The positive impact of RNs in the public arena can be traced back to the earliest American nurses. These RNs, who included women like Lillian Wald and Lavinia Dock, saw communities in desperate need and poverty—whether it was from poor sanitation, lack of opportunities for children working in sweatshops, or no access to healthcare. To advocate for their patients’ health, these nurses understood that they needed to advocate for social reform on a broader level; many early 20th century RNs were deeply involved in social movements. Wald and Dock were representative of nurses who expanded the role of RNs in advocating on behalf of the public interest by speaking out on issues such as women's suffrage, child labor law protections, and union and worker's rights.