Community nurses in rural Romania go the extra mile for COVID-19 vaccination

COVID-19 has hit Romania hard. The pandemic has brought new and enormous challenges for the health system, including the need to vaccinate the entire adult population, as well as roll out booster doses. With almost half (46%) of Romania’s population living in rural areas, it has been challenging to provide equal access to vaccination for all communities. For Romanians, there have also been questions about whether and how to get vaccinated, and where to go for support and information. 

This is where the community nurses step in. These frontline workers care for whole villages, with 800 or more people on each of their lists, although the true number of those who benefit from their care far exceeds this. Throughout the COVID-19 pandemic, they have acted as a strong bridge between communities and primary health care, most notably in their efforts to help people get vaccinated.

Mariana Stoian is the only community health nurse for Ștefan Vodă Commune, Călărași County. Having been born and raised in the village, she has worked there for over 17 years. Most of all, she loves the “fieldwork”, finding joy in working with people she knows well. Her support has been invaluable.

Since the onset of the pandemic, Mariana has taken on a significant number of COVID-19-related activities, with vaccination taking up a quarter of her time. Although community nurses do not directly vaccinate patients, she is dedicated to a broad range of support work, from vaccination counselling, to following patients up on second doses, to arranging transport to vaccination centres. 

Community nurses like Mariana engage with everyone in the village. This includes spending time persuading local public figures to recommend vaccination to the community at large. Trust evidently plays a significant role in their success.

By acting as the link between marginalized communities and primary health care, community nurses ensure no one is left behind in COVID-19 vaccination efforts. Direct communication with families ensures there are fewer information gaps. Many elderly members of the community feared the potential side-effects of the vaccine more than the disease itself.

Disinformation is swiftly and expertly dispelled because every citizen has direct, regular contact with a health professional who can give up-to-date advice. If a patient has questions about the importance of getting the vaccine, for example, nurses like Mariana can reassure them. They can also speak with those around the patient, to shore up a network of support for COVID-19 vaccination.

 “When I see someone afraid of getting vaccinated or not being sure about this decision, I try to talk to them and see what the root cause of their fear or concern is,” explains Mariana. “For the elderly, I noticed it is important to talk with their family, with their caregivers, because they have a great deal of influence on my patient, and they can help me explain the benefits of vaccination better. Family members can facilitate the dialogue.”

Vaccination rates in Călărași are as high as the national average, thanks in part to the dedication of community nurses. This is not only a triumph for locally organized care, but also provides a lifeline for rural parts of Romania, so that communities are not left behind in the fight against COVID-19.

This work does not come without challenges, however. Of the 2200 people in Mariana’s care, about 30% are of low economic status and 800 are registered as vulnerable or at-risk patients. Like many workers in the health sector, community nurses’ workloads increased during the pandemic as duties, such as monitoring vulnerable patients in isolation, multiplied. 

Transport also used to be a difficult element of community nurses’ work. There is little public transport in rural areas, and no funds to reimburse nurses for transport costs. A recent donation of 1800 bicycles from WHO provided much-needed mobility for them, along with all the health and environmental benefits of cycling. With their transportation burdens eased by cycling, community nurses will be more efficient and far-reaching in all of their duties, including lifesaving COVID-19 vaccination support work. 

Even small investments in community nursing, like providing these bikes, appear to go a long way. By strengthening this one link in the chain, the whole COVID-19 response operation is reinforced. This investment has a spill over effect into other health work, such as routine immunization, which is likely to be strengthened in the future too. Better mobility will accelerate all aspects of nurses’ work, helping them reach more people, and faster.

The crucial work of Romania’s community nurses has been bolstered by mobile vaccination teams run by the government and, in certain areas, by the Romanian Red Cross. It became clear that understanding the social demographics of patients was vital to increase vaccination rates. For example, in Călărași, mobile vaccination teams were set up in villages during the summer of 2021 before harvest season. This was motivated by the fact that they were more likely to find members of rural communities at home, rather than engaged in agricultural activities out in the fields. This know-how ensured that the vaccination programme had far greater reach.

The relationship between authorities and community influencers is also important. “One thing became clear: the engagement of local authorities was key for successful vaccination against COVID-19,” explains Aura Giurca, President of the Călărași County Red Cross. “Mayors and local leaders need to encourage the community to seek vaccination and lead by example.”

More needs to be done to support these local interventions, however. Camelia Truică coordinates the community nurse network. “For future work, we need to provide national-level training tailored to the professional needs of community health nurses,” she explains. “They have a different job and focus than specialized and general nurses.” She cites gaps where communities are entirely without nurses. “Nobody is interested in taking the job – these are large communities with complex issues, and higher salaries are available in other areas of nursing.” The need to bolster the skills and resources of these community nurses with central support and funding is vital. This goes for COVID-19 vaccination and beyond.

Romania needs to strengthen its primary health care network, including community care. These nurses provide a fundamental link between the family doctor, communities, schools and primary care. Not only do they hold health and social infrastructure together, but they also provide thoughtful, tailored care.