that contains 55 case studies in environmental medicine from the published literature (IOM, 1995). Although the focus in the report is on undergraduate medical education, much of the information presented is directly relevant to nurses.

METHODS FOR ENHANCING DISSEMINATION OF ENVIRONMENTAL HEALTH CONTENT IN NURSING EDUCATION AT ALL LEVELS

The success of continuing education can be measured by determining whether the quality of education available to nurses positively affects a person's health and care. The dissemination of information to nurses is the first step in changing knowledge, attitudes, and behavior. Dissemination is much more than simply making information available or convincing nurses that it is important. A comprehensive plan for dissemination must consider both the system for distribution and the target of the educational program. Use of existing programs that are targeted to specific needs is a way to begin. One such program is the ATSDR Clues Course, which is designated for community health nurses and environmental health professionals. The course seeks to enhance these health professionals' understanding of the relationship of exposure to hazardous substances to health outcomes, and the role and importance of public health assessments and possible interventions (Narkunas et al., 1994).

Continuing Nursing Education

Career development in nursing consists of formal academic instruction in a defined program of higher education, licensure, professional continuing education, certification, and advanced practice academic degrees at the master's and doctoral levels. During the late 1960s, nurses nationwide began to identify a need for formal recognition of their participation in continuing education courses. To date, mandatory, approved continuing education for relicensure of registered nurses has been implemented in 22 states (NCSBN, 1994). To ensure safe and professional practice, it is a goal of NCSBN that all states require continuing education for nurses in order to continue their nursing practice. Regardless of how these goals are attained, all nurses should be encouraged to embrace the philosophy of lifelong learning.

The requirement for continuing education brings with it an obligation of the profession to provide the necessary educational programs. This commitment extends to nurses who may work in remote areas, who may not be able to travel to structured classes, or who may have personal or even job-related responsibilities that preclude attendance at workshops



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