Maldistribution of the Population Health Nursing Workforce in North Carolina

Product type: presentation delivered to the AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) on July 22, 2020.

Authors: Jacqueline Nikpour, BSN, RN, Erin Fraher, PhD, MPP


  • North Carolina has been leading the nation in the shift to value-based healthcare, including the roll out of programs through the state’s Medicaid program that address the social determinants of health
  • These efforts hinge on the state having an adequate supply and distribution of health providers, including nurses, employed in population health settings
  • This analysis:
    • describes the demographic, education, and geographic practice characteristics of the nursing workforce in population health settings which include ambulatory care, public health, community health, school-based health, long-term care, home health, correctional facility, occupational health
    • assesses how well nursing workforce supply and distribution aligns with population-level needs
  • Findings: the state’s nursing workforce in population health settings is not adequately distributed to meet population health needs. Counties with poorer health outcomes, such as preventable hospital stays, higher numbers of physically and mentally unhealthy days per month, and a larger percent of people reporting poor or fair health, have fewer nurses employed in population health settings.
  • Conclusions: This analysis has significant implications for policymakers and public health officials across the state. As health leaders begin the rollout of the Healthy Opportunities Pilots and NCCARE360 programs, consideration should be given to increased investments in the public health nursing workforce.

Check out the full presentation here.