Occupational Health
Nursing -Past, Present, Future
Sharon Kemerer, RN, MSN,
COHN-S
American Board for Occupational
Health Nurses, Inc.
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 approach
Reactive stereotype
“Mixed bag” of today
What’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 NursingUK
Phillipa Flowerday and the
JJ Coleman Company - 1878
 26 shillings per week
 Physician assistant
 Home care
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Occupational Health Nursing US
Ada Mayo Stewart,
Vermont Marble Co. - 1895
 Primary care
 Home visits
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Growth in OHN Positions
25000
20000
15000
10000
5000
0
1912 1918
1929 1939
1945 1997
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# OHNs
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 membership organizations
 Set standards of practice
 Advocates for the profession --
represent us in governmental affairs
 Provide continuing education and
professional development
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ABOHN
The OHN certification body
 Over 10,000 nurses certified since
1972
 Evaluates knowledge of
professional standards
Research approach
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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
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Demographic Information
95% female
90.2% Caucasian
Responses received from all states
Wide variety of industries
47.4 years of age as mean
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Highest Level of Education
by % of Respondents
60
%
40
%
20
0
AD or Diploma
42%
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Bachelors or Higher
58%
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
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Bachelors
 Establish goals and
objectives
 Recommend hazard
control measures
 Conduct cost/benefit
analysis
 Conduct job analysis
Two Test Blueprints
COHN
Clinician/
Direct Care
 Advisor
 Coordinator
 Case Manager
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COHN-S
Clinician/
Direct Care
 Manager
 Educator
 Consultant
 Case Manager
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
•
•
•
•
•
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Direct care
Manager
Educator
Case Manager
Consultant
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
collection
Current practice assessment
Recommendations/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”
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