Occupational Health Nursing --

Past, Present, Future

Sharon Kemerer, RN, MSN,

COHN-S

American Board for Occupational Health Nurses, Inc.

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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

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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.

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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?

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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 protection from occupational and environmental hazards.

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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

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Evolution of the OHN Role

Public Health approachReactive stereotype“Mixed bag” of todayWhat’s in our future?

» …….let’s take a closer look

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The Influence of Florence Nightingale

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Occupational Health Nursing-UKPhillipa Flowerday and the Phillipa Flowerday and the

JJ Coleman Company - 1878 JJ Coleman Company - 1878 26 shillings per week26 shillings per week Physician assistant Physician assistant Home careHome care

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Occupational Health Nursing - USAda Mayo Stewart, Ada Mayo Stewart,

Vermont Marble Co. - 1895Vermont Marble Co. - 1895 Primary carePrimary care Home visitsHome visits

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Growth in OHN Positions

1912 1918 1929 1939 1945 1997

# OHNs

0

5000

10000

15000

20000

25000

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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

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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

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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

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But what does the “public” know about OHNs?

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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

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Categories of Competence

Clinical care Case management Workforce, environmental issues Regulatory Management Health promotion Education Research Professionalism

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AAOHN Job Titles

OHN Clinician Case Manager OHS Coordinator Health Promotion Specialist Manager/Administrator Nurse Practitioner Corporate Director Consultant Educator Researcher

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AAOHN/AOHP OHN OHN membershipmembership organizationsorganizations Set standards of practice Set standards of practice Advocates for the profession --Advocates for the profession --

represent us in governmental affairs represent us in governmental affairs Provide continuing education and Provide continuing education and

professional development professional development

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ABOHN The OHN The OHN certificationcertification body body Over 10,000 nurses certified sinceOver 10,000 nurses certified since

1972 1972 Evaluates knowledge of Evaluates knowledge of

professional standards professional standards Research approachResearch approach

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Role Delineation Study ... Dictates the Exam Last completed in 1999/2000Last completed in 1999/2000 Basis of new test outlinesBasis of new test outlines Tells ABOHN what knowledge,Tells ABOHN what knowledge,

skills, and abilities are required for skills, and abilities are required for current practice in OHN current practice in OHN

Forms a significant basis for theForms a significant basis for the two credential system two credential system

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

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Highest Level of Educationby % of Respondents

0

20

40

60

AD or Diploma Bachelors or Higher

%

%

42% 58%

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Activities Ranked Significantly Different by Education

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

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Two Test Blueprints

COHN-S Clinician/Clinician/

Direct Care Direct Care ManagerManager EducatorEducator ConsultantConsultant Case ManagerCase Manager

COHN Clinician/Clinician/

Direct Care Direct Care AdvisorAdvisor CoordinatorCoordinator Case ManagerCase Manager

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What are we saying to business??

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What we know about us...

Very diverse practice Very diverse practice settings Interdisciplinary overlap Dynamically changing workplaces

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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

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Or even simpler…..

The OHN as

Health Risk Manager

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A Risk Management Approach

Injuries/Workers’ Compensation Chronic Illness/Toxic torts Regulatory Compliance/OSHA Criminal Prosecution

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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

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Critical Components Targeted programs Appropriate interventions Critical analysis of outcome data Up-to-date use of information

resources Active communication channels

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OHS Audit as the Foundation

Historical Review/Data collectionCurrent practice assessmentRecommendations/Action plan

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

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

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Action Plan Description of areas of concern Recommendations for improvement Clear identification of baseline

conditions Client participation requirements

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Risk Remediation

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

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The future for BUSINESS Globalization Fluid corporate definitions Downsizing Outsourcing Overlapping roles … wearing many

hats Economic justification and demands

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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

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Create a “Win-Win”