Pima County Public Library (PCPL) staff identified several libraries (Joel D. Valdez Main, Santa Rosa, Woods, Martha Cooper, Eckstrom-Columbus and Sam Lena-South Tucson) that exhibited an unsafe and unwelcoming environment for patrons and staff primarily due to other patrons with traumatic crisis episodes and behavioral health concerns, as well as ongoing problems such as loitering, people setting up camps near library property, and child and elder abandonment. While traditional library service provides for information and referral to individuals in crisis, PCPL staff often called 911 for assistance in handling customers’ behavior issues. The initial goal of the Library Nurse program was to provide a safe and welcoming environment for all patrons and staff. A secondary goal was to minimize the number of calls to 911 for non-medical emergencies, freeing up law enforcement resources. Public Health Nurse Daniel Lopez reports that he sometimes sees up to 30 people with behavioral issues on any given day at the library: “If I weren’t here, I think a lot of these individuals would fall through the cracks. I can open doors for them and they can walk on through. I think it makes for a healthier Pima County." Nurse.com, 2/11/2013

PCPL staff attended a workshop in 2010 about San Francisco Public Library adding a Social Worker to their staff. Recognizing this as an innovation that might work in managing crisis episodes for PCPL, the library sought out Pima County Health Department as a natural partner to determine how a similar position might be created. Working with the health department, staff learned about Public Health Nurses (PHNs) and recognized that they would be a better fit for the library’s needs. Public Health Nurses are population-focused, looking at what people need and how to keep them healthy. Public Health Nurses also perform advocacy activities. Discussions ensued between the two county departments, and it was determined that PCPL would fund a Public Health Nurse position to work in libraries with clinical oversight by the health department. Initially, one Public Health Nurse was hired for 40 hours per week. The Main Library was the home base, and the nurse spent other days in other library locations. After six months, it was determined that the work load was too much for one nurse and could be better managed with a different staffing model. Today, the position is still funded at 40 hours; however, the hours are now distributed among five nurses who work at six libraries. The lead nurse provides 24 hours of service between the Main Library and the Woods Library. The remaining four nurses provide four hours per week of service at the remaining libraries. “On a typical Monday, Lopez moves through the downtown library, gently approaching patrons to let them know what he does. Some patrons, knowing Lopez’s schedule, seek him out.” Arizona Daily Star, 10/21/12

This was an exciting and successful first year for the program. The library nurses interacted with 2,871 patrons in 2012. Overall, 911 police calls were reduced by 6 percent; 911 medical calls were reduced by 20 percent. Health interventions are available to patrons, and through substantial media publicity, PCPL has received positive feedback from patrons, staff, and the community. “Pima County Public Library is addressing conditions that have long existed in nearly every urban and rural library in the country, said Maureen Sullivan, president of the American Library Association.” TODAY.com, 3/28/2013 Library workers are the eyes and ears for the Public Health Nurses and now feel supported to have on-site professionals to handle customer issues that may have resulted in 911 calls in the past. PCPL librarians who co-authored an article about the program wrote: ”Due to their consistent presence inside our libraries, our nurses are helping to find solutions to those unfortunate, stressful situations, and create positive outcomes for our patrons, staff, and community as a whole.” National Network of Libraries of Medicine Pacific Southwest Region Newsletter, 8/14/2012 Other libraries are taking notice: “Congratulations on this story and the entire program! Working toward a similar program here - you inspired us!” Albuquerque Bernalillo County Library on Twitter, 3/28/13 The Health Department has seen this partnership as a tremendous way for Public Health Nurses to be recognized in the community. As a result, all 16 county PHNs have been charged with connecting with the library in their assigned neighborhood!