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One Public Health Nurse's Full Circle Journey
Jul 26, 2013, 1:00 PM, Posted by Cassandra Standifer
Cassandra Standifer, BSN, PHN-NFP, is a public health nurse working in the Nurse Family Partnership program in Renton.
When I think about public health, I don't think only of my nursing practice. I think about where I came from and how I got here. When I sit with my clients I can see in their situations my own mother, my aunt, my cousins and myself.
I work with first-time teen moms in a program called the Nurse Family Partnership. Today I met my client, Sarah*, at her transitional housing. As I sat outside waiting for her, I thought back to 1990 when I was seven years old and living with my mother and sister in transitional housing. My mother was addicted to cocaine and attempting recovery—again. Transitional housing was an improvement from the hotel we had been living in, but I was well aware, even then, that there had to be something better out there than this halfway house.
During our home visit we chatted about Sarah's daughter. She exclaimed, "She has eight teeth on the bottom and eight teeth on the top, no cavities!"
As I got into my county car to head back to the clinic, I thought, "She really loves her daughter!" I remembered that when my sister and I were finally removed from my mother's care because she couldn't stay clean, I went to the dentist for the first time at the age of nine, and had eleven cavities! My sister and I eventually received the care we needed, and when we did, it came from public health.
With the love and support of many people, I graduated high school and chose nursing as a career. My childhood experiences had fostered in me a great desire to work in a 'helping' profession and to give back to the community. I graduated from Seattle University and, after becoming a mother myself, eventually changed my focus to maternal health. For me, that is a full circle journey.
I stay in public health because I believe in the power it has to effect change in the community. I am attuned to this because of how it effected change in my own life. When I relate to my clients, I relate as one WIC mom to another.
My one wish for public health is that the nursing workforce would reflect the diversity of our population. As one of a very few African American public health nurses in our agency, I hope to set an example to my clients that they, too, can someday come full circle.
*name and some information changed to protect confidentiality
Read more about the Robert Wood Johnson Foundation's work on public health nursing.
Read a blog post about the Nurse-Family Partnership.
This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.


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SUMMARY: Indianapolis-based premium loudspeaker manufacturer Klipsch, LLC has changed its name to Klipsch Audio Technologies. The company's new state-of-the-art worldwide headquarters could be complete before the end of the year.
INDIANAPOLIS (August 23, 2000) - With a new name and a new worldwide headquarters, Klipsch is setting the stage to hold on to its position as the number one specialty audio loudspeaker brand in the United States.
According to Chairman and Owner Fred Klipsch, the 55-year-old "Legend in Sound" company has doubled its sales in the last three years through stellar core business performance, along with major contributions from other business units including professional cinema, international operations and multimedia audio.
Klipsch, which employs about 55 people at its current Indianapolis facility, will move its worldwide headquarters to 3502 Woodview Trace in College Park on the city's northwest side. The expansion involves a capital investment of approximately $12.8 million and the creation of 132 new, high-wage jobs over three years. The Indiana Department of Commerce and the City of Indianapolis offered Klipsch incentives worth a total of $1.4 million. Commerce awarded Klipsch a Training 2000 grant of $125,000 and EDGE (Economic Development for a Growing Economy) tax credits worth up to $1 million. The city offered Klipsch five-year tax abatement on personal property valued at $62,000, and six-year abatement on real property worth $251,000.
"The audio industry, particularly consumer electronics, is a volatile business. It's just as unpredictable and fraught with change today as it was 10 years ago," Fred Klipsch said. "Fortunately, our 'best of class' product development strategy and careful brand navigation have earned us enviable positions of leadership in numerous industry categories. We are now making significant organizational and infrastructure improvements that will allow us to maintain and grow this market position."
Audio pioneer Paul W. Klipsch founded the company in 1946 under the name Klipsch & Associates. The name was changed to Klipsch, Inc. in 1989 when Fred Klipsch and his wife Judy Klipsch purchased the company, which was later reorganized and changed to Klipsch, LLC. Effective June 2000, the new public name -Klipsch Audio Technologies - was officially adopted.
"We have evolved far beyond manufacturing alone. Today, Klipsch is a technology company whose core business is designing and marketing premium loudspeaker systems," Fred Klipsch said. "We're focused on developing and utilizing new proprietary technologies that deliver the Klipsch sound experience. Our new name - Klipsch Audio Technologies - better reflects our true market position as well as who we are and where we're going as a company."
According to Mike Klipsch, executive vice president and COO for the Klipsch Worldwide Manufacturing and Supply Management Group, Klipsch will occupy 65,000 square feet of the existing 100,000 square foot, four-story building, which is more than three times the size of current 18,000 square foot corporate offices located on the northeast side of Indianapolis. Mike Klipsch said the additional 35,000 square feet of the new Klipsch worldwide headquarters building will be leased to another company or companies. Closing on the purchase of the building is scheduled for September 30, which could allow Klipsch and any tenants to move into the building as soon as late 2000 or early 2001.


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My main focus will be to collaborate with the various teacher, centre, and board teams across the province in order to provide support that makes sense for each community.
These are themes that were explored in 2015-16 and I expect they will continue throughout 2016-17. If you have something else in mind for your community, contact me (see below) and let's talk about it!
How can I help?
These are some methods I use to help support you and your learning community.
What kinds of PD and workshops can we offer?
Take a look at this list of the workshops and professional development days we offered in 2015-16 in collaboration with Avi Spector and different centre and board teams across the province.
Contact me if you would like a similar workshop or if you want to collaborate on something new and unique to your community. The best way to start the conversation is by clicking on this link. I promise to respond to all inquiries within 1 business day: Contact Tracy
I am looking forward to a great year of learning together!
I have been teaching and consulting - from primary school through adult education - since 1996. Currently an education consultant with la Commission scolaire de la Seigneurie-des-Mille-Îles in Montreal, Quebec, I believe that sharing our stories is the key to getting better together.


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Small changes, big differences
Nursing staff have saved thousands by changing the way they buy clinical supplies
The NHS spends more than £4.5 billion a year on clinical supplies and services in England alone. The RCN set up the Small Changes, Big Differences project to raise awareness of the value nurses can bring in choosing products that both improve the patient experience and are cheaper. It also exists to showcase innovation in procurement and reduction in waste.
Last year, Sandy Brown, Director of Nursing and Clinical Quality at the East of England Ambulance Service NHS Trust (EEAST), spearheaded an award-winning project to improve how ambulance and acute sectors work together to deliver clinical care. He set out to review the shared products his ambulance trust and the area's hospitals use.
"I wanted to create efficiency, while improving patient care across organisations with shared benefits," he says. "It's the first project of its kind and, as with many other successful initiatives, is simple in concept."
The pilot for the project started in July and initially focused on electrodes. The ambulance trust was using one type of electrodes which were then being replaced with a different type once the patient arrived in A&E.
"After reviewing their use, we moved to a dual-use electrode, which is multi-machine compatible and can be used by all organisations thereby allowing the product to be used for the patients' stay or up to 72 hours. Not only does this reduce waste, but A&E staff don't have to remove the product in order to carry out their duties."
Feedback from staff has been positive. "There were some initial teething problems around the awareness of both the trial and how the new product should be used. However, once staff were well informed, there was a shared agreement that the change in product improved the quality of care for patients across both services."
The financial savings are significant. According to NHS Supply Chain data, the health service buys more than 270 million electrodes every year at a cost of between 2p and 50p each. By moving to a dual-use electrode the EEAST has saved £39,000 and it is estimated Addenbrooke's Hospital A&E department will save £7,000. By rolling the initiative out nationally, the NHS could save £1.2 million annually.
Reviewing everyday items
Meanwhile, Clinical Procurement Specialist Andrew Varley and Head of Procurement Paul Saunders, both at the Taunton and Somerset NHS Foundation Trust, have set up monthly meetings to swap clinical products for cheaper alternatives.
The meetings are named after the RCN's Small Changes, Big Differences project and nursing staff of all levels are invited to review four or five clinical products that they use day-to-day.
"The products are put in the middle of the table, alongside two or three cheaper alternatives. The director of nursing is also in the room and together we decide on a new product of the same quality but for a lower price," Andrew says.
Staff are at the heart of the decision rather than having changes imposed on them
Five meetings have taken place so far and on average the trust has saved £10,000 each month. "We've swapped patients' toothpaste from a 50ml tube to a 5ml tube, changed the brand of pregnancy tests and non-woven swabs we use and identified products where we can order a lower quantity.
"All of these changes are simple but have helped us to reduce waste, save money and improve the patient experience. Staff enjoy the meetings because they are at the heart of the decision rather than having changes imposed on them," Andrew concludes.
After seeing the success of these meetings, Liam Horkan, Clinical Procurement Nurse Specialist at Colchester Hospital University NHS Foundation Trust (pictured above with nursing colleagues), set up his own Small Changes, Big Differences meetings. "I loved the concept of engaging clinical staff in a different way," he says.
"Often nursing staff don't know how to get involved in some of the decisions we make on clinical products. But the biggest challenge is them having time to come away from frontline work to feed into meetings. We're using our intranet site and encouraging staff to post and discuss ideas in staff meetings and other forums to combat this."
Being able to embed procurement into clinical practice has meant the trust is now looking at projects from all aspects of quality, safety and value. The Gloves Are Off initiative at Colchester is an example of how clinically led ideas have inspired a project that saves money and improves practice. The project has reviewed how and when staff wear gloves, focusing on appropriate use and improving hand hygiene.
Frontline staff also highlighted issues with how cardboard boxes made dispensing gloves difficult, including torn boxes and gloves coming out in handfuls rather than individually. This led to a second phase to the project where a single glove dispensing system has been introduced. This will reduce waste and also avoid the risk of contaminating gloves. The project is aiming to both reduce volumes of gloves by 30% and deliver a saving of £35,000.
The view from here
Rose Gallagher, RCN Professional Lead for Infection Prevention and Control, says: "Our Small Changes, Big Differences project has been a huge success. It's captured the imagination of nursing staff and the aim of buying better to reduce clinical waste, cut costs and improve the patient experience has resonated very strongly with our members.
"We recognised early on that most clinical staff don't associate their role with procurement, the very word is a bit of a turn off. But by shifting the focus onto quality and safety, encouraging people to take ownership of the products they use and think how they can be improved, reduced or made more efficient, we've helped members to make huge savings in their workplaces.
"However, it's not all about the money, though it is important. This is about empowering nursing staff so that they can make a difference, not only to the better running of their organisation, but to the better care of patients.
"The project has been running for four years and has evolved intuitively over that time. What's most heartening is that organisations are taking this project and making it their own.
"Now our focus shifts to waste management alongside procurement and we'll be looking to reshape how we can make small changes lead to big differences in different ways. The NHS is a massive consumer of disposable plastics and our absolute priority will be to help reduce the use of non-recyclable plastics as a matter of urgency."
Want to get involved?
Find out more about the project and get inspiration for making small changes that can make a big difference at your workplace at www.rcn.org.uk/smallchanges


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Colombo & Fille - Cornas 2012Floral Characters
Pre-order - Get it by 10th Feb 2020
Country of OriginFrance
Producer Information
Key Information
- AppellationCornas
- BrandColombo & Fille
- RegionRhone
Grape Information
- 100%Shiraz / Syrah
Other Information
- BodyFull Bodied
- Food MatchGame
- Food MatchRed Meats
- Grape TypeShiraz/Syrah
- Style of RedSpicy & Rich
- Type of closureNatural Cork
- Vintage2012
- WinemakerLaure Colombo
A special cuvee from the family vineyards.
A complex and powerful wine yet velvety at the same time.
Distinctive ripe fruit and floral characters, reminiscent of violets, dark chocolate, toasted oak, and a hint of black pepper.
The harvest is destemmed and goes through classic vinification with 3 weeks maceration. The wine is then aged for 18 months in oak barrels (1/3 new, 1/3 1 year old, 1/3 2 years old).
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Public education in general was slow in becoming a solid reality in the South. Until 1870, no statewide, organized system of public education existed in Virginia, although a few localities operated their own systems. Before the Civil War, Virginia had private academies for those White parents who could pay for schooling and a few schools for "paupers." Before the Civil War, by law, neither slave nor free Black children could attend school or even be privately taught to read and write. There were Sunday school teachers and others who broke this law, and some African Americans taught themselves. Still, the Black population was largely illiterate when the Freedmen's Bureau opened the first free schools for Blacks in Virginia near Hampton Roads in 1862. Schools opened by northern teachers under missionary auspices right after the Civil War were too closely associated with the northern interests for most Whites to send their children to them. The Virginia Constitution of 1870, under Virginia's Reconstruction government, mandated a public school system, and the following year William Henry Ruffner was appointed by the General Assembly as first superintendent of public instruction.
Ruffner's first duty was to draft legislation establishing the system. The bill he submitted was based on precedents set in New Jersey and Pennsylvania and called for the creation of a state department of public instruction, with the state having a share in the funding. Opposition to the plan was widespread and focused on the loss of traditional local authority represented by the new state agency and the state funding provision. There was also much concern expressed about the incorporation of education for Blacks, which had been illegal before the Civil War, although there was little debate about segregation. It was understood that schools would be separate, as all other aspects of public life had become racially segregated, in a de facto rather than statutory manner, after the Civil War. There was also concern that parents would be deprived of complete influence in their children's upbringing.
Funding was a problem from the start, with monies initially earmarked for public education on the state level being diverted to cover Virginia's large Civil War debt. Enrollment and tax support were both viewed as referenda on the popularity of the public schools and continued to be a problem for years. Prince Edward County's first school superintendent, Benjamin Mosby Smith, once complained that even with his other income as a religious educator, it was hard to make ends meet. By the time of Ruffner's retirement in 1882, however, the public schools were firmly established and growing.
Although Ruffner had expressed certainty that qualified Blacks would be chosen to serve on the local school boards, none were. White males, primarily property owners, made up the membership. Black teachers were paid less, for it was asserted that they were less qualified, and school facilities for Blacks tended to be less than adequate. One Black teacher in Prince Edward County remarked on the large, drafty holes in the school floors. The lack of adequate heat was also a problem. In 1896, the segregation of schools practiced in Prince Edward County and in the rest of Virginia and the south was given an implied legal sanction by the U.S. Supreme Court's decision in Plessy v. Ferguson that separation of facilities based on race was in fact legal, as long as these facilities were "equal." Before 1939, the secondary school education available to Blacks in Prince Edward County consisted of a few extra grades in one elementary school. What was loosely referred to, as "vocational training" was all that many Whites believed Blacks needed to acquire. This and "on-the job training" favored in rural areas like Prince Edward County, were considered sufficient, and even better suited for preparing Blacks than a high school education.


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LAW Writer® Ohio Laws and Rules
There is hereby created in the state treasury the Ohio nature preserves fund. The fund shall consist of the contributions that are paid to the registrar of motor vehicles by applicants who obtain Ohio nature preserves license plates pursuant to section 4503.563 of the Revised Code. All investment earnings of the fund shall be credited to the fund.
The department of natural resources shall use the money in the fund to help finance nature preserve education, nature preserve clean-up projects, and nature preserve maintenance, protection, and restoration.
Added by 128th General AssemblyFile No.9, HB 1, §101.01, eff. 10/16/2009. .