A JOURNAL READING ABOUT COMMUNITY HEALTH NURSING

A Journal Reading Presented to

Lendell Kelly B. Ytac, RN
Faculty, FNAHS BSN-Program
Davao Oriental State University

__________________________________________________________

In Partial Fulfillment
of the requirements for
NCM 113
Community Health Nursing 2
(Population,Groups and Community as Clients )

By

Regine L. Pudpud
Student Nurse,BSN-3B

September 2, 2023
Title: Rebuilding Community-Based and Public Health Nursing in the Wake of COVID-19
Author: Patricia Pittman, PhD, FAAN and Jeongyoung Park, PhD
Date Published: May 31, 2021

Summary:

Discussions on health equity public health and the future of nursing have been brought back to
life by the COVID19 pandemic. Experts had expected the reforms to pay would result in much
needed increases for both Community and public health nursing. Data reveal that, despite calls
for the nursing profession to take a leadership role in dealing with social determinants of health
and health equity, there has been an actual decrease over the last 10 years in nurses working at
Community Based Clinics and Public Health Departments. This article provides background on
the continued deterioration of public health infrastructure in the United States, an analysis of
nursing workforce data using the 2000, 2004, 2008, and 2018 National Registered Nurse Survey
and the National Association of County and City Health Authorities. between 2008 and 2019 and
a discussion of why these findings are so alarming. We discuss the policy implications of
curriculum and clinical experience for nurse educators and professional nursing organizations as
they set goals to increase and improve nursing in local clinical and public health settings. In
conclusion, we conclude that federal investment in community health centers and public health
nursing provides a short window of opportunity to reverse historic and ongoing declines and
restore a stronger community and health workforce.
Among the many issues highlighted by the COVID-19 pandemic in the United States were
two: health disparities and a crumbling public health infrastructure and workforce across much
of the country. Both have become priorities of the new federal administration, and significant
resources are now available to strengthen the nursing workforce in community and public health
settings. Pre-pandemic investments in the public health workforce have been known to decline
for at least 15 years. This is one of the reasons why social determinants of health and other
inequalities (SDOH) have not been sufficiently addressed (Castrucci and Lupi, 2020). It is less
well known that the participation of nurses in the field of public health has declined more rapidly
than other professional groups. This article examines the declining participation of nurses in both
public health and community clinics and discusses its future implications. Public health and
community nurses are no strangers to this country. In fact, they were a central force in health
care between 1910 and 1940, losing their importance only with the rise of the medical care
model and hospitals in the mid-20th century (Pittman, 2019b). Efforts to revitalize public health
nursing continued over time, especially in organizations such as the ASTDN (now the
Association of Public Health Nurses).
At the same time, many argued that nurse leaders should emphasize the importance of
reengaging public health with the core practice of nursing, as exemplified by Lillian Wald in the
1910s through the late 1930s (Hassmiller, 2013; Pittman, 2019a ; Sullivan-Marx, 2020). This call
became more compelling when researchers tracked the spread of so-called diseases of despair ,
primarily behavioral health problems and concluded that the centralized hospital-based medical
model had failed. Increased interest in SDOH, driven in part by the Health of Health goal of the
Robert Wood Johnson Foundation, and the continued emphasis on deepening the performance-
based payment of health care reform have also highlighted the promise of models that work at
the intersection of nursing and social work. When the COVID-19 pandemic emerged in early
2020, critical care nurses were in the news. The reported shortage of critical care nurses has led
to a renewed appreciation of the central role of hospitals during a public health crisis. Nurses
who worked in intensive care units under dangerous physical and mental conditions were hailed
as heroes and considered a symbol of the entire profession. There was nothing unfair or
unfortunate about this change in conversation. However, as has happened several times over the
past half century, fear of hospital shortages has once again sidelined community and public
health care Pittman, 2019. This measure included an implicit acknowledgment that
improvements can be made to prevent the spread of COVID-19 in the community. In addition to
what many saw as the previous administration's mismanagement and politicization of the
pandemic, the new policies reflected the idea that more could be done to contain the spread if the
community had a strong public health workforce. Public health infrastructure has not been a
priority for years (Taylor, 2018). Weaknesses identified during the current pandemic included
coordination of local, state and federal roles; community education on the importance of public
health preventive measures, follow-up through contact education, COVID-19 testing and vaccine
dissemination (Sullivan-Marx, 2020).
Reflection:
My opinion is that the events of the COVID-19 pandemic have raised the bar for healthcare
professionals and the nursing profession in particular. Even more obvious is the risk that our
public health infrastructure could deteriorate, as this analysis of public health nurses only
suggests. To attract more nurses to the field, employers in the public and private sectors must
address issues of proportional compensation. Nursing programs must produce more nurses who
are interested and ready to work in the fields of society and public health. Local, state, and
federal public health workforce programs must set measurable goals by region and publicly track
progress. The current administration's combined emphasis on equity and the public health
workforce offers an opportunity to reverse the historic ongoing decline outlined in this article in
community and public health nursing. Rebuilding a stronger nursing workforce will not only
prepare the United States to meet the challenges of future pandemics, but will also have a
positive impact
In conclusion, they note that the federal investments in community health centers and public
health nursing provide a short window of opportunity to reverse the historic and ongoing decline
and rebuild a stronger community and public health nurse workforce.

References:
https://ojin.nursingworld.org/table-of-contents/volume-26-2021/number-2-may-2021/rebuilding-
community-based--public-health-nursing-wake-of-covid-19/
Original Journal
The COVID-19 pandemic has reset the table for a dialogue about health equity, public health,
and the future of nursing. Experts anticipated that payment reforms would lead to a much-needed
increase in community and public health nursing. Despite calls for the profession of nursing to
take a leadership role in addressing the social determinants of health and health equity, data show
that jobs for nurses in community-based clinics and public health have actually declined in the
last decade. This article offers background on the ongoing decline in public health infrastructure
in the United States, an analysis of workforce data on nursing jobs using the National Sample
Survey of Registered Nurses from the years 2000, 2004, 2008, and 2018, and the National
Association of County and City Health Officials from 2008 to 2019, as well as a discussion of
why these findings are so troubling. We discuss policy implications for nurse educators related to
curricula and clinical experiences, and for professional nursing organizations as they set goals to
increase and improve nursing jobs in community clinics and public health settings.
In conclusion, we note that the federal investments in community health centers and public
health nursing provide a short window of opportunity to reverse the historic and ongoing decline
and rebuild a stronger community and public health nurse workforce.
Among the many problems that the COVID-19 pandemic brought to the fore in the United States
were two: health inequities and the crumbling public health infrastructure and workforce in most
parts of the country. Both have become priorities for the new federal administration, and
significant resources are now available to strengthen the nursing workforce in community-based
and public health settings (ARP, 2021).
is well known that pre-pandemic, investment in the public health workforce has been declining
for at least 15 years. This is one reason why the social determinants of health (SDOH) that drive
healthcare and other inequities have not been adequately addressed (Castrucci & Lupi, 2020).
What is less well known is that participation by nurses has been falling faster than other
professional groups within the public health workforce. This article discusses the reduced
participation by nurses in both public health and community-based clinics, and discusses
implications for the future.
Background
Public health and community health nurses are not new to this country. Indeed, they were a
central force in healthcare from 1910 to 1940, losing prominence only as the medical model of
care and the rise of hospitals gained traction through the mid-20th century (Pittman, 2019b).
Efforts to revitalize public health nursing have continued over time, especially by organizations
such as the Association for State and Territorial Directors of Nursing (ASTDN) (now the
Association of Public Health Nurses).
Figure 1 shows the range of activities public health nurses are engaged in, all of which are
essential contributions to address health equity. Since the early 1940s, there has been a general
convention that at least one public health nurse is needed per 5,000 population. In 2008, the
ASTDN called for the formalization of this goal, and specifically for additional nurse
supervisors, and a higher density of public health nurses in high poverty communities (Keller &
Litt, 2008).
 Figure 1. Contributions of Community/Public Health Nurses

 Participate in emergency preparedness

activities
 Provide health teaching to individuals
and families
 Receive and make referrals
 Work in immunization clinics
 Work in health promotion/prevention
programs in the community
 Conduct home visits
 Perform case management
 Facilitate and assist vulnerable
individuals’ access to services and
basic life needs
 Serve on or work with groups on
public health issues
 Provide health teaching to groups
 Perform activities related to vulnerable
children and/or adults
 Investigate disease and other health
threats
 Conduct health screenings
 Conduct educational classes, meetings,
workshops for providers
 Advocate for improved increased
health care availability and access
 Participate in community organizing
activities
 Chair or lead groups related to public
health issues

(Keller & Litt, 2008)

Following the 2010 Affordable Care Act (Patient Protection and Affordable Care Act, 2010),
experts hoped that progress was being made toward addressing healthcare inequities with this
change to the healthcare infrastructure. Many predicted that value-based payment would provide
an incentive for healthcare organizations to hire more nurses outside of hospitals, in areas such as
public health and community-based settings (Larson, 2017; Pittman & Forrest, 2015; Salmond &
Echevarria, 2017). The rationale was that as hospitals assumed more risk under Accountable
Care Organizations and other value-based payment programs, care would shift outside of the
hospital to ambulatory settings and homes. We would invest in public health and upstream
initiatives, such as coordination with social services, housing, and food security. (Larson, 2017).
Some chief nursing officers in hospitals were even calling for large health systems to create a
chief nursing officer position for community-based nursing (Pittman & Forrest, 2015).
At the same time, many argued that nurse leaders should emphasize the importance of
recommitting to the foundational practice of public health nursing, as exemplified by Lillian
Wald in the period of 1910 to the late 1930s (Hassmiller, 2013; Pittman, 2019a; Sullivan-Marx,
2020). This call became more compelling as researchers identified a surge in so-called diseases
of despair (i.e., primarily behavioral health-related challenges) and noted that the centralized
medical model based in hospitals was failing. The increased interest in SDOH, driven in part by
the Robert Wood Johnson Foundation Culture of Health goal (n.d.), and the continued emphasis
on deepening outcome-based payment in health reform, also highlighted the promise of models
that function at the intersection of nursing and social work.
When the COVID-19 pandemic appeared in early 2020, nurses in critical care settings occupied
the headlines. The reported shortage of critical care nurses renewed appreciation for the essential
role hospitals play during a public health emergency. Nurses who were working in intensive care
units under dangerous physical and emotional conditions were hailed as heroes and seen as the
symbol of the entire profession. Nothing about this shift in the conversation was unfair or
regrettable. However, as has happened numerous times in the last half-century, the fear of a
nursing shortage in hospitals, for a time, pushed the issue of community and public health
nursing aside, once again (Pittman, 2019a).
When the Biden Administration took office in 2021, priorities shifted and the implications of the
COVID-19 pandemic for public health and health equity became center stage. On January 21st,
one day after assuming office, President Biden issued an Executive Order that established a
Public Health Workforce Program. This order would determine how to deploy personnel in
future public health threats; establish a five-year budget requirement for a sustainable public
health workforce, including Public Health Service Commissioned Corps; and establish a U.S.
Public Health Job Corp that would conduct contact tracing, assist in vaccination outreach and
administration, and assist with training to provide testing (Biden, 2021).
Implicit in this measure was an acknowledgment that the prevention of community spread of
COVID-19 could be improved. Beyond the perceived mismanagement and politicization of the
pandemic by the former administration by many, the new policies reflected the notion that more
could have been done to prevent the spread with a robust public health workforce in the
community. Public health infrastructure had not been a priority for many years (Taylor, 2018).
Areas of weakness noted in the current pandemic included coordination between local, state, and
federal roles; community education on the importance of public health prevention measures,
surveillance through contact training, COVID-19 testing, and planning for the vaccine rollout
(Sullivan-Marx, 2020).
An example that demonstrates the importance of a robust infrastructure concerns the vaccine
rollout. West Virginia and New Mexico were far more successful in quickly vaccinating their
residents than others. These two rural states had maintained a stronger public health
infrastructure than other states. They turned to their public health workforce, rather than the
fragmented private sector pharmacy and healthcare delivery system, during the vaccine roll-out,
taking vaccines to hard-to-reach populations (Cunningham, 2021).
In March, Congress passed the American Rescue Plan Act (ARP) of 2021. The ARP provides a
significant funds for the public health workforce through multiple mechanisms, including
funding for local health departments. In keeping with the goals announced in the earlier
Executive Order (Biden, 2021), $7.66 billion in the new law is targeted to establish, expand, and
sustain a public health workforce, including awards to state, local, and territorial public health
departments (ARP, 2021).
As we contemplate the implications of this new opportunity for nurses and the profession of
nursing, it is important to understand whether payment reforms and the calls for nurses to
address SDOH were indeed having an effect before the pandemic. In order words, where does
the nursing workforce stand today, and is it positioned to expand its role in community health
and public health?
In this analysis, we question the progress made prior to the 2020 pandemic in terms of
strengthening community-based and public health nursing and discuss the implication of the
recent legislation (ARP, 2021) for the future of community and public health nursing.