Community Health Nursing with Tegan Broadhurst and Alysha Samji
Community Health Nursing with Tegan Broadhurst and Alysha Samji
In this episode we hear from two early career community health nurses working with the homeless population at the COVID Assisted Self Isolation Site run by The Alex in Calgary, Alberta. Tegan Broadhurst and Alysha Samji have taken the initiative to learn and expand their knowledge in an area of nursing that they have grown to love.
Hear about what they do, the challenges they have faced, and how they equipped themselves with knowledge to become better nurses, and to help their clients in this challenging area.
Alysha Samji RN Charge Nurse, Nights Assisted Self-Isolation Site, The Alex Calgary
Alysha Samji is a Registered Nurse working in Calgary, Alberta. Her nursing practice is centred around public health/community nursing. Alysha is currently working as a full-time charge nurse in the community at ASIS where she works alongside vulnerable populations facing addictions, mental health, and homelessness. She has found immense fulfilment in working in the community and plans to further her career and education in this field.
I attended Mount Royal University for my RN degree in September of 2015. I recently graduated from nursing school in April 2020 and completed my final focus placement in public health. Growing up I have always found that my happiness and self-fulfillment comes from caring for others and focusing on the concept of empowering individuals through “doing with not doing for.” Being able to practice in many diverse environments throughout nursing school including both acute and community settings, helped me find my true calling in working alongside vulnerable populations in the community. I thrive in my nursing practice where I am able to provide holistic care and advocate for as well as provide care for those who may not have access to the determinants of health to do so for themselves.
Being able to start my career as a front-line worker at ASIS has helped me grow in many ways. At ASIS I have had the opportunity to work with individuals facing addictions, mental health, and homelessness. I learned quickly by working with this population that although the topic of acute care nursing is focused more on in nursing school, it is just one of the multiple fields of such a rewarding career. During the last year I have learned so much about addictions, mental health, and trauma informed care. I have also gained major insight into the stigma that this vulnerable population faces every day. I am honoured to be able to advocate for these resilient individuals and I take great pride in my line of work. I am so thankful to have had this opportunity to start off my nursing career and I look forward to the adventures and fulfillment that my career will continue to bring me!
Tegan Broadhurst LPN Staff Nurse Assisted Self-Isolation Site, The Alex Calgary
Tegan Broadhurst is a Licensed Practical Nurse in Calgary, Alberta. Through her roles working in both acute care and community/ addictions nursing, she has found her passion in helping create better outcomes for vulnerable populations both while in hospital and in the community.
Though my nursing career began a little later in life than most, I feel a huge part of my identity has always been to help and protect others. I started nursing school midway through my twenties and since then I have learned so much more about myself and where my place in the world is. I know now more than ever I am here to care for, support, and advocate for people who don’t always have the tools to do so for themselves.
I have been nursing in acute care for 3 years, and in 2020 I was given an opportunity in a community nursing setting that focuses on helping people with addictions, mental health issues, or experiencing homelessness. Despite having minimal experience and knowledge in this area initially, this opportunity has brought me more fulfillment than I could have dreamed of. I consider myself extremely lucky to have found these roles, especially during a pandemic, that have brought me such a sense of purpose and have me so excited for what the future holds.
Community Health Nursing with Alysha Samji and Tegan Broadhurst
Announcer: [00:00:00] This is nurses’ voices
Mary Wheeler: [00:00:04] On today’s episode of nurses’ voices. We’ll be speaking with, two early career community health nurses from Calgary. I’ve heard their stories. They are amazing. You’ll want it tune in.
Announcer: [00:00:15] Nurses’ Voices is supported by the Canadian Nurses Foundation. And by the Canadian Nurses Association,
Mary Wheeler: [00:00:24] I’m pleased to introduce two nurses.
First, Teagan Broadhurst. Who’s a licensed practical nurse through her roles, working in both acute care and community and addictions nursing. Teagan told me that she’s found her passion in helping create better outcomes for vulnerable populations, both while in hospital, in the community date. So welcome Teagan.
All right. And we have Alysha Samji. Alysha is a registered nurse and a new grad. She just graduated last year. She has already a full-time charge position and she works alongside vulnerable populations that face addiction, mental health and homelessness. Alysha told me, she’s found an immense fulfillment in working in the community and plans to further her career and her education in this field.
I’m wondering if we could start with you Teagan, and if you could just tell us and the listener about the assistant self isolation site?
Tegan Broadhurst: [00:01:28] Um, it was kind of like a pop-up projects. We saw the need for isolating people who typically stay in shelters and we need a better option just to reduce that spread of COVID within that population.
So the Alex, working with AHS and working with the government has leased a hotel for people from those populations to isolate with us that we provide like nursing and social care while they’re, while they’re with us isolating.
Mary Wheeler: [00:01:57] What is your role?
Tegan Broadhurst: [00:01:58] Monitoring if people are not doing well with their COVID symptoms intervening, if we need to and making that call, if they need to be hospitalized or what kind of care they need with COVID, but also recognizing the need for support and withdrawal management. People from that population often need some support there if they’re not able to be using. And if they do decide to keep using, we can support that too. If we need, we just understand the reality of harm reduction.
Gail Donner: [00:02:30] How many clients do you have there then?
Alysha Samji: [00:02:33] I think the most we’ve had is around 65, around 65 to 70 clients.
Yeah. Yeah, that’s when it was probably the busiest. Yeah. And you’re looking to go from maybe four clients and then all of a sudden we’ll surge and we’ll get 50 and takes an a day. So…
Mary Wheeler: [00:02:48] So I’d be curious to know Alysha you’re one year out of graduation. What drew you to this?
Alysha Samji: [00:02:55] Mmhmm, so I actually did my final focus in public health.
Um, I was doing vaccinations at a well-child clinic. So throughout nursing school, I was able to experience kind of both acute care as well as community and community nursing was what really got me feeling passionate and I felt super fulfilled with what I was doing over there, as opposed to the acute side of things.
And I found that it was less skillset focused and more, a holistic approach to care. So you actually get to know these clients and, uh, see what you can do and work with multiple teams and, you know, work socially as well as medically. And so I found a posting for the Alex, uh, with, uh, ASIS a month after I wrote my RN exam.
Um, and so I applied over there. I had no idea what I was getting myself into. Um, and they started the program up in April. Um, and I started in May. And so when I started over there, we were kind of getting our bearings together, figuring out medication delivery, how do we get clients intake?
Do you know the whole process of things? And so, um, just being there from day one and watching how much our program has evolved has been amazing.
Gail Donner: [00:04:04] What can you, can you talk a little more about what a day would be like or a shift I won’t say a day, maybe night, whatever, what? Uh, because it strikes me if anything, this is what we mean when we talk about social determinants of health, but by the same token, I do, I’d like to have a better idea of what a, what a day is like, because I would imagine there’s a lot of unpredictability.
Alysha Samji: [00:04:29] Yeah. I mean, I could probably let Teagan speak more about the days I’d been working full-time nights there it’s been a while that have been at ASIS during the day. Um, nights can be pretty crazy too, though. It just kind of depends. You said, uh, based on the social determinants of health, right. And, um, unfortunately a lot of these individuals are not able to access a lot of these things that we have, um, including just the basics, right?
Like, like just. Adverse childhood events and things like that, that they’d gone through and the physical environments that they have to survive in. It’s really difficult. Um, and so, yeah, there’s a lot of things that we have to consider. Um, and on nights we don’t really have our social team. Leads present, and we don’t have our physicians present either.
Um, which makes it a little bit more difficult. So we do have a really great team where we’re able to work cohesively and pass off onto shift report and make sure that our clients are safe at all times. And that we’re doing our best to make sure that, you know, they’re happy and feel comfortable with us.
Tegan Broadhurst: [00:05:27] Day shift is a lot of like… first thing in the morning, we’re handing out medications, whether it be. Withdrawal management medications or what these clients are on in the community. And we’re optimizing, uh, their knowledge of allow them to ask questions about why they’re on their medications. If people need housing while they’re there, we’ve been lucky enough to be able to start that conversation have their, like housing assessments done.
That’s like a huge part of it is socially. What can we do while we have you here? Um, right. You wouldn’t be able to access this support while you’re “sleeping rough” is like sleeping on the streets, or if you’re at, um, our shelters in Calgary, you might not be able to access these social programs, but while we have you here, what can we do to like better your, your opportunities and your outcomes?
Gail Donner: [00:06:19] I’m just listening and thinking. Whoa, that’s a huge challenge and not something you get a lot of experience with in nursing school. Can you talk a little bit about what that was like?
Alysha Samji: [00:06:32] Coming into this? I honestly had no idea. I thought, you know, come straight out of nursing school where it felt kind of sheltered.
You always had somebody around you. To come into this by myself. First of all, I was super scared. Um, and then to take on charge only a couple of weeks after that, it was also quite a challenge for me. I feel like I’ve grown a lot in my nursing practice, taking courses and taking the initiative to learn about this population, learn about the concept of harm reduction of trauma informed care of, um, how can we better support these individuals as they’re so stigmatized out in the community?
They’re not really looked at as a population that matter’s, and it’s, it’s heartbreaking. And the more you learn about it, the more you feel, so honored and humbled to be able to help, uh, these individuals. You know, they deserve the same amount of care that anybody else out there does. And so we are super supported by our medical team lead, uh, Ashley’s great.
Um, we’ve also got social team leads, you know, we’ve got physicians as well. And so it’s a very, um, like a very supportive environment. There’s lots of communication between teams, um, on and off shift reports as well. And, and things like that. Made our program evolve, grow and strengthen in a lot of ways.
Mary Wheeler: [00:07:47] And what about you Tegan?
Tegan Broadhurst: [00:07:48] I come from like mostly acute care, this whole world, is completely new to me.
Like I never had a clinical placement in community, but I wanted to be involved and they encourage you to take some trauma informed care courses. And it’s just kind of opened my eyes to like how much stigma there is in medical care and people from these populations don’t access medical assistance because of that stigma.
So that’s what I’ve become really passionate about. Uh, ASIS specifically, I, the nurses and social team that we deal with every day, they’re just such a wealth of knowledge and they’re so supportive and, um, Because this was kind of like a pop-up site. Um, we have nurses from all different backgrounds, like acute care community, addictions of health, um, and everybody just like teach and support each other.
And that’s been. Really, really amazing to see and be a part of.
Gail Donner: [00:08:47] What do you tell your former classmates and colleagues who are still working in what I’ll call? The more common or more traditional roles in organizations is rule bound by a very different environment than the ones you’re in.
Tegan Broadhurst: [00:09:08] There is huge differences between acute care nursing and community nursing.
Um, and it’s just made me realize how much there is to learn. Um, Just to benefit this population. There’s just so much to learn that I didn’t know when I was working in acute care. So I’m just trying to, um, bring that to light and that whole trauma informed care lens as an acute care nurse, I didn’t understand the amount of stigma.
So I’m just trying to like voice that. And there’s a reason why even at the hotel, like. ASIS people don’t want to go to hospital and it’s made me realize how much work there is to be done. So I kind of loving being able to go to work and, and kind of advocate for this population while they’re in the hospital.
And I just want, I feel like the more we talk about it and the more education there is, the better outcome will be for this population.
Mary Wheeler: [00:10:09] So you’ve sort of got. A foot in both sectors, but boy, the opportunity Te Tegan for you to be also teaching it’s very organic. You know, you’re moving from one sector to the other, but also that ability to share knowledge and to share experiences and sort of to bridge, even when you were talking about, um, many of your clients don’t want to go there hospital.
Tegan Broadhurst: [00:10:35] In that, um, like duality of seeing both sides and trying to figure.
How we can, even it out that encourage, uh, this population to feel safe while they’re in the hospital. Um, I feel like I was just pulled to being able to advocate for people who don’t necessarily advocate for themselves all the time
Mary Wheeler: [00:10:55] In a lot of work that Gail and I have done in career. We don’t talk a lot about people moving from different sectors.
They stay in one and it’s sort of, I get identified in that way. And what you’re describing is that possibility to, to be much, much more fluidity in movement.
Gail Donner: [00:11:15] One of the things I that’s always struck me is. Somehow. And I think even in my own career, you come to work or a place or group of people or whatever it is.
And even though you might not know a lot about the, what I’ll call the technical parts of it, you don’t really know a lot about the work. It feels like the right place. And that’s a bit like what I hear you saying. I mean, I didn’t know anything about this. I didn’t have this experience in nursing school.
But then I came there and I hear you saying it, it fits for me and I have something to contribute and I have something to teach other nurses. I hear that quite a bit. And I hear both of you talking a lot about stigma. Can you say more of that, Alysha?
Alysha Samji: [00:12:05] Um, it’s so it’s more just the non considering these people as people.
Um, they’re not looked at as human beings. They’re not looked at as, you know, people that deserve the same. Like treatment that we do healthcare wise and just in general. And it really stood out to us just, you know, being able to go into these rooms and have these conversations and say, tell me about yourself and yeah, what can I do?
And, you know, just hearing that, um, You know, it can take such a long time to build rapport with some of these clients too, because they, they can’t trust you because their entire life. Right. And it’s not just from people out there like us that they’d never met, but it could be within their own like cohorts or families or whatever it is that they’ve developed so much with trust and trauma throughout their lives, that, that they kind of grow this, this wall up, it says wall and they put it up in front of them.
And so people kind of look at them as, oh, it’s just someone that’s homeless. It doesn’t matter. Right. And yeah. A lot of people do that because they don’t have the knowledge, they don’t, uh, they’ve never really interacted with these guys and take a second and actually have a conversation and ask, what do you need?
Right. Like, how can I help you? Even if it’s something as simple as giving someone a sandwich or out there, right? It’s, it’s things like that, that you can do that, that it’s the little things for them that matter. And I think that’s so unfortunate that it’s not so, um, Looked at as more of a, of a priority.
And even like Teagan said, they’re super scared to go into the hospital a lot of the time, because it’s kind of that mistreatment that we see too, where the discharge summaries that are, oh, came in, we gave them withdrawal management and kicked them out. It doesn’t matter moving on to the next, but you know, you don’t consider that these withdrawals can cause seizures.
You. You know, it’s it’s, it also is a life and death situation is something, some other health care needs would be to who, right. And so that stigma can affect the health care of these individuals as well, and just their lives in general. And it’s been unfortunate to learn that, but it’s been such a great opportunity to actually learn more about it and have a part in, in decreasing that stigma in our own way.
Gail Donner: [00:14:12] Yeah, in a way it’s so privilege when you then care for and about people that somehow seem to have been left behind by mainstream society. That’s an extra. It’s an extra privilege. I mean, it’s a privilege to go through people anyway, as a nurse, but it’s an extra privilege when it’s populations that have been somehow left behind or not, even if they’re cared for, from time to time, they’re not much cared about.
So it’s pretty impressive to me that, um, two relatively young women. Yes. taken up the cause. And, um, I applaud you for that, um, good for you, what would you tell the schools of nursing? Since I don’t think, I mean, I’ve spent most of my life as an educator. I don’t think we do much about this.
Alysha Samji: [00:15:14] Yeah. I mean, when I did my mental health rotation, uh, we did a lot of inpatient.
Uh, and talked about more about things like mental health diagnoses, so bipolar schizophrenia, things like that. And we kind of just skimmed the surface on addiction, but didn’t actually go into it and talk about what is it, what is withdrawal and how do we manage withdrawal and, um, kind of touch on these populations that are more prone to using and things like that.
And how can we actually support and, and what the topic of harm reduction even is? I had no idea what it was, uh, prior to starting at this, too. Right? So. I think, um, even though we come from a recovery based model at ASIS, we do also support clients and meet them where they’re at. And I think that’s something in nursing school that should be touched on more is just the topic of, um, trauma informed care.
How can we help you? What does addiction mean? Um, Got a different definition to everybody, right. And not only the medical treatments, but also what are therapeutic ways that we can also engage and treat these individuals with kind of nonviolent crisis intervention and just being able to hold a conversation and build that rapport.
I think that’s something that I wish I had learned a lot more about in nursing school, for sure.
Tegan Broadhurst: [00:16:24] I feel like the biggest points in working with this population is kind of lose your judgment. Cause I feel like they’re. Yeah, because of that stigma, they’re kind of looked down on, but, um, people with addictions or mental health, or just trying to cope, just like everybody else, we’ve all endured trauma in our lives.
Some people have better, more productive coping mechanisms. Some people had substance use and that’s how they had to deal in that time. And that doesn’t speak to. Who they are like as a person or like any moral short coming, like they’re just trying to get by just like everybody else. Um, not looking at anybody with judgment and just, you know, having some compassion for their story and having that, like trauma-informed care.
We don’t know these people’s stories. We could not imagine the trauma that , that they haven’t been through. We don’t need to add to that. Um, you know, making them feel stigmatized when they’re trying to reach out, have some compassion for these people who people have kind of forgotten about
Gail Donner: [00:17:27] Seems like good lessons, period for nursing, generally, not just for vulnerable populations, but just part of compassionate and caring, I would say.
And part of the expertise that, yeah.
Mary Wheeler: [00:17:43] So I’d be curious then. So this site is a pop-up it, it came to be because of COVID, but what you’re both describing what I’m hearing is. A different way of caring for individuals that people can come on. Site have an amazing team of health professionals who are listening to these individuals stories who are looking at ways of helping them.
When COVID is over, has there been conversation about a model like this, that isn’t a pop-up is the way we need to care for the vulnerable or what does it mean for you and your careers? This is where you say you want to practice.
Tegan Broadhurst: [00:18:26] There is hope that we can maybe change the format, but nothing, you know, we don’t know anything yet, but, um, if we could change, you know, formats to, or if the Alex could, um, Having opportunities for transitional housing and maintaining this safe space where people can come and have social and medical support.
We, we all hope that, but right now it’s kind of. We’re just waiting in limbo.
Alysha Samji: [00:18:56] It would break my heart if this didn’t go on. Um, so I really hope that, um, like Teagan said, it’s kind of up in the air right now, but we’ve definitely had conversations with our teams and, um, fingers crossed, uh, going forward that this will continue on.
And, you know, if we’ve got to change our model so that it’s not based off COVID, but kind of based on transitional housing and prevention, [exactly] it would be phenomenal,um, just being able to advocate and things like that as well. Um, For me. I, uh, I, I think I do want to stay in this field, working with this population and addictions. And so I, um, I was recently hired on at, uh, iOATs in Calgary at the Chumir. Um, so that’s the injectable opioid agonistic therapy program. Okay. I also learned through, um, ASIS because we’ve got clients coming to us from various places as well. And so, um, clients that came from us, came to us from over there and learned about this program in.
And so I’m kind of trying to take my career in that way. And I expand my knowledge, uh, in this kind of field of addictions.
Gail Donner: [00:19:58] What do you see yourself doing down the road?
Tegan Broadhurst: [00:20:01] I would like to continue this, um, Path that I’ve kind of found myself on. And, um, if I could find like an educational role, uh, with like harm reduction and trauma informed care, if I can, can like continue being able to learn and teach that I feel like that would be where I fit and where I feel best in my nursing practice.
I feel like that’s where my calling is right now.
Mary Wheeler: [00:20:30] I don’t know where the time went in the last half hour. Um, right. I, and I’m, I’m sure get so privileged to hear your stories. And I think so important for nurses. If you remember how we talked about this is for nurses across Canada to hear what other nurses are doing.
And so what you’re doing is something in right in the thick of COVID really helping vulnerable people. And I have been so impressed with both of your stories. I don’t know if there’s any last, when you’ve got the, the ears of nurses across Canada. Is there any last thing you’d say, I don’t want to leave this, this, uh, conversation without saying… either of you?
Alysha Samji: [00:21:15] Um, I think, uh, just advocate, advocate, advocate, look out for your clients. Don’t be judgmental. You know, you never know what’s going on in someone’s life. There’s always unspoken stories. And just take the time to really get to know your clients and know that you are their support system and you are their strength at the end of the day.
And the, uh, we got to take advantage of that and do what we can for them.
Tegan Broadhurst: [00:21:36] If you don’t know about something, if you, like, if you have questions about harm reduction or community nursing it’s okay. And to ask questions and expand on your knowledge, there’s no shame in not knowing, just continue to learn.
And I feel like. It’s going to have better outcomes.
Mary Wheeler: [00:21:54] That was a really interesting conversation. And those two women were exceptional young nurses. Uh, what I found intriguing was that they had very little knowledge about this place to go and work. And they had the courage, they found it interesting.
And they just said, what I heard is we’re, let’s just, I’m just going to try it and I’m going to learn along the way and. So that was my first, uh, aha, there that so many people take so much time. Often we know in our experience in careers in nurses to find that right spot, but there was spontaneity and they seem to have found their, their spot in nursing.
Gail Donner: [00:22:46] Yeah, it was pretty remarkable that that piece of it, because in their nursing education, they didn’t learn very much about that. And then you wouldn’t, you just take the, they took a chance. Uh, and it’s, it’s fascinating. I can’t go what I, I just, I have to say that I couldn’t stop. remembering myself. I don’t want to say how many years ago, because I always wanted to do mental health.
I had no idea what it is, but I thought I’d want to do it. I had a horrific experience in nursing school. It was really before all the advanced medication and everything, people were still, you know, being tied up and, you know, having cold baths and all of that. And then when we moved to Philadelphia, I got a job in a mental, in a very progressive, mental health setting. And I walked in, I knew nothing, nothing, and I had a diploma and it was in the U S everybody had degrees. People had graduate degrees. I didn’t even know there was such thing. And I just walked in and two weeks later I knew that was the place for me. Wow. I have to say I was stupid. I had no idea.
I w but I was probably like these young women, like a sponge. The other thing that was… struck me, they realize how important support from the team was quite happy to say, I didn’t know. I had to learn, I still have more to learn and I thought that’s amazing. Every nurse should feel that way when we get started.
So I just was having a deja-vu. It’s just remembering my own early days, but I was very impressed with their compassion and I thought they would have something to teach other nurses, where, because we’ve become quite. Technicalized well, there were ways of doing and, uh, you know, technology to help and whether it’s medication or whatever it is, and certain, right ways of doing and not right ways of doing it. And they seem quite. Learning how not to judge. I think we could all of them from that, but I think they would have something to teach nurses about how not to judge and maybe in these days of, uh, recognition of black lives, matter of other movements, recognizing diversity, I don’t know I was quite impressed with what they could teach us.
Mary Wheeler: [00:25:37] I thought the other thing that was something to explore more is Tegan’s comment that she works in acute care and she works at this pop-up and that ability to move from two different areas, two very different areas and what she’s learning and able to take what she’s learning and help teach others and also in so acute care, but also.
The her client group in this assisted self isolation site, fear hospitals. So that there’s something there that tees or that, uh, that bridging to helping. So you’re not just working in one sector or the other sector that ability to bridge for people that may know, maybe the ability to help someone who does need to go into the hospital to be able to have that experience.
I don’t know what you. Thought about her comments? I just, um, yeah,
Gail Donner: [00:26:40] I think she, I think she could probably help the nurses in acute care help. Clients who have to go to acute care feel more comfortable. But she also, because, because she would have a comfort level in acute care could reassure clients in a particular knowing, knowing way.
That might help it. There’s lots in there. I mean about stigma, about inclusion, about the other. And it’s amazing to me that, um, really relatively new younger graduates, um, can see a path for themselves. And it’s impressive.
Mary Wheeler: [00:27:31] And I think the last point for me, and it has come up in some of our other Nurses’ Voices, episodes was.
Opportunities may be in the educational system that we haven’t tapped, um, or haven’t explored. Um, so again, when Teagan talked about, I would really like to further my education so I can take on teaching. I’m not sure what, what she was thinking about teaching, but again, it’s people with experience.
Experience in a setting who are able to bridge for students in, in nursing programs, what is really going on, uh, in some of these, uh, areas that maybe aren’t the traditional ways that we look about nursing. And that’s what I’m hoping. Nurses’ voices also is a platform to help nurses hear different roles of nurses across Canada.
Gail Donner: [00:28:22] Well we’re probably gonna learn where we’ve got it right in education and where we have room to grow. I I’m, so that that’s gonna come up. It’s the world is changing and I think newer graduates are coming. They want to be part of the change. Yes. Yeah.
Mary Wheeler: [00:28:43] Yeah. And that’s what we heard there with those two women.
They want to be part of making, you know, I mean, I just put that out there. Is there a possibility for this, you know, being sustained while we’re talking about it? Like, you know, so there’s that, that movement. So that was, that was a great, that was a great interview. I agree.
We’d love to hear from you.
We’d love to hear what you thought about today’s episode. And if you’ve got a story to tell, send it to us, check us out at nursesvoices.ca
Announcer: [00:29:16] Nurses’ Voices is created by donnerwheeler. It is supported by the Canadian Nurses Foundation and the Canadian Nurses Association. Nurses’ voices is produced by Cecktor limited.
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Public Health Nursing with Janice Loe and Jane Skinner Public Health has always been at the core of communities across Canada. However, for many years the perception of public health has flown under the radar – it does great work, but without the attention that acute care often