For more than a century, nurses have served as the cornerstone of public health efforts in this country. Most Americans at some point in their lives have had contact with a public health nurse. It's hard to live for very long without meeting one. Remember the school nurse who made sure your vaccinations were up to date and bandaged the cuts and bruises you suffered during recess? She was a public health nurse. Have you or a member of your family ever needed the services of a visiting nurse to care for someone at home? She—and it  was almost always a woman—was a public health nurse, too.

Public health nursing traces its roots back to the late 19th century, when huge numbers of immigrants came to America seeking a better life but failed to find an environment conducive to healthy living. Nurse Lilian Wald receives the main credit for establishing public health nursing. Wald was inspired by a visit to the lower east side of New York City, where she witnessed residents living in incredible poverty and unhealthy conditions. She reasoned that those in ill health possessed limited chances to achieve their full potential -- and believed that nursing offered a means of improving the lot of the poor. Wald opened the Henry Street Settlement House, which quickly became a major center of health care services for those without access to care. Henry Street nurses visited the sick in their homes, identified health hazards in the community, staffed clinics and schools, advocated for better housing conditions and worked in a multitude of other jobs that promoted the health of the community in general.

Wald’s efforts were impressive. Yet she was not the first to organize public health nurses. Other large cities also set up public health/visiting nurse agencies similar to Henry Street. These agencies, often the only heath care services available to member of impoverished neighborhoods, employed public health nurses eager to take on the job of providing health care services to those unable to afford care. In 1886, a group of benevolent Philadelphian women established the District Nurse Society, later renamed the Philadelphia Visiting Nurse Service. The Visiting Nurse Service delivered care to those unable to afford or access health care services. Much of the early work of the Philadelphia Visiting Nurse Service revolved around maternal and infant services, with nurses assisting at home births and delivering follow up care after delivery. They also provided a variety of other services including care of the sick, clinic and school health work, and maintenance and promotion of health in community settings. For many, public health nurses were the connecting link to the health-care system, a position that public health nurses still hold today.

To obtain the full flavor of the essential work carried out by public health nurses and visualize how society dealt previously with public health, look through the photos posted at at the Pinterest site of the Bates Nursing Center. (Information about the full Philadelphia Visiting Nurse Service Photo Collection is posted at the University of Pennsylvania’s Barbara Bates Center for the Study of the History of Nursing.)

Jean C. Whelan, PhD, RN, is assistant director, Barbara Bates Center for the Study of the History of Nursing, and adjunct associate professor of nursing, University of Pennsylvania.

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