Occupational Health Nursing: Roles and Responsibilities

 
C
h
a
p
t
e
r
 
2
7
:
The Occupational Health Nurse
 
 
 
 
Compiled by Janvier Gasana
Associate Professor, Environmental and Occupational Health
Florida International University
 
Fundamentals of Industrial Hygiene
6
th
 Edition
 
Definition of the Occupational
Health Nurse
 
As of 2004, about 22,447 registered nurses provide care in
occupational health settings
Goal is to provide safe and healthy workplace for all, and to
protect human resources.
Occupational and environmental health nursing:
“Specialty practice that provides for and delivers health and safety
programs and services to workers, worker populations and
community groups.”
Occupational health nursing (OHN) is grounded in the
public health principles of primary, secondary, and tertiary
prevention
 
Scope of Practice
 
Occupational health nursing services include:
clinical care including assessment, diagnosis, management, and
documentation of illness and injury
case management
health hazard assessment and surveillance of employee populations,
workplaces, and community groups
investigation, monitoring, and analysis of illness and injury episodes
and trends, and methods to promote and protect employee health
and safety
compliance with laws, regulations, and standards
management and administration of occupational and environmental
health services
health promotion and disease prevention strategies
counselling, health education, and training programs
research related to occupational and environmental health
 
Practice of Occupational
Health Nursing
 
Several models for service delivery, from on-site salaried
personnel to off-site contractual arrangements
Scope of occupational health services depends on following
key industry variables:
company size and demographics of workforce
geographic distance to health care facility in community
type of industry (manufacturing vs. service)
hazard profile (review of OSHA 300 log, emergency response needs,
potential exposures/trends in claims)
risk management and health benefit philosophy of company
economic resources
self-insurance status for workers’ compensation and personal health
care
organizational climate, specifically regarding health, hazard
communication, and value of prevention activities
 
OHN Staffing and Outcomes
 
Some health issues employers face:
new health and safety regulations
hazards associated with new work processes
new environmental concerns
employment of temporary and contractual workers
musculoskeletal complaints in aging workforce
increase in obesity and diabetes in workforce
changing health care insurance system
 
OHN Staffing and Outcomes (cont.)
 
OHNs are well prepared to manage complex interactions
between health and work, while valuing prevention
agenda.
Knowledge of key players in addition to knowledge of
work process, allows for worksite interventions to improve
work environment
Majority of OHNs are employed by larger employers in
manufacturing and health care sectors
for smaller employers, OHN may be the only health care provider
on site
 
OHN Role and Levels of Prevention
 
OHN role requires knowledge, skills, and abilities in
following competencies:
clinical and primary care
case management
work force, workplace, and environmental issues
r
egulatory/legislative issues
management
health promotion and disease prevention
occupational and environmental health and safety education/training
research
professionalism
 
 
Programmatic Components
 
Primary prevention
pre-placement (post-offer) evaluations
immunizations
employee training
wellness programs
employee assistance programs
Secondary prevention
assessment and management of health complaints
health/medical surveillance
Tertiary prevention
case management
modified duty programs
Programs commonly managed by OHNs
workers’ compensation
Americans with Disabilities Act
recordkeeping
blood-borne pathogens
ergonomics
Evaluating outcomes of OHN activities
 
Primary Prevention
 
Pre-placement evaluation goal is to place workers in jobs
based on physical capabilities and make reasonable
accommodations, if needed, and stay in compliance with
ADA
Increasing immunization coverage for both adults and
children to prevent vaccine-related diseases—
Healthy
People 2020
 goal
More than 100 OSHA standards require employer to train
employees in health and safety
Employee Assistance Programs (EAPs) use both primary
and secondary prevention methods to recognize, assess,
treat, and refer employees with personal and mental health
problems that impact job performance
 
 
 
Secondary Prevention
 
Assessment and management of health complaints
Employee commonly has interaction with OHN for health complaint
(acute or chronic problem)
Screening
Tests aim for early detection of asymptomatic disease with goal that
treatment can render improved outcome
Health/medical surveillance
Occupational health surveillance is the process of monitoring health
status of worker populations to gather data about effects of workplace
exposures and to use data to prevent illness or injury
 
Tertiary Prevention
 
Case management = timely coordination of quality,
evidenced-based health services with goal to decrease
fragmentation of care, enhance client’s quality of life, and to
contain health care costs
Timely return to work, in temporary transitional or modified
duty assignments, is realistic outcome measure for case
management program targeting both non-work- and work-
related injuries and illnesses
Advocating for safe transitional work a major role for OHN
 
Common Programs Managed
 
Workers’ compensation
Job-related injuries cost employers billions of dollars per year in direct
workers’ compensation expenses:
medical care costs
temporary and permanent disability
vocational rehabilitation
medical-legal costs
Indirect costs
retraining replacement workers
lost productivity
workplace accommodation
other preventive efforts
Injured workers may sustain severe economic consequences from
workplace injuries, specifically in lost earnings, pain and functional
impairment, and decreased quality of life
 
Common Programs Managed (cont.)
 
Americans with Disabilities Act
About 43 million Americans have one or more physical or mental
disabilities
This population is targeted by ADA (Public Law No. 101336)
ADA, signed into law in 1991, prohibits discrimination against people
with disabilities in
employment
transportation
public accommodation
activities of state and local government
telecommunication relay services
 
OSHA Injury and Illness Recordkeeping Standard
Maintenance of OSHA 300 logs
Level of care and treatment provided to injured worker determines if
case is recorded on OSHA 300 log
First aid cases, as defined by OSHA, not recorded
Recordable conditions include:
every death,
every occupational illness and injury involving medical treatment beyond
first aid
lost time
work modification
job transfer
any loss of consciousness
 
Common Programs Managed (cont.)
 
Blood-borne Pathogens Program
OSHA Blood-borne Pathogens Standard, adopted in 1992, and
revised in 2001, requires employers to establish exposure control
plan for all employees who have occupational exposure to blood or
other potentially infectious materials.
It mandates
Use of universal precautions and
Provision of personal protective equipment by employer,
Safe needle disposal containers,
Self-sheathing needles, and
Safer medical devices.
Standard clarifies employer’s responsibility to provide, at no cost to
at-risk employees, hepatitis B vaccine series.
 
Common Programs Managed (cont.)
 
Ergonomics
OHNs often actively involved with ergonomic programs, both in office
and manufacturing settings
Practice of ergonomics involves work station evaluation, job analysis,
and training
Work-related musculoskeletal disorders are common in office,
manufacturing, or hospital setting, and are predominant in positions
with following risk factors:
force
repetition
duration
contact stressors
awkward postures
cold temperature
vibration
 
Common Programs Managed (cont.)
 
Evaluating Outcomes
 
Selected health outcome indicators for clinical care provided
to injured workers in occupational setting may include:
Access to care:
 Initial treatment for nonemergency work-related
conditions will be delivered within 24 hours after injury is reported.
Patient satisfaction:
 On a satisfaction survey, 85% of injured workers
identified the OHN as very to extremely helpful in answering questions
about workers’ compensation system.
Prima
ry prevention:
 High-risk health care workers will have
documentation in their pre-placement record of hepatitis B vaccination
offer/immunity.
Secondary
 prevention:
 Occupational health history is documented in
90% of those medical records of employees with occupational injury;
or chart documentation of ergonomic evaluation is in place within 1
week of diagnosis of work-related upper extremity complaint.
Tertiary
 prevention:
 Sustained return to work, without re-injury, for 90
days after release to return to work; or litigated cases decreased to
five percent after OHN case management intervention.
 
Organizational outcomes include economic indicators in
addition to productivity metrics.
Selected organizational/economic indicators for
occupational health services may include
injury experience
corrective action
productivity as measured by Stanford presenteeism scale and/or the
Work Limitations Questionnaire
sickness absence measures
worker engagement/job satisfaction measures
 
Evaluating Outcomes (cont.)
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Occupational Health Nursing involves providing health and safety programs and services to workers and communities, grounded in public health principles. It includes clinical care, case management, health hazard assessment, compliance with regulations, health promotion, and research. The practice's scope varies based on industry variables like company size, hazard profiles, and organizational climate. Employers face challenges like new regulations, environmental concerns, workforce health issues, and changing insurance trends.


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  1. Fundamentals of Industrial Hygiene 6th Edition Chapter 27: The Occupational Health Nurse Compiled by Janvier Gasana Associate Professor, Environmental and Occupational Health Florida International University

  2. Definition of the Occupational Health Nurse As of 2004, about 22,447 registered nurses provide care in occupational health settings Goal is to provide safe and healthy workplace for all, and to protect human resources. Occupational and environmental health nursing: Specialty practice that provides for and delivers health and safety programs and services to workers, worker populations and community groups. Occupational health nursing (OHN) is grounded in the public health principles of primary, secondary, and tertiary prevention

  3. Scope of Practice Occupational health nursing services include: clinical care including assessment, diagnosis, management, and documentation of illness and injury case management health hazard assessment and surveillance of employee populations, workplaces, and community groups investigation, monitoring, and analysis of illness and injury episodes and trends, and methods to promote and protect employee health and safety compliance with laws, regulations, and standards management and administration of occupational and environmental health services health promotion and disease prevention strategies counselling, health education, and training programs research related to occupational and environmental health

  4. Practice of Occupational Health Nursing Several models for service delivery, from on-site salaried personnel to off-site contractual arrangements Scope of occupational health services depends on following key industry variables: company size and demographics of workforce geographic distance to health care facility in community type of industry (manufacturing vs. service) hazard profile (review of OSHA 300 log, emergency response needs, potential exposures/trends in claims) risk management and health benefit philosophy of company economic resources self-insurance status for workers compensation and personal health care organizational climate, specifically regarding health, hazard communication, and value of prevention activities

  5. OHN Staffing and Outcomes Some health issues employers face: new health and safety regulations hazards associated with new work processes new environmental concerns employment of temporary and contractual workers musculoskeletal complaints in aging workforce increase in obesity and diabetes in workforce changing health care insurance system

  6. OHN Staffing and Outcomes (cont.) OHNs are well prepared to manage complex interactions between health and work, while valuing prevention agenda. Knowledge of key players in addition to knowledge of work process, allows for worksite interventions to improve work environment Majority of OHNs are employed by larger employers in manufacturing and health care sectors for smaller employers, OHN may be the only health care provider on site

  7. OHN Role and Levels of Prevention OHN role requires knowledge, skills, and abilities in following competencies: clinical and primary care case management work force, workplace, and environmental issues regulatory/legislative issues management health promotion and disease prevention occupational and environmental health and safety education/training research professionalism

  8. Programmatic Components Primary prevention pre-placement (post-offer) evaluations immunizations employee training wellness programs employee assistance programs Secondary prevention assessment and management of health complaints health/medical surveillance Tertiary prevention case management modified duty programs Programs commonly managed by OHNs workers compensation Americans with Disabilities Act recordkeeping blood-borne pathogens ergonomics Evaluating outcomes of OHN activities

  9. Primary Prevention Pre-placement evaluation goal is to place workers in jobs based on physical capabilities and make reasonable accommodations, if needed, and stay in compliance with ADA Increasing immunization coverage for both adults and children to prevent vaccine-related diseases Healthy People 2020 goal More than 100 OSHA standards require employer to train employees in health and safety Employee Assistance Programs (EAPs) use both primary and secondary prevention methods to recognize, assess, treat, and refer employees with personal and mental health problems that impact job performance

  10. Secondary Prevention Assessment and management of health complaints Employee commonly has interaction with OHN for health complaint (acute or chronic problem) Screening Tests aim for early detection of asymptomatic disease with goal that treatment can render improved outcome Health/medical surveillance Occupational health surveillance is the process of monitoring health status of worker populations to gather data about effects of workplace exposures and to use data to prevent illness or injury

  11. Tertiary Prevention Case management = timely coordination of quality, evidenced-based health services with goal to decrease fragmentation of care, enhance client s quality of life, and to contain health care costs Timely return to work, in temporary transitional or modified duty assignments, is realistic outcome measure for case management program targeting both non-work- and work- related injuries and illnesses Advocating for safe transitional work a major role for OHN

  12. Common Programs Managed Workers compensation Job-related injuries cost employers billions of dollars per year in direct workers compensation expenses: medical care costs temporary and permanent disability vocational rehabilitation medical-legal costs Indirect costs retraining replacement workers lost productivity workplace accommodation other preventive efforts Injured workers may sustain severe economic consequences from workplace injuries, specifically in lost earnings, pain and functional impairment, and decreased quality of life

  13. Common Programs Managed (cont.) Americans with Disabilities Act About 43 million Americans have one or more physical or mental disabilities This population is targeted by ADA (Public Law No. 101336) ADA, signed into law in 1991, prohibits discrimination against people with disabilities in employment transportation public accommodation activities of state and local government telecommunication relay services

  14. Common Programs Managed (cont.) OSHA Injury and Illness Recordkeeping Standard Maintenance of OSHA 300 logs Level of care and treatment provided to injured worker determines if case is recorded on OSHA 300 log First aid cases, as defined by OSHA, not recorded Recordable conditions include: every death, every occupational illness and injury involving medical treatment beyond first aid lost time work modification job transfer any loss of consciousness

  15. Common Programs Managed (cont.) Blood-borne Pathogens Program OSHA Blood-borne Pathogens Standard, adopted in 1992, and revised in 2001, requires employers to establish exposure control plan for all employees who have occupational exposure to blood or other potentially infectious materials. It mandates Use of universal precautions and Provision of personal protective equipment by employer, Safe needle disposal containers, Self-sheathing needles, and Safer medical devices. Standard clarifies employer s responsibility to provide, at no cost to at-risk employees, hepatitis B vaccine series.

  16. Common Programs Managed (cont.) Ergonomics OHNs often actively involved with ergonomic programs, both in office and manufacturing settings Practice of ergonomics involves work station evaluation, job analysis, and training Work-related musculoskeletal disorders are common in office, manufacturing, or hospital setting, and are predominant in positions with following risk factors: force repetition duration contact stressors awkward postures cold temperature vibration

  17. Evaluating Outcomes Selected health outcome indicators for clinical care provided to injured workers in occupational setting may include: Access to care: Initial treatment for nonemergency work-related conditions will be delivered within 24 hours after injury is reported. Patient satisfaction: On a satisfaction survey, 85% of injured workers identified the OHN as very to extremely helpful in answering questions about workers compensation system. Primary prevention: High-risk health care workers will have documentation in their pre-placement record of hepatitis B vaccination offer/immunity. Secondary prevention: Occupational health history is documented in 90% of those medical records of employees with occupational injury; or chart documentation of ergonomic evaluation is in place within 1 week of diagnosis of work-related upper extremity complaint. Tertiary prevention: Sustained return to work, without re-injury, for 90 days after release to return to work; or litigated cases decreased to five percent after OHN case management intervention.

  18. Evaluating Outcomes (cont.) Organizational outcomes include economic indicators in addition to productivity metrics. Selected organizational/economic indicators for occupational health services may include injury experience corrective action productivity as measured by Stanford presenteeism scale and/or the Work Limitations Questionnaire sickness absence measures worker engagement/job satisfaction measures

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