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A Novel Idea: Library Nurses

Oct 21 2012 6:48AM

Stephanie Innes


A slight man with a stethoscope and black medical bag regularly
walks through Tucson's downtown public library, helping patrons with
issues that have nothing to do with books.

Daniel Lopez is not a librarian, but one of the nation's first
library nurses. He checks the feet of diabetics, takes blood
pressure, gives out condoms and intervenes in medical emergencies.

Lopez is Pima County's novel answer to a common issue in public
libraries across the country - a growing number of patrons living
without shelter, health insurance, medical care or computer access.
They come to the library looking not only for resources, but also
for safety and protection from the elements. The shaky economy and
high unemployment have further fueled the need.

In response, some urban libraries have hired child psychologists,
social workers and language teachers. Others bring in teachers to
help kids with homework. No other public library system in the
country is known to employ nurses, says the nation's largest library

"We are branching out from the library-science degree and filling
positions with other expertises that apply as well," said Marcia
Warner, past president of the Public Library Association, a division
of the American Library Association. "We serve all populations, and
some populations have different issues. It's just part of serving
the public."

One More Enhancement

The national association encourages libraries to create programs
for homeless and other disadvantaged patrons because public
libraries are about equal access to information for everyone, Warner

"We don't just serve middle-class people. We serve all
populations," she said. "We don't think twice about having security
in urban libraries. This is just one more enhancement."

Local library officials had been wanting to to address social
service needs among patrons for several years but weren't quite
certain how. Then in 2010, when the San Francisco Public Library
took the unprecedented step of hiring a social worker, Pima County
officials were inspired to take similar action.

"It was like a light bulb went off," said Karyn Prechtel, chief
librarian for the Pima County Public Library's Joel D. Valdez Main
Library in downtown Tucson. "It seemed brilliant. I was able to meet
with the people in San Francisco, and we went from there."

The library partnered with the county Health Department to do
something similar and decided a public-health nurse would be the
best local solution.

"So many of our customers are uninsured and a lot are telling us
they can't afford their meds, that they can't manage their diabetes.
The problem is really complex," Prechtel said. "A public-health
nurse can potentially influence the health of the community. That is
thinking big. But they can talk about problems they see and we can
all work on solutions together."

The Nurse Is In

On a typical Monday, Lopez moves through the downtown library,
gently approaching patrons to let them know what he does. Some
patrons, knowing Lopez's schedule, seek him out.

On Wednesdays, he works out of the Woods Memorial branch, 3455 N.
First Ave., on Tucson's north side. Employees there put up a
sandwich-board sign when Lopez is working. It says, "The Nurse Is
In: Blood Pressure Screening, Health Education, Community

Some of the people he talks to are homeless; some are addicts.
Many have no health insurance. Mental health issues are common.

Patrons like Dan Russell, 65, have chronic health conditions.
Russell, a retired cook, goes to Woods every day to read the
newspaper. He has high blood pressure, and Lopez helps him to
monitor it between quarterly visits to his doctor.

On one recent Wednesday, Lopez helped a young mother at Woods as
she scanned the jobs board. She works in a convenience store but
wants to find a job where she feels safer. When Lopez asks whether
she has health concerns, the woman says she is covered by the
state's Medicaid program for the indigent, but that she hasn't been
able to get a doctor's appointment to get her daughter immunized.
Lopez gives her information about a county immunization clinic.

All are Facing Hardship

There's no general demographic profile of those who need
services, downtown librarian Prechtel said. The commonality is that
all are facing some sort of individual hardship, and all come to the
library because it's a safe place where they know they can get
information, she said.

"Public libraries have always served the poor and people who are
disenfranchised. We've always had customers who need extra support,"
she said.

The library nurse program is jointly funded by the county's
library system and its Health Department and costs $67,300 per year -
the annual cost of one full-time public-health nurse. Five Pima
County public-health nurses divide the equivalent of one full-time
position among them. The five nurses work weekdays at six local

During his downtown shift, Lopez encounters a man in his 30s
sitting in the children's area with his daughter. The man, who is
living in a shelter, is happy that he just got a job, for $8.25 per
hour. He'd been looking for a long time. But the job doesn't include
health insurance, and he's afraid his income will be too high to
continue qualifying for Medicaid. A diabetic, he worries he won't be
able to afford his medication.

Lopez, who started his job in July, gives him information about
local community-health centers and mobile clinics that offer care on
a sliding scale. It's important to continue with medication, Lopez

"If you manage your diabetes," he tells the man, "you can avoid

No Health Insurance

Lopez encounters people without health insurance on virtually
every shift. A lot are unemployed. Dental care is a big worry. Many
of them skip it to save money - but that can invite infection and
other illness. Some of the people who are most confused are those
who have recently lost jobs and have never been unemployed before.

"A lot of what I do is education," Lopez said. "The stethoscope
is mostly so people recognize me."

He has helped people with detoxification, psychiatric crisis,
injury and acute illnesses. The nurses also prevent people from
using library restrooms for bathing, librarian Prechtel said.

Lopez's rounds at the downtown library include a visit outside to
the many homeless men who regularly congregate there. Several know
him by name, though it has been a struggle to earn their trust.

One of Lopez's key contributions to the downtown library has been
preventing 911 calls. The main library has about 10 of them per
month, usually from angry people, said Prechtel.

"We don't want to call 911. We call when we don't see any other
options. Usually it is a mentally ill customer who is not doing
anything criminal but we can't manage them," she said. "We've
already seen our nurses intervene in episodes before the behavior
escalates. That is critical."

Prechtel says the program will be constantly evaluated as
economic conditions and health care change, but she suspects there
will always be a place for public-health nurses in the library.

"It is new thinking," the Public Library Association's Warner
said. "We are so used to passing out information, but we don't
always do such a good job with following up on that information,
making sure people are getting the help they need."

Participating Branches

Tucson-area library branches staffed by a nurse:

* Joel D. Valdez Main Library, 101 N. Stone Ave.

* Woods Memorial, 3455 N. First Ave.

* Martha Cooper, 1377 N. Catalina Ave.

* Sam Lena-South Tucson, 1607 S. Sixth Ave.

* Santa Rosa, 1075 S. 10th Ave.

* Eckstrom-Columbus, Pima Community College 29th Street Coalition
Center, 4355 E. Calle Aurora (temporary location)

Source: (C) 2012 The Arizona Daily Star

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