NOTE: THIS IS HISTORICAL INFORMATION ABOUT THE NEWTON VISITING NURSES ASSOCIATION. WE DO NOT MAINTAIN  ANY CURRENT INFORMATION ABOUT ANY VISITING NURSES ASSOCIATIONS. 

Mrs. William Coolidge and Mrs. Samuel Powers founded the Newton District Nurses Association (NDNA) in 1898.

At that time the idea of district nursing was a relatively new concept. Sir William Rathbone, encouraged by the work of a nurse in his own household who had been trained by Florence Nightingale, formed the first plan for bedside nursing service in Liverpool England in 1859.

Although Florence Nightingale never visited the United States, she influenced its nursing methods in a profound way. Boston was one of the first of a number of major cities in the United States to organize a public health effort with visiting nurses. It created the Boston Instructive District Nursing Association in 1886. A simultaneous effort was being undertaken in Philadelphia, New York City and Buffalo.

Earlier efforts met with skepticism since Newton was considered to be an affluent city with very few poor. Mrs. Coolidge and Mrs. Powers decided that indeed there was a need by the poor as well as other segments of the population who were in need but unwilling to ask for charity. Many immigrants were entering the city in those years.

In March of 1898 they issued a circular to stimulate interest and membership in their private charity. The circular announced its purpose to provide "nursing for the sick poor of our city at their homes . . . who would otherwise be unable to obtain the benefit of skillful nursing and also to give instruction in wholesome living".

The early organization comprised a president, vice president, treasurer, secretary and assistant secretary. The board of Managers was made up of one representative from each ward in the city. The managers were divided into two committees, the Supply and the Visiting Committees. Early members carried out administrative as well as social service work. However, the actual objectives were to supply nurses "graduated from a respected school who were to provide medical services for the sick poor", under direction of supporting physicians of the city of Newton.

They started out with one nurse and supply closets set up in each ward of the city. It was the job of the Supply committee to stock these closets with sheets, pillowcases, towels, rubber goods and baby necessities". There was no central office. Board members visited the sick along with the nurse.

In the early days people were distrustful of organized health care and uncomfortable with entry into their homes. The Association recognized that to stimulate interest in their group they would need to advertise their services.

The secretary spent a good deal of her time phoning and visiting doctors explaining the benefits of nursing work in the home and how she could assist them. They printed yellow cards "with wonderful yellow ribbons, giving nurses (sic) telephone number". These cards were intended "to hang by the doctors desks. Lest we forget. . . ."

Each nurse worked a 9-hour day travelling by bike or trolley car all through the city. She visited mostly bedridden patients and provided simple basic comforts: changing bed linens, finding fresh changes of clothing, applying dressings, bathing, airing the house, and instructing families in "simple rules of health and sanitation".

Nurses visited their patients for one hour and had 10-12 patients per day. They were dealing with such illnesses as pneumonia, diphtheria, and cancer. Many of their patients were expectant mothers.

The association secured its funding with membership dues ($2. For women and $5. For men) and fundraising efforts - rummage sales, whist parties, "entertainments" such as minstrel shows, canvassing the neighborhoods to build membership and donations to the supply closets.

Patients were asked to pay 10 cents if they could afford it. In that first year the nurse attended 80 patients and made 830 visits. The second full year the two nurses attended 370 patients and made 5,082 visits.

In 1906, the NDNA had two nurses and more than enough work answering phones and travelling to all the wards in Newton over spread out distances. They entered into an agreement with the Newton Hospital to locate an office there and employ a nurse as superintendent to direct nursing services.

The Association was represented on the Hospital Training School Committee. Two trained nursing students and another to take telephone calls were provided by the Hospital. One student was on call for mothers in labor. There was very little time for baby care instruction at this point.

In 1914 the NDNA affiliated itself with the Metropolitan Life Insurance Company, visiting policyholders and receiving a 50-cent reimbursement from the company. In 1913, the Association celebrated its fifteenth anniversary with a Christmas Magazine describing its brief history and showcasing Newtons distinguished architecture.

In 1918, the influenza epidemic seized parts of Newton. Visiting nurses were instructed to avoid contagious cases to keep from infecting other patients. Yet nurses still nursed. Though it was recommended that patients be taken to the hospital, most patients were cared for in their own surroundings another validation that the district nurse was becoming an integral part of the community.

Transportation around Newton (it is approximately 18 square miles) continued to be a problem. The Association considered purchasing a car but decided against the idea for its seeming extravagance. An anonymous gift of a Ford Sedan in 1919 solved the problem.

The next decade saw growth in structure and in services. The Association added services for any patient willing to pay a small fee who was recommended by their physician. This increased business. In 1920, the local chapter of the American Red Cross pledged to pay the salary of one graduate nurse. By this time, the national trend of "Well Baby Conferences" took hold in Newton and the visiting nurses were administering this clinic in four wards of the city: Nonantum, West Newton, Newton Centre, and Newton Upper Falls.

These clinics were instituted in 1918 to foster the health of the infant from age 2 to 5. The clinics weighed babies and attended to basic needs. Usually there was one physician and one nurse with 2 board members as volunteers.

In 1920, the Board made a recommendation to strike the word "poor" from Article 2, of the statement of purpose in the by-laws to read "The purpose of the Association shall be caring for the sick", no longer, "the poor sick".

To accommodate its growth and because nurses and administration required a centralized location the Association moved to a small room on the second floor of a building on Austin St. in Newtonville in 1923. That year was the association's twenty-fifth anniversary. Their tenants were the Central Council, the Welfare Bureau and the Red Cross, agencies with which they consulted on a regular basis.

During 1923, the Board requested that the National Organization for Public Health Nursing conduct a study of the Association. The study reaffirmed the Associations good nursing skills while analyzing its major administrative functions and its nursing services.

Recommendations called for a manual documenting good nursing technique, a formalized clinic plan for the Well Baby Conferences, better record keeping and for the Superintendent to be released from nursing activities. This would make time for the aforementioned administrative details; give the necessary supervision to her staff; provide opportunities for exposure and consultation with related social agencies; and allow her to do scheduling and better planning of the clinics.

By 1932, conditions became crowded once more and the NDNA moved to 297 Walnut St. The Association began to move toward health prevention/instruction as a more focused objective. Members emphasized that preventative medicine would head off chronic disease. Classes in hygiene of pregnancy, home visits to expectant mothers, Well Baby Clinics and immunization clinics were the norm.

In 1934 the NDNA became a "Red Feather" agency and received its money from the Newton Community Chest, a transition which began a new era and which strengthened the Associations revenue base.

During the 1930s the NDNA continued to expand its services and broaden its committee structure. In 1933 the Association, with funding from the local chapter of the Red Cross, established the Newton Nutrition Center. Staff from this new program worked with other visiting nurse programs to offer instruction and guidance on proper nutrition practices. The Nutrition Center was established as a response to the growing recognition of the importance of the science of nutrition. The purpose of the Center was to "sponsor and conduct programs . . . in cooperation with public and private organizations and individuals interested in nutrition as it effects health and welfare" Other charges were to "stimulate interest in nutrition, to encourage and sponsor surveys to evaluate nutrition needs in the community and to act on the resulting recommendations." They had a permanent desk at each Well Baby conference. This group became a separate Red Feather Agency in 1950.

A 1938 study recommended a series of improvements which included a stronger role for the Medical Advisory Committee a group of doctors who offered their consulting services for good medical care; the offer of one staff nurse to the Newton Health Department; additional staff to alleviate nurses' working overtime; salary raises and an increase in student affiliation.

By this time the staff was composed of eight full-time nurses and two students, with a superintendent to direct activities and coordinate with other local agencies. Increased health services included health supervision at the Well Baby Conference, maternity services, and morbidity service or bedside nursing care.

World War II brought with it some profound changes on the home front for the Newton District Nurses Association. In 1942 protection of children via immunizations were increased at the Well Baby Conferences. There was a severe shortage of nurses and mothers were left at home to cope with the changes.

The Association formed a local Committee on Child care to provide for "day nurseries and recreational facilities".

In 1947 the local YMCA solicited the Association to offer classes for new fathers.

In 1948, the director reported that over the past 25 years the service needs of the Association shifted from acute/communicable diseases (almost 50 percent of the caseload) to chronic conditions (from 4.5 percent in 1925 to 30 percent in 1945).

Statistics indicated a need to concentrate on rheumatism, arthritis, heart conditions, cancer and diabetes.

The Association started an immunization program in 1933 with diphtheria vaccines and by 1949, they had immunized 3582 babies -- 2600 of these for whooping cough. Cases of whooping cough went from 600 in 1937 to less than 100 in 1949.

In 1951, the Newton District Nursing Association name was changed to the Newton Visiting Nurses Association to remove any connotation of poverty that the word "district" might suggest.

In 1952 the Association moved back to the hospital grounds and enjoyed a remodeled space, which it leased from the city for $50.00 per year.

In 1953 five of the eight nurses on the staff had done post-graduate work in public health to qualify them as senior public health nurses. Katherine McDonald, executive director, reported that this foundation equipped the nurses as good field teachers for the student nurses who were required to work eight weeks with a public health agency to complete course work. The NVA enjoyed reciprocal relationships with agencies such as the Pomroy Nursery School, the Girl Scouts and the Red Cross. Staff education programs were conducted regularly.

By 1954, there were seven Well Baby Conferences: Auburndale, Newton Centre, Oak Hill, Newton Highlands, Newton Corner, West Newton and Nonantum. Health guidance, Well Baby Conferences and maternity services commanded the largest amount of time for staff with physical therapy gaining a small foothold.

In 1965, two licensed nurse practitioners were hired to provide bedside care to allow the nursing staff more time to card for mothers and babies. In 1966, a physical therapist and nutritionist were hired to accommodate growing demand.

Also in 1965, the Medicare program was initiated by the Federal government and coined the term "home health agency". This provided a second service physical therapy and homemaker/home health aides. These services were offered to everyone 65 years and older regardless of income. Some 57 percent of the VNAs total visits were made to this group in 1965.

The 1967-68 report of the Executive Director states that there was a nursing shortage due to the increase of Medicare patients. By this time the VNA employed 10 nurses and a full office staff.

In 1968 the VNA purchased property at 1589 Beacon St. (their current location) through a large private donation. In 1969, a public health nurse coordinator position was created to visit the Newton Wellesley Hospital and coordinate home health upon a patients discharge from the hospital. This program was in effect from 1969-1974, at which time the hospital hired its own coordinator.

During this period, the United Fund reduced its portion of the VNAs income from 24 percent to 20 percent. Conversely, salaries were raised to fall more closely in line with prevailing nurses wages and patient fees were increased in 1968-69.

The 1970s brought achievements and roadblocks. Fees for visiting nurses care were determined by using cost analysis. Public and third party payers (Medicare, Medicaid, and private insurance) reimbursed the organization at full cost for those patients unable to pay or who were on welfare.

Utilization review procedures resulted in limited hospital admissions and stays. This intensified the planning and work of the visiting nurse. In 1972 the NVNA perceived the need for a place for young mothers - wed or unwed - to talk with one another and share interests and concerns. "The Mothers Rap Group" was formed and a Nursing Assistant on the staff functioned as "Rap Mother" to guide the group.

A mental health program was instituted in 1972 in order to provide consultation services for patients and families on an individual/group session basis. Assistance from staff at the Newton-Wellesley Hospital and from Medfield State Hospital was given.

From 1973-1981 a series of mergers occurred. These efforts served to consolidate and expand services, improve finances and position the agency to qualify for Medicare funding.

In 1973, the Association merged with the Wellesley Friendly Aid Society and changed its name to the Newton-Wellesley Visiting Nurses Association, with authority for homecare service to the residents of both communities.

In December of 1973, the Silver Lake Family Nursing Health Center (located at 358A Watertown St.) was officially opened. This facility's services included special screening for blood pressure and blood sugar, counseling, changing of dressings, anemia tests, and EKGs.

Nursing Clinics for the Elderly, which began in 1969 at the Horace Mann Housing were expanded to include three more housing projects: Jackson Gardens, Parker House and Norumbega Gardens. In 1981, the association merged again, this time with the Weston Visiting Nurses.

By the latter part of the decade and into the 1980s the Associations work had gravitated largely toward the elderly and younger patients with disabilities. Medicare had written the young and disabled into its legislation.

While hospitals were moving patients from their care more quickly, nurses were providing at-home care with advanced technologies: ventilators, portable dialysis, and continuous infusion of medications. They were instructing patients and caregivers in their use.

The more traditional services such as mental health guidance, emotional support, health education and health counseling services were perceived as continuing to be important but went from 11 percent of caseload in 1972 to 8 percent in 1978.

Yet visiting nurses continued to do largely what they had done all along - to care for the sick and offer instruction in preventative medicine. In 1898, the Association began as a Voluntary organization and revenues were derived primarily through nontaxable funds: donations and endowments. The Visiting Nurse and Board of Managers began with 2 supply closets and revenues of $3042. In 1976, its successor the Newell Home Health Agency made 24,397 visits and had an operating budget of $535,500.

No. of boxes: 3 Boxes, 3.75 linear feet
Finding Aids: Series Description and Container Listings
References:
Friedman, E., "Troubled Past of 'Invisible' Profession" in JAMA, The Journal of the American Medical Association [Online], 264(22), 2851(5p). Available: Galegroup/General Reference Center(Magazine Index)/237366 [2001, Dec 5].

Schoen, M. A., and Koenig, R.J. "Home Health Care Nursing: Past and Present" (part 1), in Medsurg Nursing, [Online], 6(4), 230(3p). Available: Galegroup/Expanded Academic/A19865005 [2001, Dec 5].

Tinkham, Catherine W. and Voorhies, Eleanor F. 1893 1993: One Hundred years of Public Health Nursing in Massachusetts. Massachusetts Public Health Association, 1993.