1. Kovner, Christine PhD, RN, FAAN
  2. Harrington, Charlene PhD, RN, FAAN


A nursing specialty and a care setting.


Article Content

Many nurses have difficulty identifying the community health-public health (CH-PH) nurse workforce because CH-PH is both a nursing specialty and a care setting. A lack of agreement exists as to what constitutes a CH-PH setting. The National Sample Survey of Registered Nurses 2000 included the following as public or community health settings: state health departments, visiting nurse services, community or neighborhood health centers, day care centers, and hospices, among others. School health, occupational health, and ambulatory care were listed separately, although care in these settings is usually included in undergraduate and graduate CH-PH courses. Thus, nursing care provided to older adults in a physician's geriatric practice was classified as occurring in an ambulatory care setting, whereas the same care given to the same patients in a community health center or in their homes was classified as CH-PH.


All baccalaureate nursing programs provide specific education in CH-PH, whereas specialty education occurs at the master's degree level, primarily in nursing programs but also in schools of public health. Certification as a generalist or specialist can be obtained through the American Nurses Credentialing Center (visit to obtain more information). TABLE

Table. Facilities or... - Click to enlarge in new windowTable. Facilities or organizations employing newly licensed RNs

In 1999, the last year for which national data are available, 4.4% of newly licensed RNs worked in community-based care (see Facilities or Organizations Employing Newly Licensed RNs, page 59). The Bureau of Labor Statistics estimates that the demand for RNs in ambulatory care will increase 21% to 35% through 2008, at a rate faster than the average for all occupations; employment in home health care is also expected to grow rapidly. But those estimates may be inflated, given that Medicare spending for home care decreased by 32% from 1998 to 1999 (primarily as a result of the 1997 Balanced Budget Act) and that the Health Care Financing Administration reported a decline of 133,000 home health full-time equivalents (including all employees, not just RNs) between 1997 and 1999.-Christine Kovner, PhD, RN, FAAN


Sources: Bureau of Labor Statistics. Occupational outlook handbook. Bulletin No. 2520. 2000-01 ed. Washington (DC): Department of Labor; 2000; Basic statistics about home care. National Association for Home Care. 2000.



[black down pointing small triangle] In 1998, 84% of nursing assistants, 59% of LPNs and LVNs, and 45% of RNs in CH-PH settings provided direct nursing care to patients aged 65 to 85.


[black down pointing small triangle] Of RNs working in community health settings in 1998, 25% had baccalaureate degrees in nursing, 30% had associate's degrees, and 26% had nursing diplomas.


[black down pointing small triangle] In 1997, 40% of home health care users were 75 to 84 years old and 26% were aged 85 or older.


Sources: National Council of State Boards of Nursing. Data collection completed for 1998 role delineation study. Issues 1999;20(1); Health Care Financing Administration. A profile of Medicare home health: chart book. Baltimore (MD): The Administration; 1999. HCFA Pub. No. 10138.


Section Description

Nursing Counts appears in the American Journal of Nursing as a periodic column provided by the Hartford Institute for Geriatric Nursing, the Division of Nursing, New York University, New York City.