Lorne Carroll: Oh, yeah. Sure thing. Right before the pandemic got going, I submitted an application to Johns Hopkins Bloomberg School of Public Health to their fellowship program. And the fellowship, really it’s called American Health Initiative, and really, its goal is to create and sustain a nationwide network of leaders to help square up, face, and solve some really complex social issues like substance misuse and overdose, but also access to food, domestic violence, and other big challenges. So these are really big, complex issues that didn’t pop up overnight, and they’re probably not going to be solved in the near future. So the pieces of this fellowship program are there are about 50 folks chosen per cohort, and I think I was the third in the third cohort, 50 folks per year that are pursuing an MPH or a PhD in public health.
And it’s in partnership with the school, the employer, and the individual doing the program. And so some other pieces are not only to get through and enjoy what they call world class education, which I totally agree with, it’s been amazing, it’s also work in collaboration with the partnering organization on a project. So I’m not quite certain what my project is yet, but it will probably have something to do with staff development. So we have other items too, like an annual Bloomberg Fellows Summit, which actually starts tonight, and throughout the next two days. And so that’s a chance for folks to meet, just public health nursing at the local level. There’s not much better than meeting somebody to create a relationship to head off into the future. With.

Shirley Orr: Yeah, absolutely. So with these evening meetings, I guess I was thinking about the time challenges that might result for you in Alaska, but actually, the afternoon meetings, perhaps, rather than evening meetings.

Lorne Carroll: Yeah. Yeah. I’ll be going to bed early tonight, because tomorrow I’m thinking I’m getting up in the four o’clock hour to be ready for the Summit that starts at 5:00 my time.

Shirley Orr: Wow. Okay. So then I think also, if I remember correctly, which I hope this is not incorrect, or I may be behind in terms of the year, is this year that you’re serving as the president elect for Alaska Public Health Association? Is that right?

Lorne Carroll: Yeah, that’s right. I guess this initial year will be up in this coming January, at our annual health summit, then I’ll step into the role of president of ALPHA, or Alaska Public Health Association.

Shirley Orr: Okay. Very cool. What are some of the things right now that the Public Health Association there is involved with? What are some of the key priorities, or things that you’re working toward with your colleagues there?

Lorne Carroll: Yeah, that’s a great question. Number one, in this first year, I’m really learning more about what we are and who we are, and I really appreciate the structure there, so I can have an entire 12 months to learn and answer the questions. Who are we? What are we doing? And also, what’s our history? What have we done? But some of our major items there are offering an annual health summit, and this is what you would think of as a health summit. Folks submit a abstract and we review them, and then we have an entire program based upon a theme. And next year’s theme is the intersection of public health and public safety, so a lot of dots to connect there.
So that brings together a lot of folks, not only from across the state, but also nationally. And then secondly, we put the call out for resolutions, and then we’ll carry them forward to the board to see if we would like to support those as a professional organization. And as a government employee, when I’m clocked in, I’m a state employee, and that means that I’m here to serve everyone, of course, but it also means that some forms of advocacy aren’t aren’t right for me to do, wouldn’t be ethical or within my role. So being involved with professional organizations also gives me an outlet for that kind of thing, too.

Shirley Orr: Yeah. It’s so funny you brought that up, Lorne, because earlier today, I was on a Zoom meeting with some colleagues with MPHTC. My region is Region Seven, that brings together Kansas, Missouri, Iowa, and Nebraska, and we’re talking about that very thing. We all anticipate that there will be common issues that we will find ourselves immersed in once our legislative sessions begin in January, and so it’s really difficult. And we all walk, as public health practitioners who are in governmental public health, a fine line in terms of what we can do. What is providing information and education for legislators, versus what is advocate lobbying, where some challenges can arise.
So one of the things that we’re talking about is talking about how can we better prepare and support colleagues from others sectors, other areas, so that they can help to be the advocates, the allies, the champions for public health. Because certainly, I think what we’ve seen emerge in the last 18 months with COVID, and some of the negative light that’s been shown upon public health, I think it’s going to be really important for us to call upon others to help to reframe, perhaps, public health, and maybe hearken back to some of those things that people saw as real positives.
Public health has done some pretty remarkable things over its history, and has had some incredible successes. And while certainly, not everything has gone right or as we would have preferred it go during COVID, there still have been a lot of successes. So I think preparing and bringing along our colleagues who can help us share that, tell that story, and communicate that more widely is really going to be important. If it’s only coming from us, it sounds perhaps a little bit self-serving, but if others can share that message too, then I think it can perhaps be more effective. Do you see that in your area or your practice more?

Lorne Carroll: Oh, yeah. Yeah, to be sure. The thing as you were sharing that popped into my head is public health to a certain degree, but really, public health nursing to a large degree, like I was saying, we were really perceived as the people that give shots seven, eight years ago, and so we have been working on that for a long time. COVID hit, and what that meant for us is that we were public-facing more than ever. So before COVID hit, I used to be on the radio once a year, and I wouldn’t even show up to the station. I would take it by telephone, so I could have my two screens, and I could have all my info laid out. Really nervous, and I’d still get nervous to get on a podcast or radio. But the point being is I didn’t have those skillsets, and I certainly didn’t have the training.
In the world of public health nursing, that’s what’s very much throw the nurse in there, go get it, which is in our DNA. We tend to flex, and be able to discover skillsets as we need them, based upon community needs. But then COVID hit, so I made a very conscious decision. I was like, “Oh, boy. This could be a very long road, and there’s going to be a lot of opportunities, especially change, so if I don’t grab these opportunities, and if we don’t, they’re going to pass this by.” So made a big, personal, professional decision at that time, it’s been almost two years ago now, to say yes to everything. So for two years now, I’ve been saying yes. Yes to every radio, yes to every interview, so I’ve really leaned into that to try to develop these skills that I clearly didn’t have before the pandemic.

Shirley Orr: That’s really pretty phenomenal. I think that there are others that probably would say, “Wow, that’s great that you did that, but I would be terrified to do that.” So do you have any advice after this experience of two years that could perhaps cause people to feel a little less trepidation in that media work?

Lorne Carroll: Oh, yeah. Sure. I guess I would say number one is it’d be real good to consider upfront to be committed and open to receiving feedback and inputs. What do I mean? What does that look like? I would say ask for it. Each person that you work with, especially the people that you work with in an intimate space, like within a public health center, ask them constantly for feedback, and make it very welcoming, and be ready to incorporate it. I guess I would say number two, which is similar, would be have someone that you can talk to in a very honest and vulnerable way about the skillsets that you’re trying to tune in, and then ask them for feedback too.
So there’s not exactly a guide for public speaking for the public health nurse. There’s probably some tools out there, but also in line with adult learning theory, maybe there’s not much better than jumping in there and getting experience. And I guess I would say third, and lastly, is that the thing about public health nurses, one of them, is that we live with the people that we serve, so these are people that are already standing behind you in all that you do. So just know that when you’re speaking on the radio, they care about you, and they’re listening for your message. And when you stutter or you don’t have the words, they don’t even hear that, so just know that they’re there to support you.

Shirley Orr: That’s a really great point. I think sometimes as nurses, we forget that we have been for, I don’t know how many years running now, the most respected profession. People really do, I think, accept and believe messages when they hear them from public health nurses, so that’s probably something we need to really take to heart, and really think about how we can be even more effective with that.

Lorne Carroll: Yeah. Yeah. I guess that comes with that big, giant responsibility too, of when we do speak, it needs to be right, or right to the best of our ability. So what comes along with that, that I really discovered up front, was to say, “I don’t know,” and then also look into crisis risk communication skills, because there’s some really important points there to highlight when you’re speaking, especially regard in regards to something that’s quickly evolving.

Shirley Orr: So sitting where you’re sitting, Lorne, what are you seeing 10 years from now? Will you still be in Homer, perhaps? Thoughts about where you might might be at that point?

Lorne Carroll: Oh, wow. That’s a great question. I guess in my life, how I’ve tried to structure things in the past 10 or 12 years is my personal life comes first, and then my professional life, and a big part of that for me in the past seven, eight years has been where I live. I live at the end of this 1.6 mile trail, and I live in this cabin that’s off grid, and I’m out harvesting my own wood and water. And I’m highlighting this because these are the things that constantly nudge me into movement, and interacting with my natural environment, so it keeps me happy. It keeps me healthy to the degree I am today.
So sometimes I think about what would life be like if I moved to Anchorage, or Fairbanks, or made another move, but from today’s perspective, I think I’ll probably be here for a while. I’ll probably move on at some point, but today I’m happy, because like I was saying earlier, I get up, and when it’s daylight out and I look out the window, and I look through this spruce forest and see glaciers and mountains, I feel like every day is a vacation. What that means is my quality of life is really, really high right now, and that’s really important too, when thinking about how can I open up and explore ways of improving professionally?
So if I’m in a good spot, then I’m positioned well to do well, and that positions me well to support the new employees that are coming on. Employees come and go, but sometimes they make moves within this section, and take on promotions, and then sometimes folks go back to the lower 48. But a pattern that we have in Alaska is after someone’s been employed with the section and then they leave to go home to lower 48, they’ll oftentimes come back, and that feels good to support them in that.

Shirley Orr: Interesting. Well, and those things that you just described about your morning, and where you wake up, and what you see, and be working and living in concert with the environment around you, I think all of those things are really important lessons for us, especially as we’ve struggled these last couple years, and tried to help people find ways to be more resilient, that term we’ve used over and over and over, but it really is true. I think that the things that nourish you as an individual certainly enable you to maintain your practice, and to be a strong, competent public health professional.

Lorne Carroll: Yeah. And I think we need to do better, too, about hiring a more diverse public health workforce in public health nursing workforce.

Shirley Orr: Absolutely.

Lorne Carroll: I’m a very privileged a white man. I’ve got great parents I’m very close with, and they’re doing well, and I have a brother I’m close with and he doing well, and that’s not the case with everyone, and that’s certainly not the case with all the families within the communities that I work with. So we need to have a diverse set of folks that we’re working with in order to provide the most culturally competent, and otherwise appropriate, services to the communities that we serve.

Shirley Orr: Excellent, important point. So are there things perhaps that we haven’t touched on yet, Lorne, that you think might be important to share regarding your perspectives on public health, public health nursing, particularly from your vantage point there in Homer?

Lorne Carroll: Yeah. A couple things I guess that I’ve been thinking about over the course of the last two years is that as we have been nurturing these employees to do the work, the past two years has been pretty much all COVID, so they’re not getting experiences with tuberculosis, other vaccine-preventable diseases, things like domestic violence or obesity prevention, and then also, less experience with uncovering the rest. So what are the systems or community-wide interventions, or those things that impact health equity, or what’s our role in that? So I think that one of the challenges is that there’s a certain proportion of our staff that COVID is all they know, but I think that the good pieces of that are they know it well.
Just think about if we had the approach to tuberculosis like we do COVID, it might be a different story. And so what I mean more specifically is not only are we managing things like diagnostic tests and access to treatment and case managing, but nowadays, with COVID we’re having these things like echoes. So we get several folks from cross-sector backgrounds and professions on the call at the same time, that are looking at answering the same question, and the audience or the active participants are the general population. So that’s something that we’ve been trying to do for years as public health nurses, but COVID is what made it happen.
So more specifically, as we move into the future, I think we have some really good opportunities to answer the questions, how do we incorporate all core competencies of public health and public health nursing, and how do we get our new folks interested in discovering what the scope and standards of public health nursing practice are? Because a lot of these folks, eventually, COVID’s going to calm down, and we’re going to get back to broadening our services eventually, and what that’s going to mean is we’re going to need to revisit our service delivery and how we go about providing these services. And this means some of our newer employees are going to be on these work groups that are going to answer the question, how do we do this, or what do we do now?
So a real challenge, what the core competencies are they’re complicated. It’s very long. If we choose to just highlight 10 of them, then we miss out on the rest of the package deal. And so what I’m left with is this really stimulating, fascinating question, is how do we get folks to advance their public health nursing practice faster than I did? My journey nowadays began in 1997, and I would really like to get folks started off faster. It took me probably 20 years to start connecting the dots. But if we can get folks to start connecting the dots within their first couple years, I think we’ll be setting the stage to leaning into health equity, and perhaps social justice.

Shirley Orr: You know, it sounds like there’s a thesis or dissertation in there, too. Right? There you have it, perhaps.

Lorne Carroll: Maybe. I think you’re right.

Shirley Orr: Well, Lorne, I want to say thank you so much for taking time to talk with me today. Your insights about public health, your lessons learned in Alaska, are I think a phenomenal source of inspiration to all of us, not only as public health nurses, but as practitioners of public health in general. So thank you so much.

Lorne Carroll: Thanks, Shirley. I just want to give special thanks, because throughout the years, you’ve always been there, and you’ve been super accessible, and I think that really makes a difference as we look at where we’re at today and where we might be headed in the future, so these kinds of connections. Really couldn’t be where we’re at today without connections like that. And special thanks to the Share Public Health podcast, and the Midwestern Public Health Training Center. Thanks so much.

Shirley Orr: Thank you again, Lorne. That means so much. Thanks. Thank you for tuning into this episode of Share Public Health, and special thanks to our guest, Lorne Carroll. I’m Shirley Orr. It’s been my honor to be your host for this episode. I’d like to thank Melissa Richlen for audio production and support, and to Kaci Ginn for production assistance. This podcast is supported by a grant from the Health Resources and Services Administration. A transcript and evaluation for this episode is available at MPHTC.org.

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