On the Frontlines of Health: A Guide to a Career in Public Health Nursing

Public health nursing is an ideal career path for those who enjoy working in the medical field but also wish to bridge the gap between clinical care and policy.  The American Public Health Association defines public health nursing as the practice of “promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences”.  While the nursing profession generally focuses on the relationship between patient and provider, public health nursing allows medical professionals to care and advocate for an entire population.  Generally, public health nurses use their medical expertise and stake as providers in the community to identify the community's health needs, all while emphasizing disease prevention in a primary care setting.  

While public health nurses can be found at government agencies, hospitals, or even nonprofit organizations, the essential functions of a public health nurse have three main components:

1. Be an advocate for social justice by promoting health equity in the population

2. Support and engage community members and stakeholders 

3. Build public health capacity in medical settings.  

For example, using these three principles, a public health nurse might assist a government agency in interpreting disease prevalence rates of COVID-19 or the flu, then develop and administer a vaccination program within the community.  While this program is informed by public health surveillance, the public health nurses' licensing as medical professionals allows them to coordinate vaccine administration.      

There are a handful of educational options for those looking to pursue a career in public health nursing.  The most common and quickest route to the career is earning a Bachelor of Science in Nursing (BSN) from an accredited program. Once completed, students are eligible to take the NCLEX-RN examination, a licensing examination that allows students to begin practicing as registered nurses.  

From there, most people practice for a few years before deciding if they would like to move into the public health nursing role.  Although not required, developing hands-on clinical skills can be helpful when thinking about improving care in a public health setting.  

With the RN license alone, nurses can begin searching for public health jobs.  There’s no specific requirement for additional education, but some nurses opt to earn a Certified Public Health Credential to showcase additional expertise in public health.  The American Nurses Credential Center offers a variety of public health certifications for nurses, ranging from Advanced Public Health Nursing to Public/Community Health Clinical Nurse Specialist certification.  

While this is the most common career path, universities have also responded to the growing need for nurses nationally by introducing direct entry master’s programs in nursing.  Typically, in order to earn a graduate degree in nursing, applicants had to show completion of an undergraduate degree in the specialty in addition to successful completion of the NCLEX examination.  By earning a graduate degree, registered nurses become nurse practitioners, a title that allows for more autonomy in care and leadership positions. 

Direct entry nursing programs allow students without a BSN to enter the field, usually from a related degree program in the life sciences.  For some programs, students can become NCLEX certified registered nurses in as little as 15 months.  Other programs can last three years, training students as both registered nurses and nurse practitioners in that time.  Like those with a BSN, these students can also choose to enter public health nursing at any point.  

In short, there are several options for becoming a public health nurse. While some go directly into the field, others decide it’s important to have a few years of experience with patients to better equip them to meet needs in the field.        

As defined by the American Public Health Association (APHA), public health nurses aim to “improve the health outcome of all populations”.  Using their clinical background and learned experience from treating patients one-on-one, public health nurses “apply systems-level thinking” to find avenues for improvement within the healthcare and public health settings.  By conducting formal needs assessments from a clinical perspective, public health nurses then translate findings into “action for public good”.  

A public health nurse's daily life can take many forms, depending on the population of interest's needs. Generally, a public health nurse will serve as a collaborator or leader on a team of interdisciplinary individuals, all working towards developing a public health plan to tackle a need. These teams can include individuals in government, community-based partners, policy experts, researchers, or non-governmental organizations.    

Unlike the other stakeholders, public health nurses add the community perspective to the conversation, serving as the conduit between the patients who need care and the officials who can put a plan in motion.  Nurses can use their training as culturally-informed care providers to convey the needs of the people they work with. They almost function as a community advocate in conversations where participant perspectives can often get lost in bureaucracy.

Functionally, a public health nurse should be ready to continue clinical care to maintain their connection to the population.  They might also be asked to lead education initiatives in the community and translate the needs they witness into applicable policy.  The position allows a nurse to carry out a variety of functionalities, ensuring an engaging career path for years to come.       

In a post-pandemic world, nurses are urgently needed at all levels.  By some estimations, the United States will need about 193,000 nurses to enter the workforce every year until 2032.  Within that same timeframe, we only expect to see about 177,000 nurses graduate into the workforce.  As the population continues to age and overall health status declines, the need for nurses who can strategize public health solutions to tackle these macro level conundrums also expands.

The data is clear: a nursing shortage results in hospital closures, higher patient mortality rates, and greater costs to the healthcare system.  Regardless of the kind of nurse you might become, a job will be waiting for you upon licensing and graduation.  

That being said, it’s important to point out the recent issues with retention in the nursing world.  The pandemic put perhaps the worst stress on the nursing workforce.  Even before the pandemic, nurses were classically overworked and mistreated within hospital systems.  Nurses handle complex needs and personalities, often with little help and few resources, whether from doctors or angry patients.  These conditions can lead to a turnover rate as high as 37% in some regions of the country.  

This retention issue is itself, a public health crisis that a public health nurse would be equipped to tackle.  With frontline experience and the power to change policy, public health nurses are even necessary to solve the systematic failures that make their clinical experience difficult.  

Whether a public health nurse wants to work in a community clinic, in a school, in government, or as a strategist for their hospital system, there are boundless possibilities that come with having a clinical skill set and the expertise to change policy. 

Like any other career choice, there are pros and cons to entering the world of public health nursing.  One element of the career path that is a pro is the community of other nurses and the resulting professional organizations that are there to support you throughout your career journey.  

The American Public Health Association’s Public Health Nursing Section provides members with opportunities for networking and mentorship, access to conferences, and the ability to engage cross-functionally with other sections of the public health community. It provides a strong network of like-minded individuals working in the public health nursing field.    

Additional professional organizations like the Association of Public Health Nurses also provides opportunities for professional development in the field.  The association holds periodical conferences on subjects like “Policy Change through Advocacy” that are geared specifically to public health nurses. 

A career in public health nursing offers the best of both worlds, balancing clinical practice with public policy. This blend of disciplines and the ever-changing world of public health needs allows nurses to have more influence in the healthcare system, bringing a more balanced perspective to a complex system.  

Whether working on vaccination campaigns, educating the public on a health topic, or providing clinical expertise for infectious disease monitoring, public health nurses have a unique vantage point at the interface of policy and clinical practice. 

Whether you’re reading this as a practicing nurse looking for the next career move or as a current nursing student wanting to branch out of clinical practice, pursuing a career in public health nursing promises the best of both worlds.  As a clinician, you can continue to engage with patients and provide the one-on-one care that likely drew you to the field.  If you also want to make that care more accessible to the rest of the population, your position as a public health nurse allows you to sit at the table in policy discussions.  While the career can be demanding, it also promises to be deeply rewarding daily.