Nursing Activities of the Erie County
Department of Health and
Their Reporting
MARY E. JONES, R.N.
community leaders for program pro-
This is but another convincing dem- motion and professional meetings other
onstration of the widening effort on than inservice education; and (5)
the part of public health agencies
to apply modern statistical technics special nursing assignments, such as hos-
to the productive recording of serv- pital, nursing home, and midwife in-
ices rendered. What proves effec-
tive in public health nursing may be spections, epidemiologic investigations
assumed to be of practical applica- and surveys.
tion to other areas as well. The reports of the individual nursing
activities are the basis for the com-
posite reports of the nursing service of
The activities of the public health the agency. All of us who are con-
nurses of the Erie County Department cerned with the reporting of public
of Health vary little from those per- health nursing services are likewise
formed by public health nurses in any concerned with effective use of these
large county health unit. In the last reports. The primary purpose of this
few years there has been an increasing paper is to show how this agency has
demand for bedside service for the care developed a reporting system that can be
of the sick in their homes and in group utilized both by administration and
activities for health education. supervision in the areas of (1) program
Our nursing activities are classified planning and evaluation, (2) the adap-
according to type of service. The direct tation of the nursing service to meet
nursing service that is rendered to or community needs and wants, and (3)
in behalf of individuals falls into three the supervision of nursing performance.
broad categories-home visits, school In January, 1951, the mark sense
visits, and clinic visits. The clinic visits system for the reporting and tabulation
are further grouped into 12 subdivisions of nursing activities was installed. Be-
for specific type of clinic. fore that time the nurse completed a
Other than direct nursing activities daily, a monthly, and an annual report,
are classified in the following cate- as well as her service records. Under
gories: (1) inservice education; (2) the present system, the nurse checks the
community education, which covers information concerning the activity per-
talks and classes for community groups; formed on an individual card for sta-
(3) activities related to administration tistical use. With the addition of the
or supervision of service, such as indi-
vidual conferences with the supervisor
nursing notes pertaining to the content
of the activity, a duplicate card becomes
or other administrative personnel, ori- the service record. After mechanical
entation of new staff or students, or tabulation of the statistical cards by the
evaluation of individual nurse's services; service bureau, a report is available on
(4) promotional activities on an indi- a monthly and quarterly basis for each
vidual basis, such as conferences with nursing district. This report is tabulated
324
NURSING ACTIVITIES IN ERIE COUNTY VOL. 45 325
on: (1) an administrative basis, which consideration. One of the three towns
consists of the work performed by all in her district is in a fast-growing subur-
nurses assigned to the particular district ban area. It has a population of 42,000,
office, regardless of the district in which a wide range of socioeconomic levels,
the service occurs; and (2) a service but no concentrated low-income groups,
basis, which shows the amount of nurs- and it is divided into eight census tracts.
ing work performed in a given district Three nurses are assigned to this town.
by any nurse. This last tabulation is of Census Tracts 2 and 3, which cover
particular importance because of the over half the geographic area, are re-
spread of the specialized nursing serv- ceiving only a token amount of the
ice. There are four such services within nursing service, a condition which has
the 11 nursing districts. The remaining existed for a considerable period of
seven are generalized. time. The usual methods to promote
All districts use the same card for the use of the service have been
reporting which is prepunched for nurse ineffectual.
number and card number before distri- A study of the town, by nursing area,
bution. The original design of this card was undertaken. It included the collec-
was carefully planned. The evidence tion of data covering: (1) the kinds of
of this has been that, although quite people living there, (2) shifts in popula-
complex, it has had only two minor ad- tion, (3) the birth and death rates, (4)
ditions since installation. the neonatal death rate, (5) the death
It is felt that less nursing time now rates from leading causes, (6) a sum-
is spent on clerical work and, too, the mary of the Health Department services
tabulation of the reports is completed in which had been utilized, (7) a four-year
much shorter time than was possible study on a service basis of the nursing
before. This system permits more ex- visits, and (8) the individual perform-
tensive utilization of the reports for ance of each nurse assigned to the area.
study purposes. One of the most im- When the information was assembled, a
portant aspects in the effective organiza- review showed great variation in the
tion and utilization of the available data three nursing areas in the kinds of
for nursing studies is the close working people, the birth and death rates, the
relationship with the director of bio- death rates from specific causes, and in
statistics. Interested and keenly aware the type of nursing service given.
of our problems, as a consultant she After the analysis of this data, it
has given her services generously, both seemed necessary to make a concen-
in the inservice educational programs
and individually to administrators, trated effort for individual nursing con-
supervisors, and staff nurses with spe- tact with the people, particularly in
cific problems that involve the applica- Census Tracts 2 and 3. A decision was
tion of statistical methods. made to have the nurses visit all infants
born in September, 1950, 1953, and
Program Planning and Evaluation 1954. The visits to the newborns of
1954 would have the usual emphasis on
A few of the completed and current
studies of the nursing reports will be Mrs. Jones is assistant director of public
briefly reviewed to show how essential health nursing, Erie County Department of
these are to program planning and Health, Buffalo, N. Y.
This paper was presented before the Public
evaluation. Health Nursing Section of the American Pub-
Recently, one of the supervisors lic Health Association at the Eighty-second
brought a problem in for administrative Annual Meeting in Buffalo, N. Y., October 12,.
1954.
326 MARCH 1955 AMERICAN JOURNAL OF PUBLIC HEALTH
infant care; the one-year-olds, immuni- side service. At present about 60 per
zation; and the four-year-olds, emphasis cent of the nursing visits fall into this
on the sodium fluoride application, the area. Although the people are for the
audiometer test, and the preschool ex- most part in the middle and higher
amination. In addition, the nurse economic levels and could afford to pay
would attempt to secure information on for nursing service, there is no visiting
other significant health problems in the nursing service available. Therefore,
home, in particular, those in relation to the official agency is confronted with the
the maternity cycle and geriatrics. Fi- problem of meeting the pressures ex-
nally, the nurse would list any other erted by physician referrals and indi-
topics discussed with the person inter- vidual demand to provide part-time
viewed that were not covered in the nursing service for home care for the
survey form. sick. In order to meet the situation,
This phase of the study is now in particularly with limited staff, other
progress; what the findings will reveal nursing programs have had to be
is not known. Analysis and evaluation sacrificed.
by the nursing administrator, the super- A somewhat different situation was
vising nurse, and the staff we hope will evident in another district when the re-
produce clues to more adequate plan- ports of the nursing visits to similar
ning for nursing service which will meet nursing areas were examined. In one,
the needs of the community. If, after the population under five years of age
this effort to evaluate the situation, it was proportionately much greater than
should be found that there is little need the group in the older age category, but
for service, some of the nursing service the nursing visits were concentrated in
can be transferred to another area the older age group. In the other area,
where the need is more evident. where there were more old people, the
This particular study has stimulated greater proportion of the nursing visits
the preparation of similar information were to the group under five years of
for each nursing district. It is to be age. Investigation by the supervisor
assembled in loose-leaf form in order revealed that the first nurse was again
that additional information may be in- meeting community pressure for home
cluded and obsolete material deleted. care of the sick and the other nurse, who
Such a project as this will take a long liked to work with children, apparently
time to complete. The area to which a did not see the problems of the aging
new nurse is to be assigned will be population in her area.
given first priority, so that it becomes a This kind of analysis of nursing visits
natural part of her orientation. provides an opportunity to evaluate
nursing performance with objective data
Adaptation of Nursing Needs to which helps to alert the supervisor to
Meet Community Needs and Wants problem situations earlier than if she
were to rely on impressions or judgment
When a nursing supervisor has at alone.
hand pertinent information relative to
the nursing district for which she is Supervision of Staff Performance
responsible it can help her plan her
work. It also helps to justify a situation Statistical tabulation of the reports of
similar to the following which now the nursing visits has been used to
exists in one of the rural districts. This establish a base line of performance for
particular problem is concerned with a the nurse working in a particular dis-
steady increase in the demand for bed- trict. It was found that the base for
NURSING ACTIVITIES IN ERIE COUNTY VOL. 45 327
the entire service is 78.4 visits per visory tool of measurement of quantita-
month. For the generalized districts, tive performance. The basis for esti-
the range is from 66.2 to 100.0. It is mating quality control of work organiza-
true that the field visits are only one tion, content, time, and cost of visits
part of the nurses' work; therefore, a can be related to the production record.
similar base has been established for Nursing reports are only one means
both school and clinic visits. These to be used in the supervision of the
bases may change from time to time staff nurse and must be evaluated by
because of changing programs, turnover the supervisor and staff in light of all
in staff, or other related factors. other pertinent factors.
An example of the use of the indi-
vidual nursing reports was demonstrated Summary
in the study of the visits for four years
for seven nurses, all of whom are now This system of reporting and tabu-
assigned to the same nursing district. lating of nursing activities has provided
The visits were plotted on a monthly in- an effective method for quantitative
terval against the base for the district evaluation of the nursing service. With
in which they worked at any time during the volume of work in this agency,
those four years. The record of one which consists of handling 10,000 to
nurse was consistently below the base, 12,000 cards per month, the mechanical
another showed an increasing drop in system of tabulation has proved econom-
production, another hit a plateau for ical, rapid, and effective. In a smaller
four months, then gradually increased agency, manual tabulation may be more
the quantity of visits. One of the nurses, economical and equally effective.
who had been in three different districts Only a few highlights were included
during the four-year period, maintained in this discussion. There are still many
a fairly consistent level of work, above areas of study in our nursing reports
average, in each work situation. which have not been explored for their
Granted that this shows little of how application to the service programs of
the nurse functions, it at least gives evi- this agency. Occasions are continually
dence of how much she does. Joint arising in which data of this kind are of
evaluation by the supervisor and staff value in order to define and evaluate
nurse, with the nurse plotting her own problem situations in relation to either
progress and with other factors taken individual staff development or service
into consideration, provides a super- program planning and evaluation.