Public Health Nurses in an Emergency Response: Highlighting Proficiencies and Training Needs

Posted on April 17, 2024 by Shahida Shahrir

This entry is part 8 of 16 in the series May 2024

Public health nurses and nurse-led local health departments possess unique skills that were important in responding to COVID-19, especially in areas related to justice, equity, diversity and inclusion, and applying evidence-based approaches. Areas for additional training were also identified to guide future public health nurse workforce development.

Public health nurses (PHN) are integral to the public health system and are the largest professional group making up the public health workforce in state and local health departments (LHD). However, their numbers have decreased significantly over the past 10 years amidst reductions in the governmental public health workforce overall [1]. While the value of nurses as directors of LHDs has been elucidated [2], further work is needed to describe PHN staff competencies, especially in regard to public health emergencies. In our study, “Public Health Nurses’ Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study,” we sought to understand the unique skillset that PHNs offer during an emergency response by assessing their proficiencies and training needs when our public health systems were challenged by COVID-19.

Read the Article

We used the Public Health Workforce Interests and Needs Survey (PH WINS), a national dataset of LHD staff in 48 states (N=29,751), to create two binary nurse-specific predictors: (1) whether the staff person was a nurse and (2) whether the staff worked in a LHD that was “nurse-led” (directed by a nurse). For our outcomes, we identified skills important during an emergency response across eight domains based on current literature. Logistic models controlled for staff race/ethnicity, education, and tenure as well as relevant LHD and community characteristics. In the sample, 19% of respondents were nurses and 37% worked in nurse-led health departments, with a majority of nurses reporting their primary program area in maternal and child health or COVID-19 response.

Nurses compared with non-nurses had greater odds of reporting proficiency in:

Justice, Equity, Diversity and Inclusion (e.g. Deliver/implement socially, culturally, and linguistically appropriate programs; support the development of a diverse workforce)
Identify/apply evidence-based approaches to address public health issues
Systems Thinking (e.g. Describe how social determinants of health impact the community)

Nurses compared with non-nurses had greater odds of reporting training needs in several areas including:

Data-based Decision Making (e.g. Identify/ensure use of appropriate sources of data to assess health of community)
Cross-sectoral Collaboration (e.g. Engage/negotiate with partners for use of community assets)
Systems Thinking (e.g. Develop cross-sector partnerships to impact social determinants of health)
Policy Engagement (e.g. Determine feasibility of a policy)

Nurse-led staff vs. non-nurse-led staff had greater odds of reporting proficiencies in several areas including:

Data-based Decision Making (e.g. Identify/ensure use of appropriate sources of data to assess health of community)
Cross-sectoral Collaboration (e.g. Engage/negotiate with partners for use of community assets)
Systems Thinking (e.g. Develop cross-sector partnerships to impact social determinants of health)
Policy Engagement (e.g. Determine feasibility of a policy)

There were no areas in which staff at nurse-led health departments had lower odds of reporting proficiencies or higher odds of identifying training needs when compared with those in non-nurse-led health departments.

Findings from our study underscore the value of nurses serving our public health systems. PHNs reported strong proficiencies in all skills related to justice, equity, diversity, and inclusion, and in their ability to apply evidence-based approaches, which are skills that are vital to public health emergency planning efforts and ensuring health equity in their programs and communities. Still, continued gaps exist in PHN proficiencies that have been previously identified, such as policymaking and data use.

However, many of the skills that nurses identified as training needs were the very same as those identified among staff in nurse-led health departments as areas of strength. This highlights that staff in health departments led by a nurse may be particularly well-prepared to respond to emergencies, indicating the importance of having nurses involved in any future emergency preparedness planning and response. Areas of further research should include strategies to address training needs in both nursing education and workforce development, as well as research focused on better describing, growing and supporting this critical workforce.

For more details on this study, read “Public Health Nurses’ Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study” in the May 2024 issue of the Journal of Public Health Management and Practice.

Acknowledgements

I would like to acknowledge and thank my co-authors for their work on this article and project: Paula Kett, PhD, MPH, RN, IBCLC; and Betty Bekemeier, PhD, MPH, RN, FAAN.

References

[1] Grenadier A. NACCHO’s 2019 Profile Study: Changes in Local Health Department Workforce and Finance Capacity Since 2008.Washington, DC: National Association of County and City Health Officials; 2020.

[2] Kett PM, Bekemeier B, Altman MR, Herting JR. “Not everybody approaches it that way”: nurse-trained health department directors’ leadership strategies and skills in public health. Nurs Inq. 2022;29(4): e12487.

About the Author

Shahida Shahrir: Shahida Shahrir, PhD, MPH, is a research scientist at the Center for Health Workforce Studies at the University of Washington and serves on the Clallam County Board of Health. Her previous work includes research focusing on tobacco cessation, HIV, health disparities, and COVID-19.