Editor’s note: This is an edited and condensed version. For a full version, and more on the state of nursing in Maine, visit Diane Atwood’s blog at dianeatwood.com.
By Diane Atwood
Maine’s first public health nurse was Edith Soule. In 1920, Edith was named director of the newly created Division of Public Health Nursing and Child Hygiene. Two years later she asked Gov. Percival Baxter for funding to hire more nurses who could travel throughout the state.
The primary role of the public health nurses was to improve the health of pregnant women and their babies and reduce the infant mortality rate. Over the years, the program grew, reaching as many as 100. In September 2017, there were 10. Today, it’s estimated that there are about 16 public health nurses in Maine. Estimated, because no one I asked knew for sure.
These are some examples of the accomplishments of Maine’s Public Health Nursing Program:
They were our army for addressing any kind of outbreak. We would send them to an outbreak location and they would investigate the source (with direction from us in Augusta) and provide guidance.
They would conduct vaccine clinics, either in an outbreak or other situations when needed.
During the ice storm of 1998, they went door to door in the heaviest hit areas to make sure people were operating generators properly and were okay.
After 9/11, they were more fully trained in public health emergency preparedness, and were indeed on the frontlines of anthrax threats, vaccinating people against smallpox, and more.
The Public Health Program’s 2010 annual report, which marked its 90th anniversary, included these statistics for that fiscal year: 4,133 unduplicated clients; 21,581 hours of service; 10,382 hours for individuals; 4,503 hours for population-based services; 6,696 hours for non-visit case management.
The annual report also pointed out that Maine’s Public Health Nursing Program had been granted full accreditation by meeting national standards of excellence as put forth by the Community Health Accreditation Program. “We were one of, if not the only one in the nation,” said the program’s former director, Jan Morrissette.
The following year, 2011, when Gov. Paul LePage took office, it soon became clear to Morrissette, that there would be little to no support for the program. She moved on. Her position was filled, but other open positions were not.
Sarah DeCato, who worked under Morrissette for four years, said, “What I love about public health nursing, in particular, is that it really focuses on health promotion and prevention.”
“When public health nurses go into the home, they are not only assessing the child’s and the mother’s well-being, they are assessing the well-being of everyone in the home,” said Rebecca Boulos, executive director of Maine’s Public Health Association. “They are assessing if the heat is turned on or if there is food or if the home is safe. One of the most important things about public health nurses is that they’re trained to look at that entire environment, not just a checklist of indicators for a child’s well-being. If those needs aren’t being met, they would know what kind of resources are available in the community. They visit for many weeks. It’s a continuing relationship.”
DeCato left Maine’s Public Health Program in 2014. In late 2015, she reached out to the Public Health Nursing Program to discuss collaborating on a project. “I started to hear that things were happening at the state level in regards to dismantling the [public health nurse] workforce…Positions weren’t being filled, nurses were being told they weren’t being productive, and work environments were becoming very micromanaged.”
In the fall of 2016, State Sen. Brownie Carson, D-District 24, read about what was happening with the public health program. “I learned about the intentional dismantling of Maine’s public health nursing program and it didn’t make sense to me,” he said. “The more I learned, the more I thought this was a serious mistake, not just because of the essential value of public health nurses, but because it was an inexpensive way to keep newborns or nearly newborn kids from having to go back to the hospital and from having much more invasive care that separates them from their moms and can be very expensive.”
His bill, LD 1108, an Act to Restore Public Health Nursing Services, had a goal to restore 59 positions. At a public hearing before the Legislature’s Health and Human Services Committee in April 2017, 59 people testified. Fifty-eight spoke in favor of the bill. One person spoke against the bill — Dr. Christopher Pezzullo, state health officer. He said that there were concerns it would be costly and harm existing collaborative efforts. I reached out to Pezzullo for further explanation, but have not yet received a response.
Carson’s bill passed; LePage vetoed it, as expected, but the House overrode the veto 101-34.
The law mandates the Maine Department of Health and Human Services fill 48 positions that were already funded and budgeted for the current fiscal budget. The deadline for filling the positions was March 1, but it looks like only nine have as of this writing.
DHHS Commissioner Ricker Hamiltons said in February in a mandated report to legislators that Maine is experiencing a nursing crisis and that DHHS had partnered with the University of Maine System and the Maine Nursing Action Coalition to address it and the department is making progress complying with the new law.
In the meantime, it doesn’t appear that any job openings for public health nurses are even being listed on the DHHS website.
What worries Boulos is the possible consequences of not rebuilding Maine’s public health program. “The clearest example of the downside of not having a strong public health infrastructure has thankfully, not happened yet,” she said, “which is a significant infectious disease outbreak. If that were to happen, the lack of a public health nursing system would be very, very apparent.”
For many years, Diane Atwood was the health reporter on WCSH6. Now she is a blogger and podcaster at Catching Health with Diane Atwood, dianeatwood.com.
