level or higher; the other two-thirds are largely graduates of associate degree programs that provide only an observational experience in community care settings (HRSA, 1992) (see Chapter 4).

This mismatch between the level of educational preparation of RNs and their practice settings and roles in relation to environmental health is part of a more general problem in the composition of the nursing workforce. In a recent review of priorities for the health care workforce, Aiken and Salmon (1994) concluded that in terms of sheer numbers, the aggregate supply of nurses appears to be adequate for meeting national needs in the near term. However, they noted that the mix of nurses by educational background is inadequate to meet the increasing demand for nurses in leadership and advanced practice roles.


At the request of a consortium of federal agencies (Agency for Toxic Substances and Disease Registry, National Institute of Environmental Health Sciences, National Institute of Nursing Research, Health Resources and Services Administration, National Institute for Occupational Safety and Health, Environmental Protection Agency), and as follow-up to a planning meeting conducted by the Institute of Medicine (IOM), the IOM established the Committee on Enhancing Environmental Health in Nursing Practice to address issues related to the need for enhancing environmental health content in nursing practice. The committee was charged with the following tasks:

  • assess the current status of environmental health in the practice of nursing and the need for enhanced education and research;

  • provide guidance on the development of environmental health curricula for nurses;

  • identify barriers to the integration of environmental health content into nursing education and the practice of nursing;

  • develop implementation strategies for enhancing environmental health in nursing education, practice and research, including methods and resources for faculty development;

  • describe methods for evaluating the effectiveness of an enhanced environmental health curriculum; and

  • identify and describe: (a) environmental health/nursing research issues, (b) potential roles for government, industry, and academia in supporting environmental health/nursing research and practice, and (c) potential collaborative and interdisciplinary activities and research initiatives that might be undertaken in addressing environmental health/nursing issues.

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