parents concerned about the safety of the drinking water or children's play areas, workers at high risk of cancer from occupational chemical exposures, workers' compensation claimants and community litigants seeking redress for their injuries, and homeowners with questions about the health effects of residential lead or radon, as well as questions about the costs of mitigating the hazard.

In responding to citizen concerns of this kind, most nurses are at a distinct disadvantage, because in general, there is a wide disparity between a public health orientation and the way that nurses are taught to practice their profession. Public health issues must be approached from a population-based, primary prevention perspective. Yet, most nurses practice their profession from a curative perspective that focuses on ill individuals. This mismatch creates conceptual and practical difficulties for nurses involved with environmental health issues. They may feel that they lack the authority to take a public health approach or that they lack the skills to analyze health issues in population-based terms. They may be interested in reconceptualizing the ways in which environmental factors fit into their nursing practice, but they are too pressured and busy to consider such a reconceptualization. In light of the controversy that sometimes surrounds public health issues, nurses may feel safer caring for individuals because this is the task with which they are more familiar; caring for individuals allows nurses to stay solidly within the boundaries of the health care system without stepping into the social, legal, and political arenas important for disease prevention.

Tension between the paradigm of public health and the paradigm of individual care, a serious concern in environmental health, also underlies many other current debates in health care (Barnes et al., 1995). One goal of this report is to provide realistic guidance and assistance to nurses in various practice roles so that they can bridge the gulf between the two frameworks in relation to environmental health.

THE NURSING WORKFORCE

Preparing nurses to respond more effectively to environmental health problems raises complex professional issues, in part because nursing offers so many different levels of training and routes to practice. The term nurse as used in this report refers to registered nurses (RNs) who have graduated from an accredited nursing education program and who have passed the licensure examination. However, not all RNs are the same in terms of educational background, clinical experience, or preparation. The entry-level professional licensure examination (NCLEX, National Council Licensure Examination for Registered Nurses) does not include content specific to environmental health or general concepts of population-based



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