and disease prevention and, as discussed below, the curriculum standards for schools of nursing support this concept.

Undergraduate Education

Since early in the 20th century, the stated standard of preparation for a public health nurse has been the baccalaureate degree (AACN, 1999). This requirement was based on an understanding that working in the community required knowledge of community and family dynamics beyond that necessary for effective practice within an institutional setting. As standards for baccalaureate nursing education were established, public health nursing was included as a required classroom and clinical experience, and this can be seen as the major distinguishing clinical feature that differentiates the baccalaureate level of nursing education from diploma or associate degree programs. The ANA has created Standards for Public Health Nursing Practice (QCPHNO, 1999) that provide the standards against which practice should be measured. The licensing board in at least one state (California) continues to issue a separate certification for public health nursing and limits use of the title “public health nurse” to those who are so certified. The exact content of these public health nursing courses has changed over time, as have the associated clinical experiences.

Guidelines for nursing education are provided through the school accreditation process and through standards set by educators in various specialty areas. Accreditation of schools can be done by one of two organizations, the National League for Nursing Accrediting Commission, Inc., or the American Association of Colleges of Nursing (AACN). The AACN only accredits programs at the baccalaureate or higher level and includes the expected competencies items such as social justice, community health risk assessment, health promotion, risk reduction and disease prevention, human diversity, and global health care, all of which are basic for good public health practice.

Standards for associate degree programs (and the dwindling number of hospital-based diploma programs) are established by the National League for Nursing Accrediting Commission, Inc., the accrediting body. At the associate degree level, the standard requires that the curriculum provides for attainment of knowledge and skill sets in community concepts, health care delivery, critical thinking, communications, therapeutic interventions, and current trends in health care.

There is nothing in the standard that suggests that these graduates are being prepared for the level of analytic skills and community dynamics that are a key part of public health nursing practice. Because of job market pressure, however, many health departments recruit and hire graduates of associate degree programs (especially in communities in



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