Public health nurses are seen and heard

November 26, 2004

Public health nurses are seen and heard

Rare NS study explores their work  

by Catherine Young

	Dr. Donna Meagher-Stewart

According to a recent Dalhousie study, the typical public health nurse is an "initiator, organizer, collaborator, enabler, facilitator, educator, advocator and champion."  Public health nurses work in school health, youth and teen health centres, family health, and in communicable disease control, among other areas.

Their service is cost-free and often, they are associated with an official government department. But according to "The Public Health Nurses' Voices Project," they are also "increasingly invisible."

Dalhousie researchers Drs. Donna Meagher-Stewart and Megan Aston, both professors at the Dalhousie School of Nursing, and a team of co-investigators, conducted the study. $95,000 of funding from the Nova Scotia Health Research Foundation supported the work.

Meagher-Stewart says that "there's a paucity of research" on the professionals who are, for many people, the first link to the health care system. In personal interviews, they surveyed seven public health management representatives; three from the provincial Department of Health and four from the province's nine District Health Authorities.

They also conducted 44 individual interviews and focus group interviews with 32 nurses with public health nurses across Nova Scotia. All of these sessions explored the work of the public health nurse in this province and ways to make their work more effective.   

What Meagher-Stewart, Aston, and their co-investigators found is not surprising, but it is illuminating. As she says, "The public health nurses are doing amazing work in working collaboratively to promote accessibility and citizen participation in decisions and activities that promote citizen's health, especially with vulnerable populations. Another conclusion we found is the resiliency of the public health nurse and public health management working in the midst of significant constraining factors."

One of these "constraining factors" is funding. According to Meagher-Stewart, insufficient financial support of the public health system is a sad reality. There are also structural problems. In 2001, the health care system in Nova Scotia was reconfigured into nine District Health Authorities. This, said Meagher-Stewart, had the positive effect of focusing resources locally. But it had one major drawback.

"Nova Scotia is basically rural with a small population base. When you start splitting it up into nine health authorities, that splinters your ability to have an effect on the larger community. In some districts, Public Health Services' Directors report to three CEOs, three VPs of Public Health, three chairs of three boards and three boards. For public health, this system hasn't been very positive."

She also says that public health is always the "poor cousin" in the health care system.
"Everyone's fighting for dollars," she says. "What always wins is waiting times and hospital beds. When you have to have bypass surgery or someone's had a heart attack, you're not thinking about disease prevention. Public health is based on long-term goals, not short-term results."

 "One of our basic recommendations is how to enhance opportunities for building community capacity for health. We need creative ways to build partnerships among universities, the public health system, nursing and other health professions and policy makers."

Partnership building has already begun. On Oct. 29, a Knowledge Sharing Forum was held at Dalhousie to release the study's findings and discuss them. Local and national speakers provided an environmental scan of issues facing the public health field in Canada. Nurses, public health management, researchers, educators, and policy makers attended the all-day session.
Meagher-Stewart says she hopes that the Public Health Nurses' Voices study has some effect on health care policy. "It's a process of gathering very convincing evidence and hoping someone will listen to it."

A few recent developments make her feel that public health nurses' voices may be heard more in the future. The federal government recently set up a national Public Health Agency and is transferring more health care dollars to the provinces. Additionally, the Nova Scotia Department of Health also hired a consultant to review the province's public health system.
Meagher-Stewart says that it is time for  the public health system to receive some attention, especially in this region.   

"You can't ignore the realities in the Atlantic Region. We have significant  cardiovascular and cancer disease rates In Nova Scotia. Public health nurses are on the frontlines in the battle to bring those numbers down. I just hope the resiliency of the public health system , including public health nurses, other staff, and management, can continue."

For further information on the study, contact: Donna.Meagher-Stewart@dal.ca.