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

Policy Implications

Current information suggests that the payment reforms and marketplace alone are insufficient to expand nursing in the community clinics and public health. It is incumbent on nursing and health policy leaders in a variety of settings to do more. In addition to remuneration issues, the supply of nurses graduating with a focus on community and public health may also be less than is needed for an expansion.

Implications for Nursing Education

First, nursing program faculty should review curricula and bolster educational offerings in community-based healthcare and public health as appropriate. Program leaders need to identify role models in public health and offer community and public health practice settings for students to conduct clinical practice requirements. If nurses are prepared for this type of work, they may be more likely to rise within the ranks of public health departments, earn a higher salary, and report greater job satisfaction.

Second, boards of nursing in some states still require a nurse preceptor for clinical hours. For public health nurses, allowing preceptors with various non nursing backgrounds would be beneficial. Such a policy could increase the availability of clinical sites and expose nursing students to the work of interprofessional teams before they graduate. Rather than seeing these occupations as a threat, Lillian Wald, the foundational public health nurse in the early 20th century, saw the partnership with social work as critical to addressing community needs (Pittman, 2019a). Non-traditional practice would teach students about unique and critical roles of public health workers from other backgrounds, particularly social workers and community health workers.

Implications for Goal Setting

Third and last, measurable goals would spur action. An example of this is evident from the Institute of Medicine report on the Future of Nursing ([IOM], 2011), which set a goal of 80% of the nurse workforce attaining a bachelor of science level education by 2020. This measurable goal drove change in a positive direction, even if the goal was not fully attained. While public health nurses are but one component of the community and primary-based workforce needed, ASTDN has delineated an achievable set of goals for public health nursing. (Spetz, 2018) Organizations that support primary care, community-based, and school-based nurses could do the same.

The ASTDN goals are (1) one public health nurse per 5,000 population, (2) an additional 1:8 ratio for supervisors to nurses, and (3) more nurses in high-need communities. These goals suggest the need for 66,284 non-clinic-based community/public health nurses to meet the 1: 5,000 ratio, plus an additional 8,284 additional public health nurse supervisors as recommended by ASTDN. Based on the most recent estimate of 47,226 nurses in public health roles (NSSRN, 2018), we would need another 27,341 public health nurses to meet the first criterion of the ASTDN goal. More would be required to meet the needs of high poverty communities, depending on the criteria used to identify those communities.

One advantage of this type of goal is that nursing schools could estimate the number of new graduates per year specialized in public health needed in each region; public health departments could do the same. Federal health workforce program administrators could track how their programs contribute to this goal at a national and a local level. Examples of these programs are the Nurse Corps loan repayment program, which received additional funding under the American Rescue Plan Act (Health Resources and Services Administration, 2020), and Title VIII, which funds various nurse education programs and received extra support under the Coronavirus Aid, Relief, and Economic Security Act (2020).