Public Health Nurse Recruitment Barriers Detailed

While public health nurses report high levels of job satisfaction, they are "extremely unsatisfied" with their salaries, lack education and training resources, and don't see opportunities to grow into leadership roles, survey data shows.

Hospitals and health systems are not the only organizations grappling with the challenge of attracting and keeping nurses on staff. Public health departments are also struggling to fill vacant jobs.

Nurses are critically important to public and population health efforts, making up 24% of that workforce and providing much-needed clinic-based care and disease prevention services to individuals in roughly half of all state and local health departments.

But the public health sector's efforts to recruit and retain registered nurses have been hobbled by a number of factors. A report [PDF] , released last week by the University of Michigan Center of Excellence in Public Health Workforce and funded by Robert Wood Johnson Foundation, quantifies the problem and its causes.  

Among the reasons: While public health nurses surveyed recently report high levels of job satisfaction, they are "extremely unsatisfied" with their salaries, lack education and training resources, and don't see opportunities to grow into leadership roles.

Twenty-seven state health departments anticipate a shortage of public health RNs to meet population health needs within the next five years. Seventy-eight percent of those agencies cite retirement and noncompetitive wages as contributing factors, and 70% cite budget reductions as a factor.

On average it takes 10 weeks to fill an RN position at a state health department.

As much as 50% of public health department budgets are federally funded, but budget cuts have restricted salaries levels so much that they essentially can't compete with hospital or office-based nursing salaries. Salaries for public health nurses at state health departments in 31 states range from $42,998 to $71,892 for RNs.

None of the health departments cited in the RWJF report expect to see their budgets increase a great deal in the near term, which will further challenge recruiting efforts.

Aside from payroll constraints, education and training also present challenges to attracting and retaining staff. Of the nearly 2,500 currently vacant nursing positions in public health departments, 45% call for RN licensure.

"As health reform is implemented, and as public health agencies are transforming to a more population-health-oriented role in promoting health and protecting communities, public health nurses will need additional training to keep pace with the changes," stated Pamela G. Russo, MD, MPH, RWJF senior program officer in a media release.

 "There's a tremendous amount of autonomy and personal decision-making [as a public health nurse]. You get better opportunities to make independent assessments, so it increases the nurse's job satisfaction and offers up a real meaningful position for nurses to have," said Paul Jarris , MD, MBA, executive director of the Association of State and Territory Health Officials, a nonprofit organization representing U.S. public health agencies, in an interview.

"It may be more difficult to attract younger nurses now because of pay differential and unfortunate attitude in this country about government workers that aren't valued as highly as other workers, even though they are very dedicated and passionate people willing to make sacrifices on salary," said Jarris. 

But a perception among nurses that opportunities for leadership roles and career advancement are lacking in the public health sector is confirmed by the survey data. Nearly 70% of local health departments and 63% of state health departments reported that promotion opportunities are often unavailable to RNs.  

The report offers these recommendations for recruiting and retaining nurses:

• Nursing degree programs should develop more clinical training or internship options for students to work in health agencies and other public health settings  
• Health departments should consider establishing policies that allow for tuition reimbursement for RNs in exchange for a guaranteed minimum number of years of service when possible.  
• Steps must be taken to provide a pathway for experienced public health nurses to serve in public health leadership roles, including program officer/director, division/department director, and health officer.  
• Health departments should periodically evaluate the salary ranges they provide to RNs to those in jurisdictions of comparable size and geographic location to insure parity in compensation.  

"Within field of nursing, there's a misperception that the bedside is the leading place for nurses, but the industry fails to appreciate the critical role public health nurses play," says Jarvis. "I would call upon organized nursing organizations to start to include public health nursing within the issues they highlight, and support public health nursing to the same extent they support hospital and hospice nursing."