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More than just books: Arizona libraries add public health nurses

Pima County Communications Office

Nurse Karen Murphy checks a library visitor's blood pressure in Tucson, Ariz., where branches are providing public health nurses along with their other free services.

Public libraries have long been the go-to place to borrow books, attend classes or log on to public computers. But over the last decade, they have also become shelters for people in need, including the mentally ill, battered women, latchkey kids and new immigrants.

Acknowledging that reality, libraries in Tucson, Ariz., have become the first in the nation to provide registered nurses along with their other services. Placing nurses in six branches is a nod to the widely accepted transition of public libraries into de facto community centers.

Pima County Communications Office

Nurse Daniel Lopez, right, shakes hands as he makes his rounds at a Pima County library branch.

“The need in our libraries has always been there. We’ve always been a place for the underserved,” said Karyn Prechtel, deputy director of public services for Pima County Public Library. “Before, we were trying to address those needs ourselves, as librarians, but without the training there was only so much we can do to help these folks. Librarians feel a little bit like their hands are tied.”

Now they can seek help from nurses like Daniel Lopez, who roams the main library in downtown Tucson every morning with his stethoscope and black medical bag. What he encounters varies daily. He could be checking people’s blood pressure, examining the swollen limbs of diabetics, or attending to sprains and superficial cuts. On some days, he joins the library’s Story Time, helping parents find hygiene supplies or immunization clinics. Sometimes, he is called to help someone withdrawing from drugs or alcohol.

Pima County Communications Office

Nurse Daniel Lopez gives Henry Cardoza information on local shelters at the Joel D. Valdez Main Library in Tucson, Ariz.

“I’m available to anybody who walks in the door, to all parts of the community,” said Lopez, 34.

Case management occupies a significant portion of his time. On one recent day, Lopez helped arrange a medical appointment for a homeless man whose liver cancer had spread to other organs. The man had just been discharged from a hospital, even though workers there knew he had nowhere to go. Lopez set up a follow-up appointment with a charity oncologist.

Lopez also chipped away at ongoing work helping a homeless, developmentally disabled woman whose husband was in hospice. He already had set the woman up with temporary housing at the Salvation Army and arranged for her to see her husband before he died; now he was helping her deal with financial issues and finding long-term care.

“It’s whatever the individual needs, but my first priorities are always following hierarchy needs, so I look at food, shelter, and safety needs first,” Lopez said.

Pima County Public Library is addressing conditions that have long existed in nearly every urban and rural library in the country, said Maureen Sullivan, president of the American Library Association. Not only does a library offer resources free, she said: “It’s also well understood to be a safe place, a place that welcomes anyone, and so people will just go in and be there.”

Pima County Communications Office

Nurse Karen Murphy uses a food pyramid bingo card to provide information about healthy eating.

Pima County's program began in January 2012 with a single nurse who divided her time among six of the system’s 27 branches. By midyear, the program expanded to five nurses who share one full-time employee slot.

The county came up with the idea after San Francisco Public Library become the first in the nation to hire its own social worker in 2010. Pima County Public Library partnered with the county health department to follow San Francisco’s lead, but soon learned the agency didn’t employ social workers. Instead, it offered one of its public health nurses, a title bestowed to registered nurses who are more community focused and centered on preventing infectious diseases.

“It was like social work plus,” Prechtel said. “They can do all of the social work-type work, but they can also address health issues, and perhaps even community health issues. We felt that was a bonus, so that’s why we decided to go with a nurse and not a social worker. “

Pima County Communications Office

Nurse Daniel Lopez talks with a visitor at the Joel D. Valdez Main Library in Tucson, Ariz.

The nurses seem to be making a difference. At the main library, emergency calls seeking police help dropped 14 percent last year; at another branch, 911 calls dropped 60 percent.

Other libraries around the nation and in Canada have taken note.

During a Facebook forum on the nursing program hosted by the Public Library Association, a division of the American Library Association, Pima County officials fielded numerous questions and compliments from intrigued librarians throughout the country. A nursing program is also being considered by the Ottawa Public Library in Ontario, Canada

Libraries often build upon each other’s ideas, said Karen Strauss, acting chief of the main San Francisco Public Library, which inspired Pima County’s nursing program; San Francisco hired a social worker for its library. “The validation of our program is that a lot of libraries have done a variation on what we do, because it really needs to be whatever works for the community,” she said. “Not every library has the same resources or the same structure.”

What’s key is that the public understand that libraries continue working hard to provide a safe and welcoming environment to everyone.

“We don’t see this outside of our mission at all,” Prechtel said. “We’re helping library customers. These are people who are already in our libraries that we already serve other ways. This is just another service to those customers.”

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