Public Health Nursing Practice in the Affordable Care Act Era: A National Survey

Abstract

To explore public health nurses' knowledge, perceptions, and practices under the Affordable Care Act (ACA). A cross-sectional, web-based survey was completed by a sample of 1,143 public health nurses (PHNs) in the United States. Descriptive statistics were analyzed for variables related to general knowledge and perception of the ACA and for the extent of involvement in activities related to the implementation of the ACA. Qualitative analysis was conducted on free text comments to two open-ended questions about current and future PHNs involvement in the ACA. Approximately 45% of PHNs reported changes in their daily work due to the ACA. PHNs reported being very or somewhat involved in these activities of the ACA: integration of primary care and public health (62%), provision of clinical preventive services (60.3%), care coordination (55.4%), patient navigation (55.3%), establishment of private-public partnerships (55.3%), population health strategies (53.6%), population health data assessment and analysis (53.8%), community health assessments (49%), involvement in medical homes (37.8%), provision of maternal and child health home visiting services (32.1%), and involvement in Accountable Care Organizations (29.2%). PHNs are making substantial contributions to implementation of the ACA.