For 7 years, she investigated communicable diseases in the community.

Now, as one of the first nurses in the state to be certified as a lead risk inspector, she weaves environmental health into her practice. She assesses homes for sources of lead; works with landlords to fix problems; and supplies families with carbon monoxide detectors, cabinet locks, nightlights, buckets, mops—in short, anything they need to minimize hazards in their homes. At the same time, she is assessing the psychosocial aspects of families’ health and helping them reduce tobacco use and prevent or control asthma. Ms. Ayers said, “Being a nurse, I can answer a lot more questions about asthma, medications, and inhalers than somebody who may not be a nurse.” And she continues to take her turn as a home visitation nurse on weekends, seeing a child with leukemia, helping a new mother with breastfeeding, or checking on a newborn who is losing instead of gaining weight.

When I make home visits, I offer information on breastfeeding, nutrition, and lead poisoning, and I do environmental assessments. It’s definitely public health and nursing combined.

—Lisa Ayers, BSN, RN, public health nurse, Schenectady County Public Health Services, Schenectady, New York

Usually, the health department will ask a landlord for permission to inspect a home only if a child has a blood lead level of at least 15 mcg/dL. But that requirement is waived for Healthy Neighborhoods, an initiative aimed at reducing environmental hazards in two zip codes—12307 and 12304—that have had high lead-poisoning rates. Anyone living in these zip codes can request a free home assessment of air quality, asthma triggers, fire safety, and other health issues, and the assessment can be done without the landlord’s permission.

Ms. Ayers spends about 40 percent of her time on Healthy Neighborhoods and 60 percent on lead-poisoning prevention, and she finds ways to combine the work of the two programs. “When I’m out there doing prevention for air quality with Healthy Neighborhoods, I also do a visual lead inspection in the home,” she said. And she teaches families measures such as handwashing; letting water run from lead-soldered pipes before drinking; and eating foods high in iron and calcium and low in fat, which prevents lead absorption.

The county has tracked cases of elevated blood lead levels in zip code 12307 for more than two decades. Since a peak of 34 cases in 1992, the number dropped to five or fewer annually from 2006 to 2009, according to unpublished data.

Nurses’ contributions to these outcomes are not lost on Richard Daines, MD, New York State’s health commissioner, who shadowed Ms. Ayers shortly after he took office. “He was very excited [by what he saw],” said Ms. Ayers. “I think they have recognized—all the way up to the commissioner level—what a nurse can bring to this position.”

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