Nurses in the community play diverse roles in their clients' lives. These may or may not be related to traditional thoughts of what nursing practice really is.

I recently received an e-mail from a nonnursing colleague whose choice of words I thought needed to be immediately addressed. The e-mail requested volunteers to don their nursing caps and do some "real nursing" by giving annual flu shots to county employees. I never had anyone question the nature of our work as anything but nursing, and on reflection felt that this colleague may have acted in haste in order to complete her long "to do" list for the day.

Our office, home to a self-directed team of 13 community health nurses, is located in the heart of the county's seat of government. Certainly not a place you would associate with any kind of healthcare. Yet when you enter you immediately realize the extent to which our care is personalized, evident by the numerous photographs of staff and clients lining the walls. No, we do not administer "hands on" technical procedures and Medicare skilled nursing care, but is that all that constitutes "real nursing"?

We use our skills to assess hundreds of clients annually (approximately 110 clients consistently in each nurse's case load) in their homes or in local facilities. The assessment is holistic, in consideration of all our clients' needs; we are true nurse case managers in every sense of the word.

Many we directly serve are eligible for Medicaid, from the frail elderly and chronically disabled, to the most vulnerable babies born in neonatal intensive care units. When Medicaid home care services are appropriate we contract the service out to home health agencies and provide case management. We work with clients, families, and caregivers individually, in their own homes.

With the current severe nursing shortage this is no time to be imposing values or judgments. As real nurses we remain objective and attempt to meet many needs, often in very creative ways. No, we do not directly give our clients their flu shots, or do we perform their wound care or fill their medication sorters. We do write up their care plans specifying the type, amount, and frequency of care that needs to be given and we monitor its delivery.

We have also dealt with utility companies, landlords, attended many joint case conferences, and have even been known to make arrangements to install toilets, water heaters, and move a condemned trailer. Needless to say we do not wear a uniform and a change of clothes is occasionally needed after a home visit. And the local taxi companies would face a stiff challenge on who would find an address the fastest.

So what make a real nurse? I am sure that this limited interpretation of nursing may be held by many unfamiliar with the vast choice of career paths available to nurses. Technical procedures such as administering injections can be taught to anyone possessing the necessary physical ability and desire to learn. The "art" of nursing is so much more.

To be effective in the community, the ability to interact with others on many different levels during major life events is crucial to a successful outcome. As community health nurses, we have seen life when others look away and when clients have been ashamed to be seen. We are there to serve in times of great need. If that need involves operating a flu clinic we will be there, but just remember we are "real nurses" every day.