Local-Level Need, Supply, and Priority Areas for Public Health Nurses

Objectives: Public health nurses (PHNs) are one of the largest public health occupation groups, bringing important expertise to the activities of public health; however, their roles and distribution differ across the country. The objective of this study was to estimate the relative need for, supply of, and priority areas for PHNs at the county level. Methods: We used a cross-sectional design with national data sources available at the county level to measure the local need for, supply of, and priority areas for PHNs. We estimated need through a newly developed index based on 4 domains: demographic characteristics, economic characteristics, health care context, and health outcomes within the county. We estimated supply by using registered nurse staffing data from local health departments. We identified priority tiers of PHN deserts as counties with relatively high need and low supply. We conducted the study in 2024-2025. Results: The need for and supply of PHNs varied across the country, with little correlation (+0.26). For example, average need was highest in the southeastern United States (mean need score, 68.3 of 100; median need score, 76.0 of 100) and lowest in the upper northeastern United States (mean need score, 19.8 of 100; median need score, 13.5 of 100). Conclusions: The combination of local-level PHN need and supply can be used to identify potential gaps in PHN availability and can inform investment, recruitment, training, or allocation of other resources to address the PHN workforce needs of local health departments.