A History of Public
Health Nursing
Michael L. Adams, RN
NU 362: Intro to Health Promotion
Mississippi University for Women
Outline
• Definition
• Origins of Public Health Nursing
 Florence Nightingale
 Beginnings in the United States
• Public Health Nursing in the 20th Century
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Early 1900s
World War I
African-American nurses in Public Health
Between World Wars
Increasing Chronic Illness
1960s
Outline (cont’d)
• Public Health Nursing in the 20th Century (cont’d)
 1970s into the 21st Century.
• Public Health Nursing Today
• The Future of Public Health Nursing
• Conclusion
Definition
According to Stanhope & Lancaster (2016),
public health nursing practice is the synthesis
of nursing theory and public health theory
applied to promoting and preserving health of
populations.
Origins of Public Health Nursing
Florence Nightingale
• Born in Florence, Italy in 1820
• Known as the founder of modern nursing
(History, 2016)
• Established the first school of nursing
• The school credited as the first institution to train
professional nurses.
Origins of Public Health Nursing
Florence Nightingale (cont’d)
• During the Crimean war, the field hospital for
injured soldiers was very unsanitary.
• She improved the conditions at the field hospital
with simple interventions.
• Became known as the “Lady with the Lamp,”
due to her affection toward patients.
Origins of Public Health
Nursing
United States
Public health nursing in the United States
began with organizing to meet urban health
care needs, especially for the disadvantaged
(Stanhope & Lancaster, 2016). The American
Red Cross started home nursing care outside
of large cities.
Origins of Public Health
Nursing
United States (cont’d)
As the importance of public health nursing was
slowly being realized, Lillian Wald became a key
leader of the field in its early days. (Stanhope &
Lancaster, 2016).
She believed healthier people were more
productive members of society.
Origins of Public Health
Nursing
United States (cont’d)
Wald’s efforts with the American Red Cross
were able to encourage the creation of public
health departments.
Public Health Nursing in the
20th Century
Early 1900s
• When the 19th century ended, there were almost
40 states with established health departments.
• The federal government expanded their role in
public health.
• Dealing with infectious and parasitic diseases
were an early goal of federal public health.
Public Health Nursing in the
20th Century
World War I
During World War I, a nurse was loaned to
the U.S. Public Health Service to establish
public health outposts for military outposts.
This was the first federal sponsorship
of nurses (Stanhope & Lancaster, 2016).
Public Health Nursing in the
20th Century
World War I (cont’d)
During the peak of the war, the U.S.
was sending 100 nurses a day to the
war (Stanhope & Lancaster, 2016).
Public Health Nursing in the
20th Century
African-American nurses in public health
• Faced many challenges due to segregation
• Dealt with racial and wage discrimination
• Had a significant positive impact on their
communities.
Public Health Nursing in the
20th Century
Between the World Wars
The poor economy the 1930s had a drastic effect
of the development of nursing. The impoverished
had an increased need for nursing services that
weren’t available due to low funding.
The federal government put in place several
funding programs to increase public health nursing.
Public Health Nursing in the
20th Century
Between the World Wars (cont’d)
The expansion of federal government in the 1930s
effected the structure of community health resources
(Stanhope & Lancaster, 2016).
In 1935, creation of the Social Security Act provided
much needed funding to expand public health
services.
Public Health Nursing in the
20th Century
World War II
The war increased the need for nurses. They were
needed at home and overseas. This need lead to
federal funding to train new nurses.
After the war, public health facilities saw an increase
in emotional problems, accidents, and alcoholism
(Stanhope & Lancaster, 2016).
There were multiple medical advancements during
this time, such as antibiotics and photofluorography.
Public Health Nursing in the
20th Century
Increasing Chronic Illness
Due to the decrease in mortality in the first half of the
20th century, there was a significant increase in
chronic illness.
The public health field was forced to emphasize
chronic disease prevention and treatment.
The nursing field’s practice expanded to include the
psychosocial aspects of clients and their families.
Public Health Nursing in the
20th Century
1960s
The Social Security Act, which included
Medicare and Medicaid was introduced in
1965. The new funds provided by the act led
to an increase in home health care.
Public Health Nursing in the
20th Century
1970s into the 21st century
During the 70s and 80s, the cost of health care
increased greatly. This led to shifting of funds to
acute care from public health.
This led to a general decline in public health that
was noted as early as the late 1980s.
To reverse this decline, the federal government
enacted programs like Healthy People.
Public Health Nursing in the
20th Century
1970s into the 21st century (cont’d)
In the 1990s, several nursing groups lobbied for
health care reform.
They felt issues like access, quality, and cost of
healthcare needed improvements.
In 2010 the Affordable Care Act was passed.
Public Health Nursing in the
20th Century
1970s into the 21st century (cont’d)
Nursing education improved during this period.
Many professional nursing associations and
groups issued position papers to this sentiment.
The ANA developed Scope and Standards of
Public Health Nursing Practice, and periodically
revises it to maintain it’s currency.
Public Health Nursing Today
Advanced education in public health nursing is
becoming more available.
School nurses are slowly increasing nationwide.
Increased research and evidence shows the value
of public health nursing.
Caring for increasing elderly population remains a
challenge
Remember mistakes of the past, so they aren’t
repeated
The Future of Public Health
Nursing
As the importance of preventing, instead of
treating, disease is further realized, public health
nursing will remain a growing field.
Since the field is likely to grow, more nurses will
be needed to practice in the public health setting.
The Future of Public Health
Nursing (cont’d)
As a nation, we mustn’t forget the mistakes of the
past.
We still only spend 3% of healthcare dollars in
preventing disease (Writers, 2019)
We must keep public health programs adequately
funded.
Conclusion
Public health nursing has undergone a multitude
of changes since it’s beginning. The positive
impact of the field cannot be denied. As a nation,
we have witnessed what happens when public
health is not properly funded. To keep our citizens
healthy, we must maintain proper funding and
research in the field of public health nursing.
References
[History]. (2016, February 29). Florence Nightingale: Changing
the Field of Nursing - Fast Facts | History [Video File]. Retrieved
from https://www.youtube.com/watch?v=B94Zf4Vye3Y
Stanhope, Marcia, and Jeanette Lancaster. (2016) Public Health
Nursing: Population-Centered Health Care in the Community.
9th ed., Elsevier.
Writers, Staff. “The Need for Public Health Nurses on the Rise 2019 NurseJournal.org.” NurseJournal.org, NurseJournal.org,
10 Sept. 2019, nursejournal.org/community/need-for-publichealth-nurses-on-the-rise/.