The president of the Institute of Community Health Nursing tells Fiona Tyrrell the level of nurses does not reflect the populationincrease
The number of public health nurses in Ireland needs to be doubled to cater for population growth, the change in ill-health patterns and the greater reliance on community-based healthcare, according to president of the Institute of Community Health Nursing (ICHN) Breda Cleary.
Speaking in advance of the institute's annual conference and annual general meeting next Saturday, Cleary said that there has been "no resource shift" to match the growing emphasis on community-based healthcare.
Public health nurses in the Republic are employed by the Health Service Executive (HSE) areas to provide healthcare services in the community and are assigned to cover specific geographical areas.
There are around 2,100 public health nurses registered but the ICHN estimates that only 1,200 are practising. Approximately 500 of these are members of the ICHN, the professional and educational body representing public health nursing throughout the State.
Guidelines for nurses devised in 1966 recommending one public health nurse to a population of 4,000 have not been updated, despite a recommendation from the Commission on Nursing in 1988 to amend that figure to one in 2,500 in the light of changes in health patterns.
The ICHN points out that some of its members are working in areas with populations of up to 6,000.
Since public health nurses were introduced in the 1960s, Ireland has significantly changed in terms of demographics and patterns of ill health, according to Cleary. Although population and the workload in the community has significantly increased resources have not, according to the ICHN.
"More and more healthcare is being provided in the community but there is no matching of resources. Community and primary health services are often overstretched and resources do not match expectation of these services," she says.
In particular, the fact that hospitals are discharging people early or not taking them at all is putting significant pressure on community health providers, she says. This lack of provision has a "high cost" according to Cleary.
Public health nurses are supposed to concentrate on prevention and health promotion. However, lack of resources and changes in health policy mean that increasingly, they have to focus just on ill-health, she says.
Community health services need extra resources to meet the growing need, according to Cleary who adds that community nursing is significantly less expensive than acute hospital nursing.
Public health nurses are highly skilled autonomous nurse practitioners, who are qualified as general nurses and midwives and hold postgraduate diplomas in Public Health Nursing, according to Cleary.
Trained to assess the health needs of the community that they work in, they are therefore are ideally placed to articulate the nursing needs and nursing personnel required to meet those needs, she says. For this reason, the public health nurse is the ideal person to lead primary care teams proposed under the Primary Care Strategy, she adds.
The sphere of work of the public health nurse covers all stages of the life cycle, pre-cradle to the grave. Their work includes maternal and child health, care of the well through health promotion and education and assessment, management and provision of nursing for long-term illnesses, terminal care work.
Public health nurses also work with carers and facilitate discharge from hospital. Their care of the elderly has special focus on keeping them healthy and in their own homes.
The role of the public health nurse also covers specialist areas such as child protection, work with the travelling community, immunisation, nursing homes inspection, elder abuse and neglect, nurse led intervention clinics, work with children with special needs, asylum seekers and refugees.
"My hopes for the next 20 years is that the provision of primary and community health care in Ireland would be the best in the world and that some of today's problems, such as the high rate of suicide among young men and obesity, will only be found in the history books," says Cleary.
The ICHN's conference and annual general meeting will be held on Saturday at the Heritage Hotel in Portlaoise.