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doi: 10.1097/01.NURSE.0000414875.67606.a1
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Remembering visionaries in nursing practice

Voda, Sandra C. MSN, RN-C, ONC

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Sandra C. Voda, a recently retired nurse, is currently a nutrition educator in the Prenatal Access to Care Program in Burlington County, N.J.

The author has disclosed that she has no financial relationships related to this article.

ALL NURSES STRIVE to provide the best care for their patients, but some bring a special wealth of initiative and originality to the profession. This article highlights four such nursing activists who are recognized for their tireless efforts to make healthcare accessible to the poor and underserved throughout the United States.

* Lillian Wald, a nursing leader, created a foundation for public health in her urban neighborhood.

* Lavinia Lloyd Dock, a nurse educator, improved nursing practice and education.

* Mary Breckinridge, a nurse midwife, used her vision to bring homecare and midwifery to rural America.

* Susie Walking Bear Yellowtail, a nurse advocate, dedicated her working life to improving living conditions and services on American Indian reservations.

Explore how these visionary nurses created the framework that guides nursing practice today. For more information, see Recommended historical reading for nurses.

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Lillian Wald (1867–1940)

Social reformer and activist

Founder of the Henry Street Settlement

After Lillian Wald graduated from the New York Hospital Training School for Nurses in 1891, she took additional courses at the Woman's Medical College. Wald, a member of a prominent German-Jewish family, became interested in nursing after her sister became ill. In 1893, Wald and Mary Brewster, another nurse, moved into New York's Lower East Side. It was here that Wald became familiar with the poor living conditions of immigrant families in the tenement district of this culturally diverse and underserved neighborhood of Manhattan.1 Both of these nurses offered their services as visiting nurses.

With financial aid from a banker, Wald created the Nurses' Settlement. Here she taught immigrant women about health and hygiene. As her community of nurses grew to 250 in 1929, nursing services were increased to include a nurse's training program, community education programs, and youth clubs. The Nurses' Settlement came to be known internationally as the Henry Street Settlement.1

In 1902, nursing services were extended to a local public school program in Lower Manhattan and then became the first citywide public school nursing program in the world. At Wald's suggestion, insurance companies began to provide visiting nursing services for their policy holders.2 District nursing services were begun for the American Red Cross in 1912.1

Wald is also considered the founder of the profession of public health nursing. In 1912, she became president of the National Organization for Public Health Nursing. She helped found Columbia University School of Nursing and the U.S. Children's Bureau.3 Wald also influenced the organization of the National Child Labor Committee and the National Women's Trade Union League.1

Lillian Wald worked hard to start educational, recreational, and social programs in underprivileged urban neighborhoods. As a social activist, she recognized that reform was needed in areas of child labor and women's rights. Lillian Wald is one of the most respected and influential reformers in nursing history.

Because of Lillian Wald's vision, nurses today are found coordinating community education for self-management of chronic diseases, senior centers and programs for older adults, children's health and school immunization programs, and women's issues and health programs. Because Wald influenced insurance companies to employ nurses, case manager nurses now work for these companies.

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Lavinia Lloyd Dock (1858–1956)

Nurse educator and social reformer

Lavinia Lloyd Dock, who was born into a prosperous family, was educated as a nurse at New York City's Bellevue Hospital in 1886. While serving as a visiting nurse among the poor, she put together the first manual of drugs for nurses entitled Materia Medica for Nurses 1890. Dock joined the Henry Street Settlement in Lower Manhattan and worked with Lillian Wald to improve healthcare for those living in poverty.4

Dock also worked to improve education in the nursing profession by teaching, lecturing, and writing. She was a contributing editor for The American Journal of Nursing and wrote most of a four-volume nursing history book entitled History of Nursing.4

After retiring from nursing, Dock lectured about social issues affecting women and became an activist who focused on improving work conditions and eliminating prostitution and venereal disease. She was also an early advocate for birth control.6 Dock advocated for the right for women to vote.5 She also encouraged workers to unite in trade unions.6

Because Dock advocated for better education, nurses today have many nursing resources available to them. Today's nurses have the opportunity to become educators, editors, and authors.

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Mary Breckinridge (1881–1965)

Founder of the Frontier Nursing Service, Frontier School of Midwifery and Family Nursing, Courier Program, Mary Breckinridge Hospital, and rural health clinics

Mary Breckinridge was a woman of means from a distinguished southern family. During her childhood, she was educated by tutors and traveled extensively, becoming familiar with many different cultures and lifestyles. At age 23, she married an attorney, but he died of appendicitis after only 2 years of marriage. After his death, she attended and graduated from Saint Luke's Hospital School of Nursing in New York City. She married again and had two children.7 Her daughter was born prematurely and died, and her son died from complications of appendicitis at age 4.

In 1920, she divorced and restored her maiden name. Influenced by these tragic personal events, Breckinridge turned to nursing and devoted herself to helping children.7

Serving as a volunteer with the American Committee for Devastated France after World War I, she became acquainted with nurse midwives in France and Great Britain. She attended classes and studied in England. There Breckinridge formulated the idea of bringing healthcare to underserved people living in the Appalachians.

Because there were no midwifery programs in the United States, Breckinridge returned to England at age 43 to study midwifery and obtain certification. Breckinridge then brought trained English midwives to the mountains of Kentucky.

She started the Frontier Nursing Service in Leslie County, Ky., in 1925. Her project introduced a complete healthcare system to this underserved area, forming the country's first rural healthcare system. Breckinridge and her nurses combined prenatal visits with home visits to children, families, and older adults, traveling on foot or on horseback to cabins along creeks and in remote mountain areas with no roads and poor phone service.8

The Frontier Nursing Service converted the region with the nation's highest childbirth mortality to one with a rate below the national average. Breckinridge funded this project with her own money and through private donations.8

In 1939, Breckinridge started the Frontier School of Midwifery and Family Nursing, which is still in existence today along with a distance learning program. At the same time, the Courier Service began to provide medical supplies and news to outlying clinics in the mountains. Today the Frontier Nursing Service includes a hospital, a home health agency, and four rural clinics that provide preventive health services, primary care, programs for managing chronic diseases, and women's and children's health services.8

The Frontier School of Midwifery and Family Nursing is now the largest nurse-midwifery school in the United States. Its programs include a master of science in nursing with tracks to nurse midwife, family NP, and women's healthcare NP; ADN-MSN bridge program; post-master's programs; and a doctor of nursing practice degree. Many nurses who live in rural areas of the United States pursue their education through the distance learning program.

Mary Breckinridge engaged many people and traveled extensively to raise funds for her programs. Her projects were successful because she involved the community she served. She counted on the participation of local people, who often provided ideas on how to best offer services to their neighbors.9

Many of Breckinridge's ideas of nursing service don't fit traditional health and educational programs, yet they've become a model for public health and educational programs for underserved people in the United States. Today many family care centers in poor communities offer health education, healthcare, and social services. When educators and nurses follow Mary Breckinridge's policy of surveying the targeted community to find out what issues are important to that community before initiating a new health program, then the whole community becomes involved in the management of their care.

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Susie Walking Bear Yellowtail (1903–1981)

Advocate for American Indian people

A member of the Crow Tribe, Susie Walking Bear Yellowtail was the first American Indian to become an RN.10 She studied nursing at Franklin County Memorial Hospital in Northfield, Mass., before practicing at Boston City Hospital.11

Yellowtail provided healthcare and nursing services on the Crow reservation where she took a position with the Indian Health Service in Minnesota and Montana. Here she used Indian remedies along with conventional nursing practices she learned in Boston. Yellowtail later traveled extensively on Indian reservations throughout North America, observing poor living conditions.11

Evaluating life on reservations, she observed a lack of basic nursing and medical care for children and mothers because of the lack of outpatient clinics and hospitals on reservations. For instance, some babies died on their mothers' backs because the women had to walk 20 to 30 miles to reach a hospital. Yellowtail advocated for social services, better educational opportunities, and healthcare on reservations. She also advocated for an end to forced sterilization of American Indian women.12

In the 1970s, Yellowtail was appointed to President Nixon's Council on Indian Health, Education, and Welfare Board and the Federal Indian Health Advisory Committee, where she suggested solutions and recommended action plans to improve living conditions on U.S. Indian reservations. She also founded the Native American Nurses Association.11

Susie Walking Bear Yellowtail was an advocate for better education for American Indians and devoted her life to improving how they were treated. Even though Yellowtail accomplished much, healthcare, social services, and education for American Indians remain poorly funded and infant mortality continues to be high. Nurses are still needed to be the voices for American Indians and to advocate for better healthcare and living conditions on reservations.

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Voices still resonating today

These women of vision provided part of the framework of healthcare and social reform for underserved people and those living in poverty throughout the United States. They also paved the way for many advances in nursing care, nursing education, and women's rights. By following their ideas and strategies, we can continue their efforts to improve health and nursing care to all people equally.

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Recommended historical reading for nurses

* Breckinridge M. Wide Neighborhoods: A Story of the Frontier Nursing Service. Lexington, KY: The University Press of Kentucky; 1981.

* Buchannan P, Parker VK, Zajdel RH. Birthin' babies: the history of midwifery in Appalachia. Paper presented at the Annual Conference of the Women of Appalachia: their Heritage and Accomplishments. Zanesville, OH; October 26–28, 2000. http://www.eric.ed.gov/PDFS/ED464795.pdf.

* Dock LL. Text-book of Materia Medica for Nurses. 7th ed. rev. New York, NY; London: G.P. Putnam's Sons; 1921.

* Hinkell T. Nurse of the 20th Century: Susie Walking Bear Yellowtail: First Native American Registered Nurse. Shelburne, MA: Therese Hinkell, R.N.; 2000.

* Nutting MA, Dock LL. A History of Nursing; the Evolution of Nursing Systems from the Earliest Time to the Foundations of the First English and American Training School for Nurses. New York, NY, London: G.P. Putnam's Sons; 1907–1912.

* Wald LD. The House on Henry Street. New York, NY: Henry Holt and Co.; 1915.

* Wald LD. Windows on Henry Street. Boston, MA: Little, Brown; 1934.

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REFERENCES

1. Encyclopaedia Britannica Online. Lillian D. Wald. 2012. http://www.britannica.com/EBchecked/topic/634378/Lillian-D-Wald.

2. Florida Atlantic University Libraries. Jewish heroes and heroines in America. Lillian D. Wald: a pioneer in public health concerns. 2006. http://www.fau.edu/library/bro51.htm.


4. American Nurses Association. Nursing World. Lavinia Lloyd Dock (1858–1956) 1976 Inductee. http://www.nursingworld.org/LaviniaLloydDock.

5. Arizona State University. Biography of Lavinia Lloyd Dock. http://www.asu.edu/nursing/courses/nur361/leader07/bio.html.

6. American Association for the History of Nursing. Lavinia Lloyd Dock, 1858–1956. http://www.aahn.org/gravesites/dock.html.

7. Frontier Nursing Service. Mrs. Mary Breckinridge. http://www.frontiernursing.org/History/MaryBreckinridge.shtm.

8. Frontier Nursing Service. How FNS began: a brief history of the Frontier Nursing Service. http://www.frontiernursing.org/History/HowFNSbegan.shtm.

9. Encyclopaedia Britannica Online. Mary Breckinridge. 2012. http://www.britannica.com/EBchecked/topic/78640/Mary-Breckinridge.

10. Hinkell T. Nurse of the 20th Century: Susie Walking Bear Yellowtail: First Native American Registered Nurse. Shelburne, MA: Therese Hinkell, R.N.; 2000.


12. American Nurses Association. Nursing World. Susie Walking Bear Yellow Tail (1903–1981) 2002 Inductee. http://www.nursingworld.org/SusieWalkingBearYellowtail.

© 2012 Lippincott Williams & Wilkins, Inc.

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