Structural Barriers and Strategic Directions for the Professional Role of Local Government Public Health Nurses in Integrated Community Care: A Qualitative Study

Purpose: Local government public health nurses (LG PHNs) in South Korea deliver integrated community health and welfare services. However, their professional identity is often challenged within welfare-centered administrative structures, and the structural barriers to their role performance have not been fully explored.Methods: An exploratory qualitative study using focus group interviews was conducted. Seven LG PHNs from various local government divisions participated. Data were analyzed thematically to identify key challenges in role performance.Results: Three main themes emerged: (1) Systemic unreadiness and structural support gaps in deployment, characterized by inadequate orientation and ambiguous role boundaries resulting from rapid policy implementation; (2) Challenges in professional identity negotiation within integrated welfare-health frameworks, where the underutilization of nursing expertise and overlapping responsibilities within administrative settings led to role confusion and professional marginalization; and (3) Institutional isolation and absence of clinical governance, resulting from a lack of systematic clinical supervision and institutional backing. Participants reported significant difficulty prioritizing specialized nursing tasks due to limited resources and structural hierarchies.Conclusion: LG PHNs’ effectiveness is hindered by fundamental structural limitations and governance gaps. To prepare for the 2026 nationwide implementation of integrated care, a transition toward nursing-led care management is essential. Policy measures should include establishing a legal role framework, implementing dual-reporting systems for clinical supervision, and promoting inter-professional education (IPE) to empower LG PHNs as proactive community health leaders.