Community Health Nursing: What Better Partnership Could There Be?

[batsek2013, BSN]

"I did my time in the hospital", I reply when asked what kind of nurse I was. You see, I am a retired nurse with approximately 50 years of experience, primarily in public or community health. During the 60’s in my BSN program at the University of Tennessee College of Nursing in Memphis, TN, those areas of clinical experience coupled with geriatrics were the last specialty areas I would ever have considered pursuing. Strange how things turn out, because those 2 areas eventually became the essence of my career as you will soon discover.

Today, though officially retired, I maintain my North Carolina RN license via on-line CEU courses and volunteer as a nurse in several community settings working with all age groups. No, I do not carry out bedside nursing tasks, but I function in various capacities in out-patient clinics in our hospital network. In the OB-GYN Clinic I have taught prenatal patients about the Baby Friendly policies of the hospital where they will deliver and helped carry out time studies addressing waiting room wait times. In the Medical Clinic I assisted the case manager with follow-up of patients referred for specialty care similarly to work I had done as a nurse case manager years before. I administer flu shots to the large hospital staff annually and provided flu shots and education about hypertension as hospital outreach in a low-income barber shop in my city as well as providing tuberculin testing of future hospital volunteers in a special program off-site. Just this week I chaired the newly formed Patient Family Advisory Council for the Medical Clinic where I have volunteered.

Currently, I assist patients in the GI/Endoscopic Clinic with enrolling in our hospitals patient portal in addition to assisting with the discharge of patients following procedures in the clinic. My penchant for community health was a partial impetus for joining the US Peace Corps with my husband in 2010-2013, at the age of 67. For 3½ months I was a community health worker in Niger Africa, but due to safety issues in that country we were reassigned to Armenia where I taught English but tried to incorporate health teachings into my student’s English lessons.

An interest in community health has followed me over the years. Preventative healthcare and education outside the walls of the hospital continue to be a wide-open field for nurses where all the skills and knowledge one possesses are put to good use for the betterment of patients and the community.

Ironically, my first nursing job was in a pediatric hospital where I was a staff nurse on the infectious disease floor. What an education that was! Like many new graduate RN's, I was given immense responsibility for many sick babies and children and did so rotating 8 hour shifts every week before twelve-hour shifts existed. I loved being there and loved the children, but the schedule was incompatible with my personal life. After 1½ years, in the mid 60's, I accepted a position as a general public health nurse at the local county health department in Memphis, TN. My treasured, starched white cap was traded for the navy-blue uniform of a public health nurse with the bonus of a black nursing bag which was part of that uniform. Education in the BSN nursing program was the guidepost for my practice as a new public health nurse. Later on, I completed national certification in case management to better function as a case manager in one of the health department's large neighborhood clinics during the overhaul of Medicaid in Tennessee during the 80's. I am sorry to say that I by-passed two different opportunities to return to study and become a nurse practitioner. That regret follows me into retirement. As sometimes happens, the timing for both opportunities was not right and I did not pursue that advanced degree. Now that my career is winding down and health care has changed drastically, I can see the tremendous value in community health that being a nurse practitioner would have been.

The following are examples of selected experiences in various community health settings to better demonstrate why this is a specialty area filled with opportunity and fulfillment for nurses. A day's schedule varied with the year and the type of work or organization with which I was involved.

As a new general public health nurse

My work included well-child, prenatal and chronic disease neighborhood clinics. Home visits for public health issues as well as follow-up OB and infectious disease care were a part of each day, and I was responsible for health screenings and other issues for 3 schools in my district. Soon, I moved into the Tuberculosis Control Division of the Health Department. In that position I visited active tuberculosis patients in the Tuberculosis Hospital in our city to help prepare the patient for discharge as well as assure that all contacts had been tested and treated if necessary. Seeing patients in the TB Clinic for follow-up, dispensing medications and obtaining sputum specimens for diagnosis were regular assignments.

Memorable

Traveling to the rural home of a large household of contacts to a patient hospitalized with tuberculosis for the purpose of skin testing ... no one of the ten household members spoke English. Ages ranged from that of toddlers to grandparents. Communication was a challenge that day but everyone was tested with minimal crying and frustration for all.

Next

I taught Nursing of Children /Pediatrics in a hospital diploma nursing school where the first 2 male students were present in my senior level class. Hired and prepared as a BSN only nurse, a co-teacher and I worked hard and shared our knowledge and own experiences and research before each class.

Memorable

All of our students passed their State Nursing Boards in Pediatrics, hopefully due, in part, to our work with them.

Home Health Care

Following a brief stint as a public school nurse responsible for health education of middle school (junior high, at the time) students, home health care became the focus of my career and lasted 10 years. Community health covers all areas and home health fits right in. A wind-shield view of where I visited changed every day. Patients included those with serious medical conditions in addition to social and economic issues affecting their health. Trusting a family member to watch my car in a housing project while I carried out a nursing visit was not unusual. Visiting a patient at midnight when on call because of a clogged Foley catheter of several days’ duration was not rare. Teaching a patient to safely take their medications was routine. I once received a note from a patient with a severe visual impairment who had learned to draw up and give her own insulin after many tries. The note simply said, "We did good, didn’t we? Thank you for helping me."

Memorable

The patient I found on the floor in insulin shock, the patient with a lower extremity amputation who had maggots in his decubitus when I first saw him but whose wound soon began healing due to the cleaning of dead debris by nature followed by use of reputable wound healing dressings, the first patient to receive IV antibiotics at home ... memories of the 80’s and 90’s. And home health nursing continues in the community outside the walls of a hospital, just with changes due to the times in which we live.

Home Visiting ... in the late 90's

A new home visiting program was initiated at our Health Department in partnership with the University of Rochester and researcher, Dr. David Olds. The New Mothers Project was a study of nurse home visitation to first time mothers and their babies which theorized that these families would fare better in the future as a result of this intense period of health education and intervention. Of course, I jumped at the chance to participate. Most clients were teen mothers living at a poverty level and many were enrolled in school at the time of their pregnancy. Education about pregnancy, infant and child growth and development, dangers of smoking, drug and alcohol use in pregnancy, accident prevention, and attention to the young woman’s life course development were all parts of a strict protocol we home visiting nurses followed at weekly visits. Babies were followed either until 6 weeks of age or 2 years. The client and child were also interviewed and tested by research associates during the 2 years. This research continues now with the offspring and with their children. After 25 years, one of my clients found me on Facebook to report that she is finishing her doctorate in nursing in California and my "baby" is also studying to be a nurse. What a success she has become! This program is now replicated in clinics in forty-two states and several foreign countries under the title of Nurse-Family Partnership. Check if interested. There may be a clinic in your area. I am extremely proud to have been a part of that study and to see its positive outcome. I keep a small photo album of my babies and their moms as a reminder of those days in community health nursing and the lives led by so many who are less fortunate than myself.

Memorable

The pregnant teen who met me in her driveway to ask if the baby in her stomach was hungry because SHE was ... and had no food in her pantry. Note the teachable moments in this encounter.

School health rose again as a calling

I accepted a Charge Nurse position in the health department’s school nurse program which served medically fragile children in my county’s public schools. I shared responsibility with another nurse for twenty-nine school nurses in forty-nine schools including those who rode buses with the most fragile students. This job was the most challenging of my career and one I was not totally prepared for.

Memorable

I learned that management was not my "thing". I learned that hands-on contact and getting to interact and know my patients was much more my nursing style. I loved the children but never developed a close relationship with any of them due to management responsibilities and short staff. It was a fact of life and I learned from the experience.

After 3 years in the above position, I retired but continued to volunteer in a primary care clinic for patients who worked but had no insurance. Soon a part-time staff position opened up and I took it. There I again saw all elements of our community and how poverty affects access to care. Carrying out tasks of a staff nurse in this clinic was perfect for me as well as the opportunity for health teaching and follow-up of persons with uncontrolled diabetes. My working career ended after 5 years when my husband and I moved to my current state. Here my volunteer efforts have been in out-patient clinics and community settings as noted earlier in this article … the area of practice with which I fell in love over 50 years ago. As they say, "Once a nurse, always a nurse". There was nothing mentioned in that adage about age!

Community Health or Public Health, whatever the designation in your area, is a fertile field of opportunity and expanding rapidly, particularly with the emphasis on disease prevention, cost of insurance and issues with access to health care. Consider it seriously either before or after "doing your time" in a clinical setting. Times are more flexible and the work never routine. You will find many personal and professional rewards and an opportunity to continue being an active nurse for years to come. And finally, dear readers, think about continuing your education to a higher level so that you can offer even more to your community or setting, no matter what specialty you choose.