Valerie Noble Myrie | COVID-19 and the public health nurse
When the International Council of Nursing (ICN), the International Confederation of Midwives, Nursing Now and the United Nations Population Fund jointly partnered with the World Health Organization in a yearlong effort to celebrate the work and worth of nurses and midwives, COVID-19 was not on the horizon. The celebrations were intended to highlight the challenging conditions that they face and advocate for increased investments in the nursing and midwifery workforce.
Public health nurses care for entire populations; not one patient at a time. By working with whole communities, they can educate people about health issues, improve community health and safety, and improve access to care. These are the nurses that can be found in community settings who wear khaki coloured uniforms. Yes, the same ones who immunise your children and who will visit your homes during instances of disease outbreaks or to give follow-up care. You will also see her at our ports of entry as she plays her role in disease surveillance to ensure that our country is safe.
The Jamaican public health nurse is a qualified registered nurse and a registered midwife who, having furthered her studies, achieved a degree in public health nursing. This well-rounded individual has acquired the knowledge, skill and experience to face any and every emergency. COVID-19 then could have presented a challenge because of its novelty, but the public health nurse’s training prepares her to manage any health emergency. COVID-19 was the occasion to bring light to the potential of the public health nurse. They are in the front line in the fight against this pandemic, which is considered an emerging, rapidly evolving situation.
CENTRAL TO HEALTHCARE DELIVERY
ICN anticipated that 2020 would be a momentous year for the nursing profession, a year where nurses would finally be recognised for the good work that they do. Confronting the coronavirus and managing it brings home the fact in no uncertain manner that nurses are central to the delivery of healthcare, and that nurses are making an invaluable contribution to the health of people globally. The courageous work of nurses and other healthcare workers in the face of the coronavirus does honour the Year of the Nurse and the Midwife 2020 and the 200th anniversary of Florence Nightingale’s birth.
COVID-19 has had a negative social effect on nurses. Despite being in the front line offering care to those persons who became infected by COVID-19, members of the public stigmatised and discriminated against nurses. This seemed nonsensical as nurses were the very persons they were likely to encounter when they sought to access care if they became infected or affected by COVID-19. Nurses are the ones with direct and extended contact with those who are ill. Nurses are trained to preserve life and to care. It is not at all surprising that despite the possible repercussions, the nurse would still report to work daily to ensure that patients are attended to.
The work of the public health nurse takes her out into communities as she physically searches for those who are sick as well as those who have been exposed and could become ill. Their expertise, advice, and direct contact with grassroots nursing is an essential part of successfully managing epidemics such as this one. I reflect on an interview done by JIS with Senior Public Health Nurse Vassel-Shettlewood (May 2020), who was on vacation leave when the first case of COVID-19 was diagnosed in Jamaica and she was called out to lead her team. She spoke of having to self-isolate, of utilising WhatsApp, FaceTime and whatever other means was available to communicate with family members as she put measures in place to reduce the risk to her family.
During COVID-19, the general trend changed. The new norm is that public health nurses now work seven days per week with each workday lasting 12 hours or more. They must leave family members to perform devotedly their duty of treating patients. They must seek and find their patients and their contacts, and then there is the matter of follow-up care to ensure patient safety and to prevent spread. Unlike other categories of nurses, the public health nurse has a duty to go out and find her patients and not wait for them to come to her. The fact that they are in the forefront in the fight against COVID-19 does not exempt them from their routine tasks of managing primary healthcare services, school health programmes, disease investigations and epidemiological surveillance.
In the history of Jamaica’s healthcare, it is an established fact that public health nurses have rallied to address the healthcare needs of the populace in the past. They are credited with the role played in the eradication of polio and measles through immunisation and have placed Jamaica in an enviable position because of its current high immunisation coverage. Based on these achievements and the work that public health nurses do, this pandemic has brought to the fore the need to retain this category of staff and to bring young, graduates into this speciality.
The current shortage of public health nurses in Jamaica’s public health system is multifaceted. Nurse-midwives who have achieved the entry requirement for training no longer consider this speciality lucrative, as the current remuneration as well as the level assigned post-graduation is not commensurate with tuition costs and time spent in training. The School of Public Health in Kingston, Jamaica, has the capacity to train 30-35 students per year in a two-year programme. Currently, there is less than 50 per cent of this number in the programme.
I appeal to the authorities to correct the reclassification issue and reinstate this category to their rightful place. Jamaica needs public health nurses; do not allow them to become extinct. In this the Year of the Nurse, invest in the training, remuneration and retention of the public health nurse. Make public health nursing an attractive speciality again.
- Valerie Noble Myrie is nurse educator at The University of West Indies School of Nursing, Western Jamaica campus. This is one among a series of articles recognising 2020 Year of the Nurse and Midwife.