health professionals. For example, Clues to Unraveling the Association Between Illness and Environmental Exposure (Narkunas et al., 1994) is a 7.2 contact-hour program for nurses and environmental health professionals available from the Agency for Toxic Substances and Disease Registry (ATSDR), which is part of DHHS. Other agencies with educational programs include the National Center for Environmental Health and NIOSH (ERCs). The Occupational Safety and Health Administration is another federal agency that is a source of important information. A more complete listing of relevant federal agencies is contained in Appendix D.

State and Local Agencies

To ensure safe practice, each state board of nursing (or its equivalent) administers a licensing examination. Because each state board of nursing establishes its own scope of practice, it also has the responsibility to monitor the licensed nurse's practice within those parameters, or legal action can be taken. Other state agencies (e.g., health, occupational, and environmental agencies) have no direct jurisdiction over nursing education and practice. Local and state health departments employ nurses to provide services in such areas as public health, maternal-child health, school health, and other targeted areas or to specific populations, and they also serve as clinical practice sites for basic and graduate nursing students. However, funding and revenue sources tend to determine the scope of practice within the boundaries of each state's nursing practice act. For example, if funding for school-based clinics is provided and nurse practitioners are required for primary care, only those nurses who are certified by their state board and/or by the American Nurses Association as nurse practitioners can be employed.1

Although local and state environmental agencies can employ nurses, they have less direct or formal contact with nursing education programs. Yet, members of such agencies often serve on advisory committees to nursing education institutions and provide valuable real-world input for curricular improvement and the currency of curricular content. They also serve as resources for technical information and arrange material and sites for student field experience.

Most states have separate health, education, social services, occupational safety and health, environment, consumer affairs, insurance, and other departments that tend to have minimal interagency contact or coordination of services. Therefore, in teaching nurses to practice with a


 Some states have different (less) requirements for nurse practitioner registration than for ANA certification in specific areas, hence the "and/or." Then, however, they can only work within that specific state. ANA certification is recognized nationally.

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