Public health nurses are on the frontlines of health care in the best of times, but even more so with the vaccine rollout for COVID-19. During National Nursing Week, May 10 to 16, the University of Lethbridge is celebrating their contributions to the effort to fight this pandemic.

“The pandemic has shown that we need a strong nursing service in our community,” says Carmen Torrie, a registered nurse and U of L master of nursing student. “You might not think about it when you’re not sick, but when you need them, thank goodness the nurses are there.”

Torrie, an experienced public health nurse, is currently working as an assistant head nurse with the COVID Response Team. She works with patients who have been diagnosed with COVID, sometimes to inform them of their diagnosis, to take a history to see where they may have encountered the disease and to offer support to keep themselves and their contacts safe and healthy.

This isn’t Torrie’s first experience with a pandemic. She worked as a rural public health nurse during the H1N1 pandemic. Commonly called swine flu, the first cases occurred in Mexico in March of 2009. By June, the World Health Organization had declared it a global pandemic. In September, Canada announced its vaccine rollout, a time that Torrie remembers clearly.

“I was an immunizer in 2009 for the H1N1 pandemic,” she says. “I’m a public health nurse and I was an experienced public health nurse at that time, but I just found the pandemic clinics were like nothing we had ever seen before.”

Initially, the vaccine was made available to anyone over six months of age. People flocked to immunization clinics, sometimes showing up an hour before the clinic opened. In some cases, the lineups were so long that people gave up waiting. While nurses generally expected people would line up and get their immunizations in an orderly fashion, the fear and panic created a chaotic environment. More staff members were added and that meant more experienced nurses also had to supervise those who were less experienced. Clinics opened to the public on October 26, but were suspended on October 31 due to a vaccine shortage. When they reopened a few days later, the vaccine was only available to individuals of certain ages or health conditions. Although eligibility expanded, and those once eligible remained so, this meant frequent trips to vaccine clinics for families to be protected. This was a burden to rural families, especially for large families, those with limited transportation and long distances to travel to a clinic. Another option was to defer a trip to the vaccine clinic until all family members were eligible. This left all family members vulnerable to infection while they waited. Nurses on the front lines were left to explain the changes to people.

“We couldn’t deliver the kind of care we wanted to during the H1N1 immunization clinics,” says Torrie. “That was the impetus for me to study it in my master’s program. It was six years after the event, but it still haunted me and I thought what happened then could be improved upon for next time.”

For her master’s thesis, Torrie reached out to rural nurses in southern Alberta who had been part of the H1N1 mass immunization clinics. She chose five nurses and met with them to discuss their experiences during the pandemic.

“This research project changed my perspective as a nurse, in terms of the humanity of being a nurse and the closeness of nurses to their populations in rural areas,” she says. “Trust is such a fundamental part of public health nursing and if that trust is undermined, it can affect your whole work life. With immunizations, if we don’t provide a good service that the public trusts, it may impact future decisions to immunize. Vaccine hesitancy is an issue that public health nurses deal with all the time.”

The nurses also talked about urban centrism, or the idea that what works in cities will also work in rural areas. Because rural nurses know the people in their communities — some of whom could be relatives or friends — people sometimes expected a more personal touch. Other themes that emerged included the decisions around who gets vaccinated first, the lack of preparedness and the moral distress that resulted from nurses not being able to provide the care they wanted. Added to that was the stress of provincial restructuring, since the immunization campaign coincided with the amalgamation of the various health regions into Alberta Health Services. On a positive note, the nurses also said they grew as a result of facing these pressures and gained in critical thinking abilities and communication skills.

Some things haven’t changed since the H1N1 pandemic, including determining who gets the vaccine first.

“From a public health point of view, we look at the world a little differently than the medical model,” says Torrie. “In public health, we’re concerned with the health of groups, not so much the individual. Although the individual is important, it’s the group that is the segment of the population that we’re most interested in for immunization clinics.

“With the COVID situation, it’s been fascinating to watch how they’re rolling out vaccine because it’s still very much based on a medical model, where it’s based on individuals. There has been a constant struggle between individual freedom and considering your neighbour. When you have a communicable disease, you have to think of the group.”

Nurses are the backbone of the health-care system and it’s emergencies like the COVID pandemic that remind us of that fact.

“We are lucky in Alberta to have a nursing service you don’t have to pay out of pocket for. There are dedicated professionals working to keep people safe and healthy,” says Torrie.