64 ■ I: HISTORICAL AND THEORETICAL FOUNDATIONS FOR ROLE DELINEATION
nurses participated and started a new role for nurses: short term caring for and educat-
ing families in their homes. The settlement house movement, which flourished in many
cities beginning in the late 1800s, interested many individuals from all walks of life who
subscribed to a belief in social welfare, and who sought to help raise the lives of the
poor immigrants (Wade, 1967). Their social activism was intentional and aimed at the
social determinants of health by assisting immigrant families to acculturate to urban
life in America by improving their employment, the sanitation of their living arrange-
ments, and their health. Lillian Wald, Mary Brewster, and other nurses formed the
world famous Henry Street Settlement House in New York in 1893, financed by wealthy
patrons who saw the value of improving the health and welfare of the urban working
poor (Buhler- Wilkerson, 1991). Living in the neighborhoods they served, nurses visited
tenement homes providing nursing care and health education to all members of the
family, and providing information to educate them about their capacity to care for them-
selves and to enhance their health. In the new role of the public health nurse another
opportunity was provided to increase the professionalism of nurses due to its require-
ments of higher education, specialized knowledge, and a more autonomous practice
(Brainard, 1985).
During the early 1900s, public health initiatives aimed to decrease disease, but the
social issues connected with disease remained. Despite great efforts by public health
nurses, poverty often limited individual choices and the ability to live a healthy life.
Public awareness of growing health problems created the perfect link between public
health and social reforms, forging a place for nurses to address health policies caused
by urbanization, poverty, and disease (Porter, 1994). In recognition of this need for
more specialized training for this role, Simmons College in Boston in 1904 began an
8- month course for public health nurses (Nutting, 1904). These public health nurses,
referred to as visiting nurses , worked for two types of agencies, voluntary and offi-
cial. The privately funded voluntary organizations were funded by communities and
philanthropies were run by board members who hired public health nurses. Official
agencies of the federal and state governments funded public health nurse positions
supported by tax dollars.
The National Organization of Public Health Nurses (NOPHN), started in 1912,
played a role in shaping public health nursing and attempted to bring this branch of
nursing to a higher professional level. The NOPHN promoted standards of education,
leadership, supervision, and employment and gave advice to groups looking to employ
a public health nurse. Their journal Public Health Nurse , founded in 1912, was a resource
for nurses and committees looking for legislation, statistics, health information, and
programs. Physicians contributed to the journal, writing about communicable diseases
and treatments carried out by the nurses in the home. Although NOPHN recommenda-
tions were available, there was a very limited number of employable, educated public
health nurses who met them. As a result, many organizations overlooked the NOPHN’s
minimum standards and hired unprepared nurses to public health positions, which in
many cases did not have supervisors or other nurses to assist the newly hired nurses
to fulfill their job requirements (Buhler- Wilkerson, 1987). Although the hiring of public
health nurses continued to rise, it was due to the increasing number of agencies hiring
a single public health nurse, ultimately limiting the number of citizens who came into
contact with this service (Giacomo, 1953).
With the continued rise of organized nursing and a growing diverse population,
philanthropic organizations pushed for national policy reforms and programs that
included positions for public health nurses and helped promote an increase in govern-
ment support for employing nurses (Magat, 1989). These official agencies were funded
at a variety of government levels, and employed public health nurses to address health