Just as Worcester, Massachusetts, was preparing to begin its celebration of National Public Health Week in April, four of its seven public health nurses were laid off. A total of 99 city workers were also let go and numerous positions were frozen as part of the city's budget cuts for the 2010 fiscal year. But a small group of nurses, part of the bargaining unit of the Massachusetts Nurses Association, has been fighting to preserve the city's public health department. After holding a rally and making local media appearances, they convinced the city council to try to secure the funding to reinstate three of the nurses.

Figure. Nurses rallied on May 5 in Worcester, Massachusetts, in an effort to pressure city lawmakers to rescind cuts to the public health budget. Photo courtesy of David Schildmeier / Massachusetts Nurses Association.

"I don't think they thought we'd be such a force to be reckoned with," said Debby Vescera, one of the public health nurses. "They didn't expect the little girls in the basement to make such noise. But we're not fighting for our jobs as much as we're fighting for our community."

Worcester is the second-largest city in the state, with 172,000 residents, high poverty levels, and a large immigrant population. Its public health nurses monitor the spread of more than 150 infectious diseases, such as tuberculosis, West Nile virus, and influenza A (H1N1) (swine flu), and immunize against many of them. They also provide free vaccines for public-school children and the homeless, staff health clinics in housing authority sites and senior centers, and help coordinate local response during disasters.

"Our nurses go to homeless shelters, making sure people take their medications in the parking lot," said Vescera. "We're out on the streets going places nurses don't want to go."

Pending budget approval, three of the nurses will be reinstated through September 30, when the city manager is expected to present alternative plans to cover the city's public health needs. The reinstatement of the nurses, even temporarily, is a win for public health advocates, acknowledges David Schildmeier, spokesperson for the Massachusetts Nurses Association, but he believes the community debate has been equally important. "We're talking about what the future of public health is going to look like in the city of Worcester," he said. "Public health is no longer in the background; the idea to make it an important policy consideration and a community concern has been a success."

Tammy Worth