Specialty Spotlight

Public Health Nursing: Specialty Spotlight

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By Mary A. Paterson, PhD, RN, guest contributor 

August 30, 2013 - Public health nurses are the largest professional group delivering public health services in the United States today. This nursing specialization has a long history of providing community-based care to vulnerable and culturally diverse communities in both urban and in rural areas of the United States.  

Mary Paterson: Public health nurses enjoy many career choices and report high levels of satisfaction.
Mary A. Paterson, PhD, RN, reports that public health nursing offers diversity in professional assignments, variety in areas of responsibility, and a career that practicing nurses rate as highly satisfying.

For example, one of the first public health nursing practices was the Henry Street Settlement in New York City where Lillian Wald and other nurses provided home visits, health education, and community development support to immigrant communities on the Lower East Side. The Henry Street Settlement later became the Visiting Nurse Service of New York, a non-profit organization that continues to provide public health nursing and healthcare services to all New York residents.  

Public health nurses also provided frontier nursing services to populations in remote areas of Kentucky. The experiences of these early public health nurses are recounted in books such as Lillian Wald’s The House on Henry Street and Melanie Goan’s Mary Breckinridge, The Frontier Nursing Service and Rural Health in Appalachia.

Today public health nurses continue the tradition of providing care for specific populations or in specific geographic areas such as city or county health departments, tribal areas, or underserved areas in need of essential services. They are employed in the public sector such as a local, state, or federal government, or they may work for community organizations such as the American Red Cross or the Visiting Nurses’ Association.  

Public health nurses also serve in the U.S. military or in the U.S. Public Health Service Commissioned Corps where they may be public affairs or community liaison officers. Military public health nurses may also be assigned to support troops with health education, health promotion, or individual service delivery programs. The nurses of the U.S. Public Health Service Commissioned Corps provide a wide range of services to underserved and vulnerable populations in many regions of the United States as well as serving in agencies of the Federal Government concerned with public health care.  

In any public health nursing environment, nurses may expect to encounter a variety of community needs and challenges that require skills in both individual and community nursing. The required clinical nursing skills range from providing screenings such as blood pressure monitoring or well-baby care to providing triage services and emergency care for disaster victims.

Some areas of public health nursing require intensive training in epidemiology, disease surveillance, and disease outbreak management. This is especially true for management of bioterrorism threats and communicable disease outbreak management. All areas of public health nursing practice typically require work with interprofessional teams working together to manage population needs and interventions.

Academic leaders suggest that public health nurses need strong skills in areas such as community assessment, communication, cultural competency, leadership, program planning and community development. These skills are developed through education in two- or four-year accredited general nursing programs. The entry-level educational requirement in most public health agencies is an associate’s degree in nursing, however public health agencies frequently state a preference for nurses with a baccalaureate degree.  

For specialized practice areas, a master’s degree with a concentration in public health nursing may be required. Opportunities for advancement are available both in public and private organizations, however the salary levels for community health nurses are usually lower than for nurses in acute care settings. Despite the salary shortfall in some settings, public health nurses report a very high level of job satisfaction and autonomy in their areas of professional responsibility.

In any community health setting, public health nurses can expect to deliver care to groups as well as individuals who may lack access to other private healthcare services. Advanced practice public health nurses who have passed their certification examination are designated as APHN-BC (advanced public health nurse, board certified). The American Nurses Credentialing Center (ANCC) administers this certification examination and provides information on the certification requirements on their website

Nurses certified for advanced practice in public health nursing are expected to assume leadership positions in public health nursing as well as maintain their expertise through continuing education and practice requirements. 

Public health nursing as a career choice provides diversity in professional assignments, variety in areas of responsibility, and a career that practicing public health nurses rate as highly satisfying.  The demand for public health nursing services is expected to remain strong, particularly as the Affordable Care Act is fully implemented beginning in 2014.

About the Author:
Mary A. Paterson, PhD, RN, is professor and coordinator for assessment and evaluation at The Catholic University of America, and project director for the AACN-CDC Academic Partnership Cooperative Agreement Project.

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