Rebuilding Community-Based and Public Health Nursing in the Wake of COVID-19

Patricia Pittman, PhD, FAAN; Jeongyoung Park, PhD


Online J Issues Nurs. 2021;26(2) 

In This Article

Abstract and Introduction


The COVID-19 pandemic has reset the table for a dialogue about health equity, public health, and the future of nursing. Experts anticipated that payment reforms would lead to a much-needed increase in community and public health nursing. Despite calls for the profession of nursing to take a leadership role in addressing the social determinants of health and health equity, data show that jobs for nurses in community-based clinics and public health have actually declined in the last decade. This article offers background on the ongoing decline in public health infrastructure in the United States, an analysis of workforce data on nursing jobs using the National Sample Survey of Registered Nurses from the years 2000, 2004, 2008, and 2018, and the National Association of County and City Health Officials from 2008 to 2019, as well as a discussion of why these findings are so troubling. We discuss policy implications for nurse educators related to curricula and clinical experiences, and for professional nursing organizations as they set goals to increase and improve nursing jobs in community clinics and public health settings. In conclusion, we note that the federal investments in community health centers and public health nursing provide a short window of opportunity to reverse the historic and ongoing decline and rebuild a stronger community and public health nurse workforce.


Among the many problems that the COVID-19 pandemic brought to the fore in the United States were two: health inequities and the crumbling public health infrastructure and workforce in most parts of the country. Both have become priorities for the new federal administration, and significant resources are now available to strengthen the nursing workforce in community-based and public health settings (ARP, 2021).

It is well known that pre-pandemic, investment in the public health workforce has been declining for at least 15 years. This is one reason why the social determinants of health (SDOH) that drive healthcare and other inequities have not been adequately addressed (Castrucci & Lupi, 2020). What is less well known is that participation by nurses has been falling faster than other professional groups within the public health workforce. This article discusses the reduced participation by nurses in both public health and community-based clinics, and discusses implications for the future.