2: EVOLUTION OF PROFESSIONAL ROLES IN NURSING ■ 65issues in the hope of decreasing the incidence and prevalence of disease. As public fund-
ing increased with the increased incidence of communicable diseases, public health
nurses had a choice of employment in official agencies sponsored by the government at
the state and federal levels or in voluntary agencies, usually run by a board of commun-
ity women and men (Beckemeier, 2008).
Public health nurses working in privately-funded voluntary agencies special-
ized in caring for the entire family in their home. They routinely visited many families
each day to provide nursing care and to improve public health education practices in
the home. These nurses determined the needs of the families and worked in coopera-
tion with local boards and agencies to get services delivered. There were distinct skills
required by public health nurses that were not gained from private duty or hospital
experience (Dock, 1906). Hospital training did not provide the education to prepare the
public health nurse to work with the acute and chronic health care needs seen in the
community. In the early 1900s, public health nurses worked autonomously, caring for
patients who could not afford to seek treatment from a physician (Craig, 2003). Their
role thus changed with the growing organization of public health and the interest by the
federal government in providing services.
Physicians Emerged Dominant Over Nurses in Public Health Role
C.- E. A. Winslow, a Yale professor, physician, and leader in public health, ranked the
physician as the head of the team, but he strongly promoted nurses as integral to public
health campaigns. Indeed, early on, Winslow (1911) wrote very supportively of visiting
nurses, stating:
Yet it is, I think, more and more clear that the real strategic point is by the
bedside of the patient and at the elbow of the convalescent or the carrier.
Here the chain of infection can be broken far more surely and more economi-
cally than at any point. (Winslow, 1911, p. 909)
In his view, however, physicians would still make the diagnosis or program deci-
sions that public health nurses then carried out in the homes, schools, and workplaces
in the community. Winslow pushed health education as the change factor for success-
ful public health campaigns, giving the task to nurses to interpret and translate health
information to groups, families, and individuals. Attempting to decrease the individ-
ual’s exposure to communicable diseases, public health nurses broke down scientific
health information into doable tasks to be carried out by mothers, workers, children,
and teachers. Yet, although he respected their work and realized the necessity of their
work in conjunction with public health education, his writings show the continued
ambivalent thoughts about the professional role of the nurse. He described a public
health nurse as “a community mother but armed with expert knowledge which few
mothers can possess” (Winslow, 1923, p. 56).
Supported by administrators in the powerful, pro- medicine Rockefeller Foundation
in the 1920s, physicians were formally designated as the public health team leaders in
the governmental agencies. Universities, medical schools, and schools of public health
joined to educate physicians in bacteriology, statistics, and public health principles and
administration (Winslow, 1925). Graduates took positions in health departments and
were given the official title of health officer. Public health nurses in official agencies
were once again viewed in the position of assisting physicians to carry out public health
principles and programs. Under this model, public health nurses thus lost some of the
autonomy of practice in the homes of their clients and responded by shifting their focus
to prevention instead of treatment.