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

12/7/00 UofI Objectives 4 Describe the expanding scope of OHN practice and skills needed to met new OHN challenges 4 Identify the public health principles that guide OHN practice 4 Delineate current and future roles within occupational health nursing

12/7/00 UofI First……What is an OHN? 4 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.

12/7/00 UofI But…... 4 How do nurses enter OHN? 4 What aspects of the role are professionally attractive? 4 How would you describe the role? 4 How would you describe the “public health approach” to OHN?

12/7/00 UofI Definition of OHN 4 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.

12/7/00 UofI The Public Health Approach 4 Focus on prevention 4 Health teaching 4 Control and elimination of health hazards 4 Within the context of the community 4 The worksite is a community, or an important part of one

12/7/00 UofI Evolution of the OHN Role 4 Public Health approach 4 Reactive stereotype 4 “Mixed bag” of today 4 What’s in our future? »…….let’s take a closer look

12/7/00 UofI The Influence of Florence Nightingale

12/7/00 UofI Occupational Health Nursing- UK 4 Phillipa Flowerday and the JJ Coleman Company shillings per week 4 Physician assistant 4 Home care

12/7/00 UofI Occupational Health Nursing - US 4 Ada Mayo Stewart, Vermont Marble Co Vermont Marble Co Primary care 4 Home visits

12/7/00 UofI Growth in OHN Positions

12/7/00 UofI The WWII Boom 4 High production levels in industry 4 Low emphasis on safety 4 High level of Injuries 4 Government contracts 4 Parental role of the employer 4 OHNs a “benefit” for employees

12/7/00 UofI Emergence of the Reactive Stereotype 4 Immediate care for illness and injury 4 Lack of emphasis on causation 4 “Aspirin and Band-Aids” 4 “The knitter” 4 General public stereotype of nurses

12/7/00 UofI The OHN Today….. 4 A multifaceted health and safety professional 4 Wearing many “hats” 4 Role defined by the setting and needs of the business 4 Helping healthy adults to stay healthy and productive, within a business context

12/7/00 UofI But what does the “public” know about OHNs?

12/7/00 UofI The OHN Today (AAOHN) 4 Definition and Scope of Practice 4 Standards of Practice - new in 1999 –Clinical and professional practice standards combined 4 Competencies and performance criteria –Nine categories –Competent, Proficient and Expert levels

12/7/00 UofI Categories of Competence 4 Clinical care 4 Case management 4 Workforce, environmental issues 4 Regulatory 4 Management 4 Health promotion 4 Education 4 Research 4 Professionalism

12/7/00 UofI AAOHN Job Titles 4 OHN Clinician 4 Case Manager 4 OHS Coordinator 4 Health Promotion Specialist 4 Manager/Administrator 4 Nurse Practitioner 4 Corporate Director 4 Consultant 4 Educator 4 Researcher

12/7/00 UofI AAOHN/AOHP 4 OHN membership organizations 4 Set standards of practice 4 Advocates for the profession -- represent us in governmental affairs 4 Provide continuing education and professional development

12/7/00 UofI ABOHN 4 The OHN certification body 4 Over 10,000 nurses certified since Evaluates knowledge of professional standards 4 Research approach

12/7/00 UofI Role Delineation Study... Dictates the Exam 4 Last completed in 1999/ Basis of new test outlines 4 Tells ABOHN what knowledge, skills, and abilities are required for current practice in OHN 4 Forms a significant basis for the two credential system

12/7/00 UofI Demographic Information 4 95% 4 95% female % % Caucasian 4 Responses received from 4 Responses received from all states 4 Wide variety of industries years of age as mean years of age as mean

12/7/00 UofI Highest Level of Education by % of Respondents

12/7/00 UofI Activities Ranked Significantly Different by Education AD/Diploma 4 Provide primary care 4 Develop/maintain a system of employee health records 4 Conduct audiograms 4 Provide treatment for I&I Bachelors 4 Establish goals and objectives 4 Recommend hazard control measures 4 Conduct cost/benefit analysis 4 Conduct job analysis

12/7/00 UofI Two Test Blueprints COHN-S 4 Clinician/ Direct Care 4 Manager 4 Educator 4 Consultant 4 Case Manager COHN 4 Clinician/ Direct Care 4 Advisor 4 Coordinator 4 Case Manager

12/7/00 UofI What are we saying to business??

12/7/00 UofI What we know about us... 4 Very diverse practice 4 Very diverse practice settings 4 Interdisciplinary overlap 4 Dynamically changing workplaces

12/7/00 UofI So what IS our role? 4 A scatter diagram of skills and scientific foundations 4 “Jack of all trades, …..” 4 A simpler approach Direct care Manager Educator Case Manager Consultant

12/7/00 UofI Or even simpler….. The OHN as Health Risk Manager

12/7/00 UofI A Risk Management Approach 4 Injuries/Workers’ Compensation 4 Chronic Illness/Toxic torts 4 Regulatory Compliance/OSHA 4 Criminal Prosecution

12/7/00 UofI Steps in the Risk Management Process 4 Recognize potential liabilities 4 Design a multidisciplinary response 4 Communicate and get buy-in from the client 4 Take steps to reduce the risk 4 Measure effectiveness of interventions

12/7/00 UofI Critical Components 4 Targeted programs 4 Appropriate interventions 4 Critical analysis of outcome data 4 Up-to-date use of information resources 4 Active communication channels

12/7/00 UofI OHS Audit as the Foundation 4 Historical Review/Data collection 4 Current practice assessment 4 Recommendations/Action plan

12/7/00 UofI Historical Information 4 Company concerns/priorities 4 Company policy 4 Employee demographics 4 OSHA logs/inspections 4 Incident information 4 Insurance costs/Major claims

12/7/00 UofI Current Practices 4 Exposure documentation 4 Work practices 4 Health data 4 Data analysis 4 System walk-through

12/7/00 UofI Action Plan 4 Description of areas of concern 4 Recommendations for improvement 4 Clear identification of baseline conditions 4 Client participation requirements

12/7/00 UofI Risk Remediation 4 Priority setting --- joint 4 Expectations clearly identified 4 Guideline development 4 Implementation of the plan 4 Data analysis 4 Follow up and quality assurance

12/7/00 UofI The future for BUSINESS 4 Globalization 4 Fluid corporate definitions 4 Downsizing 4 Outsourcing 4 Overlapping roles … wearing many hats 4 Economic justification and demands

12/7/00 UofI The future for the OHN 4 Flexibility is key - let risk define the role 4 Link practice to business needs and priorities 4 Communicate the OHN role 4 “If you practice in 2001 like you did in 1991, you won’t have a job in 2002” 4 Economic sensitivity and reality

12/7/00 UofI Create a “Win-Win”