On a typical misty morning in the Pacific Northwest, Joan Riemer loads her white Volkswagen with the items she'll need for the day: a baby scale, toys, and diapers — lots of diapers.
Joan works out of the Clark County Public Health office for the Nurse-Family Partnership (NFP), a national nonprofit community health program that pairs registered nurses like her with low-income first-time parents. Nurses visit moms-to-be every other week from pregnancy until the babies turn 2. Joan, like other nurses in the program, often has up to 30 families at a time in her care.
Today, Joan's first visit is with Jayme Reimann, a baby-faced 21-year-old with long brown hair and a warm smile. Shortly after 10 AM, Jayme greets Joan at the door of her second-floor apartment in Vancouver, Washington. Her bubbly 1-year-old twins, Addie and Amelia, are finishing their bottles and crawling on a blanket behind her.
"Look at those overalls!" Joan says to the twins as she comes in. Before she sits down next to them, Joan quietly sets a few cardboard boxes in the living room. The family will be moving into a new apartment soon: a first-floor unit, safer and with more play space for the newly mobile toddlers. Joan breaks out her notebook, and she and Jayme start catching up on everything from child care to job leads. Today they also discuss dental hygiene.
Handing Jayme a bright green infant toothbrush, Joan watches as the mom lays one of the twins on her back to demonstrate how she brushes their teeth. Joan talks to Jayme about sealants, fluoride, and enamel and tells her about a dental office that provides free cleanings to kids under 6.
Jayme found out she was pregnant with twins when she was 19. Estranged from her family, she learned about NFP from a pamphlet she picked up at her doctor's office. At 29 weeks, she went into preterm labor, and her girls stayed in the NICU for almost two months. While NFP nurses can't be present for delivery, Joan continued to make her visits at the hospital while the twins were there. "Joan saw me crying a lot in those days," Jayme says, recalling her difficult time in the NICU.
"You were in a tough spot," Joan says sympathetically.
Jayme begins to rattle off a list of things Joan has helped with: feeding, getting the babies on a schedule, transitioning them to solids, and navigating sleep issues.
"Joan has been my biggest support," Jayme says.
Nearby, Joan looks over modestly: "You need to take some credit for how wonderfully they're doing," she tells Jayme. "Both of the girls are very happy and curious."
Jayme scoops up a twin who's trying to chew on Joan's appointment book as they settle on a date for the next visit. Before long, it's time for Joan to depart.
"The twins love Joan," Jayme says. "When she leaves, they go to the door and cry."
Built on Trust
Over her nine years with the program, Joan has become an expert at forging relationships like the one she has with Jayme and the girls. At one of her earliest visits, she often asks the parents to make a "trust flower," listing on each petal the people they can rely on. Some can't come up with a single name. Often, Joan takes up that mantle. She keeps in touch with her moms between appointments and offers encouragement.
"They all just want to be good moms," says Joan. Founded in 1977 by David Olds, Ph.D., an expert in pediatrics and public health, the Nurse-Family Partnership is based in Denver and serves families in 41 states, the U.S. Virgin Islands, and six tribal communities.
The program has widespread support due to its research-backed success in everything from reducing kids' emergency room visits to increasing the number of months mothers are employed while participating in the program.
"We're trying to reach the hardest-to-reach moms," says Frank Daidone, president and CEO of NFP. "The nurses are our magic."
A True Calling
Back in the car after her visit with Jayme and the twins, Joan is upbeat. "Some of these moms never hear anything positive," she says. "I always make sure to leave on a good note. You can just see them sit up taller."
Not surprisingly, there's a waiting list of about 50 families requesting services right now in Joan's territory, an area of more than 600 square miles just north of Portland, Oregon. NFP generally enrolls families on a first-come, first-served basis. "We can only do so much," Joan says. "We're trying to get more funding, more positions."
A married mom of two grown children, Joan found her passion for community health nursing soon after graduating from the University of Portland nursing school. She moved to Alaska with her husband, Emil, a bush pilot, and got a job working with native communities in villages so far-flung, they had no grocery stores. She supervised a program that helped women and babies receive access to food and medical care.
After moving back to Washington with Emil, Joan, a third-generation nurse, again set out to work with low-income mothers. She was attracted to NFP because of the long-term relationships she could form with the families and the well-studied outcomes for improving their well-being.
Because of the frequency and intimacy of their visits, NFP nurses like Joan help moms make healthier choices — for some, that's kicking addiction to cigarettes, alcohol, or even heroin. "We help keep them focused on the baby," Joan says.
The Young Couple
After visiting Jayme, Joan drives 25 minutes to Battle Ground, Washington, to see Cheyenne LaFollette, 19, and Mark Gibson Jr., 21, parents of 1-year-old Raelyn.
Joan pulls a portable scale out of her bag and weighs and measures Raelyn. "Getting so big!" she exclaims. Together, the couple dress Raelyn. Joan transitions into talking about job leads, apartment searching, and teething. She recommends videos on developmental play and does the teeth-cleaning demo.
"We've been giving her water before bed, cleaning her teeth, and giving her a wet rag to chew on when teething, just like you said," Mark says.
Cheyenne started meeting Joan when she was around 12 weeks pregnant (she heard about the program from her high school guidance counselor). Joan helped Cheyenne navigate not only pregnancy issues, but also the tragic loss of her dad just before Raelyn's birth (Cheyenne's mom passed away when Cheyenne was 5).
"I was really scared when I found out I was pregnant," Cheyenne says. "But Joan convinced me I'd be okay."
Before Cheyenne gave birth, Joan informed the parents about a pregnancy clinic where they could watch parenting videos to earn free diapers, wipes, and clothes. Today, she fills them in on a program, InfantSee, that provides free eye screenings for babies 6 to 12 months old.
Most valuably, it seems, Joan is an impartial third party patients can confide in. "Joan always listens and never judges," Cheyenne says. At her next visit, they'll have a special "birthday party" for Raelyn (nurses can't attend actual family functions).
The dream of the couple, who are engaged, is for Cheyenne to get a job working with children and for Mark to find employment as a carpenter or welder. They moved to Idaho last fall. "We want to get a house with some property and have some farm animals so Raelyn can grow up with animals, and have her do well in school," Mark says.
Fond Farewell
As a child approaches 2, NFP nurses start winding down their home visits, helping the moms find affordable child care and transition into life after the program. Occasionally, Joan gets updates on past clients: One mom sends a back-to-school photo each year.
Closing each case reminds Joan of why she loves her job: She gets to help moms have successful pregnancies and help kids have healthier childhoods. "I won't be in your life forever," she says of how she thinks about her clients. "But I'll do whatever I can to give you and your child a good start."
Visit nursefamilypartnership.org for more details about NFP, to find a local program, or to refer an expectant mom.
This story originally appeared in the February 2019 issue of Woman's Day.
