Learning Objective #1: Describe the role of the Henry Street Settlement (HSS) visiting nurses related to medication administration in the early 20th century

Learning Objective #2: Discuss the social, political, legal, and economic factors that influenced the HSS nurses' work

---

Background: America must address the problem of providing widespread access to health care. One solution repeatedly considered in the United States is to expand prescriptive authority for advanced practice nurses. Understanding the extent of the work nurses have done in the past with regards to administering and prescribing medications is critical to the proposal of realistic policies. The purpose of this paper is to examine the work of the Henry Street Settlement (HSS) nurses in dispensing medications as they responded to the needs of thousands of European immigrants in New York City from 1893-1933. Methods: The methods of social history are being used in this investigation. Primary sources include the Lillian Wald papers (New York Public Library and Columbia University). Federal and New York state drug laws are also cited. Findings: The HSS Visiting Nurses routinely dispensed medications to the urban poor in New York City. At this time, there was little difference between medical and nursing care, and the nurses legally initiated treatments, serving in “the middle place” between physicians and the lay public as they provided care. They worked during a period of transition from the turn of the century in which individuals self-selected medications for symptomatic relief to mid-century when professionals prescribed new drugs (such as antibiotics) for their curative powers. They also worked in collaboration with physicians, sometimes autonomously, sometimes following standing orders, and sometimes under direct supervision. Implications: Today, America is faced with a health care system at risk of imploding with spiraling costs and increasing numbers of people who are uninsured or under insured. Access to care is a major concern. This historical examination of nursing's role in administering drugs to underprivileged populations provides insight as we try to enhance the nation's health.

Funded: (G13) National Library of Medicine, FY: 2002, 2003, 2004