Public health nurses' workforce factors and population health outcomes in the United States.

Objectives: (a) To examine associations between public health nurse (PHN) workforce factors (PHNs' highest education and PHNs' mean years of employment) and health-risk behaviors (smoking and physical inactivity rates), and (b) to investigate the associations between PHN workforce factors and premature mortality rates across all counties of the United States.

Design: Secondary analysis.

Sample: A total of 5,705 PHNs from the 2015 National Nursing Workforce Survey and 2,977 U.S. counties from the 2016 County Health Rankings & Roadmaps data were included.

Methods: Multilevel linear regression was used.

Results: Bachelor's, and master's or doctorate-prepared PHNs accounted for 41.5% and 17.0%, respectively. The mean year of employment among PHNs was 17.3. The percentages of PHNs with bachelor's, master's, and doctoral degrees were significantly associated with decreased physical inactivity rates. The PHNs' mean year of employment was significantly associated with decreased physical inactivity rates and reduced premature age-adjusted mortality rates.

Conclusions: The findings indicated that PHNs with higher levels of education and more years of employment were important in improving health outcomes (health-risk behavior and premature mortality). Policymakers need to consider strategies to encourage more PHNs to obtain advanced degrees and to retain PHNs longer in the public health field.