Primary care, team care, who cares?

 

Many nurses new to the field of camp nursing are not aware of the competing practice models for nursing service in the field. In fact for both new and experienced nurses entering the camp specialty success is often as much about the camps practice model as the individual nurse’s proficiency, and skill.

In this article I will briefly explain the advantages and drawbacks of the primary, and team models in the camp setting, how they affect nurse without a camp background especially, and what can be done to ease entry into each respective model.

Primary care nursing is practiced in 33% of camps nationwide (1). By primary care, I mean that one nurse is responsible for the totality of the medical or nursing care provided at a location. This has a few distinct advantages. One nurse handles all information and communication, presenting a unified front of practice technique and information management. There is excellent continuity of care, as the same nurse is evaluation the same situation for the duration. The nurse will generally form strong working relationships with camp management as they will be the sole contact point for health issues and questions.

This model has a major challenge for new camp nurses, the lack of clinical assistance or training. A prudent camp director will be aware and concerned with how to address this and should make arrangements. Many camps using this model will have a more experienced nurse who is available for questions via phone, or a comprehensive policy and startup guidebook. These are a big plus to helping a new nurse succeed. However new camp nurses, and even experienced nurses, will have many questions that may not be easily answered by reference materials or an offsite provider. Being the only health resource for a few hundred people can be overwhelming even for experienced nurses, who often have to call on their wits and grit to get through long nights or a disease outbreak. A better solution is if they have an experienced nurse providing onsite training for a week or two of actual in-session camp. It's even better if the more experienced nurse is locally available and can easily be physically present on camp to help if needed, or check in regularly. If proper training and support is provided, the new nurse will easily be more successful in this environment.

There are some issues that may arise that can be major obstacles to new camp nurses. Most concerning is if there is a complete lack of assistance. If previous nurses are not willing to assist, this can be an ominous sign that their experience on the job was not good. Another issue is if the camp director is dismissive or not at all concerned that you’re inexperienced. Some camp directors are completely uninterested in the challenges that face new nurses in the camp setting. A director should adequately address your weaknesses and concerns. If you don't feel this is happening, I recommend you steer clear of that camp. Finally, there should be a plan to make arrangements if you become ill, have a family or personal emergency, or are incapacitated in some way. If no plan exists, this is a red flag that you may become stuck on camp, unable to turn over you patient assignment.

Primary nursing can be a challenging but rewarding practice model. The nurse often feels fully immersed In the camp experience. Being the sole nurse is in immense responsibility, and is a huge amount of work, but many find it profoundly rewarding. Nurses who are not experienced in camp practice, or in a closely related specialty such as school nursing, should be cautious with this model, however if the known issues can be mitigated then a good experience is more likely.

A more common camp practice model is the team approach. Team nursing in the camp setting is generally defined as a single head or charge nurse who delegates tasks to other nurses or, if permitted, unlicensed assistive personnel; to provide all of the health needs of a camp. The major benefit of team nursing to the camp organization is that it allows for larger camps. A single nurse could not provide adequate care to camps that have 500+ campers and staff. A survey conducted by the Association of Camp Nurses shows that 67% of camp nurses indicate they work with another healthcare provider. Another RN was present in 19% of respondents, an LPN was on staff for 68% of respondents (1). The team approach is a newer model, coming into popularity as the complexity of camp health needs, and the size of camps, both increased. This model allows for direct collaboration between nurses. This makes unusual clinical situations or emergencies more easily managed and allow the new nurse to be supported as they learn the ropes. With the team approach, nurses are given a better work life balance as shifts are often assigned. This can prevent excessive fatigue and burnout. It also allows for staff illness and personal emergencies to happen without threatening the delivery of nursing services completely.

There are some drawbacks however; larger camps have larger organizational headaches. More camper information on intake and more nurses being needed to organize it can lead to miscommunication and confusion. There is always some degree of care in-continuity, as each nurse will have subtle differences in their approach to situations, both personal and clinical. Communication both on-camp to staff, and off-camp to parents can become fragmented, as different nurses communicate different information due to having varied levels of understanding in a particular situation. These communication and practice variances can leave new nurses feeling confused and uneasy.

These are a few things that a new nurse should look for that will make their entry into this practice environment easier. Most importantly, in my opinion, is having a good, knowledgeable manager in place. A good manager will delegate without confusion and facilitate communication. Having a good idea of the type of manager you will be working with will offer insight to the culture and work environment of the health center. Whenever possible, speak with the head nurse or health manager when being interviewed. Additionally having a sloid understanding on how communication between nurses, staff, and parent occurs is important to understanding the health services role in camp. I personally favor the team model for nurses new to camp practice, especially for recent graduates, or nurses with little pediatric experience.

Regardless of practice environment nurses of all experience levels, should set themselves up for success as much as possible. One part of this is the camp practice model and culture however a larger part of success and happiness is being open to the experience and flexible in practice. Truthfully, camp nursing is often not technically difficult; but it is personally challenging. Nurses must start a new job, move residence, and be isolated from personal supports. Keeping an open mind and staying positive will dramatically improve your experience.

Nurses will also benefit from reading up on the profession to gain insight. Two amazing resources are “The Basics of Camp Nursing” by Linda Erceg and Myra Pravda; and “Camp Nursing - Circles if Care” by Mary Casey. The Association of Camp Nurses offers a quarterly Compass Point newsletter with membership. A back catalog of Compass Points is also available.

I hope that this helps you be prepared for entering the expanding and evolving specialty of camp nursing, by increasing understanding of how each practice model benefits and challenges nurses.

 

References:

(1) ACN Compass Point volume 16, no 1 " roles and responsibilities of seasonal and year round camp nurses survey results part 1"