Agricultural Health Nurses
JOB ANALYSIS OF FUNCTIONS AND
COMPETENCIES
ABSTRACT
Agricultural health nurses address the health and
safety issues of farmers, agricultural workers, and
farm families. This nurse role incorporates both
public health and occupational health nurse spe-
cialty practice. The purpose of this study was to
describe agricultural health nurse job functions
and competencies used in providing services to
agricultural populations. A two round modified
Delphi technique was used to attain a consensus
among participants related to agricultural health
nurse functions and competencies. In Round I, a
mailed survey assessing demographic characteris-
tics, and job functions and competencies was sent
to an identified list of 61 nurses. A second mailed
survey, with categorized job function and compe-
tency responses elicited through Round I, was sent
to the 32 Round I respondents to assess the impor-
tance of the job functions and competencies and
the frequency of performing each job function.
Twenty four Round II surveys were returned. Job
functions rated highest were:
• Serve as a liaison for the agricultural, health
and medical, and nonfarm communities.
ABOUT THE AUTHORS:
Ms. Lundvall is Assistant Health Planner, Cerro
Gordo County Department of Public Health,
Mason City, IA. Ms. Olson is Instructor and
Deputy Director, Midwest Center for
Occupational Health and Safety, Division of
Environmental and Occupational Health, School
of Public Health, University of Minnesota,
Minneapolis, MN.
336
by Ann Marie Lundvall, MPH, MS, RN, and
Debra K. Olson, MPH, RN, COHN-S
• Promote agricultural health and safety issues
through the media.
• Implement educational courses for various
groups.
• Conduct follow up assessment of injury, ill-
ness, or disease occurring as a result of an agri-
cultural exposure.
• Function as a resource for information to vic-
tims of agricultural injury and illness and their
families.
The competencies of greatest importance were
interpersonal communication skills, knowledge
of injury prevention principles and measures,
ability to recognize potential hazards within the
work and home environment, and demonstrate a
strong sense of self. This study adds to the body
of knowledge needed to define the agricultural
health nurse role.
griculture has consistently ranked among the
A most dangerous occupations (Ehlers, 1993) .
According to the National Safety Council (1996),
farm residents experienced 440,000 disabling injuries in
1995; 160,000 of these injuries were attributed to work
either on or off the farm. National advances in addressing
the health and safety needs of workers often excluded
efforts directed toward farmers, agricultural workers, and
farm families (Schenker, 1996). An international confer-
ence held in Iowa City during 1989 has been credited
with reversing these trends by bringing attention to health
and safety issues experienced by those living or working
in agricultural settings (Schenker, 1996).
Nurses have been recognized in a variety of settings as
key to addressing the complex health and safety concerns
associated with agriculture (Chapman, 1996; Connon,
1993; Donham, 1997; Lexau, 1993; Randolph, 1993).
Increasing awareness among nurses about agricultural
health and safety hazards is an important step toward
improving the health of this vulnerable population (Amer-
ican Association of Occupational Health Nurses, 1997;
Ehlers, 1993; Iorio, 1985; Lexau, 1992; Werner, 1993).
Martin (1997) proposed that educators should incorporate
AAOHN JOURNAL
curriculum into nursing education that facilitates recogni-
tion of agricultural workers and their families as an at risk
population with unique concerns. The proposed curricu-
lum addresses areas of health assessment and promotion;
reproductive and mental health; pediatric, adult, and com-
munity health and safety issues; and professional issues as
might apply to working with agricultural populations.
Successful development of any curriculum for the
agricultural health nurse role requires a clear definition of
the functions performed by those within the role and the
competencies (knowledge, skills, and abilities) necessary
to execute these functions. Licensing and certification
boards commonly perform this type of job analyses to
determine the content domain of the tests administered
(Olson, & Verrall, 1997). Such analyses are used to vali-
date that individuals attaining qualifying scores on tests
possess knowledge and skills essential to competently
perform a given occupation (Burgel, 1997). This concept
of role delineation is the basis for the following study.
LITERATURE REVIEW
The agricultural health nurse role draws from both
occupational health nursing and public health nursing
(Randolph, 1993). Thus , the job functions and competen-
cies identified by current agricultural health nurse s
should be consistent with professional guidelines of these
two nurse specialtie s. A review of current literature
explored the job functions and competencies of the pub-
lic health nurse and the occupational health nurse and the
application to an agricultural population.
Public Health Nursing
In March 1996 the Public Health Nursing section of
the American Public Health Association (APHA) issued
a statement updating the definition and role of public
health nursing (American Public Health Association,
1996). According to this statement, public health nursing
uses the nursing process to "promote and protect the
health of populations" (APHA , 1996).
When developing a practice model for public health
nursing, Keller (1998) reviewed current literature to iden-
tify primary public health nursing interventions per-
formed at client, community, and system levels. A panel
of experts and 275 public health nurses located through-
out Minnesota refined this list of interventions. The final
list contained 17 interventions applicable to various prac-
tice settings as shown in the Sidebar on page 338.
Although the practice setting of agriculture was not
explicitly defined in this study, Minnesota supports a large
agricultural community ranked in the top three to five
states for many agricultural products. Keller (1998) exam-
ined competencies for public health nurses in various prac-
tice settings, and Misener (1997) examined competencies
specific to leadership in the field. A modified snowball
technique was used to obtain a national convenience sam-
ple of major public health nursing association members
and non-nurse public health leaders. Respondents exam-
ined seven practice domains and provided examples for
each of the competencies a graduate of a dual master's
degree program (nursing and public health) should have
JULY 2001, VOL. 49, NO.7
What Does This Mean for
Workplace Application?
Nurses have been recognized in a variety of
settings as key to addressing the complex health
and safety concerns associated with agriculture.
Successful development of curriculum for the
training of nurses within this role requires a clear
understanding of the functions performed by
agricultural nurses and the competencies
necessary to execute these functions.
The agricultural health nurse role draws from both
occupational health nursing and public health
nursinq, Thus, the job functions and competencies
are consistent with with professional guidelines of
these two nursing specialties. The function reported
most often by agricultural health nurses is to serve
as a liaison among the agricultural, the health and
medical, and the nonfarm communities.
(Misener, 1997). Fifty-seven competencies were consid-
ered essential to nursing leadership in public health. Four
categories emerged as encompassing these competencies:
• Political competencies.
• Busine ss acumen.
• Program leadership.
• Management capabilities.
Occupational Health Nursing
Guzik (1992) described the role functions and person-
al characteristics of master's prepared occupational health
nurses and the effect on job satisfaction. Hardy's (1981)
constructs of work situation variables (including job
description and tasks) as impacted by intervening variables
(e.g., educational background) to influence outcome vari-
ables (e.g., job and career satisfaction) served as the theo-
retical framework. A purposive sample of 235 educational
resource center trained occupational health nurses identi-
fied by the National Institute for Occupational Safety and
Health (NIOSH) was surveyed about demographic charac-
teristics, work experience, involvement in decision mak-
ing, and job satisfaction. Results from the 85 respondents
supported Hardy's (1981) theoretical model showing that
possessing a clear understanding of role functions is sig-
nificantly related to job satisfaction. Eight work tasks iden-
tified through the research included environmental and
occupational health management tasks, evaluation, com-
munication, marketing, direct care implementation, direct
care management, liaison, and consultant. Nurses sur-
veyed in this study were all masters' prepared. Thus, they
do not necessarily reflect the population of nurses func-
tioning in the occupational health nurse role.
Another study by the American Board for Occupa-
tional Health Nurses, Inc. (ABOHN) attempted to identify
competencies of the practicing occupational health nurse
including all levels of educational preparation. Burgel
(1997) surveyed the 3,805 certified occupational health
nurses in the United States. Members of the ABOHN
337

17 Public Health Nursing
Interventions
1. Advocacy.
2. Case management.
3. Coalition building.
4. Collaboration.
5. Community organizing.
6. Consultation.
7. Counseling.
8. Delegated medical treatment and observations.
9. Disease investigation.
10. Health teaching.
11. Outreach or case finding.
12. Policy development.
13. Provider education.
14. Referral and follow up.
15. Screening.
16. Social marketing.
17. Surveillance.
Keller (1998).
Board developed a list of occupational health nurse tasks
using the practice domains of clinician, manager, educator,
and consultant. Respondents rated task/activity statements
based on importance and frequency with which the
task/activity was performed. Knowledge statements were
rated according to their importance to the well being of
their clients and organization (Burgel, 1997). Of the sur-
veys sent, 1,625 usable surveys were returned. Significant
variances in practice activities were noted by degree.
Diploma and associate degree respondents indicated a
greater amount of time spent within the clinician role. Par-
ticipants with a baccalaureate degree or higher were more
likely to spend time in manager or consultant roles. Nurse
respondents from all educational levels agreed on six
task/activity statements essential to the certified occupa-
tional health nurse role (Burgel, 1997):
• Document provision of care in the employee health
record.
• Use a computer.
• Provide treatment of work related injuries and illnesses.
• Develop a system of employee health records.
• Perform case management activities.
• Manage a workers' compensation program.
The membership list of the American Association of
Occupational Health Nurses (AAOHN), was used in a
study by Olson (1997) to identify functions and compe-
tencies of occupational health nurses. A 40% random
sample of AAOHN members in eight Midwestern states
were surveyed. Respondents were asked to identify from
a list the responsibilities, tasks, and functions associated
with their current occupational health nurse position. All
respondents indicated frequent evaluation of employees
returning to work, interpretation, and monitoring of com-
338
pliance with government regulations, and providing
direct nursing care and completing appropriate records.
Variances were noted in reported job functions with edu-
cational attainment level and with the department to
which the nurse reports. Results indicated that functions
benefiting the work organization generally defined the
occupational health nurse role as opposed to specified
occupational health nurse role definitions.
Martin (1993) attempted to include both public
health and occupational health nurse populations by
using lists of the Ohio Department of Health and the
AAOHN. In addition, chief executive officers on location
at Ohio manufacturing and services companies offering
occupational health nursing services were selected using
a simple random method. The researchers used a descrip-
tive survey design to explore role modification, a model
used by organization to provide a boundary for the occu-
pational health nurse to make individual decisions. For
each survey item, respondents indicated if the service
was currently offered, desired in the future, or not applic-
able. Frequently reported current activities included
counseling employees about health risks, providing
direct care for injuries and illnesses, and workers' com-
pensation follow up. Smaller companies reported greater
claims management and safety committee activities com-
pared to larger companies. Activities indicated as desir-
able in the future were analysis of health promotion
trends, risk reduction and health care alternatives, and
interdisciplinary communication in solving problems.
Agricultural Health Nursing
While no studies identifying the competencies of agri-
cultural health nurses were found in the literature, pro-
grams where nurses contribute to improving the health and
safety of agricultural populations have been described.
Chapman (1996) surveyed nurses from the Wisconsin
county health department on agricultural safety prevention
efforts being performed and perceptions related to farm
safety problems. Of the 58 counties responding to the sur-
vey, 26 reported they performed some kind of agricultural
health and safety activities. The most prevalent safety
effort employed was health screenings (31.1%), followed
by conducting adult group meetings (16.3%); attending
continuing education events (1Ll %); conducting youth
group meetings (8.7%); answering telephone requests
(7.2%); and providing treatment, care, and support of
farmers and farm residents (6.0%). Fewer respondents
identified hazard inspections of farms and farm residences
(3.7%), reading and self study (3.3%), reporting agricul-
tural injuries and diseases (1.3%), and assisting others in
conducting injury and disease programs (0.6%) as integral
agricultural health and safety activities in their practice.
Despite the inclusion of agricultural health and safety
activities, public health nurses indicated that their county
residents had average to low ratings (using a five point
scale of very low to very high) in the following:
• Effectiveness of the efforts in improving health and
safety.
• Quality of available information.
• Interest and level of health and safety.
AAOHN JOURNAL
 The Occupational Health Nurses in Agricultural Com-
munities (OHNAC) program, a national initiative aimed
toward addressing the health and safety of agricultural
populations, also provides insight into program require-
ments. With NIOSH funding beginning in 1989, the pro-
gram placed nurses in rural hospitals, county health
departments, and clinics to achieve the program goals of
conducting active surveillance of illnesses and injuries
affecting fanners, farm workers and farm family mem-
bers, and to use this information to prevent agricultur-
ally related illnesses and injuries (Connon, 1993).
Ten states were involved in the project , promoting
the development of a program alIowing community
based and community specific interventions for address-
ing agricultural health and safety issues through the
effective evaluation of the agricultural work population.
Nurses of the OHNAC program
focused their effort s on assisting health care providers
and farmers to recognize agriculture as an industry
with both unique hazards and hazard s that are com-
mon to other industries (Connon, 1993).
Program specifics varied among the states involved,
and efforts included making literature on agricultural ilI-
nesses available to health care providers, providing edu-
cational presentations and farm walk throughs for health
care providers, obtaining farmer self report of injuries
and illnesses, and providing health screening services at
farm shows and fairs.
Essential functions performed by these occupational
health nurses in agriculture were described as
disease and injury identification, education, health
promotion and health maintenance, case management
for the injured or ill farm family member, advocacy
for workers, and a liaison relation ship between the
worker and management (Randolph, 1993).
Recognizing the barriers that may be faced including
the lack of effective regulations applicable to agriculture,
the unique nature of the agricultural work setting, and the
potential for farm worker distrust of intervening parties,
nurses were informed about the importance of raising the
awareness and importance of this role. With this in mind,
the importance of coalition building among various com-
munity stakeholders was emphasized through the
OHNAC program (Lexau, 1993; Randolph, 1993).
Another nurse focused program was developed as the
Iowa Agricultural Health and Safety Network (lA-HASN),
which addressed the provision of occupational health and
safety services to agricultural populations . The program
trains nurses in agricultural health and safety issues (Don-
ham, 1997). Each nurse providing services through the lA-
HASN clinics must complete an Agricultural Occupation-
al Health Nurse training program developed and delivered
through the University of Iowa. The training program cur-
riculum is described in the Sidebar. Developers of the cur-
riculum planned the program as a template to be used
throughout the nation, with subsequent development of a
specialty certification for agricultural health nurses.
JULY 2001, VOL. 49, NO.7
Agricultural Occupational
Health Nursing Training
Program Curriculum
1. An overview of rural health and agrimedicine .
2. An overview of occupational health nursing and
its application to agriculture.
3. Education and demonstration of general and
certain agriculture specific assessment and
physical examination skills.
4. Methods in providing individual health
promotion and education to farm family
members.
5. Agricultural respiratory diseases (includes
certification in spirometry testing).
6. Agricultural auditory alterations (includes
certification as an occupational hearing
conservationist).
7. Agricultural dermatological diseases.
8. Agricultural musculoskeletal diseases.
9. General health issues affecting numerous
systems including toxicology, cancer, and
zoonoses.
10. Agricultural injuries and safety training.
11. Agricultural illness and injury control and
prevention.
12. Optional curriculum in developing and imple-
menting a plan for an agricultural health and
safety clinic and an overview of marketing
strategies.
Many of the nurses who have completed this training
provide occupational health services to farmers , farm
families, and agricultural workers through a network of
hospital based clinics in Iowa. According to promotional
information (AgriSafe Occupational Health, 1997), ser-
vices provided by the regional centers include:
• Occupational health physical examinations and
screenings.
• Health education and health promotion programs.
• Personal protective equipment education, fit testing,
and sales .
• On site farm health hazard and environmental quality
testing.
• Comprehensive injury and disease prevention programs.
• Farm safety day camps.
• Mobile clinics.
• Referral services.
Summary
Educational preparation and work experience con-
tribute to an individual's perception of their occupational
role (Hardy, 1981). In addition, nurse roles are influenced
by the practice setting, the audience targeted for services,
and the program goals (White, 1982). With the exception
of a few program specific descriptions, there have been
no attempts to identify the characteristics of agricultural
339
health nurses. Life experiences of these nurses will have
an effect on their perception of their role as an agricul-
tural health nurse.
Agriculture is a varied industry and there is not a sin-
gle set of defined activities performed by agricultural
workers. Geographic variations and the nature of the
fanning operation (e.g., grain production, livestock pro-
duction) are just two variables influencing the duties of a
nurse serving these populations.
Competencies described as knowledge, skill, and
ability or attitude "guidelines" apply to each nurse with-
in a given specialty area regardless of the practice role
(White, 1999). Though there are variances among the
practice setting, the population receiving services, and
the goals of the services being provided, competencies of
the agricultural health nurses must be identified to assure
adequate preparation and role delineation.
The study in this article addresses these gaps in knowl-
edge by attempting to answer the following questions:
• What are the demographic characteristics of agricul-
tural health nurses?
• What are the job functions of the agricultural health
nurse?
• What competencies do agricultural health nurses pos-
sess and use in fulfilling the job functions they identify?
METHODS
The population of agricultural health nurses is not
easily recognized or accessible. For this reason a purpo-
sive, nonprobability sampling method was used to identi-
fy a population of potential participants meeting this
study's definition of agricultural health and safety nurse:
a registered nurse whose practice within the past 12
months consisted "of serving the fanner, farm family, or
agricultural worker" (Donham, 1997). A list of 61 poten-
tial participants was generated through correspondence
with three organizations in the Midwest identified as pro-
viding educational programs for agricultural health nurs-
ing, the University of Iowa's Institute for Rural and Envi-
ronmental Health, the Marshfield Clinic's National Fann
Medicine Center, and NIOSH in Ohio.
A two round modified Delphi technique was used to
describe the job functions and competencies of agricultural
health and safety nurses. The Delphi technique, often used
in professional practice evaluations, was used to attain a
consensus among participants. This technique is especially
useful when participants are from varying backgrounds, as
was assumed about the nurses identified for this study.
Procedure
Round I. The self administered questionnaire used in
the first round was based on a survey tool used to identify
the functions, job titles, and educational preparation of
occupational health nurses (Olson, 1997). Prior to distrib-
ution, a panel of agricultural health and safety profession-
als reviewed and made minor modifications of the ques-
tionnaire. A review by the university's institutional review
board determined that the reference study was exempt. A
coded questionnaire accompanied by a cover letter and a
self addressed stamped envelope was mailed to the work
340
address of each identified agricultural health and safety
nurse. The letter described the nature and purpose of the
study, described the methods employed throughout the
study to assure the confidentiality of responses and respon-
dents, described the voluntary nature of participation in the
study, and explained that consent was implied by complet-
ing and returning the questionnaire to the researcher. In an
attempt to obtain a study population consistent with pro-
fessional guidelines of both public and occupational health
nursing, those not licensed as registered nurses were asked
to return the questionnaire uncompleted. Registered nurse
participants were asked to complete the four page ques-
tionnaire and return it within 3 weeks. Follow up postcards
were mailed to individuals not responding after 2 weeks.
Round II. Job function and competency responses
were sorted into like categories. A second questionnaire
was developed in which the agricultural health and safety
nurses were asked to rate the importance of the job func-
tion and competency responses and identify the frequency
of performing each job function. The second question-
naire, a cover letter, and a self addressed stamped envelope
were mailed to the work address of the registered nurses
who responded to the first questionnaire. It was requested
that this second survey be returned within 3 weeks. A fol-
low up postcard was mailed to those not responding with-
in 2 weeks. Several attempts were made via phone to gath-
er additional descriptive data of nonrespondents.
Instrumentation
Round I. The first mailed questionnaire contained a
demographic profile consisting of 16 questions soliciting
information related to age, state of residence, gender, edu-
cation history, work history, professional certification
attainment, and the agricultural health nurse work situation
and setting. Respondents were also asked to identify the pri-
mary goals of their work as an agricultural health and safe-
ty nurse and the primary recipients of the agricultural health
and safety services they provide. The functions and compe-
tencies profile was comprised of two open ended questions:
• To list and explain the five primary job functions they
currently perform in their role as agricultural health and
safety nurses.
• To identify and explain the five primary competencies
assisting them in fulfilling their agricultural health and
safety nurse role.
Round II. The second mailed questionnaire contained
lists of 39 job functions and 59 competencies identified by
the respondents during Round I. The list items were num-
bered and randomly presented to decrease presentation
bias. Respondents were asked to rate the importance of
the job function responses on a four point scale from "not
important" to "very important" and competency respons-
es on a four point scale from "irrelevant" to "essential."
Participants were also asked to identify the frequency of
performing each job function on a five point scale from
"quarterly or less" to "more than 10 times per week."
Appropriate measures of central tendency were cal-
culated for each of the nominal and ordinal demographic
profile questionnaire items. Goals of services and service
recipients were categorized. A mean task index, as
AAOHN JOURNAL
described by Burgel (1997), was used in analyzing the
job functions. A combined index score for each job func-
tion was calculated by combining frequency and impor-
tance ratings. Importance ratings were given two times
the weight of frequency ratings, with 13 as the highest
index score possible. Ratings for all respondents per-
forming the job function were summed. A mean task
index was calculated for each job function by dividing
the summed rating by the total number of respondents.
The job functions were then ranked from highest to low-
est mean task index score for the entire group. When ana-
lyzing the competencies, respondent ratings for each
competency were summed and divided by the total num-
ber of respondents to calculate a mean rating. Mean
importance scores for the competencies were ranked
from highest to lowest.
RESULTS
Round I
Of the 61 respondents invited to participate, 36
returned the survey though 4 of these respondents indi-
cated they did not fit the study definition of an agricul-
tural health nurse. Though the geographic location of the
respondents varied, the majority resided in the Midwest
region. Most of the respondents were from Iowa (n = 15).
Four respondents came from each of the states of Ohio,
North Dakota, and Wisconsin, and one respondent each
came from Arizona, Kentucky, Nebraska, Maine and Vir-
ginia. Respondents were women with an average age of
44.4 years (range, 26 to 62 years). Average number of
years of working as a registered nurse was 17.4 years
(range, 2.5 to 40 years).
Educational preparation of individuals responding to
the survey was diverse. For 11 respondents, their highest
educational attainment was a baccalaureate degree in
nursing (BSNIBAN). Eight participants had attained an
associate degree in nursing, three held a diploma in nurs-
ing, three had a non-nursing baccalaureate degree, and
three had attained a master's degree in nursing. Two
respondents had a master's degree in public health and
two had a doctorate in nursing.
Sixteen respondents indicated they had attained some
type of professional certification. Three respondents were
certified occupational health nurses (COHN/COHN-S),
three were nurse practitioners, and one was a certified pub-
lic health nurse. Other professional certifications repre-
sented included licensed social worker (LSW), certified
hearing conservationist, certified gerontological nurse, cer-
tified nurse in the operating room (CNOR), emergency
medical technician-paramedic (EMT-P), emergency
medical technician-basic (EMT-B), certified vocational
instructor, and agricultural health nurse training through
the University of Iowa.
Among those responding to the survey, 21 had previ-
ously worked as an occupational health nurse. Average
number of years working as an occupational health nurse
was 4.5 years (range, 0.5 to 20 years). Nineteen respon-
dents had a history of working as a public health nurse.
Average years working as a public health nurse was 4.1
years (range, 1 to 22 years).
JULY 2001, VOL. 49, NO.7
Job titles held by the survey respondents were diverse.
Five respondents identified their job title as staff nurse, 4
as senior nurse or nurse administrator, 7 as manager or
director, and 11 as educator or researcher. Other job titles
represented included principal investigator, public health
nurse II, community health nurse, and clinical director for
programming servicing migrant seasonal farm workers.
Respondents had been at their current nurse position
for an average of 4.5 years (range, 0.25 to 22 years).
Respondents worked an average of 39.1 hours per week
at their current job position (range, 10 to 60 hours).
Eleven of the respondents indicated they devote less than
25% of their practice to agricultural health nurse duties.
Three respondents devoted 25% to 49% of their time to
agricultural health nursing, 4 devoted 50% to 74% of
their time to agricultural health nursing, and 13 respon-
dents devoted more than 75% of their time to performing
agricultural health nurse duties.
Number of registered nurses working at the respon-
dent's current employment site varied. Three respondents
indicated more than 100 registered nurses, 1 respondent
indicated between 50 and 100 registered nurses, and 25
respondents indicated fewer than 50 registered nurses
employed at their current employment site. The average
number of registered nurses working at their current
employment site focusing a portion of their practice direct-
ly or indirectly on providing agricultural health and safety
services was 2.6 (range, 1 to 20 agricultural health nurses).
Industry classification of the respondents' current
agricultural health nurse employment site was varied. Six-
teen respondents indicated their employer as a hospital or
medical center; four as a local government agency; three
as a college or university; three as agriculture, forestry, or
fisheries industry; one as a federal government agency;
and one as a miscellaneous services industry.
Fourteen unique goals for agricultural health nurse ser-
vices were identified. The most often cited goals were to:
• Provide health care services and early detection
screening for agricultural workers (n = 9).
• Educate and increase awareness of agricultural health
and safety issues among farm families (n = 8).
• Decrease farm related injuries and illnesses (n = 7).
• Develop or provide interventions to prevent agriculture
related injury, illness, and disease among children (n = 6).
Respondents identified 11 service recipients for their
agricultural health nurse services. Twenty seven respon-
dents identified agricultural families and rural families as
their primary recipient of services, while 22 identified
farmers as their primary recipient. Health care providers
and emergency medical services (EMS) personnel were
primary service recipients for 12 of the survey respon-
dents. Other service recipients were listed as agribusiness
(n = 10), county extension (n = 7), migrant workers (n =
6), and others (n = 5).
Respondents suggested 39 unique job functions
associated with their work as an agricultural health nurse.
Figure 1 demonstrates the distribution of these job func-
tions among the five occupational health nurse practice
roles (Rogers, 1994). The majority of the job functions
fell within the clinician and the consultant practice roles.
341
 18 17
16
14
12
...
(I)
10
.c
E8
::J
Z
6 Z
4
2 5
o
Clinician Consultant Educator Manager Researcher
Figure 1. Distribution of 39 job functions identified by
agricultural health nurses (n = 24) by occupational health
nurse practice role, 1998.
Survey respondents submitted 59 unique job competen-
cies . As evidenced by Figure 2, the majorit y of the iden-
tified competencies essential to the agricultural health
nurse role were classified as skills, followed by areas of
knowledge, and then abilities and attitudes.
Round 1/
In Round II the 32 participants were asked to rate the
importance and frequency of performing each of the job
function s and the importance of each competency as they
applied to their role as an agricultural health nurse. Twen-
ty four agricultural health nurses returned a completed
Round II survey. Respondents rated the importance and
frequency of performance of the 39 job function s identi-
fied in Round 1.
Importance was rated using a four point Likert scale,
while frequency of performance was rated using a five
point Likert scale. These two scores were then comb ined
(importance score + 2 frequency score) to get a mean task
index . Table I (page 343) summarizes the job functions
ranked according to mean task index score. The five job
function s with the highest mean task index were :
• Serve as a liaison between the agricultural , health and
medical , and the nonfarm communities.
• Promote agricultural health and safety issues through
the media.
• Conduct follow up assessment of injury, illness, or
disease occurring as a result of an agricultural exposure.
• Implement educational courses to various group s.
• Function as a resourc e for information to victims of
agricultural injury and illness and their familie s.
Among the job functions with the lowest mean index
score, reflecting a relatively low importance and frequency
of performance, were providing emergency and trauma care
services to farm injury and illness victims and providing or
assisting in the provision of appropriate surgical interven-
tions for farm injury victims. Respondents also rated each
of the 59 competencies identified in Round I using a four
342
30 28
25
19
20
Q;
.c 15
E
::J
10
o
Skills Knowledge Abilities and
Attitudes
Figure 2. Distribution of competencies identified by agri-
cultural health nurses (n = 32) by knowledge, skill, or abili-
ty and attitude, 1998.
point Likert scale (see Table 2 on page 344). The five com-
petencies of greatest importance to the agricultural health
nurse role were interpersonal communication skills, knowl-
edge of injury prevention principles and measures, ability to
recognize hazards that might create unsafe working and liv-
ing environment, written communication skills, and a
strong sense of self. Competencies with the lowest group
importance rating were ability to communicate bilingually
and having knowledge about the trauma registry.
DISCUSSION
Limitations of the Study
Use of a nonprobability sampling procedure may have
affected how representative the participants were to the
population of agricultural health nurses. With the assistance
of agricultural health and safety personnel from the Univer-
sity of Iowa's Institute for Rural and Environmental Health,
the Marshfield Clinic's National Farm Medicine Center,
and NIOSH in Ohio, a small sample population of agricul-
tural health nurses was identified. Using multiple sites and
regions of the country to identify potential participants
would enhance the generalizabilty of the study results. Par-
ticipants associated with the same agricultural health and
safety program may have similar views and experiences
influencing their definition of the agricultural health nurse
role. This may be of particular concern among those nurses
who had completed specialized educational classes as part
of their work. The response rate was less than optimal (i.e.,
36 of 61). While repeated attempts were made via phone to
contact nonrespondents, no additional description of these
participants was obtained. Therefore the results of this
study may not be representative of the total population.
Consistency with Prior Research
Many of the job functions and competencies identi-
fied by the agricultural health nurse participant s of this
AAOHN JOURNAL
 TABLE 1
Job Functions of Agricultural Health Nurses (n - 24)
Ranked by Mean Task Index, 1998
1. Serve as a liaison between the agricultural, health and medical, and nonfarm communities.
2. Promote agricultural health and safety issues to agricultural and nonagricultural communities through the
media, newsletters, and newspapers.
3. Implement educational course for various groups (e.g., health care professionals, agricultural workers, farm
families, school aged children, farm agribusiness persons, commodity groups).
4. Conduct follow up assessment of injury, illness, or disease occurring as a result of an agricultural exposure
(may include hospital chart review, conducting interviews with those affected or their families).
5. Function as a resource for information to victims of agricultural injury and illness and their families.
6. Function as a source of support for victims of agricultural injury and illness and their families.
7. Collaborate with other agencies to provide health services currently unavailable to agricultural populations.
8. Surveillance of agricultural injuries, illness, and diseases.
9. Conduct research to determine effectiveness of agricultural health and safety interventions.
10. Recommend or distribute appropriate personal protective equipment.
11. Serve on appropriate professional or community boards, committees, and councils.
12. Summarize findings or results of data gathering or research.
13. Serve as a health counselor.
14. Develop agricultural health and safety educational materials, curriculum, or programs.
15. Analyze data to describe issues associated with agricultural related diseases or injuries.
16. Act as a agricultural safety consultant or resource person.
17. Serve as a representative for agricultural health and safety at agricultural meetings or events.
18. Coordinate or perform health screening clinics or services.
19. Evaluate agricultural health and safety educational materials, curriculum, and programs.
20. Prepare written reports relative to agricultural health and safety activities.
21. Obtain health histories.
22. Obtain occupational health histories.
23. Prepare or monitor budget for agricultural health and safety program.
24. Complete grant applications or funding proposals to secure funds for agriculture related research, services,
or programs.
25. Conduct audiometric testing.
26. Perform physical health examinations.
27. Administer immunizations.
28. Publish written material in professional publications.
29. Conduct pulmonary function testing.
30. Serve as an advocate for agricultural health and safety issues through the legislative process.
31. Make appropriate health service referrals.
32. Manage staff of agricultural health and safety programs.
33. Perform occupational health examinations or assessment.
34. Collect information to determine if Worker Protection Standards (Environmental Protection Agency, 1992)
have been taught to agricultural workers and migrant workers.
35. Perform blood draws to test cholinesterase levels.
36. Assess communicable diseases and follow up or perform mandatory disease reporting.
37. Provide primary care to farmers, farm workers, and agricultural workers and their families.
38. Provide emergency and trauma care services to victims of farm injury or illness.
39. Provide or assist in providing appropriate surgical intervention to victims of farm injury.

JULY 2001, VOL. 49, NO.7 343

 TABLE 2
Competencies of Agricultural Health Nurses (n = 24)
Ranked in Order of Importance, 1998
1. Interpersonal communication skills.
2. Knowledge of injury prevention principles and measures.
3. Ability to recognize hazards that might create unsafe working/living environment.
4. Written communication skills.
5. Strong sense of self.
6. Knowledge of safety principles and how they relate to agricultural environments.
7. Flexibility and ability to perform multiple tasks or skills simultaneously.
8. Knowledge of agriculture related illnesses, injuries, and diseases.
9. Knowledge of and appropriate use of community resources to complement agricultural health programs.
10. Networking skills.
11. Leadership skills.
12. Knowledge of epidemiological principles.
13. Public speaking and presentation skills.
14. Knowledge gained from courses addressing issues affecting health, safety, and well being of agricultural
populations.
15. Knowledge of appropriate personal protective equipment for agricultural workers.
16. Ability and willingness to become involved in local community.
17. Knowledge and use of a team approach toward problem solving.
18. Knowledge of common disease processes.
19. Knowledge and use of nursing process in problem solving.
20. Knowledge of the hazards associated with handling chemicals.
21. Ability to work with various farm groups (e.g., extension, 4-H, farm bureau).
22. Patient assessment skills (e.g., biological, psychological, social, spiritual).
23. Knowledge of teaching principles and skill as an educator (e.g., use of equipment, creative educational strategies).
24. Ability to translate medical information into lay terms.
25. Use of investigative skills, including the ability to draw others into conversation.
26. Ability to express empathy toward clients.
27. Familiarity with health and safety regulations appropriate for agriculture related industries.
28. Management skills.
29. Research and data gathering skills.
30. Sense of spiritualism to assist in work with families of agricultural fatalities.
31. Computer knowledge and database management skills.
32. Community assessment skills.
33. Knowledge of normal human growth and development and the ability to recognize abnormal findings.
34. Knowledge of "anticipatory guidance" with injury prevention and health promotion being the primary focus.
35. Survey skills.
36. Ability to recognize cultural factors that may affect willingness to practice safety measures.
37. Knowledge of health screening skills (e.g., blood pressure, vision, ear examination).
38. Coalition building skills.
39. Knowledge of research methodologies.
40. Data analysis skills.
41. Case management skills.
42. Budgeting skills.
43. Marketing skills.
44. Knowledge of "family centered care."
45. Knowledge of occupational health theory and occupational health practice. Continued

344 AAOHN JOURNAL

.- - - -- - - -- -- - . --- .- - - .. ... .. _._. _.. . .-
TABLE 2 (Continued)
Competencies of Agricultural Health Nurses (n - 24)
Ranked in Order of Importance, 1998
46. Nursing background in public health.
47. Nursing background in occupational health.
48. Personal experience with farming or a farming background.
49. Ability to perform audiometric testing.
50. First aid or cardiopulmonary resuscitation certification.
51. Health policy development skills.
52. Knowledge of emergency care and trauma interventions for agricultural injuries and illnesses.
53. Nursing background in a rural hospital setting.
54. Ability to perform pulmonary function testing.
55. Certification in performing audiometric testing.
56. Knowledge of External Cause of Injury codes (E-codes) and International Classification of
Diseases-Code 9 (ICD 9).
57. Certification in performing pulmonary function testing.
58. Knowledge of trauma registry.
59. Ability to communicate bilingually.
study are consistent with job functions and competencies
identified through previous research addressing the role
delineation of public health and occupational health nurs-
ing. Comparison of the 39 agricultural health nurse job
functions (see Table 1 on page 343) with the 17 public
health nursing interventions identified by Keller (1998)
(Sidebar on page 338) revealed similarities, though some
of the interventions appear to apply to more than one agri-
cultural health nurse function.
Activity statements and knowledge statements iden-
tified by Burgel (1997) to be significantly different
among certified occupational health nurses of associate
degree or diploma and baccalaureate educational back-
ground were comparable to identified agricultural health
nurse functions and competencies. For instance, manage-
ment functions of preparing and monitoring budgets,
writing grants and reports, and managing staff were
reported as one of their top five functions only by agri-
cultural health nurses with a baccalaureate or higher.
Agricultural health nurses with diploma or associate
degrees were more likely to report clinical functions as
their top five than were baccalaureate or higher. The two
groups were equally represented in the educator role.
Job functions reported by participants can be com-
pared to agricultural health and safety efforts reported by
county health departments in Wisconsin (Chapman,
1996). The Wisconsin study identified how many county
health department nurses performed an identified type of
agricultural safety effort. The most prevalent safety effort
reported by these county health nurses was "health
screenings" (31% performed this function). However, in
the study reported in this article, when frequency and
importance of function were reported giving a mean task
index, "coordinate/perform health screening clinics/ser-
vices" ranked 18 of 39 functions (see Table 1 on page
JULY 2001, VOL. 49, NO.7
-- _.. ~. .. .-
343). While more types of clinical functions are reported
(17 of 39 functions, Figure 1 on page 342), 76% of the
clinical functions appear in the lower half of the ranking
by mean task index. Thus, while clinical functions are
performed by agricultural health nurses, reporting of the
frequency and importance of these functions may indicate
that clinical functions have less of an impact on the role of
the agricultural health nurse than previously identified.
Program specific role descriptions of the agricultur-
al health nurse have been completed, as with the OHNAC
program sponsored by NIOSH and IA-HASN Agricul-
tural Occupational Health Nurse training program (Ran-
dolph, 1993; Donham, 1997). Job functions and compe-
tencies identified through this study expand on the defin-
itions of the agricultural health nurse role as described by
agricultural health nurse programs. The program of the
OHNAC nurses to focus efforts on assisting health care
providers and farmers to recognize agriculture as a haz-
ardous industry (Connon, 1993) appears to be affirmed
by the two functions ranked highest in this study. Those
are to serve as a liaison between agricultural, health and
medical, and nonfarm communities; and promote agri-
cultural health and safety issues to agricultural and nona-
gricultural communities through the media, newsletters,
and newspapers. The top three ranked competencies of
agricultural health nurses in order of importance con-
tributing to those efforts are (see Table 2 on page 344):
• Interpersonal communication skills.
• Knowledgeof injury preventionprinciplesand measures.
• Ability to recognize hazards.
• Written communication skills.
Also noted is the competency "strong sense of self,"
reported as the fifth most important competency for agri-
cultural health nurses. These competencies are instru-
mental in reaching the goal of the OHNAC programs.
345
CONCLUSIONS AND RECOMMENDATIONS
Nurses have worked with agricultural populations for
several years, though there have been limited efforts to fully
define the job functions and competencies essential for
these nurses. This study reflects a limited exploration into
the definition of the agricultural health nurse role. Agricul-
tural health nurses work in a variety of settings and present
with varied educational backgrounds and work experi-
ences. Because of the small sample size of participants in
this study, an attempt to identify variances among the
respondent survey answers based on work experience was
not performed. Future research efforts may explore the
potential effect of these variables on perceived job func-
tions and competencies of the agricultural health nurse role.
Many of the functions and competencies identified by
the respondents are similar to those of the public health and
occupational health nursing roles, with services targeted
toward agricultural workers and those who provide services
for this population. Further research is needed to explore
whether there are job functions or essential competencies
unique to the agricultural health nurse role. The frequency
and importance of those functions must be considered to
better understand what knowledge, skills, and abilities and
attitudes are essential for successful integration of this role.
This would help assure a distinctive place within the health
care arena for the agricultural health nurse.
Finally, no attempt was made to assess the quality of
the services provided by the agricultural health nurse
respondents. Though a nurse may identify a particular area
of knowledge, a skill, or an ability or attitude as essential to
the agricultural health nurse role, this does not reflect the
nurse's mastery in performing the competency. Recent
efforts of AAOHN (White, 1999) resulted in the identifica-
tion of nine competency categories (i.e., clinical and prima-
ry care; case management; work force, workplace, and
environmental issues; regulatory and legislative manage-
ment; health promotion and disease prevention; occupa-
tional and environmental health and safety education; train-
ing; research; and professionalism). Each competency cate-
gory was then divided into levels of skill mastery (i.e., com-
petent, proficient, expert). If the agricultural health nurse
role is unique, future research should be directed toward
identifying competency categories as they apply to the role
and associated levels of mastery within these categories.
Funding was provided in part by the National Institute
for Occupational Safety and Health as part of the Midwest
Center for Occupational Health and Safety, and the Univer-
sity of Minnesota Agricultural Experiment Station. Assis-
tance of the University of Iowa's Institute for Rural and
Environmental Health, the Marshfield (Wisconsin) Clinic's
National Farm Medicine Center; and the National Institute
for Occupational Safety and Health in Ohio was helpful in
identifying potential research participants for this study.
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