The masking of the PHN specialty: Is the public health pandemic actually threatening our specialty?

Public health nurses are the lifeline of the national and global COVID-19 response. We are leading the testing, investigation, contact tracing, and vaccination efforts around the world. However, the interventions we are using to augment the lack of infrastructure in our nation's public health system and its efforts to vaccinate citizens nationwide may be masking the essential importance of the public health nursing specialty. The Public Readiness and Emergency Preparedness (PREP) Act (United States Department of Health and Human Services, 2020) and related state executive orders across the nation are paving the way for retired health care professionals, including nurses, and those with inactive, expired, or lapsed licenses, in addition to masses of unlicensed individuals, to fill the immense workforce gap needed to get vaccines into arms. An unintended consequence of the temporary COVID-19 workforce expansion is a slow demise of emphasis on public health nursing's centrality as the most skilled professionals to lead this endeavor. The public health nursing discipline ensures specially trained nurses promote and protect the health of populations using knowledge from nursing, social, and public health sciences (American Public Health Association, Public Health Nursing Section, 2013). We do this through advocacy, outreach, assessment, partnership, policy development, program planning, evaluation, surveillance, research, assurance, and employing all levels of prevention to improve outcomes at the individual, family, group, community, population, and systems levels. The common belief that a nurse is a nurse is a nurse—any nurse can step in and do any nursing job—is true for universal nursing tasks such as taking health histories, nursing assessments, vaccine administration, or observation for adverse reactions to a medication. But the use of so many non-public health nurses in these efforts obscures the crucial expertise of public health nurses, creating a metaphorical mask preventing the public's ability to see the critical importance of our work. In the seminal editorial, A Call to Action for Public Health Nurses During the COVID19 Pandemic (2020) published just 2 months into the pandemic, Edmonds et al. (2020) noted that nonessential public health services were already being suspended (p. 232). Now, 1 year later, we see the collateral damage of system inadequacies: populations with unmet health care needs continuing to carry the highest burden of chronic disease with even less access to routine and preventive health care services. Our most vulnerable populations who depend on access to safety-net health providers have seen their providers’ focus now redirected from preventive care to COVID-19 response, which is typical in local public health departments. For example, services for diagnosing and treating sexually transmitted infections (STI) have plummeted. At the same time, 37% of those STI staff, including public health nurses, are now reallocated to support COVID-19 efforts (National Coalition of STD Directors, 2021). STI clinics are either closed or have severely limited schedules, and patients are being turned away. Another example, revealed in a September 2020 report issued by the Centers for Medicare & Medicaid Services (CMS), is that child health service utilization for primary, preventive, dental, and mental health services dropped in 2020 with 22% fewer routine childhood vaccinations and 44% fewer childhood screenings compared to the same period the previous year (CMS, 2020). And unfortunately, students unable to receive their regular childhood immunizations are being suspended from school (A, Snyder, personal communication, March 6, 2021). When barriers to accessing care rise, coupled with limited health literacy and significant misunderstandings about the importance of regular and routine health care, individuals forego basic health care services, and health care needs go largely unmet. The resulting syndemic of care avoidance (Chen & McGeorge, 2020) and service reduction/redirection leave basic public health needs unaddressed. Public health nurses can, and should, be leaders in the design, implementation, and evaluation of programs that will address this imminent public health problem. As we lead efforts to get vaccines in arms, public health nurses cannot abandon our responsibility to educate the public about our specialty. Most importantly, we must expound on how public health nurses are the most well-positioned health professionals to lead the next phases of pandemic response and address future consequences of the syndemic. It is our obligation to use what we are learning from this pandemic to springboard the education of our governing boards, public health leadership, and legislators about our specialty's positive impact on health and social outcomes. Once the COVID-19 pandemic is controlled and we move into our future normal, public health nurses will be vital to addressing the health gaps and aftermath deficiencies that this pandemic will undoubtedly amplify. Public health programs are likely to get short-term COVID-19 funding windfalls due to the heightened public awareness of chronic underfunding. We must leverage this opportunity to advocate for segueing these one-time funds into recurring monies. A permanent infusion of funding is needed not only for permanent public health nursing positions and programs but also for ongoing professional development in all aspects of the specialty, including disaster preparedness, environmental health, epidemiology, health literacy, public health education, public health nursing scope and standards of practice, competency, leadership, and advocacy. We must step out from behind the metaphorical mask and resuscitate the public's understanding of our importance. Our advocacy will guide public understanding of the vital role of public health nurses leading our recovery. We must reassert our position and ensure that our practice cannot be supplanted permanently with an infusion of well-intended but unspecialized or unlicensed individuals. We are the most well-trained public health professionals able to see the real and underlying needs and the essential leaders needed post-pandemic. As Edmunds, Kneipp, and Campbell noted, “recognition of the need for a strong nursing workforce is part of our nation's history” (p. 323). Let's lift our collective voices to ensure this recognition is brought to the public health nursing specialty. The author has disclosed no potential conflicts of interest, financial or otherwise. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.