Swinging bridges of opportunity and challenges: memoirs of an African American nurse practitioner pioneer on providing primary care for the underserved

This article presents the memoirs of Mrs. Viola D. Brown, RN, FNP, a pioneer African American nurse practitioner, on opportunities and challenges involved in providing primary and public health care for underserved populations in urban and rural areas of Kentucky. Mrs. Brown began her career with a visit to Mary Breckinridge and the Frontier Nursing Service, and she was elected into the University of Kentucky's Department of Public Health Hall of Fame in 2005. This article is an adapted version of the closing keynote address presented at the 13th Primary Care for the Underserved Conference held March 2005.     

Roaming through Virginia with the public health nurse

Rural health nursing has long been considered a subspecialty within public health nursing, albeit one that required the nurse to be a generalist. In the excerpts of this article, Webb (1920) shares her observations as a State Supervising Nurse for the Red Cross in Virginia while traveling in rural areas of the state with the county public health nurses. Themes evident in these excerpts include the transportation issues associated with working in remote areas, as well as nursing work in the areas of maternal and child health, communicable diseases, case finding through health inspections, and health education. Additionally, there are themes specific to rural nursing, including distance and isolation, self-reliance, and development of trust among the rural population. In her 1922 book, The Evolution of Public Health Nursing, Annie M. Brainard identified many of these themes when she stated the ideal rural public health nurse needed to be a "school nurse, baby nurse, tuberculosis nurse, and a general visiting nurse", as well as tactful in dealing with "country people" who are "peculiarly independent and sensitive" (1985 edition, p. 303).     

School nursing on the iron range in a public health nursing model

Frontier nursing in the public health model might invoke images of school nurses on horseback in rural Kentucky or the wilds of the western prairies. Northern Minnesota was a frontier in the last decade of the 19th century, due to the discovery of one of the richest seams of iron ore on the North American continent. Immigrants from Europe responded to the opportunities this discovery created. Among the many Finns arriving on the Iron Range of Minnesota, as it came to be named, were the parents of Lillian Augusta Wilhelmena Beck, John and Hulda Beck. Over her more than nine decades of life, their daughter became one of the most well known school nurses on the Iron Range. Her story evokes memories of the creation of school nursing in the public health model by nurses at the Henry Street Settlement in New York City.     

Edna Dell Weinel, champion of public health nursing--excerpts from an oral history. Interview by Irene Kalnins.

Edna Dell Weinel is a former executive director (1980--1991) of the Family Care Center, a federally funded neighborhood health center in St. Louis, Missouri; this position capped her career as a county public health nurse, state maternal-child nursing consultant, and educator. In all her positions, Weinel lived her values: working at one's highest level of skill, social justice, and teamwork, and used political skills to build alliances for the improvement of community health. Her many contributions to public health and public health nursing were recognized by the Public Health Nursing Section of the American Public Health Association in 1993 with the Ruth B. Freeman Distinguished Career award. In interviews conducted early in 2007, Weinel spoke of her pride in being a public health nurse, her unchanging belief that health care can best be delivered by teams, and that public health nurses are an essential part of any effective team.     

Edna Dell Weinel, Champion of Public Health Nursing— Excerpts from an Oral History

ABSTRACT Edna Dell Weinel is a former executive director (1980–1991) of the Family Care Center, a federally funded neighborhood health center in St. Louis, Missouri; this position capped her career as a county public health nurse, state maternal-child nursing consultant, and educator. In all her positions, Weinel lived her values: working at one's highest level of skill, social justice, and teamwork, and used political skills to build alliances for the improvement of community health. Her many contributions to public health and public health nursing were recognized by the Public Health Nursing Section of the American Public Health Association in 1993 with the Ruth B. Freeman Distinguished Career award. In interviews conducted early in 2007, Weinel spoke of her pride in being a public health nurse, her unchanging belief that health care can best be delivered by teams, and that public health nurses are an essential part of any effective team.     

County Drought Relief: A Public Health Nurse's Problem

Editor's Note— Last winter was more than usually full of traumas, natural and unnatural. Regardless of where one lives, natural events can devastate whole geographic regions. Hurricanes, floods, mudslides, earthquakes, tornadoes, and droughts, leave in their wake ruined homes, power outages, and crop failures. All too frequently, these natural disasters cause people to die, as well. Communities are forced under such circumstances to regroup and rebuild. It is in these activities that we may sometimes learn from disaster, as individuals reach out to one another to meet temporary needs. The power of collective action is demonstrated in stories told by public health nurses who witnessed and participated in disaster recovery.
For the second in the series of three reprints highlighting nursing following natural disasters earlier in this century, I have selected the account of a public health nurse who worked in rural Virginia in the winter of 1931 following a drought that left many residents of the region destitute. It was orginally published in Public Health Nursing in August 1931. From a late twentieth century perspective, her particularism and her choice of family to portray to her readers may grate on us a bit. Yet the enduring themes of effective public health work—case-finding, grassroots involvement, and collaboration—resound from one end of the century to the other.     

Evolution of a Public Health Nursing Program, Yukon Kuskokwim Delta, Alaska, 1893-1993

Abstract The role of public health in a reformed health care system is currently a matter of great debate at the national and state levels. Many public health nursing leaders have expressed concern about changes in public health policy and funding sources that have led to the near demise of the generalist public health nurse. Generalist public health nurses may be an endangered species; however, the role is still in existence in rural Alaska. Will they be one more example of how “what we learn from history is that we don't learn from history?” Taking the discrete area of the Yukon Kuskokwim Delta of Alaska and studying the forces of geography, politics, economics, social factors and health issues, this article provides an historic account of the development of a unique health care delivery system and the role of the public health nursing structure within it, from earliest known records to present day. The long-standing efforts to document these data were spurred by the National Centennial of Public Health Nursing activities, celebrated in 1993.     

The Black Bag

In the early‐ to mid‐twentieth century, stories about nursing practice submitted by nurses frequently appeared in Public Health Nursing. The article reprinted here is an example of this genre of publications. Originally published in April 1936, this article tells the story of a day in the work of one public health nurse as she moves about the city making home visits. In this article, Snow (1936) used personification of the iconic black bag to tell her story. Using this technique she brings to life the nuances of her day, the personalities of her patients, and the importance of the black bag to the work of public health nurses. What did nurses learn from stories such as this one? Themes embedded in this story reflect the role of the Public Health Nurse (PHN), as well as the environment in which she worked. For instance, in this story we learn that not only was the PHN a welcomed visitor in the homes of families struggling with health problems, but that she brought order out of chaos, as illustrated in “The New Arrival”. “The Black Bag” also highlights the humor nurses experienced in their encounters with families, as well as the pathos in other situations. Stories served as a vehicle for nurses to share and learn about both the common elements of their work, as well as the unique features related to location and environment, such as rural and urban locales.     

Leveraging a funding collaborative to develop more PhD prepared nurse scientists and leaders

BackgroundOver its almost 50 year history, The Robert Wood Johnson Foundation (RWJF) has provided about $500M to nursing initiatives focused on education, practice, policy and leadership development. While RWJF was most often the sole funder of many of these initiatives, it has also joined with others to create a larger and more sustained impact on particularly challenging nursing, health, and health care issues.PurposeThe purpose of this article was to describe the challenges and opportunities of a unique funding collaborative developed to engage new partners, increase the visibility of doctoral nursing education and increase funding of the RWJF Future of Nursing Scholars program to develop more PhD prepared nurses and nurse faculty.MethodsInterviews were conducted with several members of the FNS Funders Collaborative as well as the scholars they supported. The perspectives of three funders, a regional philanthropy (IBC Foundation) and two health systems (Cedars Sinai and Sharp HealthCare) are presented here. Together they supported 13 nurses to complete their PhD through the RWJF Future of Nursing Scholars program.FindingsRWJF contributed $20 M and 13 other funders contributed an additional $3Mto the initiative. The additional funds supported 42 nurses to earn their PhD degree through the program. Six of the 13 funders are health systems, four are regional or health related philanthropies, and others include United Health Care, Johnson & Johnson, and the Care Institute.DiscussionThere were many lessons learned for RWJF and the other funders. Given the size of RWJF, some other philanthropies were concerned about how contributions would be represented, others wanted their funding to go directly to care improvement. Some health systems were not prepared for their nurses to decrease work time while pursuing further education. The nurse faculty and nurse PhD shortages have persisted now for over a decade. Although FNS made a significant contribution by developing over 200 new nurse PhDs (faculty and leaders), more funding collaborations that engage new and different partners must be developed so that nursing education does not have to focus on the same problems in the next decade.     

Investing in the research process: Nursing Health Services Research Unit - University of Toronto site

Linda O'Brien-Pallas, RN, PhD, FCAHS is a Professor in the Faculties of Nursing and Medicine at the University of Toronto and Director, Co-Founder and Co-Principal Investigator of the Nursing Health Services Research Unit (University of Toronto site). Dr. O'Brien-Pallas is acknowledged globally for her pioneering and innovative research in health human resources modelling, quality of work life for nurses and nursing workload measurement. The rigour of her research has been praised by respected researchers at international conferences, and her expertise is sought by governments and stakeholders at all levels in Canada and throughout the world. She is frequently called upon by the World Health Organization and the International Council of Nurses to provide high-level consultation on matters including midwifery and health human resources planning. Dr. O'Brien-Pallas has provided leadership to many boards and committees and is a co-founder of the Dorothy M. Wylie Nursing Leadership Institute, which received the 2003 Ted Freedman Award for Innovation in Education. She has received numerous awards for her research and innovative contributions to nursing, including the Canadian Nurses Association's prestigious Jeanne Mance Award in 2006.     

Field training for rural public health nurses

With the expansion of public health nursing beyond cities into rural areas, leaders in nursing education early on recognized the need for additional training to prepare nurses for the rural experience. To this end, nursing faculty at Teachers College, Columbia University developed a pilot program designed to prepare nurses for work in rural areas. These leaders recognized the unique conditions confronting the rural public health nurse in her daily work, including distances to be covered, isolation, and the dearth of facilities for health work. The pilot program discussed in this reprint, published in The Public Health Nurse in 1925, describes the genesis of this project, and the collaborative relationship that was developed with Dutchess County, a rural county about 2 hours north of New York City, to provide practical experiences for students. The project included a series of lectures on rural health issues and rural nursing, as well as field work that included school nursing, and nursing care of special populations such as tuberculosis and maternal and child health, as well as experiences in population‐based nursing akin to what we think of as community development today.     

Does Advanced Community/Public Health Nursing Practice Have a Future?

Societal trends and predicted needs of the health care system indicate that there will be increasing demands for health care professionals who can effectively manage the health needs of populations and communities. Nurses who have master's degrees in community/public health nursing have the educational background to provide this expertise. Although the Association of Community Health Nursing Educators and many nursing leaders maintain that these nurses are advanced practice nurses, most leading nursing organizations and state nurse practice acts do not include population and community health management skills in their definitions of advanced practice nursing. These exclusions have produced a serious status problem for master's programs in community/public health nursing. This article examines issues affecting the current and future status of master's-level community/public health nursing. Solutions are suggested for ensuring the viability of this specialty area.     

Public health nursing competencies 1953-1966: effective and efficient

The Quad Council of Public Health Nursing Organizations developed public health nursing competencies in 2003. They are guides for determining skills at two levels, and they identify public health nurses as providing care to individuals and families or to populations and systems with the nurse having proficiency, awareness, or knowledge. The primary purpose of this paper is to discuss historical nursing roles and qualifications as judged by the 2003 competencies, including educational preparation and experience for the administrative and staff nurse. The historical exemplar for the nursing roles is a combination public/private nursing association, referred to as the partnership, that took place in 1953-1966. Primary sources include archived material from the Instructive Visiting Nurse Association, Richmond, VA. Administrative responsibilities were divided between the chief nurse and the nursing supervisors. Staff nurse responsibilities included clinic activities, home visitation, and referral coordination between health care organizations. The delineation of nursing roles demonstrates nurses' meeting the 2003 competencies. Based on the Quad Council's 2003 public health nursing competencies, the partnership nurses were competent.     

Feeding better food habits in mid-20th-century America

Public health nursing work has always involved education about nutrition and food habits. Nurses serve as interpreters of scientific and medical knowledge and as agents of behavioral change among the individuals and groups for whom they provide care. For public health nurses in mid-20th-century America, this meant direct involvement in many aspects of family life at home. Meal preparation and the eating patterns of family members were two areas into which most public health nurses had access. This brief history provides an introduction to some of the issues confronting American public health nurses at mid-century. Examining the content of articles related to nutrition in families around mid-century yields evidence about the role of the nurse, the state of the art in nutritional knowledge, and opinions and prejudices related to eating habits prevalent at the time. These glimpses into concerns expressed in the original Public Health Nursing journal may enhance understanding of the role of public health nurses in preventing diet-related disorders and form the basis for additional historical research.     

The professional nurse and regulation.

The regulation of nursing began as a simple registry process to protect the nursing title and the public. Today, the primary purpose is still the protection of the public through defining nursing practice, approving nursing education, and overseeing the competence of nurses through licensing and disciplinary rules and regulations. State Boards of Nursing are legislatively given the authority to license and discipline the nursing profession. The RN is responsible for the care given to assigned patients. Issues of staffing, delegation, and reporting of incompetent or impaired nurses are a concern of nurses today with regard to their license. Each nurse must understand the regulations, which vary from state to state, that directly and indirectly affect his/her daily practice. As the health care environment is met with several challenges, pressures are increasing to modernize the licensing and competency assessment of nurses. Ultimately, the safety of patients must remain at the center of the regulatory debate.     

Doris Wagner Ferguson, still waters run deep: an oral history

Doris Wagner Ferguson, MS, RN, FAAN, an original member of the journal of Public Health Nursing editorial board, is now retired in Oklahoma after a 50-year career in public health nursing. She has been a staff nurse, an administrator, and an educator in several states and, in each instance, was instrumental in effecting change and improvement for the practice of her specialty. Her story informs us of earlier struggles and challenges, which we may take for granted today. Those of us currently working in public health nursing acknowledge that we stand on the shoulders of nurses like Doris Wagner Ferguson.     

Nursing, a bridge to peace in our region: Opinions on mutual co-operation between Israeli and Palestinian professional nurses and nurse educators

Raviv D, Bourgstein D, Kaplan R. International Journal of Nursing Practice 1997; 3: 159–165
Nursing: A bridge to peace in our region
The purpose of this study was to assess the activities and future direction of mutual co-operation of professional nurses from Israel and Judea and Samaria. Questionnaires were distributed to the participants, nurse educators and professional nurses from Judea and Samaria who were attending a workshop in clinical instruction at the Assaf HaRofeh School of Nursing, in Israel. Most of the nurses polled were interested in continued educational dialogue and expanded educational programmes in various nursing specialties both in education and service. The areas that received priority included: intensive care, operating room and emergency room nursing. Areas that received lower priorities included; midwifery, geriatrics and nephrology nursing. The participants expressed positive reactions to continued joint educational activities such as full length courses, workshops, day seminars and joint educational projects. The results showed an overwhelming interest for continued professional ties. Areas in the fields of clinical expertise and nursing education reflected the needs of their respective communities.     

The public health nursing practice manual: a tool for public health nurses

Public health nursing is recognized as an important and critical component of the public health workforce, and today, it makes up the largest single category of public health professionals, according to the U.S. Department of Health and Human Services. Preparation of generalist public health nurses with the knowledge base, skills, and training to effectively respond to public health challenges is essential. The County of Los Angeles Department of Health Services, Public Health Nursing Section, in response to this need, implemented the Public Health Nursing Practice Manual to provide public health nurses with interventions and guidelines to articulate their role and practice as outlined by the framework of the Public Health Nursing Practice Model developed by Los Angeles County. Identification and development of new methods to support the practice of nursing is imperative in facilitating a more sophisticated and expanded level of practice, as well as providing a means of improving, protecting, and enhancing the quality of health for all people. The Public Health Nursing Practice Manual is an effective tool to monitor performance improvement and provide standardization of the generalist public health nurse practicing in Los Angeles County.     

Public health: a new nursing role for community practitioners

This article discusses the six key activities identified by the Royal College of Nursing (1994) as essential ingredients for public health nursing. Examples of public health practice and community nurse involvement are given to illustrate each activity. Public health skills such as health profiling, building healthy alliances and policy development are outlined. Current barriers to community nurses participating in these activities are identified and models of public health practice are reviewed. The potential for a radical transformation of community nursing practice is discussed in the context of an expanding public health role of community nurses in Scotland. Options for future practice are presented and discussed.     

Public health nursing pioneer: Jane Elizabeth Hitchcock 1863-1939

Jane Elizabeth Hitchcock was one of many distinguished nursing leaders of the 19th and early 20th centuries who attended a women's college before enrolling in a nurse training school. Like many of her contemporaries with equally impeccable family credentials, Hitchcock was something of an enigma to her family for choosing nursing over teaching, the most common acceptable career for women of her social class. Hitchcock's endowment of character, according to contemporary Lavinia Dock, exemplified the best of her Puritan roots. Her contributions to the evolution of public health nursing and the integration of public health nursing content into curriculums of training schools rivalled the achievements in higher education of her famous father, grandfather, and brother but garnered no comparable recognition. Her life presents an interesting case for analysis of an independent woman, a characteristic shared by many pioneers in the early years of public health nursing: 1893 to 1920.