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


The question, then, is why public health nursing has been particularly hard hit during this period since the year 2000? Edmonds and colleagues (2020) warned against replacing public health nurses with less costly personnel in their Call to Action for Public Health Nurses, arguing that nurses' "preparation, knowledge, clinical decision-making skills, and their ability to flexibly be deployed across a diverse range of activities in response to rapidly evolving public health needs" make them irreplaceable in public health (Edmonds et al., 2020, p. 324) However, the data above do not suggest substitution

Local health departments seem to agree. In a 2017 survey of local health departments in California, 80% reported problems with recruitment or retention of nurses, and 46% reported a decrease in nurses on staff (Taylor, 2018). This finding suggests that it is not simply a problem of low job availability or a lack of appreciation for nursing contributions in these settings. They indicated that they want more nurses.

At least part of the problem appears to be on the supply side. It is possible that the interest in career advancement and continued education has led the workforce to greater specialization. Specialization in nursing, as in medicine, could be driving the workforce away from primary care, community-based care, and public health, and into hospitals and specialty physician offices.

Competition from acute care settings may also be hurting community-based healthcare and public health. The same California survey (Taylor, 2018) found that nurses reported that low compensation was a major reason for considering leaving their local health department jobs. Indeed, the most recent NSSRN (2018) showed that the mean annual salary for nurses in hospital settings was $76,506 versus $66,632 for those in public health departments (NCHWA, 2018). More jobs without increased compensation may, therefore, be an insufficient remedy.