Roles and Challenges of Community Health Nurses in Primary Healthcare Delivery

Abstract

Community Health Nurses (CHNs) have become an important part of the provision of primary healthcare (PHC), especially in low-resource and decentralized health systems like that of India. In recent years, their scopes of work have greatly increased, and they now deal with not only direct clinical care but also preventive health education, chronic disease management, and home-based outreach. Nevertheless, little empirical data exists to describe the lived experiences of CHNs and the issues they encounter in the gap between policy ambition and reality on the ground. This qualitative research paper discusses the functions and work issues of CHNs in Tamil Nadu, India. Purposive sampling was used to select 22 CHNs in rural, semi-urban, and urban PHCs, and interviewed in-depth using semi-structured interviews. Thematic analysis of data was done based on the framework by Braun and Clarke, and data were organized and coded using NVivo 12 Plus. Five themes were identified in the analysis: increased clinical and community workload, administrative workload and role overload, infrastructure and resource shortage, sociocultural barriers to community engagement, and resilience with adaptive strategies. The participants indicated that they had to work with limited resources, ambiguous role definitions, and increased documentation requirements, but remained innovative, persistent, and committed to the community. The results highlight the necessity of institutional changes that will promote workforce planning, role expectation, supply chains, and professional development investments. The need to recognize and support CHNs as key players in PHC is essential in developing equitable, efficient, and resilient health systems that can achieve national and global health objectives.