- Impact of health reform
- Cuts in public health budgets and staff due to budget shortfalls
- New consensus definitions on the scope and competencies of public health nurses
- Recommendations from the Institute of Medicine 2010 report, The Future of Nursing: Leading Change, Advancing Health, including that 80 percent of nurses achieve bachelor-level degrees by 2020
- Public health agency accreditation and adoption of quality improvement measures
- Transition in public health toward a greater emphasis on chronic disease prevention and interventions.
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