What defines the nursing profession? Bedside care, assisting in operating rooms, delivery of vaccines in a clinic, or providing health care at schools or at homes? Nurses are capable of delivering excellent care in various settings around the world, but is the breadth of delivery of that care what defines the scope of practice in the nursing profession?
Outside the clinical setting, nurses can positively impact a community and populations in that community by providing excellent care in unique ways. With advances in science and information technology, the nursing profession is inundated with ever-increasing evidence-based guidelines as well as research evidence. Some of these advances can be put into practice by various agencies to improve local community services and health, such as using cellphone applications or text messaging for health monitoring and information sharing.
As such, nurses can be valuable assets through collaboration with various types of agencies to address social and environmental health issues in a community. These issues, called social determinants of health, are conditions in which people live, work and play. Recognizing the social, political and economic agendas that create these conditions can result in nursing work that takes a more “upstream” approach to seeking solutions that mitigate ongoing disparities.
Nonprofit organizations and social service agencies offer a wide variety of services to people such as English language learning, education, housing assistance, job training and food and nutrition services through a combination of paid and volunteer staff with varying experience levels. Each agency can have very diverse staffing needs and workloads that a nurse can potentially contribute to as a volunteer. A collaborative relationship between the nurse and agency can be an effective way to determine needs that the agency may have.
Assessing the programs or work processes offered by an agency or organization for best practice methods can improve these systems and positively affect the populations they serve. Evidence-based practice models, even those not directly related to “health care,” could have applications in nonclinical settings in a community. Nurses can serve as liaisons between the agency and academia by reviewing the latest literature, summarizing the pertinent findings, and then discovering ways to apply these results to an agency workflow or process to improve outcomes.
Nurses are especially qualified in this capacity because we are required to synthesize information, formulate hypotheses, come up with a cohesive care plan, and then implement it in accordance with evidence-based practice guidelines in our daily work. These skills that we nurses routinely use at the bed side or clinic office are applicable to a community at large. Moreover, nurses can expand a nonclinical agency’s capacity by introducing best-practice guidelines and values that are unfamiliar to nonclinical organizations. Optimizing community programs can indirectly affect individual outcomes by focusing on social determinants of health.
An example of this type of community work is a project I was recently involved in. I have had the privilege of working for and with a social service agency in Washington state as a student volunteer for some years. During my tenure, this agency’s personnel expressed to me a desire to determine if their early childhood education (ECE) center could be considered a “high-quality” program, if it was optimizing the development of the refugee children they served and how favorably it compared to similar programs in the county.
While my knowledge of early childhood education was limited, as a nurse, I knew I possessed intellectual curiosity and the skills to query the literature and synthesize solutions that could help the agency. I thus collaborated with agency personnel to determineexactly what information they wanted to know and what skills I could offer the agency, and I identified an acceptable timeline for both parties. Defining the specific goals that both parties could agree upon helped maintain clarity throughout the project.
After conducting a thorough literature review, I discovered several best practices for teaching that could be applied to this agency’s workflow. I observed the agency’s teachers in the classroom setting, using a rubric derived from these best practices, and I designed a questionnaire for staff members to supplement my observations. These questions helped me discover self-reported methods teachers use in the classroom that are best-practice-oriented.
After reviewing the data, I synthesized a plan and presented a summary of the findings along with my recommendations to strengthen the delivery of education to children at this agency. Using my nursing skill set and assessment expertise, I was able to plan this project, to collect data and to present it to the agency so that they could modify their methods of education delivery using the results that I found.
Education is one component of the five social determinants of health, and providing high-quality education can impact the health of each individual and have positive effects that can extend into adulthood. My work with this social service agency was intended to enhance the ECE community program and positively influence the delivery of education to refugee children through this agency.
Nurses can be influential members of their community and positively affect the lives of many individuals in that community by venturing outside the traditional healthcare arena. Local organizations could make a greater impact in the community by utilizing the skills and tools that nurses offer. Nurses can affect the health of a community, even if not directly involved in “health care” projects, by improving social determinants, such as refugee children’s access to quality education in my case.
As nurses, we must think outside the hospital and clinical box and be confident that the skills we have can be extended to community-oriented endeavors. Working with a nonprofit community organization by promoting the use of best practices can strengthen the agency’s capacity, but more importantly, enhance the lives and health of those served, which is what the nursing profession is about.
Lauren just completed her master’s degree in community health nursing at the University of Washington. She is excited to leave the world of ICU nursing and transition into the community sphere to work upstream on health promotion and education.