Mapping the future of environmental health and nursing: strategies for integrating national competencies into nursing practice.

Nurses are increasingly the primary contact for clients concerned about health problems related to their environment. In response to the need for nursing expertise in the field of environmental health, the Institute of Medicine (IOM), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute of Nursing Research (NINR) have designed core competencies for the nursing profession. The IOM competencies focus on four areas: (1) knowledge and concepts; (2) assessment and referral; advocacy, ethics, and risk communication; and (4) legislation and regulation. The competencies establish a baseline of knowledge and awareness in order for nurses to prevent and minimize health problems associated with exposure to environmental agents. To address the known difficulties of incorporating new priorities into established practice, nurses attending an environmental health short course participated in a nominal group process focusing on the question, "What specific actions can we take to bring environmental health into the mainstream of nursing practice?" This exercise was designed to bring the concepts of the national initiatives (IOM, NINR, ATSDR) to the awareness of individual nurses involved in the direct delivery of care. Results include 38 action items nurses identified as improving awareness and utilization of environmental health principles. The top five ideas were: (1) get environmental health listed as a requirement or competency in undergraduate nursing education; (2) improve working relationships with interdepartmental persons-a team approach; (3) strategically place students in essential organizations such as NIOSH, ATSDR, or CDC; (4) educate nurse educators; and (5) create environmental health awards in nursing. The 38 original ideas were also reorganized into a five-tiered conceptual model. The concepts of this model include: (1) developing partnerships; (2) strengthening publications; (3) enhancing continuing education; (4) updating nursing practice; and (5) strengthening schools of nursing. The model serves as a road map for action in building environmental health capacity within mainstream nursing.