Columbia study urges federal recognition of public health nurses

After 140 years of vital, often invisible service, public health nurses (PHNs) deserve formal recognition as a distinct occupation, says a new study from Columbia University Mailman School of Public Health. The research argues that classifying PHNs under a unique federal occupational category would finally allow the U.S. to accurately count, compensate, and support this critical segment of the public health workforce. The findings are published in the journal Nursing Outlook.

PHNs blend clinical training with public health expertise-offering services that go far beyond bedside care. From emergency preparedness and policy advocacy to community engagement and disease surveillance, their role is unique and essential.

Public health nurses are a well-defined, highly specialized profession and are widely recognized as a core component of the public health workforce. Yet the U.S. Department of Labor does not categorize them separately from other registered nurses. Our study set out to change that."

Heather Krasna, PhD, EdD, associate dean of Career and Professional Development, Columbia Mailman School

Krasna and colleagues analyzed responses to the National Sample Survey of Registered Nurses (NSSRN) and Public Health Workforce Interests and Needs Survey (PH WINS) to compare PHNs with other nurses. They also used Lightcast, a large-scale and comprehensive database of job postings, to gather real-time data on salary, education, skills, and experience for job postings for PHNs as compared with other nurses, and conducted a literature review as well.

From these national datasets and real-time job postings, Krasna and co-authors found PHNs perform a markedly different scope of work than traditional RNs, including:

--Leading community-level assessments and surveillance of health issues and events.

--Managing cases to prevent or resolve problems and coordinating care across systems.

--Promoting health education and communicating facts and ideas.

--Building partnerships and advocating for changes in policies.

--Playing a key role in emergency preparedness, outbreak investigations, and responding to
disasters. 

Despite their distinct contributions, PHNs currently fall under the same Standard Occupational Classification (SOC) code as all RNs (29-1141). This lack of differentiation limits the ability of federal agencies to track the size, compensation, or shortages in this workforce-making it harder to close gaps during health crises.

"A separate SOC code would allow us to finally answer essential workforce questions and build capacity," said Krasna.

PHNs make up roughly 18 percent of the local and 8 percent of the state health department workforce-serving on the front lines of issues like opioid addiction, climate-related disasters, and chronic disease prevention. Yet without formal recognition, their visibility and value remain diminished in the eyes of policymakers and funders.

The next opportunity to update SOC codes is in 2028. Columbia Mailman School's study urges federal agencies to act now to ensure PHNs are classified-and counted-correctly.

Co-authors include Isabella Patino and Sarika Karra, Columbia Mailman School; and Jocelyn Leung, University of Minnesota.

The study was supported by the CDC and HRSA under awards U81HP47167 and UR2HP47371.