The origins of public health nursing in the United States lie with the first graduate nurses of America’s oldest nursing school, the Bellevue Hospital School of Nursing, founded in 1873 in New York City. These women were bold and tenacious, challenging the social convention of the day with their strength and independence. It was these very qualities that allowed them to pioneer the community health movement, as they were the first to provide much-needed healthcare services to indigent members of their community.
In 1893, nurse Lillian Wald established the Henry Street Settlement House in New York City, America’s first public health nursing agency, and was the first to coin the term “public health nurse.” Since that time, public health nurses have focused on making health care services available to the underprivileged, promoting health and diseases prevention in community-based settings throughout the country.
Advanced practice nurses have a number of options within the sphere of community health nursing, often serving as clinicians, nurse educators, or administrators. They may provide services in community-based settings, such as schools, day care centers, and community health clinics, as well as in people’s homes. In the interest of public health, they are often involved in preventing and controlling infectious disease outbreaks through screening and early detection initiatives, promoting the health of new mothers and their babies through pre and post natal care, and preventing domestic violence and child abuse through education and awareness campaigns.
Public health nurses may be involved in emergency preparedness and disaster response, developing strategies for delivering medical care in the event of natural disasters or other emergencies. In remote and deeply rural communities, public health nurses are often the singular source of medical care. They often work in partnership with community residents to promote healthier lifestyles and living conditions, and educate people on issues concerning personal and public health. At the leadership level, public health nurses are involved in establishing and amending policies and laws, promoting change in the interest of public heath.
Education and Degree Options
The educational requirements for serving as a public health nurse vary by state. While some states permit registered nurses with bachelor’s degrees and some supplemental public health training to work in community settings, more opportunities are available to nurses with graduate degrees or DNPs. Since certification in community health nursing requires a graduate degree at minimum, this is the obvious choice for most nurses interested in providing advanced medical care in community settings.
One of the more common degree options is the Master of Science in Nursing (MSN) with a Public Health Nursing concentration or specialization. Master of Public Health (MPH) degrees are also available, as are joint MSN/MPH degrees. Some educational programs are designed specifically for advanced practice nurses interested in earning nurse practitioner certification in public health, while others support the clinical nurse specialist public health designations.
Topics typically covered in a public health nursing program include community health assessment, epidemiology, models and strategies for promoting health, planning and evaluating health programs, and community health administration and research.
Public Health Nursing Certification
The American Nurses Credentialing Center (ANCC) offers a certification exam that results in earning the APHN-BC (Advanced Public Health Nurse – Board Certified) credential. ANCC currently offers three options that qualify candidates to sit for the certification exam. All three options require an active, current RN license issued in the US, or a comparable license from another country.
Option A: Nurses must have a graduate degree in public nursing or community health nursing conferred through a Commission on Collegiate Nursing Education (CCNE) or National League for Nursing Accrediting Commission (NLNAC) accredited program.
Option B: Nurses must have an MPH and a bachelor’s degree or higher in nursing.
Option C: (available until December 31, 2015): This option is for nurses who have earned a graduate degree in an area of study other than community health nursing and requires:
- A graduate degree in nursing or a related field. If the graduate degree is not in nursing, then the bachelor’s degree must be in nursing.
- At least 2,000 hours in practice providing advanced community health nursing care within the three years prior to applying.
Previously, ANCC had an exam for the Clinical Nurse Specialist in Public/Community Health (PHCNS-BC) designation, but no longer offers this exam. However, nurses who meet the Option A eligibility criteria for taking the APHN-BC exam can request the PHCNS-BC credential, if they completed a graduate-level clinical nurse specialist (CNS) program that meets the following criteria:
- Inclusion of three separate courses in advanced pathophysiology, advanced pharmacology, and advanced physical/health assessment.
- At least 500 supervised hours performing the clinical duties of a CNS in a community health setting.
The APHN-BC exam is computer-based. Renewal of certification is required every five years and is dependent on professional development.
The American Public Health Association, in existence since 1872, is open to all public health professionals, including public/community health nurses.
The Association of Community Health Nursing Educators (ACHNE) supports high-quality education in public/community health nursing and research to improve community health.
The Association of State and Territorial Directors of Nursing is an advocacy organization for public health nursing. According to their website, they are in the process of becoming the Association of Public Health Nurses.
State associations also exist, such as the Public Health Nurses Association of Colorado, the Florida Association of Public Health Nurses, and the North Carolina Association of Public Health Nurse Administrators.
A quarterly journal, Public Health Nursing, focuses on publishing empirical research reports, case reports, and program evaluations concerning at-risk populations.
Many community health nurses work for local, state, and federal government agencies, and salaries tend to be lower than for other advanced practice nursing specialties. The US Department of Labor’s Bureau of Labor Statistics shows that nationally, the median annual salary among health diagnosing and treating practitioners working in the public sector was $99,610, as of May 2011.
The 2011 AANP National NP Compensation Survey shows nurse practitioners working in community health centers earning an average of $92,110, factoring in benefits. In rural health clinics they earned much the same, averaging $92,560. Federal government positions with Veterans Administration hospitals paid an average of $111,110 in 2011, according to this survey.
Job listings as of April 2012 reveal some typical salaries. For example, community health nurse positions through the Department of Health and Human Services with the Indian Health Service offer a salary range of $50,974 to $82,131 a year.