November 10, 2014

Naomi Thulien, NP-PHC, MN, PhD Student 

My clinical practice is at Covenant House Toronto – Canada’s largest shelter for street-involved and homeless youth – where I am the first and sole nurse practitioner at this organization.

I have been involved in delivering nursing care for more than 25 years and have been a nurse practitioner for four years. I hold a specialty certificate in Primary Health Care.  

I am blessed to be able to collaborate with an amazing interprofessional team of nurses, physicians and front-line staff at Covenant House Toronto. Each month, we document over 500 youth visits to our clinic. 

Many of the youth I see live in either the shelter or the transitional housing program at Covenant House Toronto. These youth are generally seen in a traditional clinic setting within our health care services department. In 2011, I set up a makeshift clinic room in our drop-in centre in an effort to reach youth reluctant to access a traditional clinic setting. The youth seen in the drop-in centre are typically much more entrenched in street life.  Some of the youth are absolutely homeless, living in places not intended for human habitation, while others are “couch surfing”, drifting between friends, family and acquaintances. 

A typical day for me involves seeing street-involved and homeless youth for a wide range of health-related concerns ranging from acute and chronic illness to prenatal care. One of the challenges in providing care to this population is that even the most simple health matter is frequently complicated by mental illness, addiction and emotional trauma experienced as a result of a chaotic childhood. In addition, the transient nature of youth homelessness means that the healthcare these youth typically receive is inconsistent and fragmented, punctuated by frequent visits to emergency rooms across Canada. 

I work hard to offer comprehensive, holistic care at each appointment in order to improve health outcomes and decrease emergency room visits. This means I focus not only on the “chief concern”, but also on screening, prevention and life-style. I also look for gaps in current healthcare needs and connect youth with appropriate supports within the community. 

One of the unique aspects of my role is that I am able to combine my PhD studies with my clinical practice. I am currently exploring what it is like for homeless youth to try and integrate into society once they exit homelessness. I often share my ongoing learning with the youth I see in clinic and, in turn, they provide me with feedback about how this knowledge might translate in the context of improving their own lives. 

I truly feel privileged to help care for these vulnerable yet incredibly resilient young people!