Pima County, AZ, Public Library has hired the first library nurse in the United States, as far as the library knows.
The idea was inspired by the San Francisco Public Library. “We’ve always had the need in our libraries for someone to help us with customers who have exceptional social services and health needs, but the idea of hiring someone came from San Francisco when they hired a social worker back in 2010,” said Karyn Prechtel, Pima County’s deputy director. “It was like a light bulb went off.”
Partnering for Health
The library approached the Pima County Health Department, according to Kathleen Malkin, community health services division manager of the health department, and after “reviewing our different functions, we thought a nurse would better meet the needs than a social worker.”
The program began in January of this year, and since then the nurses have helped some 2896 patrons. (That’s individual contacts; they don’t track how many are repeat customers.) While the library originally started with a single nurse traveling between multiple locations, it “pretty quickly figured out that having the whole program invested in one individual was a not a good idea,” said Prechtel. Today, there the library receives one FTE’s worth of hours of nursing service, at an annual cost to the library of about $67,000, but they are spread out across five individuals at six different branches.
Though the library foots the bill for their salary, the department of health provides all of the nurses with training and support, “a lot of in-kind costs” that Malkin has not quantified, but it’s worth it to the department “because it gets us out meeting the population we serve.” Daniel Lopez, one of the nurses who serves at both the Joel D. Valdez Main Library and a branch library, agrees. “It’s sort of a perfect marriage. We’re looking at community interventions. The libraries are very forward-thinking and have made themselves the center of the community, so if I want to know my communities better, it’s a great place to be.”
From the library’s perspective, “we have a relationship with another county agency, and I think that has allowed us to be more successful,” than if the library had just hired a nurse (or several) itself, said Melinda Cervantes, executive director of the library. “It’s very comforting to have another agency do the oversight of a medical professional, because we are clearly not equipped to do that.”
Lopez and the other library nurses don’t have an office, they roam the floors, approaching customers if they think they see a need, or waiting for customers to approach them (Lopez wears a stethoscope so he’ll be recognized as a nurse). Lopez sometimes sets up a table, which “really seems to work,” according to Prechtel. Lopez also leaves the library’s four walls to go out onto the plaza in front, where some homeless patrons spend time, and carries a cell phone that only library staff members know how to reach, so he can be summoned to potential emergencies.
Usually, he said, there’s space enough where he and patrons meet for a conversation to allay privacy concerns, and if he needs to speak more discreetly or in depth, they take advantage of the library’s conference rooms. The nurses are a great fit with librarianship’s traditionally strong focus on privacy: “The nurses seem to have a more strict level of confidentially than the library staff does; they don’t repeat anything to us,” said Prechtel. Lopez confirmed that the work he does in the library is covered by the same HIPAA privacy rules as it would be in a doctor’s office.
How much of the nurses’ time is spent on emergencies, versus helping manage physical, behaviorial, and mental chronic problems, or answering informational queries, varies from day to day. But some commonalities do emerge: Lopez told LJ that most of the people he sees are uninsured or underinsured, so one of the services he provides is referrals to free and low cost clinics around the county.
One thing that’s clear is that the nurses are helping the libraries manage those emergencies that do occur better. According to Cervantes, one of the goals of the program was “reducing our need to call 911 for assistance,” and that’s been met. According to Prechtel, at the main library alone, 911 calls for behavioral health related issues dropped from 13 in 2011 to three since the nurse program was instituted. Calls for intoxication dropped from 17 to six. Calls for medical problems, however, have actually increased slightly, from nine to 12, and Prechtel said “we think that also has to do with the nurse in the library, identifying issues that the customer themselves may not realize is serious.”
Nursing the Program
“The community is overwhelmingly supportive” of the program, Cervantes said. For the most part, customers who are in the library have been grateful, have been surprised—we have some come back to see [Lopez].” “We have had a couple of people who are concerned about non-traditional library services, but those types of concerns are few.”
Malkin told LJ the health department and library plan to expand and have more nurses in libraries in 2013—as many of the library’s 27 branches as want one, in fact. The library is working with college and nursing students to do a needs assessment so they can gear the services offered to the needs of each branch’s different service area.
Right now, the nurses are funded out of the library’s budget, but the library is pursuing grants “for the health literacy component,” according to Cervantes, including one from the National Library of Medicine that deals with women’s health.
Amber Mathewson, library services manager, says the expansion fits into the county’s plan as a whole. “Pima County about a year and a half ago did a community health assessment, and one of the things that they said is that in Pima County less than 10 percent of the people are able to make judgments of their own health care. So we’re putting together a task force to promote health information, getting more information out to people where they are.”
Care Is Catching
Though Pima County is the first to hire a library nurse, it’s unlikely to be the last. “We have had calls from other libraries” already interested in implementing a similar program, said Cervantes, including San Jose Public Library. For those considering it, both the department of health and the library advise playing to local strengths rather than templating off the Pima model exactly. Some counties will have much larger departments of social services than Pima, while others’ departments of health may not even have any public health nurses left after recent budget cuts. But, they say, if a nearby university has a nursing college, that’s a good place to start.