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HISTORY OF PUBLIC HEALTH NURSING
Public health nursing in the United States began in the late 1800's through the efforts of a few wealthy women in New York, Boston, Philadelphia, and Buffalo, who hired trained nurses to care for the poor in their homes. These nurses worked six days a week, eight to ten hours a day, and were able to visit eight to twelve patients each day.
New York City established a Division of Child Hygiene in 1880 in the New York Health Department. This Division demonstrated that public health nurses could reduce infant mortality through home visiting and teaching. In 1898, Los Angeles became the first city to officially employ a nurse to care for the sick in their homes. By 1910, many of the urban visiting nurses had initiated preventive programs for school children, infants, mothers, and patients with tuberculosis.
Legislation in March 1883 created a State Board of Health in Missouri. Its purpose was to protect citizens against the dreaded diseases of smallpox, typhoid, cholera and other communicable diseases.
The history of public health nursing in Missouri began in 1891 when the Ladies Society of Kansas City's First Congregational Church employed a graduate nurse to visit the poor in their homes. The following year, the Visiting Nurse Association of Kansas City was organized with this purpose:
"to provide skilled nursing care to the sick in their homes -- to teach health and the prevention of disease. By means of cooperation with allied social agencies, assistance was rendered in the solution of social and economic as well as health problems."
In St. Louis, visiting nursing was initiated in 1895, with the VNA incorporated in 1911. At this time, several insurance companies offered the added coverage of nursing care and partly subsidized the VNA.
Public health nursing in rural Missouri had its beginning in the post-war activities of the American Red Cross and the U.S. Public Health Service (1918-1919). The child health demonstrations sponsored by these agencies led to the passage of a bill by the legislature of 1919 which created a Division of Child Hygiene within the State Board of Health. The passage of the Federal Maternity and Infancy Act in 1921 made it possible for the State Board of Health, through the Division of Child Hygiene, to employ several public health nurses.
In 1919, an agreement was reached between the Missouri State Board of Health and the Southwestern Division of the American Red Cross Society, providing a director of the Division of Public Health Nursing of the Department of Health. The purpose of the division was to organize, coordinate and supervise public health nursing activities in the rural sections of the state. Those in charge of the work desired to have communities, such as counties, villages and townships organized for public health nursing.
From the beginning, the State Board of Health made an effort to keep in touch with all local public health nurses, whether employed by private or official agencies, through letters, bulletins, and field visits. The nurses were encouraged to turn to the state for advice and help; and the Division of Child Hygiene supplied records, forms, literature, and clinic service free of charge to all local public health agencies. During the first few years, most of the local services were supported by county chapters of the American Red Cross. As the Red Cross funds were exhausted, the services were gradually taken over by the county courts or school boards. Beginning in 1923, the Division of Child Hygiene offered financial aid to counties employing public health nurses; and from 1923 to 1931, thirty counties availed themselves of this privilege.
In the 1940's, the nursing division assisted in the development of regional educational conferences and offered scholarships to assist nurses to further their education. A plan for exchanging a rural nurse for an urban nurse was initiated with the Henry Street Visiting Nurse Association of New York City. Family case records were developed and an increase in tuberculosis and other communicable diseases occupied much of the field nurses’ time. Hospitals also received nursing consultation under the emergency maternity and infant care program. Senior cadet nurses received 4-6 months of training in the rural and urban areas.
In 1945, the Missouri Constitution provided for the establishment of a department to correlate health and welfare activities; and Senate Bill 349 created such a department.
The three major divisions set up within the department were:
Division of Health
Division of Welfare
Division of Mental Diseases
The 77th General Assembly Omnibus State Act of 1974 provided for reorganization as required by the amendment of Article IV of the state constitution and amended by House Bill 957 in the 1975 78th General Assembly. This created a Department of Social Services which included several divisions, including the Division of Health.
In 1976, the revised Missouri Nurse Practice Act permitted legal expansion of the nurse's rule. Also in 1976, the title "Public Health Nurse" was changed to "Community Health Nurse".
A division/bureau of nursing existed within the Department of Health from 1931-1995. A council of nursing met during some of this time. The following people were directors of the nursing division/bureau: Pearl McIver - 1931; Ella Hott - 1945-47; Lucille Whitesides - 1947-49; Mildred McMillen - 1949-50; Helen Kinney - 1950-58; Helen Pfaff - 1958-74; Jane Dey - 1976-92; and Vida Gorsegner - 1993-95. In 1995 the Department of Health was reorganized and the Bureau of Community Health Nursing was eliminated.
In 1997, the position of Public Health Nursing Liaison and the Council of Public Health Nursing (CPHN) were established. The CPHN was created to address issues that impact public health nursing and provide leadership, expertise, and coordination of public health nursing issues such as practice, standards, and training. The Council was composed of one nurse from each division and center and two district nurses.
In 1999, the Council of Public Health Nursing was restructured and expanded to include two standing committees, one representing the Department of Health (DOH) and the other representing the Local Public Health Agencies (LPHA). The DOH committee is composed of one representatives from each division, center and district within the Department of Health; and the LPHA committee is composed of one local public health agency nurse from each district. The Public Health Nursing Liaison serves as chair of the Council.
REFERENCES
Buhler-Wilkerson. (1985). Public Health Nursing: In Sickness or in Health. 75 (10), 1155-1160.
Bureau of Community Health Nursing. (1985). Community Health Nursing Manual.
Christ, Erwin. A. (1957). Missouri Nurses. Missouri Nurses Association. Jefferson City. 270-273.
Division of Nursing. (1931). Annual Report.
Division of Nursing. (1945). Annual Report.
Division of Nursing. (1987). Annual Report.
Falter, Darlene. Personal Interview. Office of Personnel, Training and Professional Development, Missouri Department of Health.
State of Missouri. (1967-68). Official Manual. 678.
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