The Unsung Heroes of Public Health

In Collaboration with: Pat McLaine, DrPH, MPH, RN

Problem Statement:  As the US health care and economic landscape changes, comprehensive and reliable granular level workforce data are critical to plan for service delivery. In order to improve population health outcomes, health equity and control health costs, it is critical to have an adequate and competent workforce. Public health nurses (PHN’s) have successfully provided essential population-based services for decades but their recent work has largely been invisible. The future of public health nursing is in question, as the workforce ages and shrinks. Data on the state of the PHN workforce in Maryland are not available. The workforce also faces many challenges: funding cuts, low salaries, hiring and retention barriers, low interest from new graduates, and replacement of nursing positions with non-nurses. To remain viable and visible, PHN’s must take credit for their work and contributions to the health of their communities.

Approach: We contacted PHN leaders from Maryland’s 24 local health departments (LHD’s) to participate in an interview to enumerate and characterize their PHN’s, including school health nurses. In addition, we asked the PHN leaders to disseminate an online survey to their PHN’s. The study was reviewed and exempted by the University of Maryland IRB.

Products/Outcome: 19 LHD’s participated in the interviews and over 500 PHN’s participated in the online survey. Findings include the education, age, work settings, and salaries of PHN’s, perceived barriers to practice, strategies to promote the profession, and knowledge of key “Future of Nursing Campaign” initiatives. PHN leaders also identified several PHN initiatives that reduced health care costs and improved health outcomes.

Implications: Strategic efforts and political will are needed to ensure that policymakers recognize the assets of the PHN workforce and include PHN’s in plans to deliver critical population-based and public health services. PHN’s must also improve the visibility of successful programs and outcomes and widely disseminate their contributions in community publications and peer-reviewed literature.