Tuesday, October 18, 2011
I've been blogging for almost two years. 506 total posts, 507 including this one. Because I haven't been posting as much these past few months, some quick math will reveal that I was posting at a pace of more than once per day for well over a year. Social media experts, some of whom really are experts and many of whom are merely self-anointed Facebook and Twitter addicts who are trying to parlay their passion into a profession, say that frequent posting is important. Similar experts describe the endless economic possibilities and boundless business upside associated with maintaining a blog. Particularly if you're a CEO. They'll tell you it's something you just gots to do...
So I did it. Faithfully. For a long time.
Was it valuable? Well... yes and no. For me, it's been valuable. At the peak, I was getting close to a thousand unique visitors a day and several other industry blogs linked theirs to mine. In the I'll-scratch-your-back-if-you-scratch-mine world of social media, I always wondered if those other bloggers really liked what I had to say... or whether they were just in search of reciprocity. No matter, many flocked to my blog. And many commented. It was good. For me. At industry association meetings, colleagues walked up to me and said: "hey, I like your blog"... or even, on occasion, I'd get questions and feedback about something specific that I said. I never exactly became an internet sensation, but my ego felt sensational. A highlight came earlier this year when at a big conference for home care CEOs, a speaker, touting the benefits of social media, put up there in front of the ballroom my own blog front page. He spoke, gushed actually, about how great my blog was. My hits went through the roof for the next two weeks. I received emails from strangers telling me how cool I was. Nice.
But what's the business value? How does this translate into real value for my organization? That, I'm still not so sure about. It might be there, but I've just not been able to mine it. Yet.
That's why this isn't a farewell. It's a time out. I'm going to stop posting for a while and see if anybody misses me out there in cyberspace.
The world is changing and those social media experts, self-anointed and otherwise, might yet be right. If so, I'll be back.
In the meantime, if you're in search of the best home care, hospice or private care services on the planet, check out www.bostonvna.org.
If you're looking for me, I can be found at email@example.com.
Monday, August 8, 2011
If you've been following along, you know that the VNA of Boston story started far away from here (in Europe, in fact). Here's where it gets interesting... as we've now made our way to Boston. Here's Rebecca's post:
Today we arrive in Boston, about a quarter century after the founding of district nursing in England. In 1884 Abbie Crowell Howes, the unmarried daughter of a well-to-do Boston family, travelled to Liverpool to learn about Rathbone’s system of district nursing for the sick poor with hopes of establishing a similar program in Boston.
The period of reconstruction following the end of the Civil War in 1865 ushered in an era of rapid industrial, economic and population growth often referred to as the “Gilded Age”, a term coined by Mark Twain. During the 1870s and 1880s, the U.S. economy grew at the fastest rate in its history, and northern coastal cities were quickly transformed as new industries flourished and people flooded in to fill the need for workers. As in Liverpool of the mid-1800s, these new residents, in the over-crowded and poverty-stricken inner cities, often succumbed to sickness and disease leaving their families without income and threatening the social fabric of the community. At the same time, the professional and business classes became very wealthy, and many women pursued charitable activities to ease the suffering of the working classes and to promote improvements in education and health.
One such group in Boston was the Women’s Education Association (WEA). In 1871, Mrs. Charles Pierce and Mrs. B F Brooks sent out a circular proposing the establishment of an organization to support the expansion and quality of educational opportunities for women. At the first meeting, 75 women joined as charter members. Members would propose ideas for promoting the education of women, form committees with other ladies who had similar interests, and receive small grants from the Association to help jumpstart their project. The Association would remain involved for one or two years, with the expectation that the project would either take root in the community and become self-supporting or would fold. Several of the organizations started by members of the WEA include Radcliffe College, the MIT Women’s Laboratory, The Boston Training School for Nurses (the second oldest nursing school in the US based on the Nightingale model), The Boston Cooking School (where a scientific approach to food preparation was taught and where Fanny Farmer trained), the Marine Biological Laboratory at Wood’s Hole (a place where both men and women could conduct research and women were encouraged to be a part of the community of scientists – Rachel Carson formed many of her ideas at the MBL), and the Boston Children’s Museum.
Abbie Howes and her friend Phebe Adam were members of the WEA and upon Howes' return from Liverpool; she approached Adam to propose they request a grant from the WEA to start a program of district nursing in Boston. In her book, The Evolution of Public Health Nursing, Annie Brainard describes Howes as finding satisfaction and happiness in service to others. “As a social worker she had no interest in any personal rewards such as office or leadership for herself, but with rare persistence and tireless enthusiasm gave herself, at all times to the service of the poor and needy.” She describes Adam as “a lady of dominating personality” who “to some seemed stiff and forbidding, though to those who knew her better was a loved and revered leader. She had intellectual tastes and had taught school for some years. At the time of which we speak she was connected with the Shaw Day Nursery in Boston and, having already realized the need of nursing care in the homes of many of her little charges, quickly became interested in Miss Howes’ suggestion.” (For more on the Shaw Day Nurseries see http://bwht.org/shaw.
In addition to learning all they could about the Liverpool organization through visits and an active correspondence with Rathbone and his nursing superintendents, Howes and Adam also studied the situation in Boston. Howes proposed collaborating with the Boston Dispensary, an organization of physicians who had served the poor of the city since 1796. They approached Dr. W. H. H. Hastings, the Superintendent of the Dispensary and he happily agreed to the partnership. Hastings wrote “No one knows better than a Dispensary physician, how hard it is to treat a patient when there is but little to do with, and no one to properly carry out his instructions. He feels powerless, and perhaps suggests a hospital; but that recommendation is declined for fear that it may lead to the breaking up of the home and the scattering of its members. It is in such cases as these that the work of your nurses is needed to complete the efforts of the medical adviser, and accomplish the greatest amount of good for the suffering poor.” (http://en.wikipedia.org/wiki/Boston_Dispensary).
In 1885 Adam became the chairperson of the WEA’s Committee on Industrial Education – and shortly thereafter proposed the idea for District Nursing. Brainard notes that “at first it was necessary to convince the Committee that the work, which at first sight, seemed to partake only of charity, was, in fact largely educational. In this they succeeded, although at first assistance was reluctantly given, and the name “Instructive District Nursing” was adopted in order to ally the work with other educational efforts. By the end of the first year, however, ample proof having been obtained that teaching, as well as nursing, was a large part of the work, the undertaking was heartily endorsed.“
In her report on the activities of the Industrial Education Committee for the year 1885, Adam writes “In concluding our report we desire to express our gratification at the assent of the Association to work we hope to begin with the New Year, and which, for lack of a better name, we call ‘Instructive District Nursing’. It is too early for us to give details of what we propose and hope to accomplish, but, to those who question the acceptance of this work as not within the scope of an Education Association, we desire to say that one of the important portions of the work of a nurse thus employed is as a teacher, and largely consists in the instruction she is able to impart to the family and friends of the patient. Whatever may be the value of lectures on health and on the care of the sick, given to the poor and ignorant, it cannot be doubted that their practical usefulness and assistance must be vastly increased by direct lessons in a sick-room. The skillful application of a simple bandage or poultice at the bedside of a patient reaches at once even the lowest intelligence, and a competent nurse can give instruction of the greatest value in all matters of diet, ventilation, etc – lessons not confined to the immediate sick room, but spreading their beneficial influence throughout the neighborhood in which she works. We ask the interest and cooperation of all the members of the Association, and any suggestions or information bearing upon our work will be gladly received.“
In her April of 1887 report to the WEA Adam, now President of the Instructive District Nursing Association writes – “you will remember that our Association undertook the work of Instructive District Nursing in February 1886, and reports have been read at each meeting of its continued success and the growing interest in the work. At the meeting last April the Committee thought it best to withdraw from the Association, as has been the custom in the past whenever any enterprise had reached the stage when it could stand alone. The President of the new Instructive District Nursing Association reports that it continues to prosper.”
Board of Managers
IDNA – 1887 – Second Year of Operation
Miss Phebe G. Adam
Mrs. F. W. Chandler
Miss A. E. Wheelwright
Miss Hannah A. Adam (sister of Phebe)
Mrs. J.W. Andrews
Mrs. Wm. Appleton
Miss Anne P. Cary
Miss Clara T. Endicott
Mrs. J.S. Copley Green
Miss Margaret Greene
Miss Abbie C. Howes
Miss C.I. Ireland
Miss Mary Minot
Mrs. Oits Norcorss
Miss Mary Russell
Mr. Wm Endicott, Jr.
Dr. Francis Minot
Mrs. Chas D. Homans
Mrs. S. T. Hooper
Dr. Vincent Y. Bowditch
Mr. Lewis Wm. Tappan, Jr.
Mr. George Wigglesworth
First 4 IDNA Nurses Employed By the WEA (7,182 visits to 707 patients were done in the first year)
Amelia Hodgkiss Hired Feb 8, 1886 New England Hospital for Women & Children
(left in November of 1886 after finding the work too stressful)
Elizabeth Rinkler Hired June 15, 1886 Boston City Hospital Training School
Calina E. M. Somerville Hired Nov 1, 1886 Boston City Hospital Training School (went on to become Superintendent of Nurses Lawrence General Hospital)
Emma Gordon Hired May 1, 1887 Boston City Hospital Training School (also travelled to study with Rathbone/Nightingale District Nurses in London)
Thursday, July 28, 2011
We saw in the last post that Rathbone was able to overcome widespread skepticism that any good could come of trying to nurse the sick poor in their own homes when the conditions in these homes were so desperate. He successfully argued that the nurse’s efforts would result in longer lasting improvements if she addressed the environmental problems and the treatment would be less disruptive to the family and community if the patient could be nursed in place. However, there was a second difficulty – how to find enough trained nurses to meet the great need.
Florence Nightingale returned from the Crimean wars in 1856 a highly respected and famous woman. She widely promoted her beliefs about nursing as a profession, including the idea that nurses should receive rigorous training. The first modern nursing school was established at St Thomas’s Hospital in London with the first class of nurses starting in June of 1860. The curriculum was based on Nightingale’s vision of practical nursing skills learned at the bedside, the importance of creating a sanitary environment, the ability to observe the condition of the patient accurately and an emphasis on the strong moral character of the nurse. There was also a course of study including lectures on scientific and medical topics. These nurses were known as “Nightingale Nurses”. They represented a very different type of nurse from the untrained and sometimes unscrupulous women who had been serving as nurses in the poorest districts and the workhouses. The plan was for these trained nurses to establish more schools in hospitals around the country.
At this very time Rathbone was looking for trained nurses to staff his District Nursing organization in Liverpool and wrote to Nightingale in I861 asking how he could find suitable staff. Nightingale responded that it would not be possible to send any of her new nurses to work in Liverpool full time, but that she could send one to Liverpool to establish a training school in the Royal Infirmary. Thus it transpired that Rathbone also became closely involved in nursing training and in seeing that Nightingale’s vision was implemented in training programs throughout the country. This was the first contact in what became a life-long friendship with much correspondence and great mutual admiration between Nightingale and Rathbone based on their shared concern for the well-being of the poor and working classes of Great Britain. Rathbone wrote “in any matter of nursing Miss Nightingale is my Pope and I believe in her infallibility” and that he was “proud to be one of her journeymen workers”. At his death she wrote that he was “one of God’s best and greatest sons.”
In 1881 Florence Nightingale published a booklet entitled “Trained Nursing for the Sick Poor” reflecting on the progress that had been made in the 20 years since District Nursing had begun in Liverpool. The booklet was partly a plea for funding of national training programs with consistent standards and also for homes where district nurses could live together in order to develop an esprit de corps and where their meals and housekeeping would be taken care of, similar to what was provided for nurses who worked in hospitals. She also wrote about the unique nature of District Nursing.
“A District Nurse must first nurse. She must be of a yet higher class and of a yet fuller training than a hospital nurse, because she has not the doctor always at hand; because she has no hospital appliances at hand at all; and because she has to take notes of the case for the doctor, who has no one but her to report to him. She is his staff of clinical clerks, dressers and nurses. These district nurses – and it is the first time that it has ever been done - keep records of the patient’s state including pulse, temperature etc, for the doctor.”
“If a hospital must first of all be a place which shall do the sick no harm, how much more must the sick poor’s room be made a place not to render impossible recovery from the sickness which it has probably bred! This is what the London District Nurses do; they nurse the room as well as the patient, and teach the family to nurse the room.”
“A District Nurse must bring to the notice of the Officer of Health, or proper authority, sanitary defects, which he alone can remedy. Thus dustbins are emptied, water-butts cleaned, water supply and drainage examined and remedied, which looked as if this had not been done for one hundred years.”
“Hospitals are but an intermediate stage of civilization. At present hospitals are the only place where the sick poor can be nursed, or indeed, often the sick rich. But the ultimate object is to nurse all sick at home.“
Thursday, July 14, 2011
Rebecca continues the story of the first Visiting Nurse Association:
As we saw in my last post, Rathbone and Robinson considered their 1859 experiment in district nursing to be an unqualified success. They could see that the efforts of the nurse resulted not only in a marked improvement in the health of the individual patient, but also in the well being of the entire family.
However, they faced skepticism from the medical and philanthropic communities when proposing the establishment of district nursing on a larger scale. Opposing groups argued the poor could already receive free medical help in hospitals and at free dispensaries. Those in the upper class, who were familiar with the living conditions of the poor, found it hard to believe that occasional visits from a trained nurse would make any real difference. They contended that any help would be a short term gain, especially when the patient was still living in the dirty conditions of their crowded and busy homes.
True to the nature of his ancestors, William Rathbone VI stood by his conviction that this was a necessary and good plan and refused to be discouraged. He commented that “It is a work which is not immediately understood”. He offered four main arguments in support of district nursing:
1) It is about chronic conditions
“There frequently occur cases of serious illness, which are either unsuited, or not admissible into general hospitals; cases for example of chronic disease combined with extreme poverty. Such are some classes of incurable diseases as cancer, consumption (in its later stages) and paralysis, bronchitis, rheumatism, ulcers, etc. and many diseases connected with confinements.”
2) Benefits of receiving care in the home
“The invalid often objects – or his family objects – to his removal from a place which, however wretched, is still a home. The comfort to the sick and to all the family which the nurse is able to give, the relief of knowing that the invalid need not be removed to the hospital, the restoration of order, the awakening of new hopes and the introduction of a more cheerful element – such are the happy results of the nurse’s work, which help to abate the bitterness, the feeling of having been abandoned by God and man, so deplorable and yet so natural in those, who, often without any fault of their own, find themselves plunged in inexpressible wretchedness.“
3) Limited resources at hospitals
“There are not, and there never can be, hospitals large enough and numerous enough to take in all cases of grave illness among the poor.”
“The work done by district nursing is, in proportion to its results, far less costly than that done by the hospitals. “
(Rathbone quoted from Annie Barinard’s 1922 book, The Evolution of Public Health Nursing)
As I read these arguments from over 150 years ago, I am struck by how Rathbone’s conception of the unique contributions and benefits of visiting nursing are still relevant today. In modern times we would also talk about prevention of illness and the reduction of avoidable hospitalizations, but these are simply extensions of the idea that visiting nursing is a sensible way to manage chronic conditions and to avoid expensive hospital stays.
Rathbone also insisted on three main principles. First, that the work was not a work of charity and of temporary relief (which Rathbone and other reformers of the era felt would undermine the desire for self-reliance – what they termed pauperization), but of nursing and making a positive contribution to the long term well being of the person, the family and the community. Second, that the effort was to be independent of any religious motivation or influence, and lastly that the work is done by trained nurses.
Rathbone was successful in finding the funds necessary to expand the program and within four years Liverpool was divided into 18 districts, of which all were provided with visiting nurses. Wealthy ladies contributed their time as Lady Superintendents to oversee the work and to ensure funding. They took on much responsibility, and would help manage the nurses’ time, consult on new cases, hear reports on old cases, promote the service to find new cases, arrange for the supply and distribution of medical comforts and appliances, maintain an inventory of necessary supplies and a record of their use, raise the money for the continuance of the work and keep financial records. Basically, they provided all the administrative functions of the modern organization. These positions were highly coveted and were often handed down from mother to daughter. I imagine that the position provided purpose to the lives of women who would otherwise have few options for contributing to society and undertaking meaningful work.
This was the organization Abbie Howes so admired on her trip to Liverpool in 1884 – and the one she successfully recreated in Boston in 1886 with help from her friend Phebe Adam and the Women’s Education Association.
Next week I will write one last time about England in order to share how Florence Nightingale influenced William Rathbone and to summarize some of her thoughts on the development of District or Visiting Nursing.
Monday, June 20, 2011
This week we arrive in Liverpool, England circa 1859 and the creation of the first of district nursing program, upon which Abbie Howes and Phebe Adam modeled the Instructive District Nursing Association of Boston in 1886. William Rathbone VI (Feb 1819 – Mar 1902), of the Rathbone family featured in last week’s blog, is considered to be the founder of modern district nursing, and the focus of this week’s post.
In 1859, Rathbone’s first wife became gravely ill and he hired a nurse, Mary Robinson, who came into their home and greatly eased the pain and suffering of her last days. It occurred to Rathbone that this service would provide tremendous relief to the sick poor whose difficult and harsh lives often prevented them from seeking medical care. He asked Robinson if she would be willing to take part in a 3 month trial of nursing the sick poor in their homes, a pilot which he would organize and fund. She agreed and Rathbone set about arranging for the necessary equipment, medicines and nourishments.
Given his familiarity with the situation of the poor citizens of Liverpool, he believed the district nurse would have the greatest impact if she not only attended to the immediate physical ailments of the patient, but also took into consideration their social and family situation as well. His vision was that the nurse would not simply provide short-term relief, but that she would also plant a seed of long-term and widespread improvement by educating the patient and the family to caring for their own sick and instill in them the importance of healthy living and the principles of proper hygiene.
After just one month of work, Robinson asked Rathbone to be released from her contract. Although she was accustomed to sickness and death, the level of suffering and squalor she faced in serving the sick poor of Liverpool was overwhelming. She felt that her efforts were hopeless and were dwarfed by the level of need. Rathbone urged her to continue, and tried to impart in her his belief in the tremendous positive effect her work would have on the lives of those she cared for. “He showed her how much relief from suffering her care brought to the sick; how her teaching and example, must, in time, bear fruit; and that the satisfaction of knowing she had been instrumental in putting even a few families on their feet, and of blazing the path in a new field of work, would compensate her for all her present discouragements” (Brainard, The Evolution of Public Health Nursing, 1922, p 108).
Rathbone’s strong belief in the merits to the plan convinced Robinson, and she continued through her 3 month contract at which time Rathbone’s hopes were fulfilled. She was able to see her success in not only addressing the immediate ailments of the patient, but also in achieving permanent improvements in their health and standard of living. Also, in many cases, the improvement were not limited to the patient, but also their families, whose well being depended on the presence of both a mother and father as caretakers and breadwinners, and also on the community who saw the positive impact on their neighbors and changed their own behaviors. Thus it was at the end of the three month period, Robinson resolved to make district nursing her life’s work.
Rathbone felt confident that his experiment had amply demonstrated the potential benefit district nursing would bring to better the health and stability of those whose grim lives were often shadowed by loss and despair; people who would have otherwise been thought of as hopeless cases. Rathbone was determined to expand the service, but faced several barriers, including the skepticism of his peers. The prevailing opinion was that the problems faced by the multitudes of low-wage workers were insurmountable and that it would be a hopeless exercise for a nurse to try to make a difference. Also, many in the medical community did not believe that proper care could be provided in the busy and dirty conditions of the home and suggested that a hospital was only appropriate venue for care. And, even if Rathbone could convince people to support the project, finding a supply of trained nurses to provide this service throughout the impoverished districts of Liverpool was going to be almost impossible.
Next week we will see how Rathbone overcame these difficulties through a deep and persistent belief in the usefulness of the plan, by widely sharing his enthusiasm for the effort and by turning to Florence Nightingale for help and advice. Rathbone and Nightingale ended up becoming close friends each with a great admiration and respect for the work and ideas of the other.
Saturday, June 18, 2011
Tuesday, June 14, 2011
Here's the next installment of the story... from Rebecca:
In 1859, Liverpool was a well established port city pulsing with commerce and industry. The population exploded in the 200 years between 1700 and 1900 as immigrants and waves of workers from the countryside flocked to the city, drawn by the demand for labor created by the industrial revolution and trade of all sorts. Our interest is in the Rathbone family of Liverpool, a family of prominent businessmen and philanthropists, and in particular in William Rathbone VI who established the first modern District Nursing organization in 1859, upon which our agency was modeled after in 1886.
The original William Rathbone brought his family to Liverpool in the early 1700s to pursue opportunities for his family in this growing port city. Initially, he worked in a saw mill and in 1742, at the age of 46, he established his own timber business, Rathbone Brothers. Subsequent William Rathbones (there are 13 generations now) built on this foundation and grew the family business, expanding into the cotton trade, shipping, ship building and eventually merchant banking.
From the beginning, the Rathbone family had a high sense of social consciousness and each generation engaged in significant public service and philanthropy. The early Rathbones were Quakers and Nonconformists, meaning they rejected the governance of the Church of England and were advocates for religious freedom. They consistently opposed the slave trade, which was a major part of business in Liverpool. At its peak in 1799, 40% of the worlds’, and 80% of Britain’s slave trade passed through Liverpool’s ports.
William Rathbone V and his wife Elizabeth, the parents of the our William Rathbone, expanded on this work and were large supports of Kitty Wilkerson’s efforts to provide people with a place to wash their clothes and bedding during the cholera outbreak of 1832. (the result of which was the establishment of the first public baths and wash-houses in Liverpool) The famous American prison and mental health reformer Dorethea Dix spent a formative year living with the William Rathbone V and his wife in the late 1830s. While there, she met a group of men and women who advocated for government involvement in social welfare and learned about the British lunacy reform movement, whose methods of detailed investigation of madhouses and asylums she applied to her work on reform for the care of the insane poor upon her return to Massachusetts in 1840. At their deaths, obituaries said of William and Elizabeth Rathbone: "His name was a 'household word', synonymous with truth and honour and charity” and "Her life was one of constant, careful, conscientious helpfulness, on a scale that can have no record".
Next week, I will delve deeper into William Rathbone VI’s achievements and the Liverpool District Nursing organization, arguably his most far reaching effort that has had long term influence on nursing in England and the United States.
Tuesday, June 7, 2011
And he's a nice guy.
Shown here with some of our All-Star VNA of Boston managers...
Friday, June 3, 2011
Here's the next installment from Rebecca...
In this posting, I continue to share the historical insights I’ve been gleaning from reading Annie M. Brainard’s 1922 book, The Evolution of Public Health Nursing. As we enter the 1800s, we observe how the evolution of public health nursing from a service of the Church to a more independent function sets the stage for the entrance of public health nursing as an important component of the modern health care system in the early 1900s.
The Modern Deaconess Movement
It is said that travelers from Protestant countries would return home with stories of the wonderful care given by the Daughters of Charity, the ancient sisterhoods of Beguines and other groups of nursing sisters, the match of which was not to be found in their own countries. So great was the need for similar services that in 1815 an English doctor called for an order of women to be created, who like the Daughters of Charity would be “selected for good, plain common sense, kindness of disposition, indefatigable industry and deep piety; let them receive - not a technical and scientific – but a practical medical education.”
His call was not heeded in England, but in 1822, Theodor Fliedner, a young Lutheran pastor, established a Protestant sisterhood in the German town of Kaiserswerth. Inspired by an order of Mennonite deaconesses he had observed while visiting Holland and also by the work of Elizabeth Fry, a prison reformer in England, Fliedner and his wife created a Women’s Society with the mission of visiting the sick poor in their homes. Like his predecessor Vincent de Paul, he realized that the wealthy ladies interested in giving charity were not particularly suited to the work. So, as with de Paul, he sought out women of the working class with an interest in the vocation of helping the poor and nursing the sick. Fliedner took his organization a step further and provided these women with three years of training before they could be named Deaconess. Fliedner garnered great international respect and his most famous pupil was none other than Florence Nightingale. Nightingale first visited Kaiserwerth in 1846 as a crusading health care reformer, and was so favorably impressed that she later returned to enroll in Fliedner’s program, graduating in 1851.
On a side note, while researching information on deaconesses I stumbled across an article about Boston’s Beth Israel Deaconess Medical Center. I learned that the New England Deaconess Hospital (which later merged with Beth Israel) was founded in 1896 by a group of Fliedner’s deaconesses whose first 14-bed infirmary was opened in a converted five-story brownstone at 691 Massachusetts Avenue, not so far from the VNABA’s office at 561 Massachusetts Avenue (KELLY – I assume we were at 561 in 1896 yes?)
As I continue to study the history of visiting nursing and how the VNABA has grown as an organization, I will be interested to see how the roots of visiting nursing, so steeped in the culture of charity, underlie our modern identity and how we are perceived as a profession. I can’t help feeling that there must be a tension between the business entity we are today and the charitable efforts provided by our predecessors. There is a theme which runs through Brainard’s book; that the modern public health nurse is still animated by the same “spirit of service to mankind” that motivated the early deaconesses and sisters through the centuries. Even though Brainard proposes modern ideas of organization and business she still frames the career of a nurse as more of a calling or vocation rather than simply as a profession or gainful occupation. I am sure this partially reflects the time in which she was writing, but I do wonder how much our modern perception of nursing as a career still harbors an unspoken expectation that the choice to be a nurse goes beyond that of merely choosing an occupation and crosses into the realm of engaging in a “service to mankind” and if so, is there a resultant blurring of the line between the personal and the professional in the role of nurse which still persists today?