People 2000(DHHS, 1990) goals for increasing the time period during which people lead healthy lives, reducing health disparities and achieving access to disease prevention through health promotion, health protection (e.g., improved environmental health), preventive services, and surveillance and data systems. However, continued segmentation or exclusion of nursing competencies in environmental health within general nursing education will not promote nursing's full impact on the goals of Healthy People 2000. To be full participants in achieving the health objectives for the nation outlined in the Healthy People 2000 document, nurses must focus on population-based practice, risk reduction, and preventive services. This focus will require changes in nursing educational preparation, content of nursing practice, and practice settings.

Graduate Nursing Education

Specialization in nursing occurs at the master's level. In the 1994–1995 school year, there was a 10.7 percent increase in the number of master's degree students enrolled in nursing schools compared with the 1993–1994 school year (AACN, 1994). In 1993, master's programs in nursing numbered 252, with 136 of these offering nurse practitioner programs (NLN, 1994, p. 3).

Master's programs prepare leaders for advanced practice nursing as clinical nurse specialists (CNS), nurse practitioners (NP), certified nurse-midwives (CNM), certified registered nurse anesthetists (CRNA), administrators, teachers, and consultants. Courses in nursing and other science disciplines provide advanced theoretical knowledge, assessment skills, role and leadership development, advanced clinical practice in a selected specialization, and the opportunity to critique and apply nursing theory and research as a scientific base for nursing practice. Increasingly, graduate nursing curricula include core courses such as health assessment, pharmacotherapeutics, health promotion, sociocultural and community health, health economics and policy, theory and ethics, as well as research. Specialty, leadership, and elective courses complete the requirements for the degree.

To date, no standardized curriculum exists for the advanced practice of nursing. However, through regional workshops, the AACN is attempting to define academic instruction, practice, skills, and other essential standard elements of master's-level nursing education. In an AACN interim summary, a core curricular content for all nursing students in master's programs is recommended in the areas of research, economics, ethics and legal issues, health policy, professional role development, nursing theory, and cultural diversity. The areas of consensus on core curricular content for advanced practice nursing programs include advanced

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