Public Health Nurses Satisfied With Their Jobs, In High Demand

New RWJF report offers comprehensive assessment of public health nursing workforce, finds little diversity among public health nursing leaders.

    • July 10, 2013

More than four decades ago, Joy Reed took her new baccalaureate degree and set off to find her place in nursing. At the time in North Carolina, the hospitals she applied to were not keen on nurses with bachelor’s degrees “because we were known for trying to change the system, and things were just fine as they were,” she recalls. But Reed, EdD, RN, FAAN, found a warmer welcome from her local health department, which assigned her to an area where she went door to door, getting to know members of the community and learning about their pressing health issues.

“Once you became known as the community’s nurse, everyone made sure you knew what was going on with everyone else,” said Reed, an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program, president of the Association of Public Health Nurses, and head of the Local Technical Assistance and Training Branch for the Division of Public Health in the N.C. Department of Health and Human Services. “It was so fulfilling to be seen as that kind of community resource and be able to have an impact on the lives of so many people at once. Now, at the state level, what keeps me going is the chance to advocate for policies, practices, and resources that make a difference for local health departments.”

That kind of passion for making a difference is common among public health nurses, according to a new report from RWJF that provides the first comprehensive assessment of the size, composition, educational background, experience, retirement intention, job function, and job satisfaction of nurses who work for state and local health departments.

Produced by the University of Michigan Center of Excellence in Public Health Workforce Studies, Enumeration and Characterization of the Public Health Nurse Workforce: Findings of the 2012 Public Health Nurse Workforce Surveys reflects data collected from state and local public health departments and public health nurses themselves. The findings show that public health nurses play an essential role in improving the population’s health and delivering essential health services to communities, but that the public health nursing workforce is facing significant challenges. More than two in five state health departments report having “a great deal of difficulty” hiring nurses and nearly 40 percent of state and local health departments report having insufficient resources to fill vacant nurse positions.

Public health nurses have concerns about job stability, compensation, and career growth in light of budget-tightening at many state and local health departments. Yet these nurses also report very high levels of job satisfaction and that they feel they are making a difference in their communities—factors that could bolster recruitment efforts.

The report provides “a real depth of understanding that we haven’t had before,” said Paul Kuehnert, MS, RN, CPNP, senior program officer and team director of Public Health at RWJF, and an alumnus of the RWJF Executive Nurse Fellows program. “Everyone thinks of public health nurses as the people who give babies their immunization shots, but this report shows that these nurses are doing work across health departments. A key take-away is having a real, solid estimate of how large the public health nurse workforce is, and seeing the diverse duties that public health nurses have.”

A Clearly Focused Snapshot

“Public health nurses are the largest professional sector of the public health workforce. This report gives us a clearer picture of the challenges public health departments face in recruiting the nurses they need,” said Pamela G. Russo, MD, MPH, RWJF senior program officer. “As health reform is implemented, and as public health agencies are transforming to a more population-health-oriented role in promoting health and protecting communities, public health nurses will need additional training to keep pace with the changes. It should be a high priority to provide the additional education and training that nurses clearly desire based on the results of the study. The number and preparation of public health nurses greatly affects the ability of agencies to protect and improve the health of people in their jurisdictions.”

The new report offers a snapshot of the current public health nurse workforce—estimated at 34,521 full-time equivalent RNs—and highlights the need for ongoing systematic monitoring. Among its findings:

  • Nearly two in five respondents to the survey (39%) report that their highest nursing degree is a diploma/associate’s degree. Just 10 states require public health nurses to have BSN degrees. 
  • Providing clinical services is part of the work done by RNs in state and local health departments, but these nurses assume a wide variety of roles, including health promotion, disease surveillance, community health assessment, policy development, and more.
  • The public health nursing workforce does not reflect the diversity of the communities it serves. Just 4 percent of public health nurses self-identify as Hispanic/Latino and 95 percent of those in leadership positions self-identify as White.
  • The public health nurse workforce is aging; however, most RNs do not intend to retire within the next five years.
  • Recruitment and hiring of RNs into public health nurses positions can be challenging, particularly for state health departments.
  • Lack of promotion opportunities is a concern to both health departments and RNs.
  • Public health nurses report extremely high levels of job satisfaction, despite reporting high levels of dissatisfaction with salaries.

Fears About Retirement

“I was surprised to see how many public health nurses are postponing retirement,” Reed said. “When you look at recent data for the nursing workforce overall, public health nurses have been the oldest group. The economy is certainly a factor, and I’ve heard that a lot of people are staying on because they’re afraid that if they leave, the agency will eliminate another nursing position.”

“We shouldn’t overlook the importance of positive findings related to job satisfaction,” added Angela J. Beck, PhD, MPH, associate director at the University of Michigan Center of Excellence in Public Health Workforce Studies and research assistant professor at the University of Michigan School of Public Health. “With 85 percent of public health nurses reporting job satisfaction and 90 percent reporting that they feel they make a difference in the health of their communities, we have a strong foundation to build on.”

The report includes recommendations from the project’s advisory committee.

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