Sir, - I read with interest your article, "Holles Street can't keep up with the baby boom" (August 4th), detailing shortages of midwives at the National Maternity Hospital, Holles Street. However, there appears to be little knowledge in the huge deficit of staff and in particular public health nurses in the community setting. Shortages of public health nurses are more acute on the east coast of the country.
Public health nurses are qualified midwives who use this qualification in dealing with new mothers and their babies on a daily basis. The early discharge from maternity hospitals of young, first-time, often single mothers, many of them refugees, has a huge impact on the workload of the public health nurse. Her work with mothers and families does not end a couple of days after childbirth, but continues for a number of years.
Public health nurses are qualified in both general nursing and midwifery and also hold a qualification in public health nursing. However, many public health nurses hold other nursing qualifications also and are highly skilled. They work in a geographical area and their clients include all age brackets and their work involves clinical issues, e.g., wound management, school health (vision and hearing assessments), age well clinics, breast-feeding support groups, various child welfare clinics, BCG clinics, elderly assessment, etc., etc.
Because of the huge shortage of public health nurses much of their health promotional work and support services have become casualties. As independent practitioners shortage of staff is felt by their colleagues who have to take on onerous work loads.
Clients are not receiving the service that public health nurses would like to provide and this is extremely frustrating and stressful for the nurses. No increase in public health nursing numbers occurred when acute hospitals' strategy changed to early discharge. Maternity hospitals are now discharging mothers and their newborn babies into the community very soon after their confinement. There is an urgent need to strengthen the community support services and in particular to address the significant shortage of public health nurses. - Yours, etc.,
Margaret Kyne Doyle, MSc BSc (Hons), PHN RGN RM RSCN, Development Officer, Institute of Community Health Nursing, Royal City of Dublin Hospital, Upper Baggot Street, Dublin 4.