Community Health Nursing Practice- Sharing Your Stories
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|