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During the four years of researching, writing proposals, and repeatedly taking her plans to administrators, Ruiz-Contreras says she never got discouraged. “I just thought it was going to happen at some time,” she says, “and I kept on going.”

Creating change is not easy, she says, especially in the wake of harsh economic situations that have caused many hospitals to tighten their budgets. “I think there are ideas out there, but people are not sure what the next step is. We’re not doing extra things now. We’re doing what we can to survive.”

But that’s all the more reason to work for change, she says. “I always think you should keep on trying.”

Needed: Community partners

When she became director of student health services for Children’s Hospital/ Austin Independent School District in 1997, Judy Frederick, RN, immediately realized she had to do something about immunization rates. Texas had one of the lowest childhood immunization rates in the country, she says, and areas of the Austin school district had rates much lower than acceptable.

Frederick began by redesigning a system for collecting and managing immunization records. She worked with school administrators to tell parents that if their children did not follow state immunization requirements, they would be sent home from school. She and school officials held press conferences with Austin’s mayor to announce that schools would comply with state immunization regulations.

But when parents came to her saying that they couldn’t get appointments to have their children immunized, she realized that boosting immunization rates would take more than her efforts alone.

Supported by administrators at Children’s Hospital, she worked to organize a community collaboration of all who had an interest in childhood immunizations —public and private health care providers, firefighters, school officials, state health department officials, and EMS personnel. She became the group’s facilitator.

At its meetings, Frederick discovered immunization services in the area were fractured and uncoordinated. Physicians often referred patients to public health clinics because of reimbursement problems. At the clinics, two nurses gave shots mostly by appointment only. Private and public clinics gave immunizations only to their own patients. People without insurance or who came from outside the country often had nowhere to go.

Frederick’s group began looking at ways to make immunization more accessible. Firefighters and emergency service workers started offering clinics. The Children’s Hospital pediatric van, which travels from school to school, now offers immunization. Public and private clinics have geared up to increase immunizations during the summer, when parents enroll their children. Parents receive detailed calendars explaining where and when they can get their children vaccinated. An extensive advertising campaign has also raised awareness about the need for immunization and where to get shots.

Immunization rates in the district are now 95%, and many areas have 99% and 100% compliance, Frederick says.

But more needs to be done, she says. The group is working with the statewide Texas Immunization Partners to get an increase in the reimbursement rate for childhood immunizations and a law that would make sure schools did not get penalized financially for sending home children who did not have proper immunization documentation.

The improvements in immunization rates could not have happened without cooperation from community partners, Frederick says. “Fifteen different entities came together and realized that immunization is important, but none of us can do it alone,” she says. “It’s truly a community effort. Our mission is to advocate for each individual child and not rest until every barrier to optimal health is removed.”

Standing up for one’s beliefs

Pamela Rowse, RN, a quality care consultant for Saint Rose Dominican Hospitals in Henderson, Nev., had been active in nursing issues for many years. But in 1997, a family tragedy pushed her to the forefront of an education campaign to prevent what was then a little-known form of child abuse — shaken baby syndrome.

Her 14-month-old granddaughter, Kierra, was killed by a licensed day care provider who shook her. The provider had received her license in spite of previous child abuse charges, says Rowse.