Community Health Nursing Practice- Sharing Your Stories
The story of Heather, as highlighted in CHNAlberta Newsflash (October 2018)...
My journey as a global citizen and community health nurse started when I took a gap year after high school and participated in the Canadian World Youth Program. Then Canadians aged 18-21 and ten young adults from Sri Lanka met in a small town in New Brunswick where my Sri Lankan counterpart and I worked for three months in a long-term care facility providing recreational activities to seniors. We then traveled to Sri Lanka to participate in a variety of community development projects- everything from digging ditches and building a volleyball court for the community center to assisting with polio drops and basic hygiene. Unfortunately, only a month in a civil war broke out in Sri Lanka and the Canadian government evacuated us, cutting the program short and changing my life. Having to terminate close, collaborative relationships and leave Sri Lanka with 2 hours’ notice was one of the most difficult things I’ve done in my life yet it shaped “my story”. As a sheltered small-town girl from Northern Ontario, I experienced firsthand the determinants of health, global inequity, and social injustice and recognized the privilege that a simple birth right holds. This experience shaped my passion to promote justice, reduce inequities, and work towards “health for all”.
I graduated from nursing at a time when there were very few RN jobs in Canada, so under NAFTA I moved to the U.S. and worked in a small community hospital to get “foundational nursing skills” needed for public health. My desire for an upstream, holistic approach to health became clearer and my passion to support access and equity grew stronger so I moved to Calgary to “settle down” and pursue my dreams of population health. Although I loved working with communities in the well-baby, school and influenza programs, I couldn’t shake the desire to return to the developing world. In 2001 I was fortunate to travel to India with VSO/CUSO to work with a local organization to provide basic prenatal care, hygiene and training to a nomadic, Indigenous community in the foothills of the Himalayas. The program goals were to – reduce infant and maternal mortality; promote HIV awareness; and train midwives and first aid responders to improve hygiene practices. Everything I dreamed public health to be! It was a two-year project that was also unfortunately cut short due to political unrest and tension created after 911. Another reminder of inequity, privilege and gratitude for being Canadian with access to all the prerequisites for health. When I completed my project report and reflected on how I addressed the program’s goals over the first 10 months, I initially felt like a failure. Upon further reflection, I realized that despite not meeting target numbers of vaccinations, midwives trained or sessions offered; my biggest accomplishments were the relationships developed. I had empowered my colleagues and built capacity resulting in a shift of thinking which lead to a reduction of littering and improved awareness of family planning. Building on strengths, increasing skills, knowledge and willingness to act is what building capacity is all about. I came to realize the importance of setting SMART goals and establishing trusting relationships. I also realized these things take skill and sometimes A LOT of time! After this experience, theoretical concepts became clearer and the population health model became a framework to my nursing practice.
I continue to use these foundational concepts in my work with internationally educated health professionals integrating into the Canadian Health Care System. Despite two evacuation advisories, I continue to volunteer/travel abroad and ALWAYS register with the Canadian Embassy! Being a public health nurse has been rewarding and challenging. I love the variety of both population and scope but most of all, I love the collaborative nature to my practice.
The story of Christine, as highlighted in CHNAlberta Newsflash (September 2018)...
My name is Christine and I graduated from the RN program at the University of Calgary. After working as an undergrad in the hospital, I came to realize that I was passionate about health promotion and an upstream approach. This is why for my final practicum, I chose to come into Public Health. Since then, I have worked in Influenza Program, Well Child services and School Nursing. Most recently, I obtained my CCHN through CNA and came across CHNAlberta through a colleague. I recently joined CHNAlberta's executive board as I believe it will give me more opportunities to grow as a professional.
The story of Laurie, as highlighted in CHNAlberta Newsflash (April 2018)...
Nursing in Nunavut
In November of 2017 I was on my way to Iqaluit. I had signed a contract to work for four weeks as a Tuberculosis Nurse. I wanted to stretch my wings after thirty plus years working in Alberta in various positions including as a Tuberculosis Clinical Educator in Calgary.
I arrived on a Sunday and started my orientation with three nurses from around Canada.
During the week orientation I learned about the history of the Inuit and their difficulties with health care services as well as their struggles with tuberculosis. I found myself overwhelmed by the limitations of travel, the high cost of food, the loneliness of the families who were sent for treatment in a hospital so far from their homes.
People were friendly but cautious. How long was I going to stay? Had I ever worked in the north before?
The most frequent greeting was “What is your name?” I would ask the same in return.
After orientation I boarded a plane for Qikiqtarjuaq (Qik) a small community of 600 people. I lived at a nine room hotel and walked a short distance to the Health Clinic. There was a Nurse Practitioner who was the manager of the clinic. Two Public Health Nurses who were generalists. There was a Mental Health Nurse and an LPN who was the backbone for all of us. He assisted with blood draws and vaccinations and giving direct observation treatment for TB patients in the clinic as well as the community. The LPN also drove me to patients’ homes when I was nervous about the family dynamics.
The X-ray tech also served the front desk, ran errands including taking appointment cards directly to the patients’ homes, as phone service was limited. He bought groceries for the clinic so we had fresh fruit for the TB clients and he delivered sputum samples to the airport for transportation to Iqaluit.
I met the nurse I was replacing and soon we were busy assessing the grade six and older students in the one school in town. We discovered quickly was that there were many active cases in this school- aged group.
There was much activity in the small TB office. I gave medications to people of all ages. I collected sputum, drew blood, ordered Chest X-rays as per protocol. I tried to track down contacts of active cases to check for new cases of TB.
While planting skin tests I was able to ask the young teenagers about their lives. The young women I met were depressed.Their living conditions were difficult. Their parents or guardians had addiction problems. Some had been abused. They were afraid of having tuberculosis. One of the young women in the village had died of TB meningitis just months before I had arrived. I connected some of these young women to the Mental Health Nurse.
One young child – 6 years of age – had been hospitalized in Iqaluit then returned to Qik. He would get a ride to the clinic on his mother’s snowmobile to get his DOT. He would raise his eyebrows to indicate yes or scrunch his nose to say no when I asked him if he wanted an apple after taking his medications. His mother carried his younger sister in a pouch inside her hood. This family was one of the few I had met who had strong supports and were good advocates for their children. This six year old child would methodically take each of his 15 pills in a solemn and steady manner. There was no fuss or encouraging word from the parents. I, of course, told him he was my favorite patient in all of Nunavut!
I had a suspicion from the start that there were far too many active cases of TB in the community and sent several messages by text and by email to the main office in Iqaluit to send more help to Qik. Eventually one of the Communicable Disease Nurses came with my replacement, and the CD nurse finally understood the enormity of the TB crisis and the state of the facilities.
A few months after my return home the Nunavut government sent up a team of nurses, a pediatrician, lab and X-ray techs and assessed almost all the residents in Qik for tuberculosis during Feb and March 2018.
The story of Kelsey, as highlighted in CHNAlberta Newsflash (April 2018)...
I just completed my final preceptorship in Community Health Nursing at a First Nation community west of Edmonton. My interest in community health was initiated after I heard a CHN speak in front of my class about her role as an RN in First Nation health. She spoke to the importance of client-centered, relational, culturally safe, holistic care. She highlighted the importance of meeting the client where they are at, and working with them to provide care that is individualized and collaborative. Though she only spoke for thirty minutes, she had provided me with enough information for me to know that this area was where I was meant to be. Every day was a learning experience for me where I learned patience, flexibility, and the importance of empowerment and building capacity. With each group of people whether it be prenatal moms, families, youth, or school aged children they each taught me something, which I will hold on to and grow from as a RN and as a human being. While there were not many highly medicalized experiences during my preceptorship, I enhanced many other skills that I think are crucial in the Registered Nursing role. These skills included: communication, program planning, flexibility, cultural practice, conflict resolution, time management, case management, thinking outside the box, and providing care that is relational and client-centered. As I reflect back, I think that my skills in practicing safe, ethical, relational, and client-centered care have enhanced the most. As I transition into professional practice I hope I can continue to work as a CHN. As I Grad Nurse and future RN, I will always use this skill set to ensure strong, trusting, professional relationships are built and maintained with the populations I serve. My biggest take away from having my preceptorship as a Community Health Nurse, and from working in a First Nation community, would be how rewarding it is, and how resilient a community can truly be.
The story of Tahira, as highlighted in CHNAlberta Newsflash (March 2018)...
My journey to becoming a Community Health Nurse was full of many life altering experiences. After graduating, I spent three years working on a busy pediatric unit. Following that, I went on to become a palliative care nurse at a children's hospice. The experience of working with sick and dying children brought a new found perspective and deep appreciation for life, which I carry forward with me through my life and nursing practice. However, after four years in children's palliative care, I knew it was time for a change and I became a CHN. I feel grateful to be in a position where I can provide family centered care that empowers children and their families to attain a healthy lifestyle. I recently completed the Canadian Nurses Association certification for Community Health Nursing. Obtaining this certification with CNA was important to me because I was able to strengthen my community health knowledge and increase my credibility as a CHN. I encourage any Registered Nurse who is considering CNA certification in their specialty area to also take the leap and do it! The CNA Certification in Community Health Nursing has reignited my passion for my career. Furthermore, this certification has improved my nursing practice; I now have a stronger focus on societal and interpersonal factors that impact clients and affect health in both positive and negative ways.
The story of Stephanie, as highlighted in CHNAlberta Newsflash (February 2018)...
I have always had a passion for health promotion and primary prevention. Community health nursing was a perfect fit for me in this respect. I was fortunate enough to have my final practicum in public health in northern Alberta. I had experiences in many areas such as well child clinic, school health, travel clinic, postpartum home visits, and tuberculosis management. This was such a valuable experience that allowed me to identify which areas I wanted to pursue further. I enjoyed providing vaccinations knowing that this was going to protect the client from getting the disease and educating clients about health and safety so that they could make informed choices.
Currently, I work in well child clinic in Calgary and am the team lead at my office. This leadership role has provided me with an opportunity to help advocate for improvements with clinic processes/functioning and building strong collegial relationships. Given that we see a wide variety of clients at our clinic, it has been rewarding to see how appreciative they are of the service we provide and how the social determinants of health can have such an impact on a family.
The story of Naomi, as highlighted in the CHNAlberta Newsflash (January 2018)...
My name is Naomi, I moved to Calgary, Alberta at a very young age from Hong Kong. I grew up in a small family with just my parents and my younger brother. As high school approached, I started wondering about what kind of a career would I like to embark on? My father was very encouraging of my career choices and suggested nursing as he noticed that I love working with others and took an interest in how people felt. I decided to work very hard throughout my high school years to get into nursing school. I graduated from the University of Calgary in 2008 and started my career on a pulmonary acute care unit at the Peter Lougheed Center. I strongly value the experience I gained working on Unit 39 as it provided a much needed perspective and foundation to nursing. Most of my university program was geared towards acute care however I am very thankful that my final practice was based out of public health with a school health focus. I appreciate nurses who work in acute care as they work closely with individuals whom are ill, diagnosed with complex diseases, and often provide palliative care. When I graduated and took on the acute care role, I found it very challenging to be faced with life and death situations and developed a strong appreciation of public health and the importance of health promotion, preservation, and community development. As our society's demographically change, especially with aging population(s), we may experience a greater impact related to chronic disease and morbidity. However, I believe that public health can truly make a difference in the lives of those we care for. I have been working as a public health nurse since 2010 and have worked in approximately 30 schools. The School Nurse role has provided me with unique opportunities to collaborate with different school communities in promoting health and wellness for their members. I find it so interesting that each school community views health and wellness quite differently. There are always fresh and innovative ideas to deliver important health messages. I am hopeful that my role as a school nurse has impacted community members and their families in a positive way to help foster opportunities for everyone to work towards attaining better health.
To further develop my passion and knowledge as a public health nurse, I joined CHNAlberta in 2015 and became a board member and co-treasurer last year; I am very thankful for all of the experiences that CHNAlberta has provided me and I am happy to be able to advocate for advancing public health with other members across Alberta. I believe we are truly stronger in numbers and I continue to look forward to the learning opportunities I will gain through CHNAlberta. .
The story of Margo, as highlighted in the CHNAlberta Newsflash (November 2017)...
For nearly 15 years I have worked as a PHN in a variety of roles under the Community Health umbrella, and with diverse populations throughout the lifespan. During my career, I've had many positive experiences, however, one unforgettable experience stands out in my PHN career. At the time of this unforgettable experience , I was working in a clinic that was staffed by two Registered Nurses, one Nurse Practitioner and one clerical support staff. Our clinic came to fruition through a grassroots movement that was started by nursing students during their university practicum. Not only did these students identify a gap in services for teens in their city and surrounding rural areas, they worked with the community and made a strong (and successful) efforts to close the gap. And therefore, this Teen & Young Adult Clinic became an excellent example of how unique partnerships can be formed in order to meet the needs of a community.
Our clinic operated as a drop-in clinic, one afternoon a week where our four staff often collaborated with many local agencies to deliver comprehensive health services; some services included: Public Health, Urgent Care, Mental Health, Addictions, Community Links, and many middle and high schools throughout the jurisdiction. The clinic’s collaborative relationship with these agencies was invaluable from the very beginning. For many teens and young adults, a visit to the clinic was often the first time they accessed health care on their own, without their parents; therefore, we strived to make this a positive experience. As nurses, we were aware that it would inevitably play a role in shaping their perception of the health care system and their place within it. The clients reported that they valued the expertise, confidentiality, drop in style of the clinic, and the quality of time they received from the health team. The team provided comprehensive health teaching on various topics, which included: contraception, STIs, healthy relationships, mental health, and community resources available to them. Trust and rapport were integral components of the clinic’s success for providing comprehensive and effective care while teaching, testing, and treating a vulnerable population of clients. Working in this clinic was an exciting, collaborative experience that fostered a team approach to client centred care within a supportive community environment. As nurses, we felt privileged to provide health services to this unique but often forgotten population. Personally, this experience was the first time I felt a true team approach to health care delivery. This team demonstrated a deep respect for each member’s knowledge and expertise. Furthermore, this role made me feel connected to the community, and what was most meaningful was that I also impacted the community in ways that lead to positive, improved health outcomes
The story of Leah, as highlighted in the CHNAlberta Newsflash (October 2017)...
I entered my university nursing program knowing I wanted to work in community health. I had worked with non-profit organizations, building capacity in the community at a grassroots level. I was part of a board that oversaw a youth center where many kids came to find a warm, safe place to hang out. I also served as a community member on an alternative justice program where I worked to support youth and families who had for the first time, come in conflict with the law. I loved this work and I wanted to continue to grow in this area I felt such a passion for.
This curiosity ultimately led me to decide that I was absolutely meant to be in community health nursing. For eight years, I have worked in approximately thirty different school communities (in all but one quadrant of Calgary). I love to see the uniqueness of each community and the ways in which uniqueness also strenghtens a communitiy. The process of building relationships within the context of community is a rewarding expereince, as it fosters a collaborative partnership built on strengths. I really enjoy encouraging health champions in a school setting and supporting students in their pursuit to improve the health of their community.
Community health nursing has also led me into the amazing world of vaccines. In my role as a Community Health Nurse, I have had countless conversations with diverse subsets of people regarding the importance of vaccines and how disease protection can influence a population's health. It has been a rewarding experience to have these conversations. As a Community Health Nurse, I feel privileged to take an active role in protecting communities from diseases that were once very menacing.
The story of Melissa, as highlighted in the CHNAlberta Newsflash (September 2017)...
I am a Community Health Nurse with a passion for health promotion and capacity building within vulnerable populations. My current practice setting is on a First Nation's reservation where I work in collaboration with the community and various levels of government to develop, enhance and deliver culturally competent, comprehensive public health programs; some examples include: Immunization clinics, school health programs, maternal child health programs, and health promotion and disease prevention initiatives in partnerships with interdisciplinary teams on/off reserve.
In 2014 I was in my fourth year of my BScN degree and planning my final preceptorship placement, which was actually a difficult process as none of the community health placements seemed like the right fit for me. This was until my nurse mentor, who knew my desire to work closely with vulnerable populations, suggested I consider First Nation health. This immediately resonated with me and I requested my faculty find me a placement in community health within a First Nation community. I haven’t looked back since!
I have always been fascinated with culture and the ways culture shape the values and identity of a society. Over the last few years, the community where I work has taught me a great deal about their indigenous ways of knowing and as a result, I have acquired a deep understanding of how the Social Determinants of Health interconnect and impact health. These skills have been foundational when working with a population who have experienced historic and intergenerational trauma as these experiences can also influences interaction and perception of the health system.
I have dedicated my life's work to serve as an advocate for healthy public policy and service delivery that is inclusive, equitable, fosters resilience and encourages positive health outcomes for all. As a Registered Nurse, I believe health advocacy is an especially important role that nurses should utilize in professional practice. Our collective voice can make a large impact; therefore, it is our responsibility to use our profession to advocate ways we can safeguard opportunities for positive, equitable health outcomes while also speaking out against systemic barriers to health that perpetuate oppression and disparity.
The story of Wendy, as highlighted in the CHNAlberta Newsflash (June 2017)...
I’ve had a long and varied career in Nursing with many opportunities, challenges and successes. So – what has had the biggest impact in my nursing career? And that in itself is the beginning of everything – asking a simple question.
“To be curious is to have a knowledge gap between what you currently know and what you need to know to be effective” (Jeff Boss, Forbes.com).
In 2003, I was a generalist Public Health nurse in Airdrie, and I agreed to be a contact for a group of University of Calgary nursing students who were beginning their community practicum. They had more impact on the community than any of us could imagine.This group chose to assess the needs of the youth in Airdrie, and concluded, based on their community assessment, that there was a lack of readily accessible health resources for teens. The assessment was collaborative and included a number of key informants from the community, the final report and recommendations were given to these informants. A model for Teen clinics, similar to those in Ontario and Quebec, was suggested. An advisory committee was struck, and various formats were explored. In 2008, serious planning began. Over the next two years, the clinic was developed – including developing guiding principles, lab and technical support, education for our team, partnering with Mental Health and Addictions and Urgent Care, and developing reporting and communication strategies. In April 2010, the Airdrie Teen/Young Adult Clinic opened its doors. It was very well and appropriately used and it continues to be an important resource for teens in the community.
What is most telling is that this service to teens, which was developed through community collaboration which included teens, all began with questioning – What service would you like to have which is not presently available in Airdrie? Is there a model anywhere in Canada that could be referred to as an example? How could all of the Airdrie agencies collaborate to make this a reality? The question is a very powerful tool – simply asking a question immediately alters our environment. In “Embrace Curiosity: 4 Ways Questioning Makes you a Better Leader” , Boss states that “curiosity builds adaptability. Questioning facilitates dialogue to explore new possibilities, to excavate biases and assumptions taken for granted, flip them on their ugly heads and find a new angle of perspective”. This is what the nursing students did when they started asking questions in our community. And by taking this further, the community started asking “what if…?”, and this effected change.
The development of Teen Clinic had a huge impact on me. I was able to participate in and see the results and benefits of community collaboration. It has helped me to be a stronger advocate for public health work in the community. Curious questioning, became a very important tool for me as I interacted with our teen clients. I brought to the clinic a strong knowledge base of what would be important in working with our clientele. I also brought with me a degree of anxiety, because, even though I had parented four children through to adulthood, I wasn’t familiar with the situations many of these teens would present. Curious questioning allowed me to acknowledge the gap between what I knew, and what I needed to know to truly meet the client where they were, and to be effective. With this curiosity and questioning comes humility, which is really the beginning of being non-judgmental and accepting (Boss). It is an indication to the client that we are not asking questions through a filter of assumptions, that we truly want to know where they are in their lives, and where they would like to be. It is really is a request to “help me understand how you came to this place, so that I can best understand how we can work together to best meet your needs".It is a statement that we may be wise in the ways of medicine, but we are not experts in the ways of their lives. It inspires trust and a willingness to be part of a therapeutic relationship, and builds rapport.
I left Teen clinic in 2012 to assume a public health management role. I came to this management role with a fair bit of anxiety. However, the lessons and the confidence that I learned through my Teen Clinic experience have stayed with me. To fill in the gaps between what I know and what I need to know to be effective really does begin with just one thing – a question.
The story of Lorraine, as highlighted in the CHNAlberta Newsflash (April 2017)...
I love science, biology and math, and I decided that getting a university degree in nursing was for me, even though in the 70’s many were rejecting nursing as a profession, because it was so feminized. But, I wanted to continue to learn about the human body and work and travel and heard that Canadian nurses “could work anywhere in the world!” It was in the fourth year nursing class on community and public health when all the questions I had in my first three years about “why are all these people getting ‘X’ illness?” were finally getting some answers. I wanted more, found a love for epidemiology, and enrolled in grad school within 3 months of starting work, I completed the Master of Nursing with a major in public health, one course at a time, an excellent way to put knowledge into practice. Being in nursing during the peak of the feminist movement was a highlight.
For me, nursing is having expert knowledge and efficient skill, engaging in advocacy, and especially leadership for system change. Nurses have experiential knowledge and are tapped in to patients’ expressed needs. I was serious about getting to the bottom of why people get sick. Not many nurses were asking that then, not too many others were either, disease surveillance was rare, computers were new. Having the prevention conversation back then was like pushing a rock uphill, more than it even seems to be today. From these roots I am no stranger to talking about things that are considered radical or controversial. I was talking about the determinants of health in the early 90’s and chaired the first committee in the Ontario Public Health Association on that topic.
Most of my career I have been involved in advocacy for upstream approaches, and ensured that professional leaders in nursing understood the facts of the social determinants of health. I got involved in nursing education and in the 90’s community nursing organizations ensured every curriculum for nurses in Canada includes knowledge of population health and health promotion. My nursing colleagues and now many other health and allied professionals have collectively stepped up to ensure that decision makers understand the strong evidence that investment in early childhood and access to social and economic resources demonstrates the proverbial “ounce of prevention worth a pound of cure.” Along with this support, I was at the top of that hill!
Being on the executive of the CHNAlberta and the CHNC allow for the continued expression of that commitment, and I’m grateful for the opportunity to work together to decide which rocks are best to push up that hill.
The story of Carla, as highlighted in the CHNAlberta Newsflash (March 2017)...
There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, “Morning, boys. How’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, “What the hell is water?” This story by David Foster Wallace represents my journey as a Registered Nurse. I was the naïve young fish (and in many ways, I still am). My nursing career did not start in Public Health. Like most new RNs, I started my career as an acute care nurse. I loved everything about it but it was not until I started working as a Public Health Nurse that I became aware of the water I was swimming in. Working as a Well Child and School Nurse, I worked with healthy individuals. However, the lack of a medical diagnosis took me out of my comfort zone and challenged the way I understood the definition of health. I developed a deeper understanding of the social determinants of health and the role I played in promoting population health. The focus of my role as an RN became about upstream thinking, prevention, and health promotion. I am passionate about public health nursing and decided that I wanted to give the nurse educator role a try. Ten years ago, I taught my first group of undergraduate nursing students what it meant to examine health through the lens of a public health nurse.
Today, my role as an RN has changed however I carry with me the values, principles, and ideologies foundational to Community Health Nursing as I work with future RNs. My hope is that as we explore together the discourse of health that they build the capacity to navigate the water that is nursing.
The story of Diana, as highlighted in the CHNAlberta Newsflash (February 2017)...
If you had asked me when I was completing my BScN whether I would ever work in community health the answer would have been NO WAY, I AM AN ACUTE CARE NURSE! It turns out that wasn’t true! I never would have thought that I would end up working in the area of community health for the majority of my career let alone become the President of the Community Health Nurses of Alberta.
My transition to the community from acute care began when I moved to the UK in 2003. I worked as a Practice Nurse in a very busy family practice clinic in north central London. I managed everything from walk in triage clinics for adults and pediatrics; childhood and travel immunizations; chronic disease clinics to assisting with minor surgical procedures. It was exciting, challenging, autonomous and everything that I thought community health nursing wouldn’t be. I built relationships with my patients that provided me the opportunity to be a part of their ongoing health journey; the highs and the lows. Practice Nurses were an integral part of the local community, something that was new to me and took some getting used to as patients would wave to me on the street, talk to me in the grocery store and at the post office. It was apparent that their contributions within the healthcare system were highly valued and promoted and it was very inspiring.
When I returned to Canada I continued to work in the community, working in well child clinics; school health and postpartum home visiting. I began teaching undergraduate nursing students and working on my Master of Nursing degree focusing on immigrant women experiencing domestic violence and the role of the public health nurse. Today I am fulltime faculty at the University of Calgary where I continue to promote the valuable role of community health nurses as I teach 2nd year undergraduate nursing student theory courses focusing on families in transition across the lifespan.
The story of Judy, as highlighted in the CHNAlberta Newsflash (June 2016)...
My recent retirement has led me to reflect on my 43 year nursing career. While my son was speaking at my retirement party, he noted that it was often difficult to separate my role as his mom and that of a nurse! In fact, I have always thought and acted like a community health nurse. During the early years of my career, while working in an acute care setting in medicine, surgery and then emergency, I was often frustrated that I didn't have time to interact with my patients and teach them how to care for their illnesses or to prevent them from coming back to the hospital. As I examined my beliefs, I realized that what I wanted to do was health promotion, disease and injury prevention. Actually, I couldn’t believe that this is what health care was all about but what I had been taught in my diploma nursing program was mostly about illness care! At that time, occupational health nursing encompassed all of these elements, so I went to school to get my certificate and started working in Occupational Health. It was an awesome time where I was able to do lots of teaching, work with people who had short and long term illnesses as well those who were injured at work or at home. I was able to empower them to recover and go back to work and their activities of daily living. But things change, and there was not as much opportunity to do the things I loved to do.
My newly acquired bachelor of nursing was put to use by assisting me to acquire a position in public health. It was a great place to utilize my skills while working in the inner city and starting an initiative to support daycare workers to enhance the health of preschoolers. When I worked as a consultant in public health, I was able to develop many client resources. Now, when I walk into the local public health centres I can see the fruits on my labours on the walls and the shelves, and being utilized with clients of all ages. It was during this time that I realized a dream of obtaing a master's degree in health promotion. I guess my intention of being a role model for lifetime learning worked, as both of my kids have master’s degrees as well.
More changes led to a position in infection control. Most infection control practitioners work in acute care centers but my focus was working with people in the community. I was able to bring my skills as a CHN to this role and assist hospital folks to think more about how the principles of infection control are implemented in the community and how work in the community helps to prevent long term hospital stays. My focus was on the fact that community health nurses and other community practitioners are part of the continuum of care. My last goal of getting a major resource posted to the Alberta Health Services website for use of community practiioners was realized just before I retired.
Involvement with the Community Health Nurses of Alberta for the last twelve years has given me the opportunity to meet, interact and learn from other CHNs.As I retire I am going to spend time with family, travel and do volunteer work in the area of community development. Once a community health nurse always a community health nurse!
The story of Genevieve, as higlighted in the CHNAlberta Newsflash (May 2016)...
I chose nursing as my career since I wanted to work with children and families. I had no idea about community health nursing until I was fortunate as a nursing student to join a CHN on a postpartum home visit to a low income family in a rundown apartment building. I thought: “Wow can nurses really do this?” I loved the family focus, the health teaching, the consideration of the determinants of health (we did not label them this then), and the independence.
I have since this time been an advocate for children and families and have experienced community health nursing over the last 30 years in various areas such as generalist community health nurse, school nurse, family planning nurse, postpartum community health nurse, nursing manager and most recently as a associate professor working with nursing students. I am also a founding member of CHNAlberta and on the executive national board for Community Health Nurses of Canada. I have recently been involved in a project that has developed leadership competencies for public health because as you know those of us who work in the community are different and require different leadership skills to work with individuals, families, populations and systems.
I am passionate about community health nursing. Where else can you get a first hand glimpse of the factors influencing a family and their health and wellness then when you enter their front door? I have been privileged to work with families during times of vulnerability and transition and had the luxury to build tremendous connections with parents and their children. I have been activist in keeping community health nursing education in undergraduate nursing curriculum so that nursing students will also have the opportunity to see bigger picture factors that influences health before their patients are discharged from acute care facilities. I also hope some of them become interested in this type of nursing. As I tell them: “Why would you want to practice anywhere else?!”
The story of Carolyn, as highlighted in the CHNAlberta Newsflash (April 2016)...
I must confess I love my chosen discipline. My role in Public Health is a communicable disease nurse (CDN). Our responsibility is to protect the health of the population, suppress disease in those already infected, break the chain of transmission and remove the source of transmission. We investigate those with a confirmed, probable or suspected communicable disease and their contacts who may be at risk. As a nurse investigator we engage in the nurse-client therapeutic relationship through various methods of communication, that is face to face or over the telephone. As a registered nurse, our education and training focused on face to face client/patient assessments collecting objective and subjective information using our eyes, touch, non-verbal cues. The majority of communicable disease follow-up is done over the phone which relies on a different set of assessments skills such as active listening. Investigations of notifiable diseases for many clients may be perceived as an invasion of privacy, as they are the focus of reporting, transmission and preventing the spread of disease to the population. An experienced CDN has developed the art of nursing so the client feels they are the focus of the investigation, while simultaneously ensuring that all vulnerable contacts are protected. The experienced CDN has developed a learned skill, listening to the clients/patients responses or pauses or the unsaid.
The story of Deborah, as highlighted in the CHNAlberta Newsflash (March 2016)...
Deborah works as a Public Health Nurse and feels fortunate to work in three different programs. Deborah shares for us some of the special and unique aspects of each program: Safeworks, Antenatal Community Care Program, and Best Beginning Program. Occasionally Deborah will see the same clients in all three programs, which she explains, provides for wonderful continuity.
A knock on the window at the stop sign signalled the beginning a busy evening working in the Van. The Van is one of the support services provided by Safeworks in the Harm Reduction Program in Calgary. The program provides STI testing and treatment, clean equipment for drug users, counselling, nonjudgmental listening, plus much more, all in different locations in the city. Lately, the dedicated staff in this program have been working even harder to provide overdose training and Nalaxone kits to agency staff, clients, and family and friends of individuals at risk for Fentanyl overdoses. For more information on Fentanyl overdoses and the Nalaxone program click here and here.
Antenatal Community Care Program
A program that is for pregnant women that are high risk medically. They are referred by their physician with the goal to decrease hospital admissions. These women are monitored in their homes by a Registered Nurse.
A program for low income pregnant women. The program provides education, referrals, food at groups, various supports and access to a team of Registered Nurses, Registered Social Workers and Registered Dieticians.
The story of Laurel, as highlighed in the CHNAlberta Newsflash (February 2016)...
Laurel has been a community health nurse for Alberta Health Services for the past 27 years. Laurel is considered a leader on the Well Child team at her community health centre where she currently works. Throughout her career, Laurel has worked in many capacities. She has taken on the role of student preceptor, liaison, and team leader, and has continually built excitement about public health.
She is the ethics representative for her team and has been on the AHS ethics committee for several years. Laurel considers public health ethics to be new and exciting. She considers herself to be part of the future, paving the way in public health ethics. Laurel can often be found over lunch hours, initiating ethical dilemma conversations with her peers.
Laurel is passionate about community engagement projects. Recognizing a need, Laurel led her team in 2010, by initiating a diaper drive at her health centre, which has evolved to the collection over 40,000 donated diapers per year that are distributed to community agencies serving populations in need of diapers. Laurel is an example of a passionate community health nurse, who is making a difference in her community.
The story of Dawn, as highlighed in the CHNAlberta Newsflash (January 2016)...
I have been a Registered Nurse for almost 25 years! I found my calling 10 years ago when I began working as a Public Health Nurse. Three years ago, I returned to BN Education, with a clinical focus on Community Health Nursing. It has been amazing! I get to view our specialty through the excitement and enthusiasm of students and the expertise of highly skilled CHNs. The CHN skill set combines so many of the core courses/preparation in Nursing programs:
Therapeutic communication with sleep-deprived, new parents during well child appointments, or with family members preparing for the death of a loved one in palliative home care.
Psychomotor skills around safely administering multiple vaccines to a wiggly toddler, or steady hands for wound management and complex dressing changes in clients’ homes.
Research – where and how to search for credible, peer reviewed best practice information to answer questions around child development, or preparing for a home health visit with a client and family with a rare medical condition.
Pathophysiology and Pharmacology with polypharmacy and chronic illness in seniors’ home heath or ensuring informed consent around vaccines with skeptical parents
Adult and Child Health Nursing – home health and home visiting though the lifespan
Family, Community Health and Teaching and Learning brings an overwhelming number of examples to mind.
I salute CHN colleagues for the invaluable contributions to the future of Community Health Nursing in Alberta! You are recognized and appreciated by everyone in nursing education, especially the students and the Albertans who will benefit from their care in the years ahead.
The story of Andrea, as highlighted in CHNAlberta Newsflash (December 2015)...
Andrea is one of a special group of nurse leaders at her community health centre who work together to lead a ‘Learning, Doing and Giving’ steering committee. With much energy and creativity, the group organizes experiences like wellness-focused and facilitated team movie nights, bringing guest speakers to team meetings, serving breakfast to the homeless, donating blood, stuffing socks for the homeless, and making loaves of sandwiches for the working poor. The ideas arrive from all corners of the office, all colleagues are invited, and participation is optional. Supporting client-driven community initiatives, building ideas from colleagues who always wanted to try something but didn’t know exactly how to start, and bringing community members to share their wisdom, are just a few of the reasons why this group does what they do! These leaders volunteer for and attend most of these opportunities on their own time, away from work, but, with a friendly face and a kind colleague who also wants to know what it feels like to serve breakfast to the homeless, or how to get out to donate blood for the first time. For Andrea and the leaders she works with, the season for giving looks to be not just during the holidays, but all seasons of the year.
The story of Ashley, as highlighted in CHNAlberta Newsflash (November 2015)...
Ashley always knew she wanted to work in community health nursing and feels incredibly lucky to be working in the field of chronic disease management, which she feels is her true calling. Working for the primary care network, Ashley provides support and education to clients regarding management of their chronic diseases. The unique part about the clinic Ashley works in is that she works very closely with other nursing leaders and other health disciplines and as a team they are able to collaborate with the clients to develop their care plan. This is a very rewarding nursing leadership role as she empowers clients to take charge of their health and helps them make lifestyle changes that improve their health and well-being. Ashley’s leadership role is highlighted by having her Community Health Nurses Certification, her active role as a preceptor for nursing students and encouraging first year nursing students shadow her nursing practice. Ashley is honoured to work and collaborate with nursing leaders and other health disciplines to educate and support clients to lead a healthy lifestyle.
The story of Rosemary, as highlighted in CHNAlberta Newsflash (October 2015)...
Rosemary is proud to say that she is having the time of her life in her role as Nursing Practice Specialist in Home Care. Her community health nursing practice leadership role is challenging yet rewarding. She is most proud of her relationship with nursing staff and the clients they serve. She has a passion for problem solving complex clinical situations and enjoys doing joint home care visits. Mentoring and coaching are the most rewarding part of her job.
Rosemary enjoys leading a Continuing Care Ethics Committee, and Medication Safety reading group, and leads nursing education forums, the most recent included a focus on clinical questions, and panel discussion. The topic at hand related to case management and frequency of home visits, processes required when seeking advice about appropriateness of non-formulary medication administration and updates from the President-elect of the Canadian Nurses Association, and, Chair of the Calgary Nursing Council.
In addition to her leadership role, Rosemary is a consultant, expert practitioner, educator and researcher. Last month she presented the Home Care Continence and Bowel Management Practice Guideline navigational tools at a national Urological Nursing conference.She has led the development of five governance documents related to catheter care which should be released later this year. Rosemary is thrilled to work with nurses who have become enthusiastic about reading this literature.
The story of Collette, as highlighted in CHNAlberta Newsflash (September 2015)...
Collette is inspired in her practice by the nursing leadership she witnesses on a daily basis in her work. The rural health centre she works at provides public health and home care services. Excellent care is provided to clients through a unique balance of community health nursing, teamwork, support, and nursing leadership. It was this group of supportive mentors that helped Collette achieve her goal in becoming a Certified Community Health Nurse last April. Collette admitted having limited expertise in home care, and her peer nurses were open to her questions as she studied for the Canadian Nurses Association exam. Giving up their own time on a Friday night, reviewing the material with her, and providing Collette with their unique perspective enriched her learning. Collette acknowledges that she is a nursing leader through achieving her certification. And, she is inspired to be a better nurse by the leadership she sees in her colleagues. Collette feels privileged to work with a group of intelligent, passionate nursing leaders who make a difference not only with their clients but with each other as well, and sends her thanks to them!
What is Community Health Nursing Practice?
What are the Community Health Nursing Standards of Practice?
What are the Public Health Nursing Competencies?
Where do Public Health Community Health Nurses Practice?
What are the Home Health Nursing Competencies?
New Canadian Community Health Nursing Professional Practice Model
Blueprint for Action for Community Health Nursing in Canada
CHN Standards, Competencies & Certification
Community Health Nursing in Alberta, Canada
For more information on CHN Practice in Alberta (Public Health, Home Health, Community Health Nursing), please email firstname.lastname@example.org.
For more information on CHN Practice in Canada including the CHN Standards, Competencies and Certification, please visit www.chnc.ca
|CHN Standards Competencies Activities Feb 2011.pdf||1.04 MB|
|CHN Standards Competencies Presentation Feb 2011.pdf||682.27 KB|
|CHN Standards of Practice One Page summary FINALeng.pdf||104.24 KB|
|Certification Report to Members 2013.pdf||216.43 KB|