I recently spoke with public health nurses (PHNs) about the importance of warm referrals. Warm referrals involve a significant investment from the nurse who assesses available services to find the best fit for the client’s needs, actively facilitates client introductions to new providers, and then follows up to evaluate its effectiveness. Basically, what this does is move referrals from being transactional in nature, to being relational – in essence, it’s a transfer of trust. A discussion ensued about how difficult it is to quantify how much ‘time’ and ‘work’ goes into this process and many other aspects of public health nursing, specifically in home-visitation programs. It’s difficult to quantify how long it takes to build trusting relationships, or to enhance self-efficacy in new parents. How do you determine how much time it takes to support a parent through a mental health crisis or to celebrate with them as they reach a significant milestone? Public health nurses understand the importance of relational practice in home- visiting nursing and how current measures don’t always reflect what goes into the work of PHNs. Instead of trying to quantify, I wrote a poem using found poetry. This means that I took the words of PHNs who worked in the Nurse-Family Partnership® program (a home-visitation program during pregnancy and in the first two years of parenting) and created a poem that reflects the experiences of nurses. It illuminates the complexity of care, and the essential services that are provided to new parents. My hope is that this poem provides insight into the intensity of nursing practice, that it exposes the approaches taken to engage clients, and evokes understanding of the time it takes to do this important work.
Her Strength
by Karen Campbell
There’s a lot of responsibility as a nurse,
It’s a bit of an art – a bit of a dance.
It’s all about power; making them feel like they’re in control.
They’re feeling like I don’t know what I’m doing
Try out the hook – draw them into the program
I try not to let things go; where are her strengths?
Try not to overwhelm her; something valuable can come of it.
It looks crazy
Mental health issues make it even more challenging.
There are a lot of girls who have learned to be submissive to men
A number are dealing with intimate partner violence
His anger would probably be let out on her.
Why is this baby crying every time I’m there?
Life is throwing them curveballs.
She was in 33 foster homes by the time she was 15;
Now she has attachment issues.
Both of them have IQs around 70
It was really sad.
She was 18, broke up with her boyfriend; got pregnant by someone else
The baby’s father killed himself
It was really sad.
She has a great sense of humor; she’s on probation
Her probation officer would call me, she was picked up for a DUI
It was really sad.
They’re super-mobile and complicated
I was concerned about postpartum depression
It was really sad.
I feel sad about it, or I feel frustrated
I would love extra support
She could really benefit from this
She’ll dominate the situation
She is totally multitasking
She says, I feel like people are judging me
She’s just dealing with the crisis du jour.
We mesh well.
I want to help her be successful and have a healthy baby
To be able to make sure my client felt safe
I bent over backwards to help her; to protect her.
It’s hard to keep them engaged
I was sad to see her go
They don’t have use for you anymore
Once the trust is gone.
Reference: Campbell, K. A. (2023). Her strength: Reflections on nurse home-visiting. Public Health Nursing, 1–3. https://doi.org/10.1111/phn.13218