Public Health Nurses, how are things going?

Hello! I currently work as a public health nurse doing maternal infant early childhood family home visiting and I know what you mean. Some of the families we work with have so many barriers and risk factors and things they need help with that it feels like you're not getting anywhere and that it's an endless cycle. How is a mom supposed to provide adequate care for herself and the kids if she can't get a job because she can't afford childcare and then because she can't work she then is homeless and still can't afford childcare and then there is a lack of transportation and mental health providers and the list goes on and on. The work I do has been very eye opening and rewarding however. When you work in a hospital or clinic and tell a patient how to manage their health you might not realize the reality of a person's situation and how many barriers there may be to just being compliant with the plan of care a provider has recommended for a patient. What I try to do is celebrate the small wins, meet the client where they are at and work with them on things they want to work on vs trying to make them change in ways they aren't ready to yet, delegate off duties to other service providers that are available in the community if you are able to like finding a service that helps with transportation, housing, mental health, childcare, etc, have good support from your coworkers and supervisors, and have realistic goals and expectations for the clients and community you work for. Public health is slow, hard work that you hope will pay off in the future generations to come and you may not notice the payoffs immediately so trying to keep things in perspective.

Hi! I'm glad you posted; public health nursing is definitely different than other areas and it's nice to talk to others who are in it, as well. I'm an immunizations nurse for a county health department. Obviously it is rewarding in that I truly believe that I am helping people - I absolutely believe in immunizations and the incredible innovation that they are. The thing that I struggle with, though, is the growing anti-vax movement. I struggle to even reach those people - I have friends and acquaintances who are either anti-vaccination or vaccination-hesitant and, while we have clinics and I do outreach and educate providers about how to increase immunization rates, I know that there are so many out there who don't trust healthcare to the point that they aren't even taking their children (or themselves) to well visits, so they will never even get that education. I feel like there is more and more out there (even if it is bad science) that is convincing people to be skeptical of immunization that I feel like my job is a constant battle. I know that I'm doing good, but sometimes it feels like for every one person I help, there are numerous more that decide that vaccines aren't safe. I keep a close eye on social media to see what people are talking about/what the trends are as far as why they feel vaccines aren't good (lately it's a lot of mistrust when it comes to the adjuvants, for example). I just try to educate, educate, educate, even in my personal realm, but sometimes it just feels like it isn't enough. You aren't alone in feeling powerless, Everline! I'm still working on what to do to lift myself up - honestly, at this point, I just think about the fact that I believe in what I'm doing and that I just need to keep at it. And then I go home and take a bubble bath. *shrug*

I like what you wrote here about paying off in future generations to come. I agree with you that this is something I think is so important and we need to keep in mind. A lot of what people go through is generational. It just keeps going from parent to child on and on. If we can interrupt that process, we have done a lot. We may not actually witness the effects, but we can have a positive impact on what transpires down the line. If a mother had a difficult upbringing but learns to parent her own child differently, then things are changing for the better to break unhealthy cycles.

Thank you for the work you do! When I do pregnancy counseling, I refer some of the women I see to programs like Healthy Start and it really makes a difference for them!

In addition I wanted to comment on the idea of working on what the client wants to work on. That is to say, I can have a lot of hopes and possible goals for a client, but they aren't interested and I have to let that go because it isn't about what I want for them. I wish a lot of my clients would make better choices, especially the teenagers. I can educate them, provide them with medical treatment, help them to explore their options, connect them with resources, etc. But ultimately, they have to do what's necessary to make their lives better in the ways most important to them.

I think what's important to me is knowing I've done what I could to help. I have to let it go if a client chooses not to follow through or take advantage of what is being offered to them. Most days I actually do feel like I've done some good. Most days, I really love my job.

Thank you for your kind words and for the work you do as well! And I agree! Our job is to advocate for people by letting them know of all their options and their job is to pick and choose which options work best for them at that particular time and for their particular situation. I try to remind myself that people are the experts in their own life and my job is to just guide them in their decision making process by offering the most current up to date information so they can make the best choice for themselves.

Sometimes when I pass through the immunizations waiting area at our health department I hear some of the conversations people are having about vaccines and it can make me sad and frustrated. I've heard people say that they think it's better to let their children get diseases like measles and mumps (even polio!) than to vaccinate their children. That is how much they distrust vaccines and they really hate that they are required for school. So I can imagine what an uphill battle you may deal with!

On another note, I like that part of your public health nursing practice is to keep up with the vibe on social media. I love how public health nurses keep their eye on their community like that. I applaud you! That is the kind of thing that helps us know how to tweak our education and outreach.

You mentioned going home and taking a bubble bath...

I can tell you that I am finding that I have to do something to "let it go" when I get home. I don't have a nice bath tub to have a soak, but the idea behind it is the same. I have to do something to relax my body and mind from thinking about work. It's so important for me to realize that work is not all there is to life. We do the best we can for our clients and then we have to also do the best we can for ourselves!

I think a big thing that you touch on is lack of trust. I would encourage you guys to find ways to rebuild that trust in the communities you serve. Working with the community vs against it. What our public health dept has done in the past related to fear with vaccines is invite community members to events to discuss their perception of a particular vaccine and what they feel would be helpful for winning back their trust. For example we met with parents of male children to discuss their perceptions on the Gardasil vaccine and the information that was shared with us was that parents in our particular community didn't know much about the newest recommendation to vaccinate boys and the reasoning behind why it's recommended and that they trusted their doctors opinion and recommendation but didn't feel as though doctors spent much time answering their questions related to the vaccine and would just give a pamphlet from the manufacturer with information about Gardasil. Many parents don't trust the information in the manufacturers pamphlets because they feel like it's biased so they chose not to vaccinate. We also did something similar with the Somali community because we had a measles outbreak in our state due to many Somali families choosing not to vaccinate and what we found out was there is a fear in their community that vaccines cause disabilities because when they lived in Somalia they didn't have as many children diagnosed with disabilities as they do now in America. So we provided education about how in America we do lots of screening with children to find developmental delays and disabilities in order to provide services to help those children live as full of a life as they're able to which then can make it seem as though there are more disabilities in a community because we are more actively screening and diagnosing children. We have also been invited to various Somali community events to speak to and educate their community about the safety of vaccinations. Just a couple of examples of what we've been doing in our particular community. I'm sure you guys have done similar things in your communities as well.

And as you guys mentioned self care is so important in any helping profession like ours! It's truly what makes me able to keep continuing to come back to my job day after day especially when working in particularly challenging situations.