Ethical dilemmas may also arise during the course of nursing research on environmental health problems, for example whether control groups should be identified and denied intervention for the purposes of a study. Other issues in environmental health intervention research are how best to protect confidentiality and how to achieve meaningful informed consent.

Resources for addressing ethical conflicts regarding environmentally related health issues must be integral components of educational preparation for nurses at all levels of practice.

Individual licensure of nurses is conferred by meeting the eligibility requirements and achieving a passing score on the National Council Licensure Examination for Registered Nurses (NCLEX). Registered nurse (RN) licensure conveys authority for a nurse to practice within the scope of practice defined by a state. NCLEX does not directly measure the environmental health science content of the nursing curriculum, although test items may reflect nursing knowledge secondary to the understanding of underlying environmental factors. Because schools of nursing use data on the passing rate for NCLEX as an educational outcome indicator, the influence of NCLEX items and the content of this examination on curricular decisions for nursing education cannot be underestimated (see Chapter 4).

Unlike licensure, certification is a voluntary process in which an RN seeks an additional credential in a distinct practice area. In the future, recognition as an advanced practice nurse may require both certification and licensure.

Three certifying bodies, the American Nurses Credentialing Center (ANCC), the American Board for Occupational Health Nurses, Inc. (ABOHN), and the National Board for Certification of School Nurses, Inc. (NBCSN), were surveyed and asked to describe the nature of certification for environmental health nursing. Three questions were asked: (1) Is a certification examination in environmental health sponsored by the organization? (2) Identify by test content outlines and key words those certification examinations that have environmental health concepts among the test items. (3) What data, if any, does the organization have on the need for or interest in a certification examination in environmental health?