More Than One Path: Why Infection Prevention Needs the Voices of Non-RN Professionals

Infection prevention is my life’s work, but my path into this field didn’t come through a hospital bedside. Like many non-RN infection preventionists (IPs), my journey started in public health and microbiology, grounded in data analysis, population health strategy, and epidemiologic science. I have 5 academic degrees, including an MPH and a PhD in public health, and I hold national triple board certifications in infection prevention (CIC), health care quality (CPHQ), and health care executive leadership (FACHE). If I had to sum up my career in a single line, it’s this: I’ve either been growing the germs or chasing the germs.

Yet, despite these qualifications and decades of experience, I have repeatedly been told that I do not “belong” in infection prevention because I’m not a registered nurse.

It’s a profession that itself has evolved dramatically over the last half-century. Infection prevention formally took root in the 1970s, following the CDC’s groundbreaking Study on the Efficacy of Nosocomial Infection Control (SENIC Project).¹ This landmark research proved that hospitals with structured infection surveillance programs could reduce nosocomial infections by 32%. SENIC ushered in a new era of infection control, transforming it from sporadic, informal efforts, often housed within nursing units, into an organized, epidemiology-based field with a measurable impact on patient safety.

Despite the field’s evolution into a science-driven discipline, many health care organizations have remained stubbornly attached to the idea that infection prevention is fundamentally a nursing territory.

Two moments in my career stand out as particularly eye-opening. Years ago, after building a successful career in a large metropolitan health care system, I took time off to focus on family. When I returned to the workforce in a smaller city, I applied for a hospital IP position and was told, point-blank, that I wasn’t qualified because I wasn’t an RN. I pressed them, asking, “Would you really rather hire an RN with no IP experience over a non-RN with more than 10 years of experience?” The answer was yes. I was stunned. The message was clear: Credentials mattered more than competence.

Years later, with my experience refreshed, CIC certification in hand, and years of recent leadership under my belt, I applied for a role in a larger health care system in the same community. During the interview, the infection prevention director—an RN—asked me if I’d be willing to go back to school to obtain a nursing degree. I was baffled. I asked why, explaining that I already held advanced graduate degrees and national certifications. The answer? She believed non-RNs lacked “critical thinking.” I sat there, astounded, silently wondering, What critical thinking are you applying right now to ask me this question?

These experiences are not isolated. They represent a persistent, damaging bias within the field of infection prevention: The assumption that only RNs are capable of leading this work effectively. And let’s be clear: This isn’t just a philosophical debate about professional backgrounds. For non-RNs working in infection prevention, this debate is deeply personal. It’s received as a message that you are inherently incompetent and incapable of learning. It signals that no matter how much education, certification, or experience you bring, you are always seen as “less than” because your path didn’t run through the bedside.

This article is both a personal reflection and a professional call to action. Infection prevention has fundamentally changed. What began as bedside observation and nursing-led surveillance has evolved into a high-level discipline of epidemiology, performance improvement, and regulatory accountability. Yet our hiring practices, leadership pipelines, and professional cultures have not kept up.

It’s time to change that.

Infection Prevention: A Field Transformed

In the early years of hospital infection control, before the widespread use of standardized surveillance systems, IP work was rooted in bedside observation. The focus was on 'whole house surveillance,' where IPs reviewed every positive culture or fever charted in the hospital. The work was largely qualitative, informal, and case-based.

It made perfect sense that nurses, particularly those trained in acute care, were recruited for these early IP roles. Their proximity to patient care and clinical judgment made them ideal for identifying trends and enforcing hygiene protocols.

But the field didn’t stay there. With the rise of the CDC’s National Nosocomial Infections Surveillance (NNIS) system and later the National Healthcare Safety Network (NHSN), infection prevention moved from subjective assessment to statistical surveillance. The work became about baselines, risk-adjusted rates, and standardized infection ratios.

The shift accelerated when the Centers for Medicare & Medicaid Services(CMS) tied reimbursement to infection rates. Suddenly, infection prevention was not just about care; it was about financial stewardship, regulatory performance, and enterprise-wide risk management. The role demanded a new skill set: data analytics, risk modeling, policy interpretation, and hospital-wide thinking.

In short, infection prevention and control (IPC) stopped being purely clinical. It became epidemiological. ^2,3

What Non-RNs Bring to the Table

Non-RN IPs, including public health professionals, clinical microbiologists, and data scientists, bring essential skills that align directly with the modern demands of IPC. Not to say that an RN lacks these skill sets.

1. Data and epidemiology expertise: Non-RNs are often formally trained in epidemiology, statistics, and population health. They understand risk adjustment, trend analysis, and NHSN surveillance methodology—skills essential in modern infection prevention programs.
2. Microbiological insight: Those from laboratory backgrounds bring deep expertise in pathogen behavior, diagnostics, clinical microbiology operations, and infectious processes. This skillset is crucial for diagnostic stewardship, understanding organism trends, and interpreting surveillance definitions.
3. Systems-Level thinking: Public health-trained IPs are grounded in root cause analysis, performance improvement, and health systems theory. They look beyond individual behavior to system breakdowns and process failures.
4. Regulatory and policy fluency: Many non-RNs are skilled in interpreting CMS regulations, The Joint Commission standards, and public health mandates. Their perspective bridges operational performance with compliance readiness.

The scope of knowledge required today is reflected in the Association for Professionals in Infection Control and Epidemiology (APIC) Core Competency Model⁴, which defines the professional development framework for IPs across 8 domains: Leadership and Program Management, Infection Prevention and Control, Performance Improvement and Implementation Science, Technology and Informatics, Education and Training, Research and Evaluation, Professional Stewardship, and Communication and Collaboration.

These domains encompass strategic planning, data interpretation, change management, project implementation, technology utilization, teaching, policy advocacy, interpreting public policy, and interprofessional leadership. None of these competencies are exclusive to nursing practices. In fact, many align more closely with training in public health, microbiology, epidemiology, quality improvement, or health care administration.

The model itself acknowledges that infection prevention is an interdisciplinary specialty that requires diverse perspectives and validates that multiple educational and professional pathways can prepare individuals to excel in the role.

Why the RN-Only Mentality Persists

Despite these clear advantages, many health care systems still restrict infection prevention roles to RNs. This often stems from outdated assumptions that IP is an extension of bedside care or from misconceptions that non-RNs lack “clinical relevance” or “critical thinking.”

Ironically, in today’s environment, it is non-RNs who are often better positioned to lead initiatives that involve predictive analytics, health equity strategies, and multisite surveillance programs. Excluding them limits the field’s growth and undermines health care performance.

A Call to Action

Before we can successfully call on hiring managers, human resources departments, and executives to rethink the infection prevention pipeline, we must first address our own professional house. As IPs, we must embrace the fact that our colleagues can come from diverse academic and professional pathways, including nursing, public health, microbiology, sterile processing, epidemiology, laboratory science, and more.

If we cannot model that inclusivity among ourselves, our advocacy will ring hollow outside the profession. Too often, the debate over RN versus non-RN backgrounds becomes entrenched in a way that alienates capable, qualified professionals. To non-RNs, this debate isn’t academic; it’s personal, and it’s often received as a message that you are inherently less competent or incapable of learning, no matter your education, certifications, or achievements.

Requiring all IPs to be RNs is like requiring all epidemiologists to be surgeons—it conflates two distinct skill sets, assumes that a single pathway produces all necessary competencies, and ignores the value of specialized training. Infection Prevention thrives when it is multidisciplinary, not when it is narrowed to a single lens.

Only when we, as a profession, openly recognize and celebrate the varied expertise that different backgrounds bring can we credibly ask hospital systems and hiring managers to do the same.

Health care leaders must evolve with the profession:

• Revise Job Descriptions to focus on competencies like CIC certification, data fluency, and regulatory expertise, not just nursing credentials.
• Mentor Multidisciplinary Talent by creating pathways for non-RNs to grow into leadership roles within IPC departments.
• Promote Diverse Voices in Leadership by ensuring microbiologists, sterile processing professionals, MPH holders, and data scientists are eligible for director-level and system-level roles.
  
  

The Future of IPC Is Multidisciplinary

Infection prevention is no longer about anecdotal audits or informal observations; it is about leading health care systems to measurable, sustainable improvement. It is about connecting the patient room to the boardroom. It is about preventing harm at scale.

To meet these demands, we need microbiologists, public health strategists, epidemiologists, and clinical nurses working together, not gatekeeping based on outdated assumptions. The future of IPC is broader, deeper, and more interdisciplinary—and non-RN professionals are essential to that future.

References

1. Haley RW, Culver DH, White JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985;121(2):182-205. doi:10.1093/oxfordjournals.aje.a113990
2. Edwards JR, Peterson KD, Mu Y, et al. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37(10):783-805. doi:10.1016/j.ajic.2009.10.001
3. The National Healthcare Safety Network (NHSN) overview. CDC. Published 2024. Accessed December 2, 2025. https://www.cdc.gov/nhsn/about-nhsn/index.html
4. Association for Professionals in Infection Control and Epidemiology (APIC). APIC Competency Model for the Infection Preventionist, 2019 update. Accessed December 2, 2025. https://apic.org/competency-model