Lisa Ayers, BSN, RN, could tell from her initial inspection of the apartment, with its chipped paint, exposed electrical wires, and mice, that the situation was serious. As a public health nurse with Schenectady County Public Health Services near Albany, NY, she also quickly discerned that the deteriorating structure was not the only issue in need of her attention.

Ms. Ayers’ patient, a pregnant woman whose toddlers had high blood lead levels, learned about the link between asthma and cigarette smoke, the dangers of a broken electrical plate, and the importance of testing her smoke detectors. Ms. Ayers also talked with the woman about prenatal care, scheduled a lead inspection of the home, reported the mice and electrical hazards to the city, and mailed a notice of the lead inspection to the landlord.

“It was a wonderful visit,” Ms. Ayers said. “Very productive.” A lifelong Schenectady native, she and her husband have reared three children there, and she has worked for 22 years as a public health nurse for the city and county health departments. She started out, as most nurses do, as a medical–surgical nurse, but after switching to home health care, she found it difficult to balance work and family demands and applied for a public health nursing position with the city. “It was the best decision I ever made,” she said.

When she started in 1988, she and her 20 registered nurse (RN) coworkers cared for homebound older adults, pregnant women and infants, and patients with infectious diseases. In 1991 the health department expanded to cover the county, and her work in the years since has encompassed well-infant care, primary care pediatrics, and environmental health. For seven years, she investigated communicable diseases in the community.

Now, as one of the first nurses in the state to be certified as a lead risk inspector, she weaves environmental health into her practice. She assesses homes for sources of lead; works with landlords to fix problems; and supplies families with carbon monoxide detectors, cabinet locks, nightlights, buckets, mops—in short, anything they need to minimize hazards in their homes. At the same time, she is assessing the psychosocial aspects of families’ health and helping them reduce tobacco use and prevent or control asthma. Ms. Ayers said, “Being a nurse, I can answer a lot more questions about asthma, medications, and inhalers than somebody who may not be a nurse.” And she continues to take her turn as a home visitation nurse on weekends, seeing a child with leukemia, helping a new mother with breastfeeding, or checking on a newborn who is losing instead of gaining weight.

Usually, the health department will ask a landlord for permission to inspect a home only if a child has a blood lead level of at least 15 mcg/dL. But that requirement is waived for Healthy Neighborhoods, an initiative aimed at reducing environmental hazards in two zip codes—12307 and 12304—that have had high lead-poisoning rates. Anyone living in these zip codes can request a free home assessment of air quality, asthma triggers, fire safety, and other health issues, and the assessment can be done without the landlord’s permission.

Ms. Ayers spends about 40 percent of her time on Healthy Neighborhoods and 60 percent on lead poisoning prevention, and she finds ways to combine the work of the two programs. “When I’m out there doing prevention for air quality with Healthy Neighborhoods, I also do a visual lead inspection in the  home,” she said. And she teaches families measures such as handwashing; letting water run from lead-soldered pipes before drinking; and eating foods high in iron and calcium and low in fat, which prevents lead absorption.

The county has tracked cases of elevated blood lead levels in zip code 12307 for more than two decades. Since a peak of 34 cases in 1992, the number dropped to five or fewer annually from 2006 to 2009, according to unpublished data.

Nurses’ contributions to these outcomes are not lost on Richard Daines, M.D., New York State’s health commissioner, who shadowed Ms. Ayers shortly after he took office. “He was very excited [by what he saw],” said Ms. Ayers. “I think they have recognized—all the way up to the commissioner level—what a nurse can bring to this position.”