In a groundbreaking study published in the esteemed journal Nursing Outlook, researchers at Columbia University’s Mailman School of Public Health have made a compelling case for the formal recognition of public health nurses (PHNs) as a distinct occupational category in the United States. This designation, long overdue after 140 years of essential yet often unacknowledged service, promises to overhaul how PHNs are counted, compensated, and supported by federal agencies. The study’s meticulous analysis draws on diverse data sources, revealing the unique and critical roles PHNs play within the broader nursing and public health landscapes.
Public health nursing has long stood at the intersection of clinical care and population health, blending rigorous medical training with comprehensive public health principles. Unlike registered nurses who traditionally provide bedside care within clinical environments, PHNs operate beyond hospital walls, engaging communities directly. Their work encompasses a complex array of tasks, including disease surveillance, emergency preparedness, policy advocacy, and community mobilization—functions that are vital for preventing illness and promoting wellness at the macro scale.
Heather Krasna, PhD, EdD, associate dean for Career and Professional Development at Columbia Mailman School, emphasizes that despite the specialized and highly defined nature of public health nursing, federal labor classification systems have yet to reflect these distinctions. Currently, all registered nurses, including PHNs, are subsumed under the same Standard Occupational Classification (SOC) code (29-1141). This umbrella grouping masks the significant differences in job functions, competencies, and contributions within nursing subfields, hinderings granular workforce analyses and policy interventions.
To illuminate these disparities, Krasna and her colleagues undertook a rigorous comparative investigation utilizing several sophisticated data sources. They examined findings from the National Sample Survey of Registered Nurses (NSSRN) and the Public Health Workforce Interests and Needs Survey (PH WINS), both robust national surveys that capture workforce characteristics and self-reported activities. Coupling these datasets with real-time job posting analytics from Lightcast—a vast, comprehensive database cataloging occupational demand—they were able to distill critical differences in duties, required skills, education levels, and compensation between PHNs and other registered nurses.
The results are striking. Public health nurses undertake community-level health assessments and continuous surveillance activities vital for early detection of emerging health threats. Their responsibilities extend to managing individual cases to either preempt or resolve health problems while coordinating care across multiple health and social service systems. PHNs serve as trusted communicators and educators within communities, translating complex health information into accessible education campaigns and interventions that resonate at the grassroots level.
Moreover, PHNs are deeply engaged in advocacy and partnership-building efforts, striving to influence policy in ways that address social determinants of health and promote equitable health outcomes. Their involvement extends critically to frontline response roles in public health emergencies, including outbreak investigations, disaster response, and preparedness activities. This multilayered scope illustrates how PHNs serve as vital linchpins within public health infrastructure, seamlessly integrating clinical expertise with population health strategies.
Despite their indispensable contributions, the monolithic occupational classification system obscures PHNs’ true workforce size, generating significant limitations in federal data collection and analysis. This impairs the ability of health departments and policymakers to monitor workforce shortages, assess compensation adequacy, or identify training and resource needs specifically within public health nursing. Consequently, strategic planning for addressing urgent and emerging health crises remains suboptimal.
Quantitatively, PHNs represent approximately 18 percent of the workforce in local health departments and 8 percent at the state health department level. They confront some of the most pressing public health challenges, including managing the opioid epidemic, addressing health impacts of climate-induced disasters, and leading chronic disease prevention initiatives. Their unique training and positioning empower them to serve as crucial agents in mitigating these complex, multi-faceted issues.
The study’s authors highlight the upcoming 2028 revision opportunity for the SOC codes as a critical juncture to enact this change. They urge federal agencies, including the Department of Labor, to incorporate a dedicated classification for public health nursing. Such recognition would enable comprehensive and precise workforce surveillance, ensuring that PHNs receive rightful acknowledgment, targeted resources, and equitable pay reflecting their specialized roles.
Implementing a distinct SOC code for PHNs would also catalyze academic and professional workforce development programs by clarifying the career pathways unique to this discipline. Enhanced visibility on labor market analytics would attract new entrants to the profession, reinforce retention, and support funding streams essential for sustaining a vibrant public health nursing workforce.
The implications of adopting a formal occupation code extend beyond internal workforce management. In the broader context of public health preparedness and response, accurately quantifying and supporting the PHN workforce will enhance national capacity to respond to future pandemics and health emergencies. It will also facilitate more nuanced research on workforce dynamics, linking nurse deployment to health outcomes with greater precision.
This pioneering research was led by Krasna alongside co-authors Isabella Patino and Sarika Karra from Columbia Mailman School of Public Health, and Jocelyn Leung from the University of Minnesota. The study was generously funded by the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA), underscoring its significance to federal health initiatives.
Founded in 1922, Columbia University’s Mailman School of Public Health remains a leader in public health research and education, employing nearly 300 multidisciplinary faculty and educating over 1,300 graduate students worldwide. Its faculty work at the forefront of essential health challenges such as infectious and chronic diseases, environmental health, and public health preparedness—fields in which the distinct contributions of PHNs are increasingly indispensable.
For policymakers, academic administrators, and public health leaders, this study issues a clear and urgent call to action: formal recognition and classification of public health nurses are not merely administrative adjustments but critical steps to safeguard and enhance the nation’s public health infrastructure. As future health crises loom on the horizon, empowering this specialized workforce segment benefits all facets of society by reinforcing the foundational systems that protect and promote population health.
Subject of Research: Public health nursing as a distinct occupational classification within the U.S. nursing workforce.
Article Title: The public health nurse is a distinct occupation: Contrasting skills, competencies, and job tasks between public health nurses and registered nurses
News Publication Date: August 26, 2025
Web References:
Columbia University Mailman School of Public Health
DOI link to article
References:
Krasna, H., Patino, I., Karra, S., & Leung, J. (2025). The public health nurse is a distinct occupation: Contrasting skills, competencies, and job tasks between public health nurses and registered nurses. Nursing Outlook. https://doi.org/10.1016/j.outlook.2025.102534
Keywords:
Public health nursing, occupational classification, workforce development, registered nurses, public health workforce, emergency preparedness, disease surveillance, health policy advocacy, community health, health disparities, nursing competencies, federal labor statistics
Tags: Columbia University nursing studycommunity health engagement strategiesdisease prevention and wellness promotionemergency preparedness in public healthepidemiology and public healthHealthcare workforce developmentnursing workforce support initiativesoccupational classification public healthpolicy advocacy for nursespublic health nurses recognitionpublic health nursing historypublic health nursing roles
