Holding the safety net together

Almost a year into contract negotiations, the mood among King County's public health nurses has shifted-from patience to resolve. For months, nurses represented by the Washington State Nurses Association have been at the bargaining table with King County, pressing leaders to fix a wage scale that caps out after just 10 steps-roughly 10 years of service. By contrast, hospital systems across the region offer 25 to 30 steps, recognizing longevity, expertise and institutional knowledge.

At first glance, it might look like a standard labor dispute. But for the nurses doing the work, the stakes are much higher. This fight is about whether the county truly values the workforce that holds together its public health safety net-and what happens to communities when that workforce is pushed out.

"Our wage scale stops at 11," says Kiesha Garcia-Stubbs, a public health nurse with the Nurse-Family Partnership who has served the county for nearly five years. "Other healthcare organizations go up to 25 or 30 steps because they want to respect and value years of experience. We have nurses who've been here 20 years sitting at the same wage. Ten years ago, that might have sufficed. Today, it absolutely does not," says Garcia-Stubbs, who is also a grievance officer for the WSNA public health staff nurses in the Seattle-King County local.

A capped scale means seasoned nurses can't envision a future in public service. As they leave, they take with them decades of trust, cultural knowledge and relationship-based care-elements that cannot be replaced quickly, or cheaply. The loss is real. It shows up in homes, shelters and encampments across the county.

Caring without a safety net

Kai Rapaport knows this firsthand. Now four years into nursing, Rapaport didn't arrive in healthcare through a straight line. Before nursing school, he traveled, worked on farms, studied different fields and stepped away from school more than once. What ultimately drew him in wasn't prestige or predictability-it was a desire to work directly with people, especially those navigating the hardest circumstances.

Whatcom County public health nurse Kai Rapaport, on the right, recently helped his local secure a new union contract.

After two years in a hospital, Rapaport moved into public health, where he's spent the last two years responding to the opioid crisis, practicing street medicine, managing tuberculosis cases and caring for people who are unhoused or living in transitional housing. Rapaport is a WSNA co-chair at Whatcom County Health and Community Services, which covers Bellingham, about 100 miles north of King County.

Much of his work reveals a hard truth: Healthcare cannot succeed without housing.

"I'll provide wound care, do everything right," Rapaport explains. "But if someone doesn't have a place to stay clean and dry, those wounds don't heal. It becomes really clear-people would be so much better if they just had housing."

Conditions like trench foot and chronic wounds persist not because of clinical failure, but because patients are trying to recover without stability. For public health nurses, housing is more than just a policy issue-it's the foundation of whether care works at all.

Invisible labor, expanding roles

Public health nurses are often mistaken for clinic-based providers. In reality, their roles stretch far beyond exam rooms.

Garcia-Stubbs' days include home visits with new parents, supporting families experiencing homelessness, addressing behavioral health crises, navigating insurance systems and acting as what she calls "the catch-all" for clients who have nowhere else to turn.

Kiesha Garcia-Stubbs, a public health nurse in King County and her WSNA colleagues have been fighting for a fair contract.

"When we walk into someone's space, we're not just nurses," she says. "We're social workers, behavioral health providers, safety planners. We hold these trusting relationships because we're the ones who show up when no one else does."

Her caseload of 20 to 25 families spans one of the largest counties in the state-often requiring hourlong drives between visits. Many clients are juggling housing instability, intimate partner violence, food insecurity and barriers to medical care all at once.

Rapaport sees the same layering of crises in his work. Many of his patients lack insurance-or have plans that barely cover care. Others can't navigate complex systems because of language barriers.

"These aren't single-issue problems," Rapaport says. "People are dealing with multiple barriers at the same time. It's not that they don't want care-it's that the system isn't built for their reality."

For immigrant patients, fear itself becomes a medical issue.

Rapaport sees how immigration concerns shape whether people seek care, move freely or even show up for appointments. That fear doesn't just harm individuals-it weakens public health for everyone.

"When people are scared to use services," he explains, "preventive care breaks down. Things escalate. Conditions get worse."

Public health systems are designed to prevent crises. But prevention fails when people are afraid to access care.

Doing more with less

Inside the health departments, pressures continue to mount. Budget freezes and hiring freezes mean positions left vacant by departing staff aren't being refilled. Nurses are providing the same services with fewer colleagues-and at the same compensation.

The result is predictable: burnout, rising stress and scaled-back programs.

Services that once helped immigrants navigate healthcare systems have been reduced. Vaccine programs have been cut back. Navigation services-often the difference between care accessed and care denied-have shrunk under funding constraints.

"If we had more funding," Rapaport says, "the first thing I'd want is to rehire the staff we've lost. Then we could get back to providing the full spectrum of services-and actually grow."

Garcia-Stubbs has watched the ripple effects play out in real time. Perinatal care coordinators were laid off. Mental health waitlists grew longer. Families lost trusted points of contact.

"Those coordinators helped our clients get ultrasounds, doulas and childbirth classes," she says. "When they were cut, all of that fell onto nurses who were already stretched thin."

When experienced nurses leave, the continuity of care disappears. Parents struggle to enroll newborns in insurance. Pregnant clients in shelters lose help accessing prenatal care. Families miss appointments when phones are disconnected or transportation falls through. Patients fall through bureaucratic cracks that only a skilled, persistent nurse can bridge.

Public health nurses are often the last-and sometimes only-line holding these systems together.

The communities most affected by understaffing are the same ones King County has pledged to prioritize in its health equity commitments: low-income families, immigrants, communities of color and people experiencing homelessness.

The quiet work that saves lives

County leaders frequently speak about dismantling health inequities. On the ground, nurses see a widening gap between rhetoric and reality.

"There are basic things our program should be able to provide-safe sleep spaces for babies, car seats, supplies," Garcia-Stubbs says. "Instead, nurses are scrambling, calling partners, writing grants after hours, using personal time to find resources."

Recruiting and retaining a diverse workforce-essential for culturally grounded care-is nearly impossible when the wage scale punishes longevity. Meanwhile, documentation and reporting demands continue to grow, often without input from the people doing the work.

"It makes us feel unseen," she says. "If leadership supported us, we could show up with the energy our clients deserve."

Public health briefly captured national attention during COVID. Since then, that attention has faded-even as the work continues preventing hospitalizations, incarcerations and higher downstream costs.

"When public health works," Rapaport says, "it's invisible."

That invisibility makes advocacy harder. Preventive care doesn't generate dramatic headlines-but it saves lives, stabilizes families and reduces strain on emergency systems. The expertise public health nurses bring is hard-won, built through training, experience and deep community relationships.

Nurses like Rapaport bring their frontline experience into union negotiations, serving on bargaining committees for the first time. The goal is to fight for wages and benefits that make public health nursing a career people can enter-and stay.

Without competitive pay and sustainable staffing, public health loses skilled nurses to burnout or higher-paying sectors. The consequences land squarely on patients who already have the fewest options.

"I think it's all about our patients," Rapaport says. "And one of the best ways to help them is having enough staff to do the work well."

After nearly six months of negotiations, WSNA's Whatcom public health nurses and Whatcom County came to an agreement. The nurses ratified a new contract with the county that addressed wages and other benefits. The two-year contract went into effect on Jan. 1, 2026.

Holding firm in King County

As negotiations continue in King County, the nurses are holding firm. They know what's at risk: pregnant parents living in shelters, babies who need insurance, families navigating systems stacked against them, and entire communities who rely on the steady presence of skilled, trusted nurses.

Every day, public health nurses in King County drive across vast distances, step into homes and shelters, hold space during crises and guide families through their most vulnerable moments. They offer not just care, but connection-the foundation of long-term community health.

But they cannot continue doing this work if the county refuses to invest in them.

Garcia-Stubbs puts it plainly: "Nurses who feel supported can show up fully. We stay motivated. We stay present. We keep advocating. But we need the county to meet us halfway. We're exhausted-and still fighting."

The question now is whether King County will recognize the true cost of underinvesting in public health-and choose to stand with the workforce holding its health equity promises together.

[Adrienne Coles]