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RNs patrol Pima County libraries to provide patient assessment

Monday February 11, 2013
Daniel Lopez, RN, is proactive, approaching patrons and telling them about his role and how they can reach him, being careful to maintain privacy by using staff-only phones and communicating in removed areas. He performs focused assessments and refers patients to clinics, shelters, food providers and various agencies and resources.
Daniel Lopez, RN, is proactive, approaching patrons and telling them about his role and how they can reach him, being careful to maintain privacy by using staff-only phones and communicating in removed areas. He performs focused assessments and refers patients to clinics, shelters, food providers and various agencies and resources.
(Photos courtesy of Pima County Public Library)
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Daniel Lopez, RN, right, said library nursing requires good listening skills and a nonjudgmental perspective. He has helped people facing unemployment, domestic violence, homelessness, illness, dental needs and psychological distress, and believes some background in psychiatric nursing is essential for library nurse work.
Public health nurses in Arizona’s Pima County have discovered an original venue for recognizing and serving the needs of the community: public libraries.

Thought to be a unique initiative, the library nurse program began in January 2012 with one nurse working in one county library. A year later, 11 nurses work among 13 libraries and a bookmobile, said Kathy Malkin, RN, MSN, division manager of Pima County Community Health Services.

"The library program makes our nurses much more visible," Malkin said. "As of the end of October, our nurses had over 3,000 interventions with people in the libraries. Those interventions wouldn’t have happened if the nurses weren’t [there]."

The program has been well-received by civic leaders and the community, said nurses and librarians. The managing librarian at Pima’s main library kick-started the program when she asked the county health department to provide a social worker to help the library handle various challenges: parents dropping off children or elderly relatives and expecting library staff to take care of them; homeless patrons with behavioral health issues; and even gang activity. Believing nurses could offer more services, the county sent an RN to the library instead. Now the library system and the health department want to "put a nurse in every library that wants one."

"Some of the nurses were hesitant to take on library nursing," Malkin said. "They were unsure of what to do and how to approach people."


Daniel Lopez, RN, said he might see an average of five to 30 people with behavioral issues in the libraries on any given day.
The program began with the nurses dividing up the equivalent of one full-time position. The frequency and duration of nurse visits depends on libraries’ needs and the demographics of their patrons. While the nurses may take vital signs, teach wound care and provide snacks, hygiene supplies and clothing, they are primarily focused on patient assessment, case management and education.

"We don’t have the financial resources to do more medical intervention," Malkin said. "We do lots of referring, especially with the mentally ill. We connect with the housing authority and VA hospital, since many homeless people are vets."

Since the program began, 911 calls from libraries have decreased by 33%, said Malkin, partly because nurses trained library staff to recognize when behavioral issues are escalating and to intervene appropriately.

While the library nurses function fairly autonomously, Debbie Weber, RN, BSN, public health nurse manager, oversees their work and coordinates with librarians on staffing, data collection and documentation.

Daniel Lopez, RN, BSN, divides his 24 hours a week between the Joel D. Valdez Main Library in Tucson, Ariz., and the Woods Memorial Branch Library nearby. Like the other nurses, he wears a stethoscope so people can identify him as a healthcare worker.

Lopez said library nursing requires good listening skills, a nonjudgmental perspective and a background in psychiatric nursing. "In the past, the behavior could simply be an outburst, and then they were asked to leave," he said. "[But] sometimes people need transport to higher medical care or acute detoxification. There’s no blaming, no asking 'Why?’"

Lopez said he sometimes sees up to 30 people with behavioral issues on any given day. "If I weren’t here, I think a lot of these individuals would fall through the cracks," he said. "I can open doors for them and they can walk on through. Overall, I think it makes for a healthier Pima County."


Lori Fagan is a copy editor. Send letters to editorWest@nurse.com or post a comment below.