Preserving health in the Marcellus region.

Community health nurses (CHNs) have an opportunity and responsibility to address potential environmental health issues related to shale drilling, even in the face of scientific uncertainty. Potential health impacts to air and water quality related to shale drilling are addressed within the context of the CHNs role of educator, case finder, advocate and researcher. Since 2005, an estimated 5,500 unconventional natural gas wells have been drilled in Pennsylvania's Marcellus Shale (Pennsylvania Department of Environmental Protection [PA DEP], n.d.), resulting in tremendous controversy throughout the state regarding impacts to human health and the environment. Although there are numerous anecdotal reports of illnesses in humans and animals living in drilling areas, there is a notable lack of peer-reviewed research on the impacts. Research efforts are underway to study these issues, including a proposed retrospective study of hospital and clinic data by Geisinger Health System's Weis Center for Research (Begos, 2012). However, CHNs have the opportunity and the responsibility to help address potential environmental health issues related to shale drilling, even in the face of scientific uncertainty. This responsibility is highlighted by the American Nurses Association's (ANA) (2003, p. 2) adoption of the Precautionary Principle, which states that "when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." CHN practice includes the promotion and preservation of health, and the prevention of disease, as well as assisting people in their response to illness (Maurer & Smith, 2009). In Pennsylvania's Marcellus Shale regions, CHNs must assume the critical nursing roles of educator, case finder, advocate and researcher when addressing the health needs in shale drilling communities. Unfortunately, CHNs practicing within these regions may feel unprepared to take on these roles related to unconventional gas extraction. The following discusses these CHN roles in the context of environmental health impacts of shale drilling on air and water quality.