Building Community and Public Health Nursing Capacity

Maximizing Community Health Nursing Capacity in Canada: A Research Summary for Decision Makers

Principal Investigator: Jane Underwood, RN, MBA
Associate Clinical Professor, Nursing Health Services Research Unit
McMaster University
February 2010

Full Report (PDF, 299 KB)


Nursing has always been an integral part of community healthcare, and that role will grow in the future. Rising hospital and long-term care costs, medical breakthroughs and new attitudes toward care are all driving demand for improved home care, public health, primary healthcare and other community care services. This move to community health requires careful human resources planning to ensure adequate skilled staff are available to deliver services and are used to their full potential.

We did this three-part study as a first step toward meeting the information needs of health system administrators, planners and policy makers as they develop human resources policies for community health. We set out to answer three broad questions about community health nursing:

  • Who makes up the community nursing workforce and where do they work?
  • What are enablers and barriers to community nurses working effectively?
  • How can organizations support public health nurses to practise the full scope of their competencies?

Main Messages

  • Results of this study provide helpful information for decision -makers at all levels to strengthen community health nursing capacity. We have provided a starting point for planning with an overview of the community nursing workforce and the perspectives of approximately 7,000 community nurses on optimal conditions for them to do their jobs effectively.
  • More than 46,000 registered nurses and 7,000 licensed practical nurses work in community health in Canada, about 16% of the nursing workforce. Community nurses are older than the nursing profession in general, and there are fewer younger nurses entering community health. Community health nursing needs to be seen as a desirable and fulfilling career to continue to attract and keep nurses and to meet the growing demand for community-based care.
  • There are limitations for counting CHNs because:
    • Provincial and regional health authorities organize and identify similar programs differently
    • Inconsistent and interchangeable terms are used by CHNs to identify themselves
    • Although attempts have been made to align data collection, regulatory bodies continue to utilize some inconsistent terminology.
  • Careful attention to supports for community nurses to practice their full scope of competencies will improve recruitment and retention, make more efficient use of available community nursing resources and contribute to improved health outcomes in Canada's communities.
  • Community nurses are most effective in workplaces where they share the vision and goals of their organization and work collaboratively in an atmosphere that supports creative, autonomous practice.
  • Community nurses work well together, but need time, flexible funding and management support to sustain relationships with the community and their clients and to build teams with other professionals.
  • Employers and managers should support community nurses to keep up to date with more access to continuing education, policies, procedures, evidence and debriefing sessions, so nurses can maintain their competencies and confidence in their professional abilities.
  • Effective community health leaders (from senior government levels to local managers) publicly acknowledge community health nurses and openly promote their programs and services. These leaders create a culture that encourages creativity and innovation and empowers community nurses and their colleagues to be effective in their roles.


Funding provided by:
Canadian Health Services Research Foundation
Health Canada

Public Health Agency of Canada
Health Human Resources Strategy Division
Office of Nursing Policy
First Nations and Inuit Health Branch

British Columbia Ministry of Health Services

Nursing Directorate
Communicable Diseases and Addictions Prevention Branch

McMaster University, Nursing Health Services Research Unit
Vancouver Coastal Health