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This year marks both the completion of a century ofpublic health nursing in the United States and the beginning of national health care reform. Public health nurses across the nation are wondering what these major turning points mean for them in their practices. An even more central question is, How can public health nursing best be used to advance the public health mission, particularly in the face of health care reform? This is not a question for nurses alone. Rather, it is a question for health departments, public policy experts, and communities as they seek to ensure the health of the people in a rapidly changing, unpredictable system of health services.Perhaps this question is best answered by considering some ofthe lessons learned from a century of public health nursing services. First, we have learned that public health nurses are "functional."That is, the form oftheir practice has from the beginning followed the functions required by society.' Lillian Wald's found-

This study identified core components of the curriculum for master's-level community health nurses (CHNs) and assessed whether leaders in service agreed with leaders in education on the importance of these components. Through a mailed survey, 588 leaders in CHN service and education identified the following as the most important to include in the core CHN curriculum: a practicum experience; epidemiology; community health assessment and diagnosis; administration and management, including public health administration, management theory, program planning and evaluation, financial management and budgeting, and quality assurance; research methods and biostatistics; health promotion and disease prevention; intervention at the aggregate level; and leadership theory. These leaders also indicated that skills in both administration and direct care are essential for CHN practice. While there was remarkable agreement between service and education leaders in many areas, notable disagreements were seen in the importance accorded administrative skills. Service leaders rated these skills much more highly than did leaders in education.

This study identified population groups, health conditions, and employment settings considered appropriate for graduate-level community health nursing (CHN) practice and employment, and described the relative importance of each of these areas as assessed by CHN leaders. According to 588 leaders in CHN service and education, (1) the population groups most in need of graduate-prepared CHNs are the elderly, persons of low socioeconomic status, the homeless, adolescents, and the unemployed; and (2) the health conditions most in need of CHN services are AIDS, pregnancy and prenatal problems, low birth weight and infant mortality, stress-related illness, and Alzheimer's and other chronic diseases of the elderly. Among the many employment settings rated as having a great need for CHNs are state and local health departments and home health agencies. The findings provide the direction and justification for developing specialty options within CHN that correspond to these identified and changing needs. This article provides suggestions and possible alternatives for initiating educational change to prepare graduate-level CHNs for these various specialties and for the settings in which the specialties will be applied.