Where are the students and new graduates in community health?

As I read the paper by Jane Underwood and colleagues on the National Community Health Nursing Study, published in the September/October 2009 issue of the CJPH,1 I could not help asking myself the question, “Where are the students and new graduates in community health?” The study, based on the analysis of workforce data, a survey and focus groups with urban and rural managers and frontline public health nurses, aimed to describe the status of community health nursing between 2005-2008. The study portrays an older workforce, experienced in collaborating interprofessionally to address community needs and social determinants of health. The authors revealed that only 5% of community nurses were younger than 30 years old. Due to the relatively small percentage of younger nurses who participated in the study, the challenges of new and recent graduates and required supports remain unknown. I anticipate that junior community health nurses or those new to community health will face a steep learning curve as connected, knowledgeable mentors leave the workforce. In recent years, demands for community health nurses have grown exponentially as a result of shortened length of stays in hospital, increased numbers of patients living with chronic illness requiring intervention and monitoring, and an aging population requiring supportive care. However, there have been only modest increases in numbers of community health nurses, and actual declines in visiting nurses in Ontario to exemplify the trends, as outlined by the Nursing Health Services Research Unit.2 To respond to this situation, Richard et al.3 (in a previous letter to the editor) concluded that investment in continuing education and training is required. Although most recent graduates have had the necessary exposure to educational preparation to meet the Canadian Community Health Nursing Standards of Practice,4 Cohen and Gregory indicate that few enter the community health workforce upon graduation to apply that knowledge.5,6 Thus, I contend that it is important to uncover the viewpoints of students and novice nurses regarding community health in anticipation of the upcoming workforce demands. We need to create dialogue between community health practitioners, managers, researchers, educators, policy-makers and new graduates to understand this under-representation of novice nurses in community health in Canada and to create strategies to address the issue.