Most graduating nurses picture hospitals when they think of their future careers. From recruitment ads that picture nurses in scrubs, to nursing training that often downplays community nursing, there is a general lack of information about what community nursing is all about. 

But while community nursing is largely invisible as a career choice, its benefits are many.  

Working out of CMHA Toronto's west-end primary care clinic, Nurse Practitioner Letticia Adinkrah and Case Manager Anisa Carrascal, a Registered Practical Nurse, say community nursing demands a broader range of skills than many hospital roles while offering unusual opportunities for autonomy, professional growth, and long-term relationships with clients.

One of the biggest differences is that community nursing offers a different lens on patient care. It is built on developing a long-term relationship and gives the nurse the opportunity to see the patient from initial hospital discharge all the way through to recovery. 

“You’re seeing so much more of the life of the client,” says Anisa. “I have visited their homes, I know their families, I know their pets, I understand the stressors outside of their own illnesses. I know if somebody’s having a bad day at work, what kind of work they do, whether that impacts their health. I know their diets. There are so many more opportunities to educate a client when you are in contact with with them over the long term and holistically."

Such is not the case in acute care settings, where interactions between the patient and their nurse are necessarily episodic and task-based. “When you have eight patients that you have to take care of, there’s no time for conversations to ask them how they are really doing, talk about their home environment, or their family relationships,” says Letticia.  

In community mental health, those conversations aren't simply about building rapport. They are often central to a client's recovery.  

“You need to learn how to talk to people, how to persuade, how to connect with them and build a therapeutic relationship that is based on honesty and trust,” says Anisa.  

Those relationships develop because community nurses accompany clients long after they leave hospital. 

For the community health nurse, receiving a patient into care after discharge from hospital is the first step on a much longer journey. "The object in the hospital is to stabilize a patient and get them out. For us, we are the out," says Anisa.

Community nurses don't simply support recovery — they witness it. As Letticia puts it, “It's a long journey, and it's a rewarding journey,” with the gratification that comes from being a participant in the continuity of care for each client. 

Unlike acute care, community nursing gives practitioners the time to educate patients about their illness, support medication management, coordinate community services, and help people become active participants in their own care. 

For Anisa, those conversations aren't simply about building rapport — they often reveal the root cause of a person's health challenges. 

Drawing on years of hospital psychiatric nursing, including work on CMHA Toronto's Assertive Community Treatment team, Anisa says those conversations often uncover the underlying circumstances driving a person's distress. 

“For a person with major depressive disorder showing up with suicidal ideation, everyone asks ‘how long have you been feeling like this?’ but nobody’s asking, ‘is there something happening in your life? Are you housed?’ Sometimes somebody’s depressed because they been living on the streets for 10 years. It makes absolute sense.”  

Building relationships is only the beginning. Those relationships allow community nurses to advocate for clients in ways that extend well beyond traditional clinical care. 

The role community health nurses play as a patient advocate is especially important because a patient’s mental health is just one part of their total health picture. Too often, mental health concerns are poorly understood even among medical staff. “As soon as you say that you have a mental illness, or you give the history of your medications and they see an antipsychotic there, [some physicians will] dismiss your symptoms. So sometimes I accompany [the client] and say, ‘no, actually, these symptoms are real, and this is what is going on,’” says Anisa. 

Advocacy often means helping clients navigate barriers that have little to do with medicine itself. Housing, income, language, stigma, and other social determinants of health often shape a person's recovery as much as clinical treatment. 

Rather than applying concepts like the social determinants of health in theory, community nurses encounter them daily, adapting their care to each client's circumstances, culture, language, and lived experience.  

“Community nursing and mental health nursing gives the nurse a sense of autonomy and independence. Yes, there’s clinical thinking, but there’s no prescription there for you,” says Letticia. 

That autonomy demands broad clinical judgement. Particularly in community mental health, situations rarely unfold according to standard protocols. Clients' needs can change from day to day — even hour to hour — requiring nurses to draw on strong conflict resolution and problem-solving skills, clinical judgement, and the ability to adapt quickly. 

“In a hospital, you have a safety net. You call security guards if a person is becoming violent. You have a team of nurses that, if you don’t know something, somebody else in that room is going to know it,” says Anisa.  

Instead, in community nursing, the nurse is often on their own with a client. “When you’re face to face with a client, sitting down in a Tim Hortons talking about their anxiety and something happens, it’s on you. You learn so much just by being very independent,” Anisa adds. 

Clinical judgement often means departing from standard procedures when a client's circumstances demand it. “Maybe you need to jump over a few steps … because that’s what actually makes sense for the patient," Letticia says. 

"So many different variables impact the decisions we make, and how we provide the care,” Letticia adds.  Every decision is shaped by the client's circumstances — whether they're newly arrived in Canada, living without stable housing, navigating language barriers, or facing other challenges beyond their medical condition.  

“The current healthcare system doesn’t always work for our population, so we have to be a bit more strategic and more critical” in how we approach patient care, Letticia says. 

Community mental health nurses don't work in isolation from the broader healthcare system. As hospitals face growing pressures from staffing shortages, underfunding, and increasing demand, community providers are often left caring for clients with more complex needs — and fewer resources to meet them.  

“We will receive the stream from hospitals much faster, and we have fewer options to work with. We're sometimes pulling resources out of thin air,” says Anisa.  

Anisa jokingly calls the days Letticia spends trying to find services for clients her "searching for the unicorn" days. 

Letticia adds that the impacts of cracks in the healthcare system are also seen in community health services seeing more acute patients. “They’re not as stable coming out of hospital, so there’s a lot more work to do,” she says. She is transparent about the fact that many working in community health operate in a deficit of time, resources, and funding.  

 “We’re such workhorses that we don’t recognize that we’re operating in a deficit sometimes. We just know that the work has to be done.”  

That resourcefulness frequently means tracking down community supports that can be elusive. “When we can't manage, then I am searching for that unicorn, and I manage to find that unicorn or as close as we can. We have to make it work … because we’re [the patient’s] last resort.”  

Anisa and Letticia both believe that more nurses would choose community nursing if they had the chance to discover it earlier in their careers. Instead, many complete their education with little understanding of what community nursing can offer. 

“Many of the nurses I met throughout my life would have loved to have this experience and opportunity, they just never got introduced to it,” says Anisa. 

For both nurses, community practice has offered something they didn't find elsewhere: autonomy, flexibility, long-term relationships with clients, and the opportunity to witness recovery over time.  

Anisa says that, for her, the chief benefit by far is “the incredibly rewarding experience of the way that you really, truly, apply the full scope of your practice.” 

She’s quick to list off a series of other rewards: “It’s also the independence, the sense of belonging to a community, and growing, and supporting the community itself, not just the client.” 

There are practical advantages too, including greater flexibility and more predictable schedules than many hospital roles. “You do get to have a life that is kind of normal,” says Anisa. 

She and Letticia are looking forward to the days they can pass the baton to a new generation of nurses.  

“We do want good people to come and work in community mental health,” Anisa says. “We want nurses to understand that there’s a different path, and a more exciting option than working 12 hours in a hospital and wearing scrubs,” she laughs.