Growing up, I absorbed the idea that to be a nurse is a terrible thing. My grandmother trained as a nurse right before the 1918 flu epidemic. She was so horrified by the illness and death she saw during that epidemic that she never practiced nursing again.

It took me quite a while to overcome that story, but at the age of 36, with two young children, I decided that the profession had likely changed enough that it was worth pursuing. Five years later, I had a third child, a bachelor of science in nursing degree, and a license to practice as a registered nurse.

Right away, I applied for jobs in public health, but was not hired. My first nursing job was at our local hospital, in the birthing unit. I loved working there, and I learned a lot. But as a new nurse, I worked nights and evenings, which became more challenging as my children grew older. Finally, I was offered a part-time public health nurse job. Little did I know what I was getting into.

I was privileged to become a home visiting public health nurse in the classic sense, working with families with children with special needs, and later also with pregnant women and babies. I learned about all the resources in our community and in our state that support families and children. I also learned about how frustrating it can be to navigate through these systems: filling out multiple application forms, waiting for someone to call, worrying about whether health insurance will cover the expenses, and whether the time you need to take off work will leave your family destitute, without a safe place to stay.

I learned about how hard it is to find support without blame when your child’s behavior leads to expulsion from school. I learned that even very young children can be expelled from preschool. I learned that some of the most vulnerable families don’t trust anyone. I learned that some of the most vulnerable families may have a hard time expressing their point of view and needs. It takes careful listening and reflecting back what you’ve heard just to start to understand. It takes a lot of time. I often wondered how I would handle some of the stressful life experiences that my clients were dealing with. These experiences were life-changing for me, and exhausting too.

After nine years, I left home visiting work. I went back to school and got a master’s degree. Then I went back to public health work as a supervisor. This time, my work involved overseeing several staff members, communicable disease investigations, harm reduction programs, and the few remaining clinical services we provide at Kittitas County Public Health. Again, I learned a lot and got to work with many wonderful colleagues. I was able to participate in many community initiatives and get to know even more community partners.

But now it is time for me to retire. As I reflect on my career, I would like everyone to have the same opportunity I have had to think about what public health programs might make the most difference to the most people.

The Centers for Disease Control and Prevention (CDC) has published an initiative called “Health Impact in 5 Years,” or “HI-5.” They focus on cost-effective, evidence-based approaches that can produce results within five years. Many of these programs require collaborative community efforts — public health alone can’t make these things happen.

The HI-5 initiative classifies these approaches into two main types of “interventions that have the greatest potential for impact on health because they reach entire populations of people at once and require less individual effort.” These are some of the interventions classified as addressing Social Determinants of Health:

· Early childhood education

· Public transportation systems

· Earned Income Tax Credits

And these are some of the interventions that make the healthy choice the easy choice:

· Safe routes to school

· Pricing strategies for alcohol

· Access to clean syringes

If you find these ideas intriguing or mystifying, you can learn more at: https://www.cdc.gov/policy/hst/hi5/index.html.

I am retiring on July 12 but not leaving the Kittitas County community, which has become very dear to me. I expect to continue to advocate for early childhood education, which has always been important to me. I hope you will see me more often singing and dancing and less often attending meetings. And I wish you all the very best.

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