Recognition for Public Health Nurses: A Necessity for Effective Health Care

Public health nurses (PHNs) have been providing crucial, often overlooked services for over 140 years, and a new study from Columbia University's Mailman School of Public Health emphasizes the need for formal acknowledgment of their distinct role within the healthcare system. The research advocates for the creation of a unique federal occupational classification for PHNs, which would enable the United States to accurately assess, compensate, and support this important segment of the public health workforce.

Published in the journal Nursing Outlook, the study highlights the unique blend of clinical training and public health expertise that defines PHNs. Their responsibilities extend far beyond traditional bedside nursing, encompassing tasks such as emergency preparedness, policy advocacy, community engagement, and disease surveillance.

According to the research team, the lack of a specialized classification for PHNs by the U.S. Department of Labor limits their visibility and ability to be effectively tracked and supported. Heather Krasna, an associate dean at Columbia Mailman School, emphasized that while PHNs are recognized as a core component of the public health workforce, they are currently grouped with registered nurses (RNs) under the same Standard Occupational Classification (SOC) code.

The study analyzed data from the National Sample Survey of Registered Nurses (NSSRN) and the Public Health Workforce Interests and Needs Survey (PH WINS), comparing the roles and responsibilities of PHNs with those of other nursing professionals. Additionally, researchers utilized Lightcast, a comprehensive database of job postings, to gather real-time information regarding salary, education, skills, and experience relevant to PHNs.

The findings reveal that PHNs engage in a significantly different scope of work compared to traditional RNs. Their contributions include:

• Conducting community-level health assessments and surveillance.
• Managing cases to prevent and resolve public health issues while coordinating care across various systems.
• Facilitating health education and effectively communicating essential health information.
• Building community partnerships and advocating for policy changes.
• Playing a pivotal role in emergency preparedness, outbreak investigations, and responses to disasters.

Despite these vital contributions, the indistinct classification under a shared SOC code with RNs hampers federal agencies' ability to monitor the size and compensation of the PHN workforce. This lack of differentiation also complicates efforts to address workforce shortages, particularly during public health crises.

PHNs account for approximately 18% of local health department personnel and 8% of the state health department workforce, addressing urgent issues such as opioid addiction, climate-related health challenges, and chronic disease prevention. However, without formal recognition, their impact remains largely unacknowledged by policymakers and funding bodies.

The study suggests that the upcoming opportunity to revise SOC codes in 2028 should be utilized to ensure that PHNs are properly classified and counted, paving the way for improved workforce planning and resource allocation.

Co-authors of the study include Isabella Patino and Sarika Karra from the Columbia Mailman School, along with Jocelyn Leung from the University of Minnesota.