Bowers (1994), in responding for the ANCC, stated that environmental health nursing does not have a specific certification examination. Among the 24 certification areas where examinations do exist, a review of test content found that one or more concepts of environmental health nursing could be inferred in 21 of the examinations. These were typified by "lead poisoning, safety, poisoning and air pollution."

Further analysis revealed that 19 of 24 certification areas included the word environment in the outline. Test content outlines of two examinations included environmental science: community health nurse and clinical specialist in community health nursing practice. The pediatric nurse practitioner examination content outline dedicated a section to environmental issues, and the general nursing practice test content outline noted the influence of "environmental and occupational factors" in consideration of health promotion, disease prevention, and control.

A key word search of environmental health and its derivatives (e.g., air pollution, sanitation, and safety) located the presence of at least one key word in 15 of 24 banks of items for specific examinations. Bowers reports that ANCC has not gathered data to substantiate or refute the need for a certification program in environmental health nursing and has no current plan to offer such an examination (Bowers, 1994).

The ABOHN certification exam has integrated environmental health concepts into the certifying examination. Six content domains make up the examination blueprint, one of which is labeled "health and environment relationships." This area focuses on environmental exposure in the workplace and the application of the nursing process to the health status of workers. ABOHN has not compiled data to substantiate the need for developing a certification examination in environmental health separate from an examination in occupational health.

The NBCSN includes questions on its certifying exam related to environment and human health. These questions are found under the topic areas of health promotion/disease prevention, health problems, nursing management, and emergency care.

Currently, certification in environmental health nursing does not exist for the generalist nor for those in advanced practice, although several certifying organizations report that environmental health concepts are present to some degree. Based on this survey of certifying organizations, current credentialing systems do not include the specificity and breadth of environmental health content necessary to ensure its inclusion in basic generalist practice.

Changes in Health Care Delivery

Health care delivery is undergoing rapid change, with a pervasive trend toward institutional consolidation and emphasis on cost cutting.

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