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Public Health Nurses: The Heart of the Public Health Workforce
Public Health Nurses: The Heart of the Public Health Workforce
BY HEATHER KRASNA, MS
Imagine that instead of working to heal an individual patient, if your “patient” was your whole community. And, instead of saving one life at a time, your job was to keep whole populations healthy and out of the hospital in the first place. That is one way to describe the rewarding and important work of a public health nurse. For many nurses, public health nursing was not a career path that was discussed much in nursing school. Many nurses who have worked in clinical care may not be familiar with what a public health nurse does, or how their skills might fit. But for those who work in public health, especially in local or state health departments, public health nurses are considered one of the key professions within the workforce. In fact, when the first schools of public health were proposed back in 1915, nurses were listed as among the five crucial occupations needed in every health department, along with health commissioners, local health officers, scientists (including epidemiologists and engineers), and health inspectors.
With around 22% of local and state health department workers saying they are ready to retire, and the Biden Administration investing $7.4 billion in the public health workforce (including $500 million for school nurses as well as $3.4 billion to staff up local and state health departments), there are likely to be many opportunities in public health nursing. There are opportunities in a range of settings, including at the 2,600 local health departments in the United States, which employ about 136,000 people, and at the state and territorial health departments, which employ about 91,540 staff; at federal government agencies like the U.S. Department of Health and Human Services; and nonprofit organizations, Native American tribal health departments, and other organizations. Nurses make up 18% of the entire workforce in local health departments, and 7.8% of state health department staff. The U.S. Department of Health employs around 4,440 nurses, too.
So, if your patient is a community, what does that mean in terms of what a public health nurse actually does on a typical day? There is a broad range of work involved, including some direct care, but also assessing community health, designing and advocating for better health policies, leading and implementing health education programs, planning for disasters or emergencies, or conducting community outreach. They can work on a broad range of issues, from infectious disease to maternal and child health, and from environmental health to substance use disorder. During the Covid-19 pandemic, nurses have been significantly involved in contact tracing, testing, and immunization efforts, to prevent the spread of the disease (and keep patients healthy and out of the hospital, and thus protecting clinical nurses and other frontline health workers). Public health nurses also can become leaders and directors of health departments.
Donna Bean, MPH, RN, an infectious disease nurse consultant for the State of Alaska, says her work as a public health nurse can include: “walking or driving though a community to perform a ‘windshield survey’ to assess built environments, food sources and availability, access to healthcare services and other community services; meeting with community leaders and organizations to get feedback on community needs; providing vaccinations in a rural school, conducting home visits to new mothers in urban areas, teaching hand hygiene to preschoolers,” and much more. “While you can and will have relationships with individual patients, you also take on an entire community as a patient,” says Bean. “The length of the relationship with the patient and community also changes—you are an integral part of the health and wellbeing of a community, providing services, education, and connecting to resources as needed.”
How is being a public health nurse different from being a clinical nurse? “Public health and clinical nursing are both grounded in nursing theory,” says Shirley Orr, MHS, APRN, NEA-BC, executive director of the Association of Public Health Nurses, “but the practice of public health and clinical nursing are very different. Public health nursing interventions are focused at the population level and include data assessment and analysis, health policy and program development, community engagement, and advocacy for health and social justice… their primary emphasis is primary prevention.”
If you are exploring becoming a public health nurse, “I would suggest reaching out to other nurses in the field to have a conversation or possibly shadow them for a day or two,” says Jamie Jablonowski, MPH, BSN, RN, CIC, CPH, who is a public health nurse consultant at the United Nations. “There are so many options that many nurses are unaware of, and by reaching out to other nurses in unique positions, you can learn more about the options. Examples I was unaware of as a new nurse were roles in global health, occupational health, infection control, and addiction.”
Orr agrees: “If you don’t know a public health nurse already, contact your local health department and ask to speak with the public health nursing supervisor. Public health nurses love to engage with nurses from other areas to connect and form professional collaborations.”
Bean also suggests volunteering in a local health department to get a first-hand look at the work involved. To make the switch, Bean adds, “Consider a certificate or degree in public health. Most states require either a certification or higher level of education in public health, and/or experience in community or public health nursing.”
“The best part of being a public health nurse is the opportunity to work on larger problems affecting the community. To have the opportunity to prevent disease, whether infectious or chronic, is a real privilege,” says Jablonowski.
Covid-19 has shown the world the crucial importance of nurses and illustrated the importance of public health efforts to keeping populations healthy and protected from disease. The health of our communities depends on public health nurses, and now may be the best time to think about becoming one.
