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A Public Health Nursing Shortage

Reilly, Janet E. Resop, DNP, APRN-BC, RN; Fargen, Julie, MSN, RN; Walker-Daniels, Kimberly K., BSN, ADN, RN-BC, CMSRN

AJN The American Journal of Nursing: July 2011 - Volume 111 - Issue 7 - p 11
doi: 10.1097/01.NAJ.0000399292.51773.e3

Encouraging nurses to go back to school can augment this workforce.

Janet E. Resop Reilly is an assistant professor and family NP at the University of Wisconsin–Green Bay Professional Program in Nursing. Julie Fargen is an instructor of nursing at Western Technical College, La Crosse, WI. Kimberly K. Walker-Daniels is a medical–surgical nurse in Madison, WI. Contact author: Janet E. Resop Reilly, This manuscript was supported by funds from the Division of Nursing, Bureau of Health Professions, Health Resources and Services Administration (HRSA), and the Department of Health and Human Services (DHHS) under DHHS/HRSA D11HP07731, Linking Education and Practice for Excellence in Public Health Nursing.



In 1980 there were 219 public health nurses per 100,000 people; by 2000 this number had dropped to 158 per 100,000, according to a 2008 report by the Robert Wood Johnson Foundation. Fewer nurses are entering this field—even as their services are in greater demand. Last year's Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act extend the provision of prevention and wellness services that are often provided by public health nurses. In light of a predicted general shortage of 1 million nurses by 2020, the Institute of Medicine, in its recent Future of Nursing report, stressed the importance of "attracting and retaining well-prepared nurses in multiple care settings," including those in public health.

Although a bachelor of science in nursing (BSN) degree isn't universally required for entry into public health nursing, it's practically essential. The U.S. military, U.S. Department of Veteran's Affairs, U.S. Public Health Service, many hospitals, and some states require a bachelor's degree as the minimum educational preparation for nurses. Yet most RNs with diplomas or associate's degrees don't continue their education and are thus ineligible to work in public health. The 2008 National Sample Survey of Registered Nurses found that only 12.4% of nurses who obtained a diploma or associate's degree between 2001 and 2004 went on to earn an additional degree.

Unfortunately, recruiting nurses to BSN programs for the study of public health isn't as simple as hanging a "help wanted" sign. Among the formidable barriers is a lack of information about public health nursing in associate's degree program curricula, which typically expose students to hospital-based and long-term care nursing almost exclusively. Associate's degree students may be more likely to consider completing a BSN and working in this field if they're taught about the role of public health nurses as educators and case managers and learn about the potential advantages—autonomous practice and flexible hours, for instance—of a career in public health.

Other barriers facing students who seek to further their education include a significant outlay of time and money, personal and family issues related to these challenges, and the complexity of the application process. Structured advising and professional mentoring that focuses on each student's particular needs can help address these concerns.

The nursing student support staff at the University of Wisconsin–Green Bay Professional Program in Nursing, which specializes in RN-to-BSN education, speak to students earning their associate's degrees in the classroom and at educational fairs, for instance, emphasizing that professional options are more plentiful for nurses who attain a BSN. In addition, these students are offered guidance on the procedures to follow when transferring credits. Two BSN-level nursing courses, Community Health Nursing and Nursing Research, are also offered to select students before they formally matriculate into the BSN-completion program, speeding up the time it takes to achieve this degree.

We must nurture in all students the belief that an associate's degree is just the first step on the way to a BSN or more advanced degree. Doing so will enable us to develop a public health nursing workforce that meets the intensifying demands placed on this field.

© 2011 Lippincott Williams & Wilkins, Inc.