Gentle stillness shining through

Gentle stillness settled over the apartment, and I was keenly aware of it.

It was my first visit as a public health nurse alongside an enthusiastic colleague, who also became a wonderful future mentor. Today we reviewed maternal, child and family health with a new mom. My colleague spoke of home safety, basics of pest control and infant care.

When I followed the recent new mom into the bedroom, we both learned from my new colleague all the safety tips that came along with basic rental living for new families and new care for newborns. From cultural myths to misunderstood generational advice, my new nurse colleague addressed and clarified all the appropriate health and parenting techniques for this new mom. Throughout that day, I also became acutely aware of the similarities and differences in this nursing compared to that of hospital life. When our new mom proudly demonstrated safe sleep technique and child development understanding, it was equally as reassuring as a hospital discharge return demonstration. When we called the state’s Medicaid system to advocate for and obtain a case number so a newly pregnant woman could make a doctor’s appointment? It was just as time-consuming as procedure juggling for patients on the floor.

And as I sat across my colleague in the living room, an epiphany struck. It became clearer over the following months on the job. The main difference of public health nursing is stillness.

For all the newborns, sick, tired, and loudly crying, for all the older children running around and unable to remain seated, for all the toys and videos and multiple families living in housing, for all the neighbor’s music on top volume…..there is an incredible stillness to the public health nursing practice. It is a quiet sense of patience, timing and allowance of momentarily silences to be the ultimate communication. In calm reassurance, in crises and service access, in quiet confidences shared, stillness resonates.

Professionals in hospitals and other health facilities may evoke peace during shared moments with patients. The usual noise, rush and bustle of the facilities rarely allow for true gentle voice over multiple encounters, however. In public health there is not only an allowance for, there is a shaping and shining of still and quiet voice. For me, it was my natural and true voice. Years of working in other healthcare institutions with a focus on patient throughput masked that expression of patience and stillness. Public health nursing colleagues, true mentors, brought it to light.  

Let’s back up for just a moment:

It was the end of my shift. I’d finished report on a bustling, busy transplant unit with call lights and pagers creating an ever-constant overhead repertoire. I headed to the locker room, exhausted and over-caffeinated. By now, almost a year into the medical and surgical aspects of hospital nursing, I’d grown into my scrubs. Anticipation of patient needs based on surgery type, navigation of pain management and ambulation, calling a rapid response or rushing to another’s aide, advocating for those that weren’t progressing the way they should….it all was coming together. I’d grown accustomed to rotating shifts and made quite a few friendships along the way. I’d even grown accustomed to my hospital nursing voice: compassionate but direct, and at times regrettably hurried.

Through it all I couldn’t help my curiosity, though. Why were some of our recipients struggling with Medicaid bureaucracy so desperately? Could we have prevented the trauma overflow: the gunshot wounds, overdoses and impaired driving accidents? Wouldn’t our healthcare cost and spending look drastically different for research and access to desperately needed medication if our population prevention strategies could be strengthened?

I opened my locker and checked my phone. A voicemail signal appeared and I was thrilled when the message was from a local county health department administrator.

Curiosity and enthusiasm only grew after my interview and acceptance to the public health nursing position. I’d just traded in my scrubs, hospital ID and all that special electronic medical record training for community health. And, instead of meeting a clinical coordinator to partner for report on 4-5 patients, I walked into our local office and met my new peers for an office tour.

The office space had just enough leg room with each desk, just enough space in the filing cabinet for a few more charts. My slacks and blouse fit right in. None of the other public health nurses were in my age group, an entirely new change from my previous job.

I instantly connected with my new colleagues, and I immediately knew the ladies I now called peers would be mentors and incredible nurses. Unbeknownst on my first day, I’d eventually be lucky enough to call them friends.

We reviewed home visit assessments, infant and pregnancy development, community resources, basic shelter and service needs. I sat through the most intense, and best, immunization training one could ever experience. On Fridays we went out to lunch, my schedule was always Monday through Friday, and the pay cut was extremely noticeable.

Within a short amount of time I hopped in the car with my new boss and we drove through our community, discussing resources, landmarks and our population. I quickly understood how to look for and identify roaches and pests, unsafe sleeping conditions and less than admirable landlords. I listened and understood to give women the benefit of the doubt when they agreed to care for personal mental health or addiction, but to follow up consistently and thoroughly. I was educated in our role as partners in health, and also in our role to ensure that the primary objective, health and safety of the child, was always the priority. I observed gentle voice and stillness in my colleagues as they saw new and former families, time and time again. We celebrated when families made healthy choices. We leaned on each other for advice and provided a listening ear when a new mom did not make good decisions. I understood what a car ride voucher meant to someone with no other means.

And I loved it.

Through my direct supervisor I was taught how to investigate while also building an honest, trusting relationship. Through my direct supervisor and peers I was encouraged to advocate for equity in health and always maintain that expectation. We were nurses and that was our job. Even if we had to call five overwhelmed provider offices to ask for another patient to be accepted, we did it. Even if we had to go to the home more frequently when we suspected a new mom needed education reinforcement, we did it.

She alongside the other public health nurses modeled the essence of the role: dedication, compassion, integrity, bonding and genuine love for the community.

Often, there were encounters with nurses in other health agencies, whether we met for education, contracting, observation or even just as peers in the field. Some would comment that they didn’t like the public health part of the job, clinical rotation or other position. Some would say “this is social work, this isn’t nursing” or “I’d love to volunteer my time, too, when I’m not at the hospital”. Others might cry "I don't want to give shots all day" or “I prefer hands-on nursing”.

Public health nursing, I always reply, is hands on.

I’d ask these observers to accompany me in the field (in the community). I’d also walk them through all that my peers and supervisor were responsible for as the public health nurses for our county. The healthy kids running around our waiting room, as well as their moms, had all been case managed by public health nurses. Newly pregnant women experiencing abnormal symptoms were guided to the right medical provider through our expertise. In fact, husbands, partners, sisters, grandparents, and other family members without any means to care also came for basic guidance. As the first point of contact in the healthcare system, public health nurses easily identify a high blood pressure or other concern. Knowing Medicaid processes might mean weeks before a provider appointment, public health nurses can make critical decisions on care. The domestic violence screens may not have always produced the most heartening stories but the screens also addressed and opened an avenue to help. Our depression screens, paid for through grants and taxes, identified significant concerns that allowed for new referrals and links to providers. Without an advocate, a nurse stationed in the community, those intimate conversations would not have the same outcomes. When a first time pregnant mom would call and talk through serious symptoms with us, we became not only her nurse and case manager, but also her advocate and guide. Without this communication, other nursing professionals may never fully understand the scope of the practice nor the gentle stillness of the public health nursing profession.

Never before had I felt nurses could accomplish so much and provide amazing care to so many until I worked with these wonderful, incomparable nurses. My public health nursing peers and managers, the ones who allowed that inner, gentle, natural voice of mine to be in good company.

The ones who showed me how diverse nursing truly is.

Okay, back to the present.

For all the clamor and noise in healthcare, much of it necessary and vibrant, public health nursing differs. Public health nursing brings stillness.

Surrounded by incredible, intelligent nurses in public health, I realized diversity in nursing wasn’t just about patient populations. Diversity in nursing is more than just cultural competence, understanding multigenerational workforce or acclimating to an urban versus rural health organization. Diversity in nursing is accepting one another’s natural voice, natural expression. Part of this acceptance is internal, allowing our own voice to shine through. Much of this acceptance is harnessed and grown through the right colleagues. Like a diamond in the rough, each nurse identifies with their nursing practice best when their natural expression sparkles. For me, observing the compassion, kindness and gentle touch of my colleagues in public health was as centering as it was refreshing.

Inclusion and understanding in nursing are defined not just through who we serve but also through respect and understanding of the nursing profession as a whole.

Public health nursing isn’t an alternative career in nursing. It is nursing. As nurses, we must remain open and understanding to eachothers’ talents and roles. Growing in knowledge and understanding of each other, in all capabilities and capacities, is a privilege we are afforded. We should take care to integrate with one another as much as we can: in conferences, societies and associations. Just as we should take care to allow one another’s inner, true voice to shine. Public health is a variety of nursing, even if it illuminates a stillness unmatched.

Given the chance, this quiet calm is a welcome, refreshing variety. It is a variety that others may just agree to be a true and essential component of nursing.

Just as one’s gentle voice may be their true, tender expressive.

To this day I am proud to call myself a nurse and know I’ve been given the best gift of my professional life: incredible mentors, both peers and friends, who welcomed me to their public health nursing family. A family in which, after all the noise and chaos is said and done, provides a gentle voice of stillness.