Home/ Diverse Peoples, Diverse Needs: A History of the Visiting Nurse Service of New York
Diverse Peoples, Diverse Needs: A History of the Visiting Nurse Service of New York
by Susan Rita Ruel, Ph.D. Minority Nurse Writer
In 1909, Lillian Wald, founder of the Visiting Nurse Service of New York (VNSNY) and the "mother of public health nursing," hosted the NAACP's inaugural meeting at her agency's early headquarters, at a time when integrated meetings were forbidden by local ordinance. Last year, the NAACP remembered Wald's courage and work during its centennial anniversary celebration in New York City. On their website, they refer to Wald as one of the organization's "first and oldest friends."
Wald truly set a tone for the agency she established. From its founding in the late 19th century, the VNSNY has served a broad range of diverse communities, played pioneering roles in the civil and women's rights movements, and blazed a trail for diversity in the workforce.
In the late 1800s, Manhattan's Lower East Side neighborhood was deemed the world's most densely populated slum. At that time, Wald was a young graduate of New York Hospital's nursing program, studying medicine and teaching immigrant women about home health and hygiene. Galvanized by the public health needs she saw among immigrant communities in the area, she and a fellow volunteer launched VNSNY in 1893. Wald and her colleague became the first public health nurses in the country.
Wald championed women's rights by hiring and promoting women. In fact, the National Women's History Project included her among its 2009 honorees. She played a prominent role in the women's suffrage movement and is enshrined with Susan B. Anthony, Elizabeth Cady Stanton, and others in the National Women's Hall of Fame. From Wald's 1933 retirement to present day, women have led the VNSNY, culminating in 1989 with the arrival of current President and CEO, Carol Raphael. Ten years ago, the VNSNY staff was composed of over 90% women. Today, that figure stands at about 80%. Because of the agency's highly diverse clientele, VNSNY has been at the forefront of promoting cultural awareness, developing and retaining a diverse workforce, and creating an inclusive environment—all elements that are crucial to effective service delivery. According to U.S. Census data, nearly 37% of New York City's population is foreign-born, and 48% of the city's residents speak a language other than English at home. More than a quarter of VNSNY patients are non- English speaking, and its staff members speak more than 50 languages.
Following their founder's example, the agency has a proud legacy in the hiring of minorities. In the 1920s, when mortality rates in the black community were 200% higher than elsewhere in New York City, African Americans comprised 15% of VNSNY's patients. Wald and other agency leaders responded by increasing its African American nursing staff from one supervisor and four nurses to two supervisors and 18 nurses, a number commensurate with their patient load. In her 1933 book Windows on Henry Street, Wald noted that VNSNY was the first organization to hire black nurses on equal terms. Today, roughly a quarter of its patients and more than half of its employees are descendants of the African diaspora, including African Americans, Afro-Caribbeans, and colleagues from Nigeria, Sierra Leone, Togo, and other African nations. VNSNY has also been caring for Asian and Hispanic immigrant patients and hiring staff of the same descents.
For most of its history, VNSNY also has been caring for patients in a number of other ethnic communities, while employing clinicians who share their cultures and heritages. In recent years, VNSNY developed multicultural home care programs dedicated to serving New York's Hispanic, Asian, and Russian communities. Patients often feel more comfortable and, in some cases, recover more quickly, when they receive care from nurses and other caregivers who speak their language and have in-depth knowledge of their culture.
Currently, VNSNY employs the largest pools of Asian and Hispanic caregivers in the New York area, offering home health care teams trained in providing culturally sensitive care to patients in their native languages, incorporating their customs and values. Staff tailor comprehensive home health care and community-based services to the more than two million Spanish-speaking residents of New York City, who trace their heritage to 35 nations worldwide. Patients from these communities make up approximately 20% of active cases, a fi gure that mirrors the 20% of VNSNY colleagues who self-identify as Hispanic/ Latino.
Features offered include a Spanish-language telephone hotline for referral and information; nutritional diet plans specifically designed for Hispanics; patient forms and educational materials in Spanish; partnership programs with key Hispanic community organizations and referrals to community resources; and a close alliance with Hispanic community agencies, doctors, hospitals, and managed-care organizations. In late 2008, VNSNY was honored with a special institutional award from the New York chapter of the National Association of Hispanic Nurses for extraordinary outreach in that community.
The composition of VNSNY's workforce and patient populations also reflect a spike in Asian immigration to New York City over the past decade. The staff now includes more than 700 colleagues of Asian descent, including Chinese, Filipino, Indian, Korean, Pakistani, and other nationalities. These colleagues speak several dialects of Chinese, Tagalog (Philippines), Korean, Hindi, and other Asian languages. They provide home health care familiar with the cultures, values, and customs of many different Asian groups. VNSNY also administers the Chinatown Community Center, which has served more than 65,000 community residents since it opened in 1999. The facility administered hundreds of free fl u shots last year, and it regularly provides free cholesterol, diabetes, and blood pressure screenings; health classes; community outreach; and other services to residents, particularly seniors, of New York's Chinatown. VNSNY also runs the Chinatown Neighborhood Naturally Occurring Retirement Community (NNORC) program, launched in 2006. In addition to the public health services offered at its Chinatown Community Center, the Chinatown NNORC nurses and social workers visit homebound seniors to assess their individual needs and provide culturally sensitive care.
To serve the more than one million émigrés from the former Soviet Union now residing in the New York area, VNSNY has hired more than 200 colleagues who immigrated from Russia and former Soviet republics, including Ukraine, Azerbaijan, and more. The agency also employs escort translators who speak other languages, ranging from Korean and Japanese to Haitian Creole. In addition to the VNSNY Multicultural Home Care Programs, the agency makes a number of smaller, less formal arrangements to coordinate caregivers and patients in New York's many other diverse communities. VNSNY also regularly sponsors events tailored to recruit nurses and other staff members from various multicultural NYC communities.
In 2009, CATALYST, a global organization dedicated to promoting diversity in the workplace, added VNSNY to its roster of "case studies"—models of inclusive practices in the workplace.
Comfortable with their knowledge of other cultures, VNSNY staff often act as the organization's ambassadors to various New York communities and teach coworkers about their cultural heritages. VNSNY has carried its 117-year-old inclusive, multicultural approach well into the 21st century, a philosophy suited to a highly diverse workforce and its patients.