In January 2012, the B.C. Government plans to launch the Nurse-Family Partnership program (NFP), a nurse home-visitation program offered to vulnerable, young, first-time mothers who have low incomes and are at an early stage in their pregnancy (28 weeks or earlier). (http://www2.news.gov.bc.ca/news_releases_2009-2013/2011HLTH0036-000672.htm). The program is based on compelling research evidence from US studies that demonstrates the importance of intensive nurse follow-up for high risk families.
As nurses, we should support the introduction of NFP as a key strategy that could expand the family-focused programs that currently exist in British Columbia. Unfortunately, B.C. health authorities have been instructed to implement this program without the benefit of new funding. As a result, public health nurses and families are very concerned that the program will replace existing family-focused services instead of complementing those already in place.
Currently, all families who have a newborn may access a visit from a public health nurse. The NFP program however, focuses only on high risk families. News about the potential loss of these universal visits has generated numerous calls and messages to the media over the past week. Parents have described their personal experiences during the first days at home with their infants and spoke of the tremendous value of home visits by public health nurses.
We do not know what the policy outcomes of implementing this program will be, but it will likely manifest in the loss or erosion of a universal family health promotion program that has for decades made a difference to the health of families in B.C.. With no new funding, valued public health nursing programs such as universal visits and follow up with new families will have to undergo cuts, likely with little input into policy decisions from the nurses who know their communities best.
Public health nurses recognize that any family whether deemed high risk or not, may face challenges that can only be identified during a trusting, intimate and knowledge-based post-natal visit. Families themselves cannot be asked to assess their own level of risk. For this reason, it is important that all families can access home visits – this has been shown to prevent problems such as post-natal depression and family violence.
Through post-natal home visits, public health nurses promote optimum health by linking families with a system of ongoing care through public health and other community resources. Public health programs are cost-effective as they receive less than five per cent of the total health budget, contributing to significant health outcomes that may not be immediately recognizable until they are no longer achieved and health data signifies that we have lost ground in child health or other family health outcomes. Despite their significant and cost effective contributions to population health, public health nursing programs have been disproportionately vulnerable to cuts over the years.
Our policy position is this -- Rather than insist the NFP be launched under the existing health authority budget, it should be allocated new resources so that the full range of existing programs and population health needs are not compromised by the addition of one new program.
Nurses must consider the evidence, ask critical questions and bring solutions to government and health authorities that clearly demonstrate how these policy decisions could impact the health of our population.
ARNBC wants to hear your views on this important topic. Please share your comments with us and your colleagues across the province.
Dr. Susan Duncan, Co-chair of the ARNBC, teaches at Thompson Rivers University in Kamloops and serves on the Board of Directors of the Canadian Association of Schools of Nursing.