Leveraging Public Health Nursing to Build a
Culture of Health
Susan B. Hassmiller, RN, PhD, FAAN
P
ublic health nurses promote and protect the health
of communities and populations and seek to reduce
health disparities. They provide reliable informa-
tion to a variety of community groups of all ages to explain
proper nutrition, demonstrate effective safety practices,
and promote early detection of common diseases.
Despite the potential of public health nurses to con-
tribute to better population-based health outcomes, the
field remains beset with challenges. State and federal budget
cuts have slashed public health departments, with public
health nursing sustaining the largest share of the cuts.1
Public health nurses need more competitive salaries for
hiring and retaining qualified staff. The workforce is aging
and has too few diverse and baccalaureate-prepared nurses,
and there is a concurrent shortage of faculty to teach the
next generation.2,3 Furthermore, schools of nursing should
teach more public health nursing content in their classes,
and public health departments should offer additional
training opportunities to nurses already in the field.
Leveraging the public health nursing field is crucial to
fully achieving the promise of health reform, with a health
system that prevents disease and promotes health instead of
focusing on acuity and illness. Public health nurses must
help to lead efforts to build a Culture of Health, which the
Robert Wood Johnson Foundation (RWJF) defines as
shifting the values—and the actions—of this country so that
health and healthy decisions become a part of everything
Americans do. RWJF wants to enable all of U.S. society to
lead healthy lives, now and for generations to come.
Preparing the Public Health Nursing
Workforce for the Future
In 2012, RWJF convened a Forum on the Future of the
Public Health Nursing, where experts discussed chal-
lenges and opportunities to developing a shared vision
for the field’s future direction.4 In 2013, the Quad
Council of Public Health Nursing Organizations held
an Invitational Forum on the Role and Future of Nurses
in Public Health to develop consensus among public
health nursing leaders in education, practice, and
From the Senior Adviser for Nursing, Robert Wood Johnson Foundation,
Princeton, New Jersey
0749-3797/$36.00
http://dx.doi.org/10.1016/j.amepre.2014.07.027
& 2014 American Journal of Preventive Medicine  Published by Elsevier Inc.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
research and experts outside the field on action steps to
enhance the ability of public health nurses to improve the
public’s health.1 RWJF had previously funded a study
that analyzed the size, makeup, and preparation of the
public health nursing workforce to give a clearer picture
of the challenges facing the workforce.3 These meetings
and studies offer a roadmap for the public health nursing
field to maximize its contribution to improving health.
Education
Public health nurses address population health needs;
thus, they must be well versed in clinical prevention,
healthcare policy, leadership, research, finance and
regulatory environments, and interprofessional colla-
boration.5 They should be able to conduct community
assessments and apply the principles of epidemiology.6
These competencies should be found in baccalaureate
and higher degree programs, yet health departments
report that nearly one third of their nursing workforce is
educated at the associate’s-degree/diploma level.3
The IOM report “The Future of Nursing: Leading
Change, Advancing Health”7 calls for 80% of the general
nursing workforce to receive a baccalaureate degree or
higher by 2020 and to increase the diversity of the
nursing workforce. Because of the special competencies
needed for their role, it is crucial for public health nursing
to achieve at least the 80% goal. Public health organiza-
tions should provide opportunities for their nurses to
have additional education and training opportunities.
The American Association of Colleges of Nursing’s
agreement with CDC for Academic Partnerships to
Improve Health offers a great example of an initiative
to transform education for future public health practice.
The program offers improved integration of public
health concepts into nursing education programs,
increased hands-on experience for students working with
communities and public health partners, and an
expanded fellowship model that can lead to field place-
ments in health agencies and communities.8
Leadership
Public health nurses bring a unique focus from individuals
and families to populations and systems, so they are well
situated to integrate new health system models and meet
the demands of a health system undergoing transformation.
Am J Prev Med 2014;47(5S3):S391–S392 S391
S392 Hassmiller / Am J Prev Med 2014;47(5S3):S391–S392
As public health agencies increasingly focus on quality
and accountability through national accreditation and
attainment of public health standards, public health
nurses need to lead efforts related to accreditation,
community assessment, health improvement, planning,
quality improvement, performance management, and
strategic planning.4 Leadership content is critical in
nursing programs, with continued opportunities for
training and mentorship available for public health
nurses in the workforce.
Public health nurses should advocate for health
promotion and prevention activities and policies to
reduce disparities at the local, state, and national levels,
and they need training to better impact systems change.
The Future of Nursing: Campaign for Action (campaign-
foraction.org/), a national initiative led by RWJF and
AARP to implement the IOM recommendations on the
future of nursing, is seeking as many nurses as possible to
sit on committees and boards, including public health
nurses.
Research
More research is needed to document the effects of public
health nursing interventions on population-focused
health outcomes,9 and more public health nurses should
be trained to conduct evidence-based research around
their practice. Researchers must test emerging care
models that demonstrate impact on improved care and
cost-effectiveness. The Nurse–Family Partnership pro-
gram is among the most heralded public health nursing
programs precisely because of rigorous longitudinal
research demonstrating its success.10 Public health nur-
sing is more likely to be supported and funded with
evidence demonstrating its role in promoting health and
protecting communities.
Conclusions
Public health nurses should play a critical role in leading
health transformation to a system focused on health
promotion and prevention. The vision for the Future of
Nursing: Campaign for Action is that “everyone in
America can live a healthier life, supported by a system
in which nurses are essential partners in providing care
and promoting health.” That vision is unachievable
without the involvement of public health nursing and
other key public health stakeholders. The field must
strengthen nursing education, promote leadership, and
foster research to build a Culture of Health that will
enable all in our diverse society to lead healthy lives, now
and for generations to come.
Publication of this article was supported by the U.S. Centers for
Disease Control and Prevention (CDC), an Agency of the
Department of Health and Human Services, under the
Cooperative Agreement with the Public Health Foundation
and University of Michigan Center of Excellence in Public
Health Workforce Studies (CDC RFA-OT13-1302). The ideas
expressed in the articles are those of the authors and do not
necessarily reflect the official position of CDC.
No other financial disclosures were reported by the author of
this paper.
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