Enumeration of Public Health Nurses in the United States: Limits of Current Standards

Distribution and Specialties of Broadly Versus Narrowly Defined Public Health Nurses Working in Government Settings in the United States, 2022

Objectives. To estimate the size of the US governmental public health nurse (PHN) workforce by setting and specialty, including those working outside of health departments. Methods. We used 2022 data from the National Council of State Boards of Nursing, representing 2846 registered nurses (RNs) in almost all states, with weights applied. We examined "setting" and "specialty" of PHNs according to broad and more restricted definitions. Results. Using a broad definition, PHNs in government settings made up 3.7% of the RN workforce, and 1.8% when specialty areas were narrowly defined. These percentages varied by state. PHNs working in public health, school health, and correctional health settings largely indicated their specialty practice areas as public health, school health, and "unspecified" rather than more narrow specialty areas. Conclusions. PHNs are a small proportion of the RN workforce. They consider themselves generalists and can be identified by specialty and when working in governmental settings outside of health departments. Public Health Implications. States with few PHNs may be underserving their communities. Better data are needed to understand specific functions and activities of the PHN workforce. (Am J Public Health. 2025;115(4):536-545. https://doi.org/10.2105/AJPH.2024.307950).

The demographics, training, and job functions of the United States Public Health Service Commissioned Corps nursing workforce

BACKGROUND

There is a need for better public health nursing (PHN) workforce measurement approaches that focus on their functions and activities as well as a need for more data inclusive of PHNs at the federal level.

PURPOSE

For this cross-sectional study, we conducted an online survey with nurse officers in the U.S. Public Health Service to describe the demographics and experience of this workforce and to test job function and activity questions.

METHODS

We conducted descriptive analyses to characterize the full sample (N = 565). We also stratified the sample into "primarily nonclinical" and "primarily clinical" nurses and compared their responses to function and activity questions.

DISCUSSION

Our findings describe a highly educated and diverse UPSHS nursing workforce with wide-ranging responsibilities. Respondents indicated the function and activity questions that accurately described their work, with most reporting Health Promotion and Protection functions (48.7%). Compared with primarily clinical respondents, more primarily nonclinical respondents reported Policy and Advocacy (24.1% vs. 12.2%), Enforcing Laws and Regulations (22.5% vs. 11.2%), and Research (26.0% vs. 16.8%) functions.

CONCLUSION

Findings highlight potential opportunities to learn from the USPHS nursing workforce about ways to grow a more diverse nursing workforce and emphasize the utility of function and activity questions in nursing workforce assessments for gaining a deeper understanding of PHNs' roles.

Social entrepreneurship and public health nursing knowledge: Opportunities for innovating nursing education in population health

Public health nursing (PHN) competencies are fundamental for addressing population health inequities. Few pathways exist for employing these competencies in the United States (US). Social entrepreneurship in nursing education might provide opportunities for innovating engagement in population health. Partnerships between business and nursing schools have the potential to fulfill this opportunity.

PURPOSE

Explore opportunities for re-invigorating public health nursing through social entrepreneurship education in nursing-business partnerships in U.S. universities.

METHODS

Reviewed programs in nursing/business school partnerships from Carnegie-classified R1 Universities. Identified appropriate coursework.

RESULTS

Of 96 identified nursing schools, eight had business school partnerships, providing 12 programs. Most programs (n = 11) targeted graduate students and addressed core competencies for entrepreneurship. Five business schools had entrepreneurship expertise. Five nursing schools had PHN expertise. Three programs included population health competencies.

DISCUSSION

Despite missed opportunities for advancing social entrepreneurship education among undergraduate and graduate nursing students, existing curricular offerings in the partnerships provide promise. Business/nursing partnerships and PHN knowledge can stimulate the preparation and agency of nurses in addressing population health inequities.

The crucial importance of accurate enumeration to bringing public health nurses out from behind the "Other" category

Public health nursing is a unique field of nursing with specialized skills, roles, and functions designed to address disease prevention and health promotion of populations and to respond to emerging health crisis such the COVID-19 pandemic. Despite the unique role and professional responsibilities of public health nurses, they are not identified as a distinct nursing specially by the U.S. Bureau of Labor Statistics workforce data. This is problematic as accurate enumeration of public health nursing can supply the necessary data to identify gaps of these essential professionals. To effectively address this gap and have the capacity to identify public health nursing workforce needs, a method to define, describe, and enumerate the public health nursing workforce nationally with a unique split Standard Occupational Classification is necessary. Further, the Centers for Disease Control and Prevention's Public Health and Data Authority must have the ability to coordinate data reporting on the public health workforce, support standardization, and streamline annual enumeration.

The use of Community/Public Health Nursing Competencies during the COVID-19 pandemic

OBJECTIVES

(1) Ascertain the use of the Quad Council Competencies for Community/Public Health Nursing (QCC-C/PHN) Competencies by community/public health nurses (C/PHNs) during the COVID-19 pandemic; (2) Inform from a systems-level the need to sustain the C/PHN workforce; (3) Assess the C/PHN infrastructure for response capacity.

DESIGN

Cross-sectional. Statewide email distribution lists were used for dissemination.

SAMPLE

Convenience sample (n = 169) obtained using emailed Qualtrics link with the eligibility criteria of self-identification as a C/PHN who works in the state of Missouri.

MEASUREMENTS

Demographic questions included employment sector, nursing education level, years of nursing, and C/PHN experience. Two Likert-type questions and one optional open-text question were created for the eight domains.

RESULTS

One hundred sixty-nine participants' data were analyzed. One hundred fifty-four were employed in a local public health agency. Total 63.2% held a bachelor's degree in nursing or higher. The average number of years of nurse experience was 20.84, and C/PHN experience was 9.84. The domain of Communication Skills scored highest and Cultural Competency was the lowest. Three themes emerged from the open-ended questions including vulnerabilities of the public health system.

CONCLUSION

Understanding the experiences of C/PHNs in Missouri related to the utilization of QCC-C/PHN competencies informs efforts to strengthen public health infrastructure and target resources to equip Missouri's C/PHNs.

Critical consciousness of public health nurses: A descriptive, comparative survey

BACKGROUND

Public Health Nurses (PHN) caring for vulnerable populations amid systemic inequality must navigate complex situations, and consequently they may experience serious moral distress known to be detrimental to PHN wellbeing.

OBJECTIVE

Given PHN awareness of social inequities, the study aimed to determine if PHNs were motivated to enact social change and engage in social and political action to address inequality.

DESIGN AND SAMPLE

A survey of 173 PHNs was conducted in fall 2022. The convenience sample was mainly female (96.5%), White (85%), had associate/bachelor's degrees (71.7%), and worked in governmental public health settings (70.7%).

MEASURE

The study employed the Short Critical Consciousness Scales' subscales: Critical Reflection, Critical Motivation, and Critical Action.

RESULTS

PHNs were highly motivated to address inequities (Critical Motivation = 20.83; SD = 3.16), with similarly high awareness (Critical Reflection = 17.89; SD = 5.18). However, social and political action scores were much lower (Critical Action = 7.13; SD = 2.63). A subgroup of PHNs with strong agreement regarding the impact of poverty were more likely to be younger (p = .039) and work in a community setting (p = .003); with higher scores across subscales (p < .001).

CONCLUSIONS

High critical reflection and motivation among PHNs aligned with literature. Lower Critical Action scores warrant investigation into validity for PHNs, and possible role constraints.

Using data visualization to characterize whole-person health of public health nurses

OBJECTIVE

To characterize patterns in whole-person health of public health nurses (PHNs).

DESIGN AND SAMPLE

Survey of a convenience sample of PHNs (n = 132) in 2022. PHNs self-identified as female (96.2%), white (86.4%), between the ages 25-44 (54.5%) and 45-64 (40.2%), had bachelor's degrees (65.9%) and incomes of $50-75,000 (30.3%) and $75-100,000/year (29.5%).

MEASUREMENTS

Simplified Omaha System Terms (SOST) within the MyStrengths+MyHealth assessment of whole-person health (strengths, challenges, and needs) across Environmental, Psychosocial, Physiological, and Health-related Behaviors domains.

RESULTS

PHNs had more strengths than challenges; and more challenges than needs. Four patterns were discovered: (1) inverse relationship between strengths and challenges/needs; (2) Many strengths; (3) High needs in Income; (4) Fewest strengths in Sleeping, Emotions, Nutrition, and Exercise. PHNs with Income as a strength (n = 79) had more strengths (t = 5.570, p < .001); fewer challenges (t = -5.270, p < .001) and needs (t = -3.659, p < .001) compared to others (n = 53).

CONCLUSIONS

PHNs had many strengths compared to previous research with other samples, despite concerning patterns of challenges and needs. Most PHN whole-person health patterns aligned with previous literature. Further research is needed to validate and extend these findings toward improving PHN health.

Public health nursing workforce and learning needs: A national sample survey analysis

OBJECTIVES

Generate national estimates of the public health nursing workforce's (1) demographic and work characteristics and (2) continuing education learning needs in the United States.

DESIGN

Secondary data analysis of the 2018 National Sample Survey of Registered Nurses.

SAMPLE

Total 7352 of the 50,273 survey respondents were categorized as public health nurses (PHNs), representing an estimated 467,271 national workforce.

MEASUREMENTS

Survey items for demographics, practice setting, training topics, and language(s) spoken fluently were analyzed.

RESULTS

Workforce demographic characteristics are included. Mental health training was the most frequently endorsed topic by PHNs, followed by patient-centered care and evidence-based care. Training topic needs vary by practice setting.

CONCLUSIONS

Results here can be used as a needs assessment for national public health nursing professional development and education initiatives. Further research is needed to refine and survey a nationally representative sample in a manner meaningful to public health nursing practice.