Nursing Leader: Lillian Wald

This is a series of post regarding notable nursing leaders who have given many contribution to nursing and their influence uplifted the nursing profession.


Nursing Leaders
Florence Nightingale, Clara Barton, Lillian Wald, Lavinia Dock, Margaret Sanger, and Mary Breckinridge are among the leaders who have made notable contributions both to nursing's history and to women's history. These women were all politically astute pioneers. Their skills at influencing others and bringing about change remain models for political nurse activists today. Contemporary nursing leaders, such as Virginia Henderson, who created a modern worldwide definition of nursing, and Martha Rogers, a catalyst for theory  development


Wald (1867-1940)
Lillian Wald (Figure 1-13 •) is considered the founder of public health nursing. Wald and Mary Brewster were the first to offer trained nursing services to the poor in the New York slums. Their home among the poor on the upper floor of a tenement, called the Henry Street Settlement and Visiting Nurse Service,provided nursing services, social services, and organized educational and cultural activities. Soon after the founding of the

Lillian Wald invented public health nursing in 1893, making this year the field's centennial. One of nursing's visionaries, Wald secured reforms in health, industry, education, recreation, and housing. This historical inquiry examines three of Wald's critical experiments, each of which illuminates the past of public health nursing and its contemporary dilemmas: invention of public health nursing itself, establishment of a nationwide system of insurance payments for home-based care, and creation of a national public health nursing service.

Lllian Wald was born into a comfortable Jewish family in 1867, but chose to work in the tenements of New York City. She coined the phrase “public health nursing” and is considered to be the founder of that profession.

Lillian was educated at a private boarding school. She had graduated from a two-year nursing program and was taking classes at the Women’s Medical College when she became involved in organizing a class in home nursing for poor immigrants on New York’s Lower East Side. Lillian, distressed by the conditions in the multi-story walk-up, cold-water flats, moved to the neighborhood and, along with her classmate and colleague Mary Brewster, volunteered her services as a visiting nurse. With the aid of a couple of wealthy patrons, the operation quickly grew in size. The Henry Street Settlement (otherwise known as the VNS, or Visiting Nurse Service) grew from 2 nurses in 1893 to 27 in 1906, and to 92 in 1913.

The nurses educated the tenement residents about infection control, disease transmission, and personal hygiene. They stressed the importance of preventative care, but also provided acute and long-term care for the ill. They received fees based on the patient’s ability to pay. The organization also eventually incorporated housing, employment, and educational assistance and recreational programs as well. In 1912, Wald helped found the National Organization for Public Health Nursing, which would set professional standards and share information. She served as its first president.

Her other accomplishments included:
• Persuading President Theodore Roosevelt to create a Federal Children’s Bureau to protect children from abuse, especially exploitation such as improper child labor.
• Lobbying for health inspections of the workplace to protect workers from unsafe conditions and encouraging employers to have nursing or medical professionals on-site.
• Convincing the New York Board of Education to hire its first nurse, which lead to the standard practice within in the U.S. of having a nurse on duty at schools.
• Persuading Columbia University to appoint the first professor of nursing in the country, and initiating a series of lectures for prospective nurses at Columbia’s Teachers College. This became the basis a few years later for the University’s Department of Nursing and Health and caused nursing education to shift away from solely hospital-taught training to university courses augmented by hospital fieldwork.

Wald wrote two books about her experiences, The House on Henry Street, and Windows on Henry Street. She died in Westport, Connecticut, on September 1, 1940. Wald’s legacy is seen in the lasting good of her many accomplishments in the areas of public health and social services, not the least of which is her founding of the VNS. The New York Visiting Nurse Service continued to grow and thrive, increasing to 3,000 employees, with the number of people served annually now totaling 700,000. The original VNS is still a model for the 13,000 visiting nurse groups which exist today.

Wald said, “Nursing is love in action, and there is no finer manifestation of it than the care of the poor and disabled in their own homes.”

Summary
Wald coined the term "public health nurse" in 1893 for nurses who worked outside hospitals in poor and middle-class communities. Specializing in both preventative care and the preservation of health, these nurses responded to referrals from physicians and patients, and received fees based on the patient's ability to pay. In response to growing demand from all sides, Wald helped to initiate a series of lectures to educate prospective nurses at Columbia University's Teachers College in 1899. Students attended classes at Columbia and received their field training at Henry Street. This series led to the formation of the University's Department of Nursing and Health in 1910. By 1912, public health nurses—sometimes called visiting or district nurses—had begun to have significant impact. Wald and her colleagues in the public health movement recognized the need for the establishment of professional standards for public health nurses. Like other professional organizations, the National Organization of Public Health Nurses (NOPHN) was designed to set professional standards, share techniques and protect the reputations of its members. Wald was elected as the organization's first president.