Nursing cuts go deep



Recent news indicates that Maine’s financial health is improving. The “Rainy Day” fund is climbing, the state’s bond rating has improved, and both Medicaid debt owed to our hospitals and the unfunded pension liability have been paid down. But isn’t this just half the story?

The other half is the list of programs and services we may have given up to make this financial progress. Is it clear what programs have been eliminated? Do we agree with what has been cut?

One program that has dwindled to an alarmingly low level is public health nursing services in Maine. Those services traditionally include health screening clinics, vaccination campaigns and support of patients with chronic illnesses. In addition, public health nurses are the front lines in public health emergencies such as natural disasters or infectious disease epidemics.

The unique aspect of public health nursing is that it extends health care from the hospital or doctor’s office right to the doorstep of Mainers in need of care. In a largely rural state where health care providers might be a prohibitive drive from the patient’s home, public health nurses go to the patient.

For the homebound or the elderly in wheelchairs or with other mobility limits, it is a major undertaking to find transportation, get in and out of a vehicle and into a health care facility. That challenge is compounded in winter.

A visiting nurse is a godsend to the homebound. Health complications can be identified early, making successful treatment more likely. For those without family nearby, the nurse may be the only visitor to the home most days, and they are warmly welcomed. Public health nurses should be prepared to drink a lot of coffee.

Perhaps the biggest advantage of public health nursing is the ability to see and care for the patient in the context of home. At one time, every newborn in Maine was offered a home visit by a public health nurse. Even in homes with adequate food, warmth and shelter, those visits were revealing.

Most new parents have questions. Many of them greet the nurse with: “I’m so glad you’re here! I felt silly calling the doctor about this.” Support for breastfeeding and other questions about nutrition were common.

New parents have questions that unsettle them. Is my baby too hot in her crib? His breathing sounds funny. How do I cut her fingernails?

Most of the time, it is a matter of reassurance and a demonstration of how to handle the small but daunting details of baby care. Once in a while, a more significant problem is identified and the baby is referred to a doctor.

At a home visit, the nurse works with the same tools available to the parents to care for their baby. It is an invaluable opportunity to assess the home for basic cleanliness, safety factors, relationship problems and other conditions that could adversely impact the baby’s development, conditions that a pediatrician in an office might never discover.

Does the doctor who recommends bed rest in the last month of a pregnancy know that the mother-to-be has a bedroom upstairs, a bathroom downstairs,and two toddlers in her care all day?

Sometimes there is a need for more challenging interventions. Are there smokers in the home? Signs of drug abuse? Domestic violence? Fire hazards? These are all areas public health nurses are trained to observe, and work to improve.

Maine is in the midst of an opioid abuse crisis. We have the highest obesity rate in New England (30 percent of our population). Fifteen percent of adults (over 18) binge drink (five or more drinks in a sitting) in a 30-day period, as do 17 percent of high school students. Over 18 percent of adults in Maine smoke cigarettes, putting us at 25th in the country. Is this the time to cut public health nurses by two thirds, which is what the state has done?

In 1996, Maine had the lowest infant mortality rate in the U.S. In 2014, we had fallen to 37th. Last year we were the only state where infant mortality increased from one decade to the next.

The future costs of inadequate prenatal and newborn care are enormous. Physical, psychological and social deficits in a child’s earliest years have repercussions throughout life. Public health nurses, working in the home, promote the health of babies and of the adults who care for them.

It is one thing to reduce benefits for able-bodied adults. It is another to deprive our newborn babies of the best possible start in life. Spending wisely is critical to our state, but penny wise can be pound foolish if it means looming costs to society for future generations.

It is time to resuscitate public health nursing services in Maine. LD 1108, An Act to Restore Public Health Nursing Services, would do that. It would help to address some of the biggest health problems facing our state now and reduce future costs for dealing with the consequences of poor early childhood care. It should be a spending priority.

Jill Goldthwait

Jill Goldthwait

Retired nurse and former independent Maine State Senator.

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