The scope of public health nursing practice in China: a cross-sectional study

Public health nurses (PHNs) play a critical role in delivering community-based healthcare services in China. However, the scope of PHN practice and the factors influencing service delivery remain insufficiently documented. This study aimed to describe the range of services provided by PHNs in China and identify factors associated with their practice. A descriptive cross-sectional study was conducted among 1,286 PHNs from six geographical regions of China between October 2024 and January 2025. Data were collected using a self-designed, pre-tested, validated questionnaire and analyzed using descriptive statistics, Mann–Whitney U tests, and Spearman’s correlation analysis. Of 1,580 eligible PHNs, 1,286 returned usable questionnaires (response rate: 81.4%). The median age of participants was 37 years, and 28.4% had received formal PHN training. Most PHNs were actively involved in non-communicable disease (NCD) prevention (98.2%), postnatal home visits (97.3%), child health assessments (96.5%), immunization services (95.8%), and health promotion activities. Palliative care services were provided by 78.6% of PHNs, while engagement in disaster management (18.6%), research activities (12.3%), and pain assessment (48.2%) was comparatively limited. Significant regional disparities were observed, with PHNs in western China experiencing greater workloads but fewer training opportunities. Female PHNs were more likely to provide maternal mental health support (p-value = 0.012), and PHN age showed a significant but weak positive correlation with elderly care visits (r s = 0.246, p-value = 0.004). PHNs make substantial contributions to maternal and child health, NCD prevention, palliative care, and community health promotion in China. However, important gaps remain in disaster preparedness, research engagement, pain management, and workforce development. Strengthening PHN education, expanding training opportunities, clarifying professional roles, and implementing targeted workforce planning strategies are essential to optimize PHN contributions to community health.