A Glimpse into the Life of an Occupational Health Nurse
Monday May 15, 2000
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MaryLou Mills, manager, Clinic Center, at the Environmental and Occupational Health Services, Newark, NJ, confers with staff nurse Susan Anastario, RN.
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Occupational health nurses (OHNs) work in a variety of settings and roles. They may be involved in education, research, management, or direct patient care. Some of the more common settings in which OHNs are employed are hospitals, freestanding occupational health clinics, theme parks, museums, pharmaceuticals, the communication industry, technology companies, and industries. "Regardless of where the OHN practices, he or she must have a strong knowledge-base of community resources and be able to connect employees and companies with these resources," says Gail Buckler, RN, MPH, COHN-S, an educator at the University of Medicine and Dentistry (UMDNJ) in New Brunswick, NJ, and clinical assistant professor in the School of Nursing and the director of the Occupational Health Track at Robert Wood Johnson Medical School, New Brunswick, NJ.
More Than Just Band-Aids
Health promotion and illness prevention are the two primary roles of the OHN in both white- and blue-collar industries. According to Buckler, "The OHN is often the first and only health professional that the employee has on the job, and sometimes, in life. He or she must be knowledgeable about a wide variety of issues, have excellent clinical skills, and be well-versed in specific occupational health regulations and issues." At the worksite, the OHN -
· implements and monitors surveillance programs to decrease risk of exposure to harmful substances or environments
· works to improve employee health and work conditions
· teaches employees emergency first aid and CPR, and creates emergency response teams
· provides first-aid and emergency care when needed
· provides follow-up and referral to employees as needed
· conducts worksite evaluations and identifies health-related trends at the worksite
· provides case management for worker's compensation injuries and nonwork-related disabilities.
The OHN may also counsel employees and offer referrals for persons who have substance abuse and mental health problems.
Educational and Certification Requirements
There are no specific educational requirements for OHNs. However, certification is required for most OHN positions and the American Board of Occupational Health Nurses is moving toward requiring bachelor's degree in nursing for certification eligibility.
Educational programs that prepare advanced practice nurses in occupational health often emphasize clinical experience and teaching skills. "Teaching is a major part of health promotion and illness prevention," says Buckler. "Having a critical care or emergency care background with an advanced cardiac life support (ACLS) certification is desirable. You need to be prepared when you are the only healthcare professional on site," she adds.
To transition into occupational health, Buckler recommends that you shadow an OHN for two days to really get a feel for what he or she does. She also suggests attending a state association meeting. "Make it known that you are interested. Get a sense of what's important to know, then get involved," she says.
Role of the Manager in Occupational Health Nursing
"The OHN manager role is totally different from the nursing role," says Mary Lou Mills, RN, BSN, COHN-S, OHN manager, Clinic Center, at the Environmental and Occupational Health Services Institute, Newark, NJ, a joint effort between Rutgers University and UMDNJ. According to Mills, "The diversity of health issues that you see and the variety of skills that an OHN needs are extremely high. Issues in the acute care setting spill over to the employee clinic setting." For example, an employee may have questions about his child who was diagnosed with viral meningitis; the OHN must have current knowledge of treatment and act as healthcare interpreter. The employee may be overwrought and may not be able to function at work. Acting as counselor and advocate, the OHN works with the individual and his or her supervisor to arrange for time off. The OHN must have the expertise to advise the employee and the company about the Family Medical Leave Act and how it applies to the employee's situation. If coworkers have questions about contracting contagious illnesses or have resentment about missed work time, the OHN educates and supports them.
"OHNs also play key roles in helping companies accommodate the disabled," says Mills. Often an employee can perform a certain job but may need workspace adjustments. OHNs interpret laws such as the Americans with Disabilities Act, and recommend building or workstation modifications. They may also arrange home health aide visits to assist disabled employees with hygiene and other daily care needs.
Managing and designing an occupational health program is complex. The OHN must continually assess the needs of the company and recommend changes in company policies when necessary.
The Nurse Practitioner in Occupational Health
"There's a clear difference between nurse practitioners (NPs) and RNs in occupational health," says Karen Van Varick-McGuire, MSN, RN, NP-C, COHN. Working with Lucent Technologies Corporate Headquarters, Murray, NJ. Van Varick-McGuire is more involved in direct patient care. She conducts occupational assessments and physical exams, writes prescriptions, and orders tests, x-rays, and treatments such as physical therapy. She treats occupational injuries and illnesses, and delivers primary care in collaboration with a physician. "We work as a team for the health and welfare of the employee and his or her family. The program's goal is to have the employee go home in as good a shape or better than when he arrived in the morning," says Van-Varick-McGuire.
Van Varick-McGuire sees employees from all work areas. The technical and administrative staff may complain of ergonomic problems such as carpal tunnel syndrome from working at a keyboard for long periods. When this situation arises she consults with an ergonomist, conducts a worksite assessment, treats the employee with wrist splints, refers the employee for physical therapy, writes a prescription for an antiinflamatory medication , and conducts a follow-up evaluation.
The NP also monitors the worksite employees for exposure to toxic chemicals. Periodically, when indicated, employees may undergo specific tests to detect pulmonary or other work-related illnesses. The NP orders the necessary tests, examines the employees, and make referrals to specialists when necessary. The NP works closely with the company to resolve any work-related issues.
According to Van Varick-McGuire, although OHNs work in different settings, they have one thing in common. "We spend a lot of time teaching and looking at the employee as a whole. We're patient advocates and customer-focused above all else."
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