Report of a 1999 survey of public health nurses: is public health restructuring in Ontario, Canada moving toward primary health care?

Abstract

Public health restructuring in Ontario, Canada occurred in the midst of the rhetoric of ‘primary health care (PHC) reform’. The purpose of this descriptive mailed survey of nurses working in public health nursing in Ontario, Canada was to describe the nature and scope of public health nursing practice, establish a baseline against which to monitor future change, examine nurses’ reports of changes in practice that had occurred in the previous five years, and determine current public health nursing staffing levels. Findings were examined to ascertain whether the changes had moved Ontario closer to PHC. Two sets of questionnaires were mailed in 1999: one to a public health nurse (PHN) in a senior manager position in each of Ontario’s 37 official public health units and one to all PHNs in Ontario.Response rate was 87% for the managers’ surveys (n = 32) and 77% for PHNs (n = 2242). Reported staffing levels represent an 11% reduction in public health nursing full-time equivalents (FTEs) from 1988 data. Furthermore, between 1993 and 1998, the population:nurse ratio rose 32% from 3710:1 to 4910:1. Many traditional public health nursing services, such as those to individuals, families, and schools, had been reduced or eliminated. Significant regional disparities were revealed. Nurses used a wide variety of individual, community, and population-focused health promotion strategies consistent with principles of PHC in their practice but evidence suggested the continuance of biomedical domination of public health and public health nursing, rather than the shift to a multidisciplinary model that would be more consistent with PHC.Findings suggest that changes in public health nursing over the last 20 years are incongruent with several tenets of PHC, such as equity, accessibility, social justice, and community participation.