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Exploring key practices in harm reduction outreach: improving care by reaching out to people where they are

Learn more about the role of outreach nursing at the client, care team, organizational, and political levels

By Riley M. Hammond & Kristin McGee
June 27, 2024
Riley Hammond
Harm reduction outreach nurses find ways to reduce barriers to accessing vital services while meeting people where they are, such as at this downtown Edmonton encampment during winter.

This article is part of the Canadian Nurse series, Harm Reduction Saves Lives.

Outreach nursing is about meeting people in unconventional places to provide care. It recognizes that not everyone has the same access to health services. Harm reduction, helping people stay safe and healthy in their everyday lives, is vital to this approach.

Harm reduction outreach nursing draws on a grassroots, community-based health-care delivery model to reach out to groups that often face barriers to traditional health-care services, such as people who are homeless, people who use drugs, and people involved in sex work. Harm reduction outreach nurses (a) provide personalized care, (b) advocate for their clients, (c) get communities involved, and (d) push for political changes to make health care fairer (Hardill, 2007).

In this article, we explore how nursing, community outreach and harm reduction come together to meet people where they are. In alignment with Ferlie and Shortell (2001), we discuss harm reduction outreach nursing across four interconnected health-care system levels.

Client level

First, we have the client level, which focuses on those receiving care and their families. Here, harm reduction outreach nurses play a crucial role in building trust with a diverse range of people, especially those who might feel left out, ignored or judged in traditional health services.

Nurses in this role who may have personal experience with their own substance use challenges bring forward their lived experience to help them connect with people on a deeper level. In outreach, trust is treasured because many community members are hesitant to seek help due to past bad experiences. Imagine being in pain but afraid to go to the emergency department because you weren’t taken seriously before. Building strong bonds between nurses and clients helps overcome clients’ worries about health-care interactions. This connection also allows nurses to do the following:

  • Carefully assess and address client needs
  • Ensure that everyone’s voices are heard
  • Guide clients to the right services

It’s all about forming strong, reliable connections that last.

Riley Hammond
Outreach nurses provide essential goods such as snacks, water, hygiene items, safer sex supplies, and harm reduction supplies. They also serve as educators and links between communities and health-care systems. Above: drinking water jugs at a community freshwater site in downtown Edmonton.

Care team level

Second, we have the care team level, which focuses on the range of practical skills and abilities harm reduction outreach nurses are required to demonstrate in their daily interactions with clients.

Psychosocial approaches

Psychosocial approaches include conducting needs assessments and providing brief, trauma-informed, non-judgmental interventions. These may include techniques such as motivational therapy as an evidence-based approach to behaviour change, non-violent crisis intervention, mental health first aid, and suicide awareness and prevention training. Nurses create a non-judgmental environment by:

  • Asking open-ended questions
  • Listening empathetically
  • Assessing for harm risks
  • Offering clients reassurance and affirmation
  • Encouraging clients to seek relevant supports
  • Empowering clients for self-help and other support strategies

Imagine encountering a familiar client in a downtown park who is visibly upset after recently losing a second loved one to drug poisoning. By asking open-ended questions, listening empathetically, and providing affirmation while assessing for harm risks, nurses empower clients to lead the conversation, determine what aspects are important to them, and consider what supports are needed going forward. This scenario underscores the importance of these supportive approaches in daily situations.

Medical approaches

Harm reduction outreach nurses are equally skilled in various medical areas. These include the following:

  • Wound care
  • Providing vaccinations
  • Testing for sexually transmitted and blood-borne infections (STBBIs)
  • Responding to drug poisonings

Nurses may also need to tackle community-based infectious disease outbreaks, such as Shigella, and address key social and health challenges among people who are homeless and other vulnerable populations. Nurses could work with a web of community partners to organize a rapid community-based public health response to a Shigella outbreak during severe weather, ensuring that affected people who are homeless receive prompt testing and treatment. This scenario highlights the unique health challenges faced by outreach nurses and their adaptable, collaborative solutions.

Integrated approaches to care

It is crucial for outreach nurses to document their interactions and care strategies using mobile, integrated health service apps. These data help visualize emerging trends and ensure continuity of care. Strengthening pathways of connection between outreach nurses, outpatient clinics, and acute care staff — a crucial aspect of improving the coordination of care as clients move between services — involves an understanding of different health-care milieus and the roles and capacities of service providers, including areas of expertise, triage protocols, and scope of practice. To improve collaboration between hospital and clinical nurses and outreach nurses, it is essential for nurses to advocate for integrated health-care technology systems, allowing for seamless communication and real-time information exchange.

Organizational level

Third, at the organizational level, we consider how we can support harm reduction outreach nurses by providing them with adequate resources.

Resources and education

Outreach nurses provide essential goods such as snacks, water, hygiene items, safer sex supplies, and harm reduction supplies. They also serve as educators and links between communities and health-care systems. They find ways to reduce barriers to accessing vital services while meeting people where they are. In consequence, harm reduction education is integrated into their nursing practice, covering topics such as safer substance use and sex work. Nurses may also address questions from the general public, business owners, and law enforcement about harm reduction approaches in their communities.

Networking and community development

Outreach nurses work closely with various groups — such as community agencies, social workers, and peer support workers — to enhance harm reduction efforts. They don’t just educate these groups about harm reduction. Outreach nurses also interact with clients, law enforcement and businesses to build stronger community networks. For instance, when clinical nurses push for policies ensuring that patients have shelter and housing support before leaving medical facilities, they not only strengthen community networks but also help vulnerable individuals. This example shows how advocating for harm reduction policies in health-care facilities and including harm reduction education in nursing curricula align with the ethos of meeting people where they are, which is central to harm reduction outreach nursing.

Political and structural level

At its core, harm reduction outreach nursing involves advocating for policies, programs and services to better meet the diverse needs of communities within the political and economic landscape. For instance, nurses are well positioned to influence legislation and help create innovative strategies such as street-based outreach programs in busy areas where accessing traditional health services is difficult.

Public advocacy by individual nurses, often through media channels, forums and town halls, can raise awareness of community health issues and promote primary care in underserved areas. Nurses in hospitals and clinics, meanwhile, can strengthen collaboration with community-based nurses by joining policy and advocacy groups such as the Alberta Nurses Coalition for Harm Reduction or the Harm Reduction Nurses Association.

Nurses in all practice settings can understand the roles, resources and strategies employed by harm reduction outreach nurses to meet people where they are. There are practical ways to integrate harm reduction principles into client care, whether in the community or the clinic. By prioritizing trauma-informed, non-judgmental and collaborative approaches across all levels of health-care systems, nurses can play a significant role in improving the health outcomes of diverse populations and create a more inclusive health-care environment.


Ferlie, E. B., & Shortell, S. M. (2001). Improving the quality of health care in the United Kingdom and the United States: A framework for change. The Millbank Quarterly, 79(2), 281–315. doi:10.1111/1468-0009.00206

Hardill, K. (2007). From the Grey Nuns to the streets: A critical history of outreach nursing in Canada. Public Health Nursing, 24(1), 91–97.

Riley Hammond, RPN, BScPN, is a master of science research student in the School of Public Health at the University of Alberta and an active registered psychiatric nurse practising in Alberta.
Kristin McGee, LPN, is an assistant manager for Streetworks at Boyle Street Community Services and an active licensed practical nurse in Alberta.