Large urban libraries have always been a refuge for underserved and marginalized individuals, and library users around the country are increasingly grappling with serious difficulties in their everyday lives. Library staff is well-trained in connecting library users to community resources, yet they are not typically able to help a customer through an entire social service or health referral process. Staff does not feel competent in assisting homeless and/or mentally ill customers, and incident reports indicate that library management often resorts to calling 911 for assistance with mentally ill and homeless customers who act out. Calling for help from paramedics and police officers who are already spread thin throughout our community has not addressed our customers’ underlying issues, often resulting in repeat incidents.

We looked for ways to mimic San Francisco Public Library’s model of staffing their Main Library with a Social Worker and “Health and Safety Associates”, and we pursued a partnership with the Pima County Health Department. Our final decision to hire a Public Health Nurse was based on our desire to address public health concerns in our libraries through education and prevention while also meeting the needs of our most underserved library users including the homeless and people who suffer from mental illness. To the best of our knowledge, no other library in the United States has employed a nurse to address customer needs.

The structure of this program is designed to be comprehensive in nature with the overarching goal of providing a safe and welcoming environment for all library customers. We have outlined 6 objectives for this innovative program:

1. The nurse will work one-on-one with library customers that have exceptional social service and health needs. She will roam the Main Library and 5 library branches to observe customer’s behaviors, and when appropriate, engage in discussions about available services.
2. The nurse will address public health issues in our facilities including infection control, disease control and hygiene.
3. The Nurse will design curriculum for staff training.
4. She will identify additional services, programs, or workshops for unmet patron needs.
5. She will identify and participate in outreach opportunities for underserved community members.
6. She will help forge stronger collaborative relationships with local social service agencies.

Pima County Public Library’s Public Health Nurse was hired in January of 2012. Publicity has garnered strong community support and interest by way of emails, and phone calls. As a result of the press release alone, we have been contacted by and are forging new relationships with assistance agencies in our community.

Plans to evaluate this new service are in place and include an evaluation of incident reports and staff surveys at 6-month intervals as well as a comprehensive comparison of results to objectives. In her first 10 weeks in the position, the Library Nurse made over 650 one-on-one contacts with library customers at six Pima County Public Library locations. The contacts fall into 20 different categories related to education, intervention, and referral. She has also assisted in two medical emergencies, helped a victim of domestic violence find shelter and support, and helped create a buddy system for our homeless regulars. Anecdotally, library management has noticed an almost immediate drop in 911 calls for assistance with behavioral health issues, and library staff has expressed a decrease in stress related to working with individuals with behavioral problems. Our evaluation of the program after six months will help us quantify these anecdotal findings.

We are fully expecting this program to be a success and we are already in communication with the University of Arizona’s School of Nursing to place nursing students in “service learning” positions in several of our branches.