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Relationships Between Local Public Health Agency Functions and Agency Leadership and Staffing: A Look at Nurses

Bekemeier, Betty PhD, MPH, RN; Jones, Maggie MPH

Journal of Public Health Management and Practice: March-April 2010 - Volume 16 - Issue 2 - p e8–e16
doi: 10.1097/PHH.0b013e3181bdebfe

The United States is facing a severe shortage of well-trained public health workers, and public health nursing is the discipline with the greatest shortage. A local public health agency's (LPHA's) staffing and leadership characteristics are critical in determining its programs, performance, and capacity. A better understanding of the relationship between specific staffing and leadership characteristics and public health programs is needed to address this capacity challenge.

Method Data from the 2005 National Profile of Local Health Departments, were examined to identify associations between an LPHA's nursing workforce and the specific activities performed by LPHAs.

Results LPHAs with a nurse as senior executive had a greater breadth of immunization, maternal/child health, and prevention activities than their nonnurse-led counterpart LPHAs, particularly in rural areas. Nurse-led LPHAs were less likely, however, to have a broad level of environmental health and regulation activities or to have recently conducted community assessment and planning activities.

Conclusions Both LPHA nurse leaders and nursing staff play an important role in the provision of LPHA services, and a shortage of LPHA nursing leaders and staff, particularly in rural areas, will likely have a major impact on certain LPHA programs unless steps are taken to address these challenges.

This study helps inform policy and decision making regarding how staffing shortages for LPHAs may impact community priorities, identifies potential areas for workforce training and development, and suggests directions for further research.

Betty Bekemeier, PhD, MPH, RN, is Assistant Professor, Psychosocial and Community Health, School of Nursing, University of Washington, Seattle.

Maggie Jones, MPH, is Research Associate, Center for Community Health and Evaluation, Group Health Research Institute, Seattle, Washington.

Corresponding Author: Betty Bekemeier, PhD, MPH, RN, School of Nursing, University of Washington, 1959 NE Pacific St, PO Box 357263, Seattle, WA 98195 (

This work was supported by the Robert Wood Johnson Foundation through the University of Kentucky College of Public Health's Assuring the Future of Public Health Systems Research program.

© 2010 Lippincott Williams & Wilkins, Inc.