Eye opening is how former nursing student McKenzie Adams describes her community clinical experience with Church Hill House through the Richmond Health and Wellness Program, which targets vulnerable older adults and disabled adults residing in low-income housing settings.

It was the first time Adams interacted with patients outside of the hospital setting and in their homes.

When Adams, a 2022 graduate of Virginia Commonwealth University’s School of Nursing, started nursing school she had no idea what path she wanted to pursue in her career. She never really “stopped to think about how a patient's living environment could impact their health,” she said.

Community health nurses must think creatively

Many nursing students concentrate on working in a hospital and forget to consider other types of nursing. Kimberly Davis, clinical assistant professor in the School of Nursing, teaches the Community Health Nursing course and uses the class to open students’ eyes “to different nursing opportunities in the community,” she said.

Areas of interest within community nursing are varied, including everything from school nursing and working for a local health department to serving in positions at home agencies or community health centers.

Community health nurses go out into the community to meet the need where it is, making health care more accessible to communities that might not otherwise seek it out. It puts nurses at the doorstep of those who need help, removing some of the care burden and ensuring equitable access to health care.

Complex and creative care

Nurses in the field make a large impact through their patient-focused emphasis on preventive and holistic health and wellness. As a result, working in a community setting can be more complex than in a hospital. It requires nurses to support patients with health promotion, disease prevention, management of chronic illness and support of patients’ self-management goals across the lifespan.

Community nurses also provide coordination by connecting patients to resources and health teams so the right care is delivered at the right time.

“They have to think more creatively,” Davis said of working in the field.

During the semester, her nursing students complete a service-learning project that includes a community needs assessment – identifying a priority need, creating a workplan, implementing a health promotion activity and evaluating the project. Interventions must be data-driven.

During her project in Davis’ class, Adams implemented a magnet system through which Church Hill House residents perform wellness checks on each other. Residents place a magnet on their door frame with the red side facing out, and every day by noon, they turn their magnet to the green side. This represents a visual cue to check on any resident who does not have the magnet turned by noon.

“When I was interviewing residents about their concerns, several mentioned how they feared dying alone in their apartment and not being found,” Adams said. “It became a big problem after the start of the pandemic. Apparently, before the pandemic, there was a real sense of community within the residence where everyone would interact.”

The goals of her project were to increase feelings of social support and safety and to restore a sense of community. Adams hoped at least a handful of residents would participate and check on their neighbors. On launch day, 33 were lined up to receive their magnets. “By the end of the enrollment period, we had 37 people actively participating,” she said.

Davis said her students do “amazing things” with their projects. “They put a lot of heart and soul in the projects. It’s a great learning opportunity.”

A growing interest in community health

Recently, Davis has seen more students expressing an interest in community nursing. Her single-semester class, which runs spring and fall, typically has up to 100 students. “Students like to get clinical experience in the hospital, but they also enjoy getting involved in or volunteering in local communities,” she said.

Vicki Stamps, nurse manager, senior at Chesterfield Health District, is a true believer in developing the next generation of public health professionals. She works closely with VCU nursing students who are completing their community clinical experience at the health district.

Stamps has been involved in public health nursing for more than four decades and has seen growth in the field. Progress includes a focus on population health, which looks at social determinants of health and how these impact individuals and communities.

“Nursing has learned that we not only need to care for a client's physical well-being, but we also need to look deeper at all of the social, emotional and environmental factors that contribute to their health,” Stamps said.

VCU nursing students working in health districts have developed educational materials and presentations for clients, families and communities; supported community activities and health fairs; and worked with nurses in clinics, including delivery of flu and COVID-19 vaccinations. Nursing students this past spring partnered with a local health district to develop and implement a social media campaign to promote vaccination among school-age children.

“Most of all, they have given us some fresh thoughts and ideas that have helped us to develop efficiencies,” Stamps said. "We love our students and feel very satisfied when we hear them say ‘I had no idea public health does all that!’ We are especially proud when one of them returns to work for us as a public health nurse, because we helped them to understand and love what we do.”

A rewarding experience

Adams, who is now working in a North Carolina hospital ICU, said her experience with community health will “stick with me for the rest of my life.”

“It’s one thing to have a program and hope that it succeeds. It’s another to see it unfold in front of you and improve the well-being of individuals,” she said.

Adams said she also learned the importance of actively listening to patients. If she hadn’t, she would never have learned about their deepest concerns and fears.

“Before having my community nursing experience, I had never even considered the field as an area that I would be interested in. But it felt so rewarding to be able to help those in my community and to see the impact it had on the lives of individuals,” Adams said. “As I progress throughout my career, I am open to the possibility of going into community nursing.”