Accepting the Challenges of Paradigm Shifts in Community

and Public Health Nursing Canadian Association of Schools of Nursing May,

2009 J. Underwood, D. Meagher-Stewart, M. MacDonald, L.L. Stamler,

B. Schoenfeld, K. Knibbs

Background

Adequate community health capacity can mitigate pressures on acute care and long-term care

Health Care System shift: from hospital to communityto health promotion, disease prevention

Purpose of our research

To examine: Existing community health

nursing (CHN) workforce capacity, including public health nursing

Strategies for optimizing utilization of CHN workforce

What does this mean for Schools of Nursing?

Methods

Demographic Profile In 2007, 16% (53,404) 327,670 nurses in Canada were CHNs

(46,273 RNs; 7,131 LPNs)

CHN workforce older

LPNs: ~9.5% >60 years old (compared to 7% of all LPNs)

RN: ~28% >55 years old (compared to 22% of all RNs)

Fewer younger CHNs RNs: ~ 5% <30 years

(compared to 10% of all RNs)

•

Survey results: Enablers

Selected statements/factors

Agreed or strongly agreed

(%)

RN LPN

CHNs feel professional confidence 96 93Positive Nurse/Nurse Relationship 92 88Positive Nurse/Other Professionals Relationship

87 83

Survey results: Potential Barriers

Selected statements/factors

Agreed or strongly agreed

(%)RN LPN

Positive Physician/ Nurse Relationship 68 70

Organization uses community-based approach to address social health determinants

47 42

CHNs have time/money/access to learning resources

45 45

Focus Group Results: Organizational attributes that support PHN practice

ConclusionsCHNs~ 16 per cent of the nursing workforce. CHNs thrive in workplaces that collaboratively share

vision/goals and support creative, autonomous practice.CHNs work well together, but need time, flexible funding

and management support to develop relationships with community/clients, and other professionals.

Employers and managers should encourage CHNs to keep up-to-date, provide more access to continuing education, policies, evidence and debriefing sessions, (assure competency & professional confidence)

Why is this important for Schools of Nursing?Educational institutions who offer basic and

continuing nursing education will: Provide relevant education to student nurses Facilitate educators staying up-to-date Have new funding opportunities consistent with

focus on sustainability and entrepreneurial approaches within some universities

Implications:undergraduate education

Continue to build confidence in nursing abilities relative to community health nursing practice

Continue to work on team relationship skills

Implications:Undergraduate curricula

Preparing for system shift includes:Determinants of healthPrimary health careHealth PromotionDisease PreventionEmergency preparednessOther

Implications:Continuing EducationImprove access to evidence and

continuing educationTeach practitioners about

knowledge translation and exchange

Update knowledge, e.g. social determinants of health

Implications:Management Development

Effective human resource planning Coordination and planningCreating an ongoing learning culture

Creating a supportive work environment

Facilitating autonomous practice

Implications: Leadership EducationPublic health leadership

Visionary and responsive to community needs

Champions for Public Health

ConclusionsThe comprehensive national research

program of study about community health nursing (CHN) produced results relevant to Nursing Educators

Nursing Education Programs have opportunities to be creative and innovative

Opportunity

Schools of Nursing Masters of Public Health Programscould partner with:Employers, health organizations and governments

The Goals of the Partnership:

Researchers Jane Underwood (McMaster University) PI,

co-lead Dr. Andrea Baumann (McMaster University) Dr. Donna Ciliska (McMaster University) Dr. Donna Meagher-Stewart (Dalhousie

University) Dr. Raisa Deber (University of Toronto) Mary MacDonald (University of

Saskatchewan) Anne Ehrlich (McMaster University) Bonnie Schoenfeld (University of

Saskatchewan) Dr. Melanie Lavoie-Tremblay (McGill

University) Dr. Jennifer Blythe (McMaster University) Dr. Audrey LaPorte (University of Toronto) Val Munroe (Vancouver Coastal Health) Kristin Knibbs (University of Saskatchewan)

Dr. David Mowat (Peel Public Health), co- lead Dr. David Butler-Jones (Public Health Agency of Canada ) Sandra McDonald Rencz (Office of Nursing Policy, Health

Canada) Barbara Oke ( First Nations and Inuit Health Branch ) Valerie St. John ( British Columbia Ministry of Health

Services) Dr. Susan Matthews ( Niagara Health System) Carla Troy (Public Health Agency of Canada) Lynn Jobin (Quebec Direction générale de la santé publique) Lynnette Leeseberg Stamler (Canadian Ass’n Schools of

Nursing) Rosemarie Goodyear (Community Health Nurses Association

of Canada/ Central Health Region, NFLD) Dr. John Blatherwick ( retired, Vancouver Coastal Health) Dr. Cory Neudorf (Saskatoon Health Region) Paul Fisher (Canadian Council for Practical Nurse

Regulators) Dr. Ron Wall (Public Health Agency of Canada)

Decision Makers

Funders Canadian Health Services Research Foundation Health Canada

Public Health Agency for Canada Health Human Resources Strategy DivisionOffice of Nursing Policy Health Canada First Nations & Inuit Health Branch

British Columbia Ministry of Health Nursing DirectorateCommunicable Diseases & Addictions Prevention

Branch McMaster Nursing Health Services Research Unit

Vancouver Coastal Health Authority

Contact

Jane Underwood BScN, MBAConsultant/ Co-Investigator,

Nursing Health Services Research UnitPhone: (905) 525-9140 x 22380

Email:undrwood@mcmaster.ca