practice central to public health, which include the environment as a primary determinant of health. The current curricular content relevant to environmental health varies dramatically among professional nursing education programs.
Despite their common licensure status, not all nurses are trained to practice in the same settings, with the same level of skill, or in the same roles. Most RNs receive their basic nursing education in one of three programs: hospital diploma, associate degree, or baccalaureate degree.1 Graduates with hospital diplomas and associate degrees are prepared primarily as skilled members of the team that delivers direct patient care services in institutional settings. Nurses with baccalaureate degrees are likewise prepared primarily for patient care in institutional or organized care settings, including community-based health care facilities. However, they also serve in leadership roles and are expected to revise nursing practice, conduct quality control analyses, and participate in research.
Nurses with clinical graduate degrees and/or specialty certification are commonly referred to as advanced practice nurses (APNs). These include clinical nurse specialists, who are often employed in tertiary-care settings, and nurse practitioners, who often work in the community (AACN, 1994). These nurses are prepared for leadership roles in advanced practice and collaborative roles with other health care professionals. Independent practice and practice in partnership with physicians may require educational preparation at the master's level or higher as well as national certification. These nurses structure, implement, and evaluate systems of health care delivery in hospitals or community-based settings and provide continuing education to other staff to improve practice. While some APNs may have received some formal preparation in environmental health concepts through occupational health nursing programs at the master's or doctoral level, the supply of nurses with this kind of training is meager.
One of the fundamental problems related to enhancing environmental health content in nursing practice is the fact that only about one-third of the nurses in community-based settings have formal training in public health or environmental health concepts and the related clinical experience necessary to deal adequately with the environmental aspects of health. This problem has occurred because only nurses prepared at the baccalaureate level or higher are likely to have formal training in basic public health and environmental health concepts, and only one-third of the RNs in community-based settings have training at the baccalaureate