Nursing borders: Looking through the fence

Introduction: Although non-acute nursing roles and work settings have a long and rich history, there may be little understanding or knowledge within the profession of these roles. This pattern emerged during a two year period (four terms 2006-7) of an RN to BS Community Health course where 105 RNs were engaged in a student driven online dialog about their knowledge, understanding and observations of public/community health nursing. Objective: To qualitatively explore discussion themes and derive meaning about RN understanding of P/CHN role after a community health clinical term. Methods: RN students explored their experiences within the online threaded discussions culminating in shared “Ah Hah” experiences in the last week. The dialog was copied from the online course, student names were replaced with numbered identification and comments were explored for themes related to perceptions, understanding, knowledge, and perceptual changes of the student related to the P/CHN role. Validity of coding and themes was obtained with an external faculty member and coding was adjusted until agreement was determined. Basic demographic statistics were collected. QSR Nudist was used for qualitative analysis. Results: Students were primarily female, graduates of ADN programs, and acute care nurses immediately post-ADN as well as those with up to 30 years of practice. An overarching theme indicated surprise about the autonomy, resourcefulness, level of nursing knowledge, and multi-role function of the P/CHN. For those nurses continuing with acute care practice during and post-degree, the discussion included the need for better links to the community to improve patient care with discharge. Conclusions: Nursing professionals looking through the fence with poor awareness of the P/CHN role creates serious issues in the health care community. The P/CHN community is facing the same nursing shortage as the rest of the profession, but may have difficulty attracting qualified nurses. Poor understanding of the community resources and the P/CHN role on the part of acute care RNs may affect continuity of care. This presentation will discuss the findings from this study and explore reasons for the boundaries found in professional understanding of nursing practice roles.