Public Health Nursing Needs Recognition

The COVID-19 pandemic has pushed the field of public health into the spotlight. Yet nurses, who often work most closely with the community, have somehow remained largely in the background. (Stories from the Field) 

In the following article: Stories from the Field, public health nurses Susan Blue and Maureen Cava capture the essence of public health nursing. The six podcasts they developed showcase actual public health nurses telling their stories in order to recruit nurses and educate the general public. Canadian public health nursing shares a similar goal with their American counterparts: . . . putting energy and rescores into disease prevention instead of waiting until people get sick to spring into action. As a public health nurse, that means reaching the entire population to maintain and improve people’s health and quality of life. (Susan Blue)

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University of Toronto

September 30, 2021

Stories from the Field: Podcast on public health nursing launched with U of T support 

by Rebecca Biason

Susan Blue and Maureen Cava, both retired public health nurses, created the Stories from the Field podcast to shine a light on the important role public health nursing plays in the health-care system. 

The COVID-19 pandemic has pushed the field of public health into the spotlight. Yet nurses, who often work most closely with the community, have somehow remained largely in the background.

It’s an oversight Susan Blue, an alumna of the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing, and Maureen Cava, who was cross-appointed to the faculty and taught community health nursing, are hoping to rectify.

Both retired public health nurses, the pair decided to create a podcast called Stories from the Field to amplify nursing voices and help students and the wider public learn more about what public health nurses do – perhaps even consider it as a career. 

Stories from the Field’s six episodes (takes) listeners on a journey across Ontario as co-hosts Blue and Cava speak with public health nurses about everything from harm reduction and the opioid crisis to nursing leadership and the COVID-19 pandemic.

“I’ve worked in public health for almost 40 years, and I still get asked what hospital I work in,” (emphasis mine) says Cava, who is also the former president of the Ontario Association of Public Health Nursing Leaders. 

“We are passionate about public health and committed to ensuring the public, as well as other nurses, know what public health nursing means.”

“As a public health nurse, you are taking a preventative approach to the health and wellbeing of the community at large, as well as individuals,” adds Blue, “It’s why we hope to see more nurses in the field.”

The podcast is proudly sponsored by the Lawrence S. Bloomberg Faculty of Nursing’s Verna Huffman Splane Fund, an endowed award named after Verna Splane, a public health nurse who graduated from U of T in 1939 and enjoyed an illustrious career in nursing and health care.

“Maureen and Susan have captured the essence of what makes public health nursing essential and have shone a much-needed light on the work of our public health nurses,” says Linda Johnston, dean of the Lawrence S. Bloomberg Faculty of Nursing. “This podcast will be an important tool for future nurses to see the breadth of expertise that this particular field of nursing has to offer.”

Writer Rebecca Biason recently spoke with Blue and Cava about the importance of giving nurses a voice and what they are hoping the podcast’s listeners will learn.

What is the role of the public health nurse?

Blue: To me, public health nursing means putting energy and resources into disease prevention instead of waiting until people get sick to spring into action. As a public health nurse, that means reaching the entire population to maintain and improve people’s health and quality of life.

The community is our client and that’s something I’m very passionate about. Keeping people out of hospitals can make a real difference in their health.

Cava: Public health nurses play a significant role in policy development – things like food security, basic income, housing and other social determinants of health. That kind of preventative upstream approach is what we focus on to ensure people are healthy, physically fit, have harm reduction strategies and have the resources they need so they don’t end up in emergency rooms or hospitalized for things that are preventable.

It makes sense to put money into prevention, but there has been a chronic lack of funding since we’ve been in the field. Public health gets a small piece of the pie to do an inordinate amount of work in preventing people from getting sick. It is why we are so committed to our work, as we see the value in public health nursing as an investment in the future of society.

What led to the creation of Stories from the Field?

Cava: Public health nursing is not well understood – by nurses, by politicians, by the public. When I was the president of the Ontario public health nursing leaders association, it was one of my goals to ensure people knew about what public health nurses do and the impact they have.

When I worked at Toronto Public Health, many of the student nurses I encountered had no idea about the scope and breadth of all that is involved as a public health nurse. It was such an eye-opening experience for them, as I hope this podcast will be for other nursing students.

Blue: Maureen and I met in 1990 working for the former North York Public Health Department (now Toronto Public Health). So, having known each for other for 30 years, it wasn’t a huge leap to consider embarking on this project together. We both share a drive to ensure public health nursing is understood and valued as a key part of the health care sector and wanting public health nursing to be brought to the forefront.

What were some of the unforeseen challenges in creating the podcast?

Blue: Well, we are novice podcast hosts. We had listened to a few podcasts, but certainly hadn’t developed one. Maureen came across a podcast camp offered through Ryerson University, and we thought it would be a good way to get some knowledge under our belts.

Cava: Following that camp, we thought, “Oh, for sure we could do this!” But it turns out we were a bit naive about the whole process. We had some initial challenges getting funding for the podcast, but eventually after speaking with Dean Johnston of the Lawrence S. Bloomberg Faculty of Nursing, her support and that of the Verna Huffman Splane fund helped get our project off the ground.

Blue: COVID threw a wrench into everything. We thought we would be recording in a studio together, but soon we were met with a steep learning curve of having to set-up equipment and software on our own. We were grateful to the producers at Vocal Fry Studios for assisting us along the way, but it was very tough in the beginning.

Cava: COVID also meant that many of our nursing colleagues who we planned to have as guests were working full tilt, and that took precedence over everything. We were lucky to be able to eventually meet and interview many experienced public health nurses to share their stories. It just goes to show how involved public health nurses are across the health-care spectrum.

Do you have a favourite episode?

Cava: For me, “Episode Three: Frontline in a Pandemic” stands out. It tells a captivating story about the early stages of the pandemic and the work nurses do behind the scenes to get those shots into arms. It shines a light on the role they had across Ontario in a way that hasn’t really been shown throughout the pandemic. Public health nurses were front and centre since the beginning of the pandemic and are continuing to lead in their roles as things are evolving.

Blue: “Episode Two: Harm Reduction Approaches to Opioid Use” is a favourite. Our guest Rhonda Lovell spoke from a personal perspective about being a young mum and how her interactions with public health nurses during that time in her life motivated her to consider this field of practice and move into public health nursing. She shared such great insights and knowledge.

What are you hoping students and the public will take away from this podcast?

Cava: It goes back to why we started the podcast. We want students to be inspired and think about public health as a career choice. We want them to hear from public health nurses who are passionate and excited about what they do, so that they can see the depth and variety of opportunities there are to work with people and communities. And if they do choose public health, or have chosen it already, I hope this also inspires them to advocate and to give back to the field.

Blue: It’s a career where nurses have considerable variety and can move to other areas of practice. Public health nursing offers lots of flexibility, learning and growth opportunities. For the general public, I think just hearing these human-interest stories will change their viewpoints about public health. Hopefully anyone, whether they are a nurse or not, can relate to this content and be informed.

Cava: These are true stories from the field. We hope students, nursing colleagues and those in other disciplines will listen and consider the impact of public health nursing.

Three Trailblazing Nurses

Lorraine Starsky writes in the Pittsburgh Post-Gazette about three “extraordinary” Pittsburgh women who happened to be nurses. Each woman had provided services beyond the boundaries of the nursing role. 

My hope is that in the World Health Organization’s 2020 International Year of the Nurse and Midwife more “extraordinary” nurses will be the subject of media attention. 

I hope you enjoy these stories as much as I have. 

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Three extraordinary Pittsburgh women

In this International Year of the Nurse and Midwife, Lorraine Starsky tells the story of three women who were trailblazers 

LORRAINE STARSKY OCT 25, 2020 9:00 AM

In May 2019, long before COVID-19 became a worldwide pandemic, the World Health Assembly designated 2020 as the International Year of the Nurse and the Midwife.

The designation was, in part, to pay tribute to Florence Nightingale. Considered the founder of modern nursing, Nightingale was born on May 12, 1820, making 2020 the 200th year anniversary of her birth.

Nurses and midwives have had a long, rich history of safeguarding the health of people. Primarily they work without recognition and pass into history with their names unknown and their stories untold. In honor of the International Year of the Nurse and the Midwife, here are the remarkable stories of one midwife and two nurses who worked in the Pittsburgh area.

Hannah Sandusky

Hannah Sandusky was born in 1827 to a Jewish family in Kovno, Lithuania. With no doctor in the village, Hannah was taught important skills by accompanying her midwife mother as she assisted with local births. She married Louis Sandusky, a window glazer, who came to Pittsburgh in 1860. Hannah and their son joined him 1861. She began working as a midwife, as well as providing care to the many impoverished residents of the Hill District — newly arriving Eastern European immigrants and Blacks from the South.

Her reputation drew the attention of a local doctor who called on her intermittently to assist him with difficult deliveries. He was very impressed by her skill and in appreciation for her help, he sent Sandusky and her son, who had an eye problem, to Germany to see an eye specialist. During the time that her son received treatment for his eye, Hannah attended a recognized school of midwifery.

With her son’s eye treatments completed and her midwifery education finished, Hannah returned to Pittsburgh with formal certification as a midwife, making her one of only a few women in the U.S. with that credential. She delivered 3,571 registered births, but there were, no doubt, many more births that went undocumented. Her passion for providing care did not always carry over to paperwork and The Birth Registration Act didn’t go into effect until 1870. Regardless of the exact number of deliveries; it is an impressive feat since she accomplished this while she raised her seven children.

Sandusky was very kind-hearted and was known for providing her services for free. In situations where a family was facing hardship, she also gave food, baby clothes, and blankets after a birth. She was affectionately known as Bubbe (Yiddish for grandmother) Hannah throughout the Hill District. She was 82 when she delivered her last baby and died at age 86 on November 15, 1913.

Her legacy lives on through the Bubbe Hannah Fund at The Midwife Center for Birth and Women’s Health at 2831 Penn Ave. Donations to the fund underwrite services for individuals experiencing barriers to quality health care. The Midwife Center overcame attempts to drive it out of existence, flourished with grassroots support, and expanded to become the nation’s largest free-standing birth center operated by midwives.

An exquisite, art quilt portrait of Bubbe Hannah hangs on the waiting room wall sweetly looking on the families awaiting the midwives’ services.

Anna Heldman

Anna Heldman

Like midwife Hannah Sandusky, public health nurse Anna Heldman spent the bulk of her nursing career in the Hill District.

Anna Barbara Heldman was born in Castle Shannon on January 15, 1873. Early on, she felt the call of nursing and found work as a practical nurse at Allegheny Hospital in 1893 despite the fact that she had no training or experience. When South Side Hospital established a Hospital Training School for Nurses, Heldman enrolled and was given a year’s worth of credit for her two years of practical nursing at Allegheny Hospital.

She was among the first graduating class of the South Side Hospital Training School for Nurses, receiving her diploma on April 8, 1897. About a year later, she volunteered to serve as a nurse in the Medical Department of the United States Army during the Spanish-American War. She served in Florida, Georgia, and Cuba. When she returned from her tour of duty, she worked briefly as a private duty nurse.

Heldman didn’t find private duty nursing challenging. In 1902 she learned about a new type of nursing referred to as community visiting nursing, the genesis of public health nursing. She was hired at the Columbian School and Settlement in the Hill District modeled after the Hull House in Chicago.

It evolved into the Irene Kaufmann Settlement. At this time Pittsburgh had very high rates of tuberculosis and typhoid, with the Hill District being a hot spot since it was crowded with the poorest of the poor — Blacks escaping the South and new immigrants.

Initially Heldman was discouraged, but she persisted. She already was fluent in German and that helped her master Yiddish, which was useful for nursing Jewish immigrants. She also learned Syrian, Lithuanian, Polish, and Italian, which gained her the trust and affection of the community. She became a recurring sight in the Hill District’s streets and alleys carrying her black nurse’s satchel. Soon people began referring to Anna as “Heldi.”

Her commitment included fighting for better housing conditions, stricter labor laws in the Hill’s cigar factories, better schools, workers’ compensation and the first legal aid service. She and her staff nursed well over 1,000 flu and pneumonia victims during the 1918 flu epidemic.

In addition, she initiated numerous public health programs that ultimately became city services, including a visiting nurses service, a prenatal nursing service, baby clinics and regular medical inspection of students in Pittsburgh’s schools.

The Hill District became Heldman’s family as she never married or had children. Because her dedication touched the lives of so many men, women and children in her 38 years of service as a public health nurse, she became known as the “Angel of the Hill District.”

As an expression of gratitude for her devotion to the Hill District, the city in 1939 renamed Overhill Street, Heldman Street, which still exists. When she died in March 1940 at 67, her body was brought to the Irene Kaufmann Settlement House. Thousands filed past her coffin to pay their respects to the indomitable woman they called the “Angel of the Hill District.”

Evelyn Paige Parke

Evelyn Page Parker was born January 8, 1921 in Pittsburgh. While she was a student at Westinghouse High School, she knew she wanted to become a nurse. However, in 1940 no schools of nursing in Pittsburgh would admit Black students to become Registered Nurses, so she left for Philadelphia. She enrolled at Mercy Douglass Hospital School for Nurses, which was the first nursing school in Philadelphia for Blacks.

While at Mercy Douglass she took a course at Philadelphia General Hospital, where she learned that Blacks were not permitted to eat in their cafeteria. She was not deterred and continued to go to the cafeteria. Eventually the cafeteria cooks let her eat.

Later in life she related the story, “Everyone started looking at me, thinking ‘What’s she doing here?’ But then, they started letting African American students eat there.”

Parker graduated in 1943 from Mercy-Douglas. She persisted in her efforts to promote equality for Blacks. Philadelphia General Hospital finally opened its nursing school and internship programs to Black students in 1945.

In the meantime, she pursued her nursing career in Philadelphia. She focused on public health nursing and was instrumental in helping to found the Community Nursing Services of Philadelphia in 1959. During this time, she married, had a son, and worked on her bachelors in Nursing from the University of Pennsylvania, which was awarded in 1961.

In the late 60s Parker returned to Pittsburgh and enrolled at the Graduate School of Public Health at Pitt. She finished her Master’s degree in Public Health in 1969 and became a faculty member at the University of Pittsburgh’s School of Nursing until 1981.

She then taught at Duquesne University’s School of Nursing until 1984 when she retired. She mentored students at both universities throughout her career. Even in retirement, her passion for nursing and social justice burned bright as she continued to help young Blacks pursue their dreams of a career in nursing.

Parker volunteered for many causes, from the local NAACP chapter, the AARP health committee, American Heart Association’s Sister to Sister Program and many cancer survivors’ groups. Probably closest to her heart was the Pittsburgh chapter of the National Black Nurses Association, which is called Pittsburgh Black Nurses in Action.

Evelyn remained a devoted member until her death in 2008. In her obituary, her son Tom Parker said “I think the challenges she faced just motivated her more.”

Today the Pittsburgh Black Nurses in Action carries on her legacy by offering support to prospective Black nursing students and addressing health disparities in the community. The Evelyn Paige Parker Scholarship is awarded annually.

Lorraine Starsky BSN, RN, retired in 2019 as a Public Health Nurse with the Allegheny County Health Department. She is working part time currently as a community health nurse consultant for Project Destiny. She can be reached at lorrainestarsky@gmail.com

First Published October 25, 2020, 9:00am