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Introduction Public health nurses (PHNs) often serve as primary care providers, yet few studies have examined their practice patterns in the early detection of breast and cervical cancer. Methods We conducted a cross-sectional survey of all PHNs (N = 1,894) employed by the county health departments of North Carolina in July 1993 to describe the predictors of their performance of breast and cervical cancer early detection. The main outcome measures were self-report of cancer prevention and screening services provided for their adult clients, nursing self-confidence for counseling clients about cancer prevention, and training experience. Self-confidence for counseling clients about cancer prevention was measured by asking whether a nurse had sufficient knowledge to educate clients about cancer prevention as well as by obtaining nursing perception of the quality of their clinical skills. Results The response rate was 78%. Final sample consisted of 1,369 PHNs, after exclusion of 101 nurse practitioners. Nurses reported high performance rates of cancer screening, although self-rating of the quality of their clinical skills was often low. However, nurses who reported having higher quality clinical skills or who reported having sufficient knowledge to educate clients were significantly more likely to report a greater frequency of performing cancer screening and counseling. This self-confidence and performance association was independent of nursing certification to perform screening, job classification, education, knowledge, or continuing education coursework. Conclusions Self-confidence is a significant predictor of PHNs’ reported performance of cancer screening and counseling. Further studies to verify whether self-report predicts actual performance of cancer early detection are needed.