An Assessment of Alignment of a Public Health Nursing Workforce with Organizational Health Promotion Priorities

Background: The implementation of healthcare reform has resulted in a sweeping movement to provide population-focused, health promotion services to medical beneficiaries.  Subsequently, public health nursing (PHN) leaders are faced with the challenge of supporting these initiatives in an environment that has historically placed higher value on individual-focused clinical practice. For many organizations, successful transition to this health promotion-focused paradigm will require changes to the practice of PHN’s and to their care orientation. The development of sustainable strategies to increase PHN support of population-based health promotion initiatives can facilitate demonstration of value added for this unique public health workforce.

Methods: Utilizing a phased and emergent design, a mixed-methods assessment of PHN health promotion practice was conducted to describe current PHN health promotion practice.  Special attention was given to the macro, organizational, and staff-level factors impacting PHN practice as it is understood that systems-level factors are important considerations for public health practice and outcomes.  Methods included key informant interviews, PHN staff surveys, document reviews and gap assessments.  

Results: Findings indicate that gaps exist between current PHN practice, organizational health promotion priorities and related practice regulations.  Differences in practice were observed between educational categories, roles, and experience-levels.  Results indicate that the PHN workforce is well-suited to support organizational health promotion initiatives; their support is largely contingent on leader efforts to improve conditions for health promotion practice.

Conclusions: Systems-level assessment of PHN practice can provide leaders with insight into contextual issues impacting practice and can therefore facilitate improvement of workforce alignment with organizational priorities.