Occupational Health Nursing -- Past, Present, Future

1. Occupational Health Nursing --Past, Present, Future Sharon Kemerer, RN, MSN, COHN-S American Board for Occupational Health Nurses, Inc.

2. Objectives • Describe the expanding scope of OHN practice and skills needed to met new OHN challenges • Identify the public health principles that guide OHN practice • Delineate current and future roles within occupational health nursing

3. First……What is an OHN? • OHN is the specialty practice that provides for and delivers health and safety services to employees, employee populations, and community groups. The practice focuses on promotion and restoration of health, prevention, and protection from occupational and environmental hazards.

4. But…... • How do nurses enter OHN? • What aspects of the role are professionally attractive? • How would you describe the role? • How would you describe the “public health approach” to OHN?

5. Definition of OHN • OHN is the specialty practice that provides for and delivers health and safety services to employees, employee populations, and community groups. The practice focuses on promotion and restoration of health, prevention, and protectionfrom occupational and environmental hazards.

6. The Public Health Approach • Focus on prevention • Health teaching • Control and elimination of health hazards • Within the context of the community • The worksite is a community, or an important part of one

7. Evolution of the OHN Role • Public Health approach • Reactive stereotype • “Mixed bag” of today • What’s in our future? • …….let’s take a closer look

8. The Influence of Florence Nightingale

9. Occupational Health Nursing-UK • Phillipa Flowerday and the JJ Coleman Company - 1878 • 26 shillings per week • Physician assistant • Home care

10. Occupational Health Nursing - US • Ada Mayo Stewart, Vermont Marble Co. - 1895 • Primary care • Home visits

11. Growth in OHN Positions

12. The WWII Boom • High production levels in industry • Low emphasis on safety • High level of Injuries • Government contracts • Parental role of the employer • OHNs a “benefit” for employees

13. Emergence of the Reactive Stereotype • Immediate care for illness and injury • Lack of emphasis on causation • “Aspirin and Band-Aids” • “The knitter” • General public stereotype of nurses

14. The OHN Today….. • A multifaceted health and safety professional • Wearing many “hats” • Role defined by the setting and needs of the business • Helping healthy adults to stay healthy and productive, within a business context

15. But what does the “public” know about OHNs?

16. The OHN Today (AAOHN) • Definition and Scope of Practice • Standards of Practice - new in 1999 • Clinical and professional practice standards combined • Competencies and performance criteria • Nine categories • Competent, Proficient and Expert levels

17. Categories of Competence • Clinical care • Case management • Workforce, environmental issues • Regulatory • Management • Health promotion • Education • Research • Professionalism

18. AAOHN Job Titles • OHN Clinician • Case Manager • OHS Coordinator • Health Promotion Specialist • Manager/Administrator • Nurse Practitioner • Corporate Director • Consultant • Educator • Researcher

19. AAOHN/AOHP • OHN membershiporganizations • Set standards of practice • Advocates for the profession -- represent us in governmental affairs • Provide continuing education and professional development

20. ABOHN • The OHN certification body • Over 10,000 nurses certified since 1972 • Evaluates knowledge of professional standards • Research approach

21. Role Delineation Study ... Dictates the Exam • Last completed in 1999/2000 • Basis of new test outlines • Tells ABOHN what knowledge, skills, and abilities are required for current practice in OHN • Forms a significant basis for the two credential system

22. Demographic Information • 95% female • 90.2% Caucasian • Responses received from all states • Wide variety of industries • 47.4years of age as mean

23. Highest Level of Educationby % of Respondents

24. AD/Diploma Provide primary care Develop/maintain a system of employee health records Conduct audiograms Provide treatment for I&I Bachelors Establish goals and objectives Recommend hazard control measures Conduct cost/benefit analysis Conduct job analysis Activities Ranked Significantly Different by Education

25. COHN-S Clinician/ Direct Care Manager Educator Consultant Case Manager COHN Clinician/ Direct Care Advisor Coordinator Case Manager Two Test Blueprints

26. What are we saying to business??

27. What we know about us... • Very diverse practice • Very diverse practice settings • Interdisciplinary overlap • Dynamically changing workplaces

28. So what IS our role? • A scatter diagram of skills and scientific foundations • “Jack of all trades, …..” • A simpler approach • Direct care • Manager • Educator • Case Manager • Consultant

29. Or even simpler….. The OHN as Health Risk Manager

30. A Risk Management Approach • Injuries/Workers’ Compensation • Chronic Illness/Toxic torts • Regulatory Compliance/OSHA • Criminal Prosecution

31. Steps in the Risk Management Process • Recognize potential liabilities • Design a multidisciplinary response • Communicate and get buy-in from the client • Take steps to reduce the risk • Measure effectiveness of interventions

32. Critical Components • Targeted programs • Appropriate interventions • Critical analysis of outcome data • Up-to-date use of information resources • Active communication channels

33. OHS Audit as the Foundation • Historical Review/Data collection • Current practice assessment • Recommendations/Action plan

34. Historical Information • Company concerns/priorities • Company policy • Employee demographics • OSHA logs/inspections • Incident information • Insurance costs/Major claims

35. Current Practices • Exposure documentation • Work practices • Health data • Data analysis • System walk-through

36. Action Plan • Description of areas of concern • Recommendations for improvement • Clear identification of baseline conditions • Client participation requirements

37. Risk Remediation • Priority setting --- joint • Expectations clearly identified • Guideline development • Implementation of the plan • Data analysis • Follow up and quality assurance

38. The future for BUSINESS • Globalization • Fluid corporate definitions • Downsizing • Outsourcing • Overlapping roles … wearing many hats • Economic justification and demands

39. The future for the OHN • Flexibility is key - let risk define the role • Link practice to business needs and priorities • Communicate the OHN role • “If you practice in 2001 like you did in 1991, you won’t have a job in 2002” • Economic sensitivity and reality

40. Create a “Win-Win”