Jessie Sleet Scales

(1865–1956)
 

As the City of Milwaukee Health Department (MHD) recognizes Black History Month, we take this opportunity to honor the contributions of Black pioneers in public health. In this post, we highlight the accomplishments of Jessie Sleet Scales, the first Black public health nurse in the United States.

Scales’ work laid the foundation for community-based nursing, a philosophy that continues to guide current public health initiatives. Even today, her legacy continues to live on as MHD prepares to launch the Scales Neighborhood Nursing pilot program, an initiative deeply rooted in Scales’ approach to care.
 

About Jessie Sleet Scales 

Born in Stratford, Ontario, Canada, Jessie Sleet Scales attended Provident Hospital in Chicago, graduating in 1895. She furthered her training with a six-month course at Freedman’s Hospital in Washington, D.C., before working at a winter health resort in Lakewood, New Jersey. Determined to become a district nurse, she moved to New York City but faced months of job rejection due to racism. 

Her breakthrough came when Dr. Edward T. Devine, General Secretary of the Charity Organization Society (COS), recognized the need for a Black district nurse to address tuberculosis within New York’s African American community. Despite opposition from the hiring committee, Scales was appointed the first Black district nurse in 1900. She was tasked with treating tuberculosis while overcoming distrust of formal medical care among Black families.
 

“When I think of Jesse Sleet Scales, I think of her courage, her holistic care, and her trailblazing,” said Jefflyn Brown, a public health nurse and MHD’s Deputy Commissioner of Clinical Services. “She went into homes of families with tuberculosis—a communicable disease that lacked effective treatments at the time. Scales was bold and courageous enough to enter these homes and ensure families had what they needed.” 

Scales’ responsibilities soon expanded beyond tuberculosis to include childbirth, chickenpox, heart disease, cancer, and more. In a two-month period, she made 156 home visits to 41 families—a staggering workload that underscored both the need for her work and her unwavering dedication. Her pioneering efforts inspired other organizations to hire Black community health nurses, often based on her recommendations. 

Sources: American Journal of Nursing, "A Successful Experiment" (1901); Seo Yoon Lee, "Honoring Ms. Jessie Sleet Scales," Lorien Health Blog, 2024; Charity Organization Society Records, New York Historical Society.) 
 

Meeting People Where They Are

Scales’ approach to healthcare—treating patients holistically, fostering trust, and providing care within their own environments—remains a guiding principle in public health nursing. 

"What she did was meet people in their homes, in their environments—taking care of them, providing education, and building trust within communities. During that time, healthcare mistrust was widespread, especially among Black families, given the historical context,” Brown said. “She showed us how critical it is to meet people where they are and equip them with the education they need to care for themselves." 

Even today, public health professionals continue to confront many of the same challenges Scales faced. Systemic barriers still disproportionately impact Black nurses and communities of color. Brown emphasizes the importance of diversifying the nursing workforce.  

"It's important to have a workforce that reflects the community you serve,” Brown explained. “There’s been longstanding mistrust in healthcare, and people naturally feel more comfortable speaking with providers who look like them, share similar lived experiences, and truly understand their perspectives." 
 

The Continued Adversities of Black Nurses

While Jessie Sleet Scales paved the way for Black nurses in public health, the barriers she faced persist today, affecting every stage of a nurse's career—from education to employment and advancement.  

“For Black nurses, just getting through school can be difficult,” said Brown, who previously detailed racism and systemic barriers throughout her career as a Black public health nurse. “Many are not traditional students—they often have children, families, and unresolved trauma to navigate alongside their education. This reality affects how many nurses of color enter and stay in the workforce.” 

Once in the field, Black nurses often face discriminatory hiring practices and workplace inequities.  

"We all know that sometimes people look at resumes and a name can throw somebody off. You can get into a position and not feel seen or heard, and I think that causes a lot of Black nurses to bounce around," said Brown.  

This lack of representation at higher levels only reinforces disparities. According to the American Association of Colleges of Nursing, less than 10% of U.S. nurses are BIPOC, and only 6% are Black. Representation dwindles further up the hierarchy, with just 8% of healthcare executives and board members identifying as Black. In the state of Wisconsin, less than 3% of physicians are Black. 

Sources: April 2024 Nursing Workforce Fact Sheet, American Association of Colleges of Nursing; and Wisconsin 2022 RN survey Report, Wisconsin Center for Nursing.
 

Dominique Hyatt-Oates, a public health nurse and MHD’s Deputy Commissioner of Policy, Innovation, and Equity further highlights how these challenges extend beyond work.  

"Systemic racism in the workplace often manifests as being told, 'You're not right for this job' or 'You're not qualified for that role,' while simultaneously being deemed 'good enough' to care for other Black people,” Hyatt-Oates said.

“This raises an important question: What message does that send about Black communities and their worth?" 

These barriers don't just affect nurses—they have tangible consequences for patient care. Studies consistently show that Black patients experience poorer health outcomes, receive fewer preventive services, and are more likely to face biases during treatment.  

“Improving health outcomes won’t come from a pill, surgery, or a single appointment with a specialist. Real progress starts with understanding—listening to people’s needs, recognizing barriers, and offering culturally responsive care,” Hyatt-Oates said.  

This understanding is precisely why representation in healthcare matters. Research shows that patients are more likely to trust providers who share their racial, cultural, or linguistic backgrounds. This trust leads to better adherence to treatment plans, improved health outcomes, and more equitable care overall. MHD is proud to have recruited and supported Deputy Commissioners Brown and Hyatt-Oates as part of its leadership. As the highest-ranking public health nurses at the department, they exemplify the kind of leadership that reflects and serves the diverse population of Milwaukee. 
 

Introducing the Scales Neighborhood Nursing Program 

In the spirit of Scales’ approach to care, MHD is launching a pilot program later this year called Scales Neighborhood Nursing. The initiative aims to rebuild trust by embedding nurses directly into the communities they serve. 

"We’re taking a page out of Jesse Sleet Scales’ book—going into neighborhoods to care for families and patients. We plan to support people across the entire lifespan, from newborns to older adults, including those on hospice." Hyatt-Oates said.

Unlike traditional clinical settings, where patients must seek care, neighborhood nurses will be embedded in communities, working directly with residents in their homes, schools, and community centers.  

“Teams will go door to door. They will be in the neighborhoods. They will also be in schools. They will have relationships with any churches or other community-based organizations within that area. It's important that we go to the people," Brown said. 

Continuing the Work of a Trailblazer 

Public health nursing has always been about more than just treating illnesses—it’s about breaking down barriers, advocating for communities, and addressing the root causes of health disparities.  

"This work isn’t new,” said Hyatt-Oates. “Public health efforts like home visiting programs, holistic patient care, and addressing social determinants of health—where people live, work, and connect—have been around for centuries." 

Hyatt-Oates spent two years visiting clients in their homes as a public health nurse with MHD’s Childhood Lead Poisoning Prevention Program, followed by another two years managing MHD’s Breast and Cervical Cancer Prevention Program (MBCCAP) before her recent promotion to Deputy Commissioner of Policy, Innovation, and Equity. 

“It’s getting back to the basics, getting back to the roots of what worked for the community,” Hyatt-Oates said.  

By launching the Scales Neighborhood Nursing program, Milwaukee is not just reviving an old model of care—it’s honoring a legacy. It’s a direct reflection of the work that Jessie Sleet Scales began over a century ago, ensuring that healthcare reaches the people who need it most. 

“This is an extremely rewarding moment for me. Scales was a trailblazer in this work, and to be able to be in a position to implement a program that I know will benefit the community is just amazing. We're very excited about it,” Brown said.