Superheroes Can Be Experts Too: The Importance of Nurses to Public Health Policy

The COVID-19 pandemic has inflicted structural damage to public health systems that we cannot yet fully comprehend. Although much attention is now paid to COVID-19 issues of social and economic upheaval, public health nurses remain focused on the cracks in health care's foundation-such as the slow drip of resignations, revenue loss, and rural clinic closures-that are steadily undermining our country's ability to provide health services to all citizens. Nurses, the "health care heroes" celebrated at the start of the pandemic, remain "inside the house," and they can see the direct causal relationships between health system breakdowns and the global disruptions making headlines today.Frontline heroes can be system experts too. And yet, the visibility of nurses in public health policy remains woefully lacking. Despite nursing being the largest health care profession, chief nursing officers account for only about 0.8% of voting power on hospital boards, and nurses make up about 2.3% of voting power on community health boards.1 The National Academy of Medicine's 2021 Future of Nursing Report 2020-2030 (https://bit.ly/3NhiuJh) highlights this staggering dichotomy between nurses' presence in health systems and their representation in roles of influence. The National Academy of Medicine underscores the needs not only to invest in nursing education and practice but to cultivate the leadership potential of nurses as well.2Two articles in this special issue of AJPH (Zauche et al., p. S226; Morone et al., p. S231) describe the public health leadership roles nurses assumed duringthe pandemic, and both reach similar conclusions: the visibility of public health nurses must continue to grow. Florence Nightingale is widely acknowledged for her leadership both in the design of care and in measuring population health outcomes and instituting public health interventions. Despite Florence's legacy, the contributions of public health nurses have been largely overshadowed by prominent figures in medicine and epidemiology. A key focus of this special issue is to understand why.