The Career Pathways and Employment Experiences of Public Health Nurses Compared to Nurses Outside of Public Health, 2008 to 2022

Public health nurses are a critical, yet understudied part of the public health workforce – more information is needed regarding the potential unique assets and needs of PHNs compared to other RNs.

To examine how PHN demographics, career pathways and employment experiences have changed over time and compare to other RNs.

To inform public health nurse (PHN) workforce planning, we used 2008, 2018, and 2022 National Sample Survey of Registered Nurses data to examine PHN career pathways and workforce changes over time and compared to other RNs (“non-PHNs”). We identified PHNs using setting, specialty, and level of care and used descriptive statistics and predicted probabilities for comparisons.

PHNs were more likely to have been a community health worker (CHW) prior to nursing (4% v. 2%, p < 0.05), and having a non-nursing Master’s degree (4% v. 2%, p < 0.05) compared to non-PHNs. Also compared to non-PHNs, PHNs were more likely to spend time in research (36% v. 20%, p < 0.05) and “other” (20% v. 14%, p < 0.05) activities, less likely to report practicing at top of scope (93% v. 97%, p < 0.05) and reported significantly lower earnings.

Findings demonstrate PHN workforce strengths and challenges, including on-going PHN/non-PHN salary disparities, limited workforce diversity and concerns regarding PHNs’ ability to practice to the top of their scope.

Addressing these challenges is essential to building a PHN workforce representative of the communities it serves and ensuring PHNs are adequately supported, utilized, and compensated.