Wage Inequity: Within-Market Comparative Analysis of Salary for Public Health Nurses and Hospital Nurses

Salary Disparities in Public Health Occupations: Analysis of Federal Data, 2021‒2022

Objectives. To assess salary differences between workers within key public health occupations in local or state government and workers in the same occupations in the private sector. Methods. We used the US Department of Labor's Occupational Employment and Wage Survey (OEWS). Referencing previous studies matching Standard Occupational Classification (SOC) codes with health department occupations, we selected 44 SOC codes. We contrasted median salaries in OEWS for workers in each occupation within state or local government with workers in the same occupations outside government. Results. Thirty of 44 occupations paid at least 5% less in government than the private sector, with 10 occupations, primarily in management, computer, and scientific or research occupations paying between 20% and 46.9% less in government. Inspection and compliance roles, technicians, and certain clinicians had disparities of 10% to 19%. Six occupations, primarily in social work or counseling, paid 24% to 38.7% more in government. Conclusions. To develop a sustainable public health workforce, health departments must consider adjusting their salaries if possible, market their strong benefits or public service mission, or use creative recruitment incentives such as student loan repayment programs for hard-to-fill roles. (Am J Public Health. 2024;114(3):329-339. https://doi.org/10.2105/AJPH.2023.307512).

Performance of the Mexican nursing labor market: a repeated cross-sectional study, 2005-2019

BACKGROUND

The close link between human resources for health and the performance of health systems calls for a comprehensive study of the labor market. This paper proposes a performance metric for the nursing labor market, measures its magnitude and analyzes its predictors over the last 15 years.

DESIGN AND METHODS

A repeated cross-sectional analysis using data from the quarterly population-based National Survey of Occupation and Employment 2005-2019 (ENOE in Spanish). An aggregate total of 19,311 Mexican nurses (population N = 4,816,930) was analyzed. Nursing labor market performance was defined as the level of non-precarious employment of nurses in the health sector. After describing the sociodemographic, labor and contextual characteristics of the nurses surveyed, we identified the key correlates of market performance using repeated cross-sectional multiple logistic regression analysis. We then estimated the adjusted prevalence of market performance according to the survey period and socioeconomic region of residence.

RESULTS

The exogenous indicators analyzed shed light on various aspects of the market structure. Unemployment remained stable at 5% during the period examined, but underemployment rose by 26% and precarious employment, our endogenous indicator, also grew significantly. On the whole, our indicators revealed a notable deterioration in the structure of the nursing labor market; they varied by age and sex as well as between public and private institutions. Although the steepest deterioration occurred in the private sector, we observed an increase in precarious jobs among public institutions formerly protective of employment conditions.

CONCLUSIONS

The deterioration of the labor market jeopardizes the ability of nursing professionals to participate in the market as well as to obtain secure jobs once they do enter. The Mexican Health System suffers from a chronic dearth of nurses, reducing its capacity to achieve its core objectives including enhanced coverage and increased effectiveness. Nursing workforce planning requires a context where the conditions in which the market currently operates, and its potential deterioration are considered.

A critical gap: Advanced practice nurses focused on the public's health

BACKGROUND

The COVID-19 pandemic has highlighted the need for nurse leaders who "embrace the interconnection" between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. Yet, despite a clear need for improved population health, educational programs designed to produce Advanced Public Health Nurses, with skills to address complex system changes, have become increasingly scarce.

PURPOSE

We put forward the perspective that the nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health.

DISCUSSION

We argue that opportunities should be expanded for nurses to attain education for these roles through increased investments in the Doctor of Nursing Practice model to prepare nurses for advanced public health specialty practice.

Public health nurses' graduate education decision making processes

INTRODUCTION

A well-educated public health workforce is needed to improve population health. Although nurses constitute the largest number of U.S. public health professionals, those holding graduate degrees remain low. This study describes public health nurses' (PHNs) perspectives on graduate school decision-making processes.

METHODS

Using a qualitative descriptive design, semi-structured, qualitative telephone interviews with PHNs (n=30) were conducted June 2014-January 2015. Study participants included PHNs from 17 states employed in a variety of positions within government health agencies, academe, and business. Interview transcripts were coded and thematically analyzed.

RESULTS

PHNs' pursuit of a graduate degree varied, often depending on work setting and/or availability of degree programs. Many study participants were unaware of the public health nursing graduate degree option, with only 9 of 26 participants obtaining an advanced degree in public health nursing. The MPH degree however, was well-known and particularly valued.

CONCLUSION

Opportunities for graduate public health nursing are limited; as such, marketing of existing programs need to be nationally coordinated and new collaborative efforts between schools of nursing and schools of public health developed. These efforts are required if graduate-prepared public health nurses are to be part of the future workforce, prepared to tackle increasingly complex population health issues.