For almost 20 years, Gloria Hall was a pediatrics nurse in the District's Southwest Neighborhood Health Center. She treated two generations of children and saw the city's social problems escalate while its clinic services declined sharply.

"So many mothers today are substance abusers, and the children come in dirty and hungry, or they miss appointments," said Hall, 43. "We used to have enough nurses to target and follow up certain cases, but now, when the need is even greater, we're not there."

Last December, nearing a sense of burnout from the crush of nursing and non-nursing duties, Hall quit to go to work for the Group Health Association, a health maintenance organization. She is paid about $33,000 a year at GHA, less than the $38,000 she was being paid after 22 years of D.C. government employment. But GHA benefits and working conditions are better and she now looks forward to going to work.

"I'm a nurse again," an elated Hall said recently. "I'm no longer doing it all."

At Southwest, "I was there every day at 7:30 a.m. to get caught up on paperwork and to keep the doctor's office going by ordering lab materials and pharmaceuticals," she said. "I had my own patients because every patient that comes in has to see the nurse. And we also did triage {emergency} work and some social work."

When staffing was short, "I'd work in pediatrics and podiatry," Hall said. "If we ran out of OB-GYN gloves or gowns, the nurses had to call around to try to find them. And we had to make urgent recalls to get back patients who were behind in their shots or whose lab tests showed infections . . . all this in an eight-hour day." A big concern: "I didn't have time to sit and talk with my moms, and many patients needed that extra stroking."

Nurses and clerks also keep records of who comes in and who they see, with separate logs of immunizations, high-risk patients, D.C. General referrals and sickle cell anemia cases. And record-keeping, except billing, isn't computerized.

Hall, whose clinic duties when she quit were absorbed by another nurse, worries about the staff and what she viewed as the crumbling services she left behind. She warns that retirements in the next five years will leave the clinics in even worse shape.

"The people there are stressed and stretched and strained," she said. "They're just overwhelmed . . . . I'm glad I'm out of it."