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Visiting Nurses Association of America

By Diane Sussman
December 27, 1999

Visiting nursing traces its origins to mid-19th century Liverpool, England, and philanthropist William Rathbone, his ailing wife, and Mary Robinson, the nurse who cared for her throughout a long, painful illness. Despite opposition from physicians who argued that the lives of the poor were too squalid to benefit from skilled nursing, Rathbone persisted in pushing forward the notion, founding the first visiting nursing program, with Robinson at the helm, in 1859.

In the United States, visiting nursing began to take root in 1877, when the Women's Branch of the New York City Mission sent its first trained nurse into the homes of the indigent. A few years later, the New York Ethical Society placed nurses in city dispensaries, then sent a nurse to Chicago to do similar work. By 1890, 21 organizations in the United States had embarked on visiting nursing programs.

While English visiting nursing may have had a man of means to push it forward, the United States had a woman whose pluck outstripped her means: Lillian Wald, who graduated from the New York School of Nursing in 1891. Wald only needed to visit a New York City tenement once-where she met with squalor and starvation-to set her future course. Joining forces with fellow nurse Mary Brewster, the two set up a Nurses Settlement House in an impoverished section of the Lower East Side. Their mission was simple: to offer nursing services to all who needed them.

Two years later, philanthropist Jacob Schiff helped move the operation to 265 Henry St. By 1905, Henry Street nurses numbered 37, and the organization had expanded to offering an obstetric service and supplying a daily supplement of milk.

Today, the specialty that once had to convince physicians and officials of its worthiness has grown into a network of 400 associations nationwide that employs 90,000 full-time nurses, therapists, and home health care aides and sees 10 million people a year. "I think the success of the organization is that, in 130 years, we have never changed the focus of our mission, providing health care at home to people who need it," said Carolyn Mackey, RN, president and CEO of the Visiting Nurse Associations of America, headquartered in Boston.