Purpose of study: The purpose of this social historical study is to identify, describe, and analyze the origins and evolving role of the school nurse in the largely rural counties of Virginia, 1900-1925. A particular focus is set on investigating how rurality, poverty and race affected the Commonwealth of Virginia’s attempts to develop and provide school nursing throughout the diverse rural counties across the state. Understanding the connection and collaboration of community support in order to catalyze the role of the school nurse from a historical perspective, can inform current policy on advocacy for the role of the school nurse today.
Rationale and significance: School nurses today continue to face the same struggles as the first school nurses in Virginia in the early 1900s. It is a different time and society, with different social and physical health concerns; yet similar problems, particularly as they relate to rurality, poverty and race remain much the same. Thus, just as the Virginia State Board of Health and the first school nurses demonstrated heroic measures in identifying and attempting to meet the needs of rural school aged children and their families at the turn of the 20th century, today’s school nurses must demonstrate knowledge, persistence, and creative ingenuity in doing the same.
Description of methodology: Traditional historical methods with a social history framework were used in this investigation.
Major primary and secondary sources: Primary sources included The Lillian D. Wald Papers New York Public Library, Lillian D. Wald Papers Columbia University Library. Published works by Lillian Wald, Lavinia Dock, Lina Rogers and other nursing leaders at the turn of the twentieth century were evaluated. Primary sources also included Archived Instructive Visiting Nurse Association papers, Archived Annual Reports from the Commissioner of Health to the Governor of Virginia, 1905 – 1926, Archived Annual Reports from the Superintendent of Education to the Governor of Virginia, Archived Report: A Sanitary Survey of the Schools of Orange County, Virginia, The Virginia Health Bulletin (Archived Editions), The Virginia Journal of Education (Archived Editions), Biography of the Richmond Professional Institute, historical newspaper accounts and numerous historical journal articles written by leaders in public health in the early 20th century. Secondary sources included published books, government websites, nursing, history and public health journals and textbooks.
Results: At the turn of the 20th century, school nurses encountered tremendous challenges and demonstrated valiant measures to provide care for thousands of school children and their families. Her position in the schools and her visits to the home were the first line of providing access to medical care to families who would have otherwise gone without. They journeyed beyond the reach of the medical doctors and advocated for health equality. They demonstrated autonomy in their role and practice; and pushed boundaries of rurality, poverty and race to meet the needs of rural school children and their families. Identified problems included difficulties in securing financial support, lack of knowledge regarding benefits of the role, racial disparities, cultural differences, poor pay and scarcity of appropriately trained nurses. Children’s health concerns have changed across the century, but the objectives of the school nurse remain the same. Funding and advocacy persist as challenges, as does meeting the multitude of complex health care needs of school children. Core fundamental concepts of school nursing steadfastly provide a framework for providing much needed health services to school aged children today.
Conclusions: School nurses today continue to face the same struggles as the first school nurses in Virginia in the early 1900s. Challenges include attending to multiple student health issues both acute and chronic, as well as issues of funding, advocacy, public confusion of the role and the need for evidence-based research to support their role. Understanding the emergence of community support and collaboration for the role of the school nurse from a historical perspective can inform current policy on advocacy for the role of the school nurse today.