History of Public Health Nursing in Missouri

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. In 1880, New York City established a Division of Child Hygiene 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.

In March 1883, a State Board of Health was created in Missouri. Its purpose was to protect citizens against the dreaded diseases of smallpox, typhoid, cholera and other communicable diseases. Public health nursing began in Missouri 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, and the Visiting Nurses Association (VNA) was incorporated in 1911. At this time, several insurance companies offered 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 that 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.

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 Department of Social Services was created in 1974 and included several divisions, including the Division of Health. The title, public health nurse was changed to community health nurse in 1976. The Department of Health was created in 1987.

There was a division/bureau of nursing from 1931-1995 and a council of nursing met during some of this

Time. In 1997, the position of Public Health Nursing Liaison and the Council of Public Health Nursing were established.

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.

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