The Impact of a Public Health Nursing Shortage on the Nation's Public Health Infrastructure

[摘要]

State level fiscal conditions continue to deteriorate. At the beginning of FY 2003, 46 states reported the budget gap had grown to $37.2 billion. Although states have employed a variety of activities such as implementing targeted or across-the-board budget cuts, using “rainy day” funds, and redirecting tobacco settlement funds, the fiscal situation is not anticipated to improve in the near future. Health comprises the largest single category of expenditures in state government budgets.¹ Concerns over states’ ability to assure that essential public health functions are continued persist and describe a public health system where lives may be at risk.²

The largest single workforce central to assuring that essential public health functions are provided is public health nursing. An inadequate supply of public health nurses over the next decade has the potential to diminish services provided by the public health infrastructure.³ A shortage of nurses already exists and will become more acute by the year 2010 when the nursing supply will no longer be able to meet the demand, regardless of distribution or educational preparation.⁴ Data from the 2000 National Sample Survey of Registered Nurses (conducted by the Health Resources Services Administration, Division of Nursing) indicate that the number of registered nurses (RNs) employed in public/community health settings with the title “public health nurse” has decreased from 39 percent in 1980 to just 17.6 percent in 2000. Even in the overall public/community nursing group, there was a decrease of almost 16 percent between 1996 and 2000. Finally, the aging of the overall nursing population is also critical for public health nursing. According to recent data from that survey, the average age of all RNs is 45.², while for public health nurses it is 49.⁵ Since public health nurses work in and with communities to promote health and meet population-focused needs, it is more critical than ever that the public health nursing workforce “mirror” the population it is attempting to serve. Therefore, there is a critical need to prepare a larger and more diverse public health nursing workforce. This is an increasing, if not impossible, challenge, at a time when an overall nursing shortage is growing.^3,4,6-8

In recent years, the Quad Council of Public Health Nursing Organizations* clarified the effects of the shortage on public health nursing in the United States. Since the 1970’s, the public health nursing workforce has become more differentiated in terms of educational preparation as the result of three interacting trends. In the 1970’s, as a result of budget shortfalls, health departments shifted from providing services centered on home and community visits to services provided in clinics at the health department site. Second, the availability of reimbursement through Medicare and Medicaid for individual clinical rather than population-based community-focused services led many agencies to change their focus to “capture” these funds as a means of replacing dwindling local, state and federal appropriations.^3,6,7,9 Third, both because many health department leaders did not differentiate between hiring baccalaureate prepared nurses when services were provided to individuals in the health department setting and because there were not enough nurses prepared at this level to fill positions (especially in rural areas), increasing numbers of associate degree prepared nurses were hired to work in public health agencies. Graduates of baccalaureate nursing programs are best prepared to provide population-based nursing care that is grounded in public health concepts and principles. The result has been a growing population of nurses who have required intense orientation and ongoing staff development.^6,7

The recent attention to emergency preparedness, coupled with a renewed focus on detecting and preventing emerging infectious diseases, calls for a stronger public health nursing workforce than ever before. It is vital to the existence of the total public health infrastructure that adequate numbers of well-prepared public health nurses be available to provide essential public health functions.^6,7,10

Therefore, to assure that the United States has a critical mass of public health nurses to staff its infrastructure, the American Public Health Association urges that:

1. States ensure that essential public health functions be protected in any situation where state budget shortfalls threaten to eliminate those fuctions;
2. States give priority attention to the impending nursing shortage and make immediate plans to implement innovative solutions to assure the public that public health nurses will be available to provide essential public health functions;
3. Congress assist states by enacting legislation to include public health nursing services in secured provisions for public health funding that limit the severity of state-based Medicaid cuts and support the continued funding for maternal-child health programs, emergency preparedness, and other population-based funding sources;
4. The Health Resources and Services Administration, Bureau of Health Professions, increase its funding priorities to include studies of models for recruiting and retaining public health nurses for the purpose of assuring that essential public health functions are available to communities in this country; and
5. The Centers for Disease Control and Prevention, the Association of State and Territorial Health Officials, the National Association of City and County Health Officials, the National Association of Local Boards of Health, and the American Nurses Association collaborate with the American Public Health Association, Public Health Nursing Section and leadership, to explore strategies to alleviate the public health nursing shortage’s impact on the public health infrastructure in the workforce development activities already under way.

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References

1. National Conference of State Legislatures. State budget action 2002: executive summary (posted April 16, 2003). Available at http://www.ncsl.org.
2. American Public Health Association. Protecting essential public health functions amidst state economic downturns (2002 policy brief LBO2-4). Available at http://www.apha.org/legislative.
3. QUAD Council of Public Health Nursing Organizations. October 2001. Position Paper on the Impact of the Nursing Shortage on Public Health Nursing. 
4. Kimball B, O’Neil E. 2002. Health Care’s Human Crisis: The American Nursing Shortage. Health Workforce Solutions for The Robert Wood Johnson Foundation. 
5. Health Resources and Services Administration (July 2002). Projected Supply, Demand, and Shortages of Registered Nurses: 2000-2020. Rockville, MD.
6. Institute of Medicine. 2002. Who Will Keep the Public Healthy? Washington, DC: National Academy Press.
7. Institute of Medicine. 2002. The Future of the Public’s Health. Washington, DC: National Academy Press.
8. McNeil C (Ed). 1993. Public Health Nursing Within Core Public Health function——a Progress Report from the Public Health Nursing Directors of Washington. Olympia, WA: Washington State Department of Health.
9. Institute of Medicine. 1988. The Future of Public Health. Washington, DC: National Academy Press.
10. Association of State and Territorial Directors of Nursing (ASTDN). 2000. Public Health Nursing: A Partner for Healthy Populations. Washington, DC: American Nurses Publishing.

Quad Council of Public Health Nursing Organizations:

• Association of Community Health Nursing Educators
• American Nurses Association, Congress on Nursing Practice and Economics
• American Public Health Association, Public Health Nursing Section
• Association of State and Territorial Directors of Nursing

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[发布日期] 2003-11-18

[学科分类] 医学（综合）