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 longterm care
 Health Care System shift:
 from hospital to community
 to 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?
Need curricula to respond to
changing paradigms for nursing
practice and community health care
Support practicing CHNs to
respond to paradigms shifts by
providing targeted educational
opportunities
Methods
Analysis of CHN demographic attributes was conducted
using the 2007 CIHI Secondary database
A survey polled 13,775 nurses from all community sub
sectors and yielded 7839 responses (57% response rate)
23 focus groups of public health professionals were held in
6 geographic regions in Canada using Appreciative Inquiry
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
Positive Nurse/Nurse Relationship
Positive Nurse/Other Professionals
Relationship
96
92
93
88
87
83
Survey results: Potential Barriers
Selected statements/factors
Positive Physician/ Nurse Relationship
Organization uses community-based
approach to address social health
determinants
CHNs have time/money/access to learning
resources
Agreed or
strongly
agreed
(%)
RN LPN
68
70
47
42
45
45
Focus Group Results: Organizational
attributes that support PHN practice
Conclusions
 CHNs~ 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 health
 Primary health care
 Health Promotion
 Disease Prevention
 Emergency preparedness
 Other
Implications:
Continuing Education
 Improve access to evidence and
continuing education
 Teach practitioners about
knowledge translation and
exchange
 Update knowledge, e.g. social
determinants of health
Implications:
Management Development
Effective human resource
planning
Coordination and planning
Creating an ongoing learning
culture
Creating a supportive work
environment
Facilitating autonomous practice
Implications:
Leadership Education
 Public health leadership
 Visionary and responsive to
community needs
 Champions for Public Health
Conclusions
 The 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 Programs
could partner with:
Employers, health organizations and
governments
The Goals of the Partnership:
Ensure undergraduate
curricula are relevant
to community health
nursing practice
Improve access to
evidence and
continuing education
Make funding for
community and public
health leadership and
management
development available
Decision Makers
Researchers
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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)
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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)
Funders
 Canadian Health Services Research Foundation
 Health Canada
 Public Health Agency for Canada
 Health Human Resources Strategy Division
 Office of Nursing Policy
 Health Canada First Nations & Inuit Health
Branch
 British Columbia Ministry of Health
 Nursing Directorate
 Communicable Diseases & Addictions Prevention
Branch
 McMaster Nursing Health Services Research Unit
 Vancouver Coastal Health Authority
Contact
Jane Underwood BScN, MBA
Consultant/ Co-Investigator,
Nursing Health Services Research Unit
Phone: (905) 525-9140 x 22380
Email:undrwood@mcmaster.ca