Why do nurses enter community and public health practice?

Abstract

Current policy places much emphasis on public health and care outside hospital. To provide this requires a qualified work force but a large number of community nurses are approaching retirement. While there is a commitment to recruit and retain such nurses, there is little information available on community nurses' career trajectories, or on why staff choose to work in the community and why they undertake community specialist practice (CSP) programmes. This paper reports the findings of a survey of community specialist practice students--community children's nurses (CCNs), community mental health nurses (CMHNs) district nurses (DNs), health visitors (HVs), practice nurses (PNs), school nurses (SNs)--in a large London based programme. They were asked why they had entered community practice and why they had undertaken a community specialist practice programme. Findings were not categorical; the reasons for entering community work included increased initiative, more autonomy and preferred hours. Scope for initiative, autonomy and increased independence were reasons for undertaking the CSP programme, as well as better promotion prospects. Differences were evident in response by age of respondent and by whether they had dependent children. All types of respondents saw themselves as public health practitioners. Practice nurses stood out as different from the others, seeing hours as significant, but not promotion prospects despite expecting higher grades on completion of the programme. The study raises various questions, which could be explored after refinement of the study tool and using students in different locations throughout the country.