Staff shortages, turnover hinder health promotion

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.