October 1, 2004
Staff shortages, turnover hinder health promotion
"We need someone
to develop short, simple programs for the schools"
JANE GEORGE
High turnover and too much work means there is no time for the kind of health
prevention or promotion activities that could keep Nunavummiut healthier and
ease the burden on health care workers.
That's the clear message from a report prepared for Nunavut's department of
health and social services, called Nursing Perspectives on Public Health Programming.
The report concludes Nunavut needs more nurses, public health nurses, nutritionists
and community heath representatives along with more training, education, support
and coordination and a territorial resource centre on public health.
"Both regional and territorial support for public health programs is underdeveloped
in Nunavut," says the report, prepared late last year, but released only
recently.
The report's authors, who include Dr. Ann Roberts, Nunavut's former director
of public health, went straight to the territory's nurses to learn what Nunavut
needs to improve the overall health of its residents.
Prevention programming is sidelined "at every turn," says the report,
due to other demands on nurses.
Poor nutrition, high smoking rates, sexually transmitted diseases, and mental
and emotional health needs are among the most pressing public health concerns
for adult women, while for men, these also include substance abuse, poor anger
management and nutrition.
But in Iqaluit, more nurses and health care staff are needed before there can
be a "well adult" clinic. Due to the same under-staffing, the report
also says women in Iqaluit don't get prenatal care "as early or often"
as in other communities.
High staff turnover is the major barrier to improving public health, particularly
in small communities.
Half the health centres lack a stable staff and most nurses stay in Nunavut
for less than four years.
Most nurses have public health experience, but say they can't use it because
they're too busy: they don't even have the time for telehealth or to do online
research.
Despite their concerns about pregnant women travelling out weeks before their
due date for deliveries, nurses are even worried about having women give birth
in the communities because of the additional strain on the staff, lack of equipment
and blood for transfusions as well as the distance to specialized medical care
units.
Moreover, about 10 communities in Nunavut don't have community health representatives
to assist with health prevention or promotion.
Either due to a lack of direction or encouragement, many communities don't
take advantage of programs such as Brighter Futures, Canada's prenatal nutrition
program or the aboriginal Headstart program.
Nurses say they want more CHRs and more support for CHRs so they can promote
public health in the communities.
"A functioning CHR who is trained and enthusiastic would take a lot of
the public health burden off the nurses and would really benefit the community,"
the report quotes one nurse as saying.
Not having a CHR is also considered the main reason for some communities' low
involvement in public health programs, particularly for school-aged children.
On the positive side, nurses say infant and child health programs do well,
most in-school programs are adequate and nearly all children have up-to-date
immunizations.
But nurses are still worried about the health of school-aged children, their
nutrition, poor dental health, high smoking rates, STDs and teenage pregnancy.
Screening for eye and ear problems is often neglected because there's not enough
time.
The nurses want more staff and more resources, information and personal development
for themselves and for CHRs.
"We need someone to develop simple, short programs to teach in all the
schools. This would save a lot of time and improve the program across the territory it would prevent reinventing the wheel," says a nurse quoted in the report.
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