Public Health Nursing and the Affordable Care Act: Survey Results

Background: With the Affordable Care Act (ACA) of 2010, public health nurses (PHNs) face new opportunities. However, little is known about the extent to which PHNs are implementing activities associated with the provisions delineated under the ACA. The study aimed to evaluate PHNs’ general knowledge, perceptions, and roles under the ACA.

Methods: A web-based survey was administered to self-identified PHNs in the United States from November-December 2014. Descriptive statistics were calculated for all study variables and logistic regression was used to calculate predictive models. Responses to open ended questions were subject to content analysis.

Results: A total of 1070 public health nurses completed the survey and the average age was 50 (SD 11.7) years. The majority of respondents (57.7%) were favorable toward the ACA and 38% reported that their daily work had changed due to the ACA. Involvement in activities ranged from integrating primary care and public health (48%), to assessing and analyzing population health data (36.9%), to working with an Accountable Care Organization (25.3%). Involvement in community benefit related assessment was reported by 40.1% of respondents, Comments reflect uncertainty with regard to the future role of PHNs in ACA implementation. Masters level education and ACA related work changes were predictive of a belief in a future role for PHNs in health reform.

 Conclusions: PHNs are generally supportive of the ACA and involved in activities associated with its implementation. Leadership in policy, education, and practice are needed for PHNs to assume a future role in health care reform.