Navy Occupational Health Nursing 101

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Navy Occupational Health Nursing 101

• Denise M. Mullins, RN, COHN
• Navy Marine Corps Public Health
• NMCPHC
• OEM Directorate

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SLIDE INDEX
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STATISTICS
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What is Occupational Health Nursing?

• Upon doing some Internet searching for the most
  common definition of Occupational Health
  Nursing.5,850,000 hits?!?

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Statistics

• Registered nurses constitute the largest health
  care occupation, with 2.4 million jobs (OSHA
  2007)
• There are currently 6,800 active Certified
  Occupational Health Nurses (COHN/COHN-S) ABOHN
  2006
• .00283 or 2/10th of 1
• Practicing Certified RNs in Occ Health!

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DEFINITION
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So what IS the definition of Occupational
Health Nursing?

• AAOHNthe American Association of Occupational
  Health Nurses
• Occupational and environmental health nursing is,
  "the specialty practice that provides for and
  delivers health and safety services to employees,
  employee populations, and community groups
• OSHAUnited States Department of Labor (DOL)
  Occupational Safety Health Administration
• Occupational Health Nurses (OHN)s are registered
  nurses who independently observe and assess the
  worker's health status with respect to job tasks
  and hazards. Using their specialized experience
  and education, these registered nurses recognize
  and prevent health effects from hazardous
  exposures and treat workers' injuries/illnesses.

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So what IS the definition of Occupational
Health Nursing?

• Since 1950, the International Labour Organization
  (ILO) and the World Health Organization (WHO)
  have had a common definition of occupational
  health.
• This definition was adopted by the Joint ILO/WHO
  Committee on Occupational Health at its First
  Session (1950) and revised at its 12th Session
  (1995) "Occupational health should aim at the
  promotion and maintenance of the highest degree
  of physical, mental and social well-being of
  workers in all occupations the prevention
  amongst workers of departures from health caused
  by their working conditions the protection of
  workers in their employment from risks resulting
  from factors adverse to health the placing and
  maintenance of the worker in an occupational
  environment adapted to his physiological and
  psychological capabilities and, to summarize,
  the adaptation of work to man and of each man to
  his job."
• In fact the World Health Organization (WHO) has
  entire document devoted to us! A favorite
  section heading is The occupational health nurse
  as a unique frontliner
• The whole 76 pagedocument is titled The Role of
  the Occupational Health Nurse in Workplace Health
  Management

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MOST IMPORTANTLY..

• Our main priority is the health and well-being
  of our Navy and Marine Corps personnel in the
  workplace, said Lori OBerry, senior
  occupational health nurse consultant, Navy
  Environmental Health Center (NEHC), Portsmouth,
  Va. Whether coping with injuries suffered on the
  job, work-related stress, or promoting safe work
  environment practices, our nurses are there to
  assist with the best medical care possible.
  from Navy Newstand, Navy Occupational Health
  Nurse Program Promotes Healthy Workplace
  Environment, Story Number NNS050722-07, Release
  Date 7/21/2005

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Occupational Health Nursing

• CAN BE.
• Fun
• Rewarding
• Challenging
• Enriching
• Frustrating
• Fast-paced
• Multi-tasked

• IS NOT.
• Dull
• Mindless
• Repetitive
• Boring
• Easy
• Slow
• Single-tasked

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I am already a RN, what more does it take to be
an OHN?
THE CURIOSITY THE CHALLENGE THE CALL
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THE CURIOSITY

• Have you ever wondered?
• How some employees can get money for getting ill
  or injured and other cant?
• How your Command can be fined or cited for safety
  or health violations?
• How many times does it take to explain a process
  before employees can perform it safely?
• How many rules or instructions can be
  incorporated into one process at a time?
• How to do seven things at one time and like it?

• Are you interested in?
• Case management
• Counseling and crisis intervention
• Health promotion
• Legal and regulatory compliance
• Worker and workplace hazard detection

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THE CHALLENGE

• Occupational health nursing requires a broad
  knowledge base not only in assessment and
  treatment of injured workers but also in public
  health issues and regulatory requirements of the
  workers in the workplace. The occupational health
  nurse must be knowledgeable in work-place hazards
  as well as injury and illness prevention, often
  for multiple commands or processes. Instead of
  caring for patients, he/she will develop a
  trusting relationship with the injured worker to
  facilitate healing and safe return to full duty.
  All of this is done while communicating and
  advocating for your commands rights and the
  safety of the whole workforce while maintaining
  confidentiality according to state and federal
  regulations and practice standards.
• The occupational health nurse must also become
  knowledgeable in the management of infectious and
  toxic exposures and the management of
  pre-placement screening, certification and
  surveillance exams again adhering to the
  regulations that govern this practice. If the
  clinic provides on-site services, the nurse must
  learn the specific types of services provided and
  the policies and procedures that govern their
  delivery for the command where she is assigned.
  This nurse should also possess good teaching
  skills for both one-on-one and group instruction
  on safety, wellness and prevention.

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THE CHALLENGE

• Perhaps most importantly, the occupational health
  nurse will need the ability to think and act
  independently and have good interpersonal skills
  to navigate command politics. At times, these
  politics may place the OHN in direct opposition
  to their own chain of command, or supported
  command officers, medical providers and other
  health care personnel, employee supervisors and
  co-workers, and sometimes even the employee
  themselves. In these instances, federal
  regulations, command instruction and the local
  occupational health policies and procedures must
  be communicated tactfully and followed, unless
  the medical director determines there is a
  substantially compelling reason to make an
  exception. Depending on the OHNs placement, he
  or she may be isolated from a direct
  organizational support network, so they must be
  able to navigate turbulent waters independently
  but know when to appropriately involve or inform
  others.

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THE CALLToday, the primary objectives of
Occupational Health Nursing include the
following

• 1. Prevention of work-related illness and
  injuries though a systematic process of
  assessment, data collection, planning,
  intervention and evaluation.
• 2. Evaluation and treatment of work-related
  injury or illness.
• 3. Promotion of health and safety activities
  among workers.
• 4. Advocacy within in the workplace in terms of
  environmental concerns as they relate to the
  workers, their families and the community
• 5. Development and maintenance of an adequate
  record system
• 6. Development of statistical and
  epidemiological data for relevant program
  development and evaluation
• 7. Developing and evaluating programs to meet
  the identified health needs of individuals
  acting as a resource to the health and safety
  committee and management
• 8. . Interpreting and promoting conformity to
  legislation

IMPORTANT READING AMERICAN ASSOCIATION OF
OCCUPATIONAL HEALTH NURSES THE OCCUPATIONAL AND
ENVIRONMENTAL HEALTH NURSING PROFESSION FAQ SHEET
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STANDARDS OF PRACTICE

• As nurses we all know
• 1. The are the traditional Standards of Nursing
  Practice established by the American Nurses
  Association and for each state you are licensed
  in (i.e. Florida Nursing Practice Act) that
  govern how we practice nursing.
• 2. There is a Code of Ethics for Nurses
• 3. The is standardized competency for the
  practice of registered nursing from the various
  regulatory bodies including your own Command
  level (click here for example)! which will
  covered later in this program

• But did you know?
• 1. There are specific Standards of Practice for
  Occupational Health Nurses established
  by the AAOHN (American Association of
  Occupational Health Nurses)?
• 2. There is a specific Code of Ethics?
• 3. And there are specific competency standards
  for Occupational Health Nurses?

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SPECIAL SKILLSfor Specialty Nurses
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What special skills are required of Navy OHN's

• Certification as a Hearing Conservationist (NEHC
  approved hearing conservation course)
• http//www-nehc.med.navy.mil/occmed/AUDIOTNG.HTM
• Certification in NIOSH Spirometry (NEHC approved
  spirometry course)
• http//www-nehc.med.navy.mil/occmed/spirotrn.htm

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What special skills are recommended for Navy OHNs

• COHN or COHN-S
• http//www.abohn.org/
• Ergonomics
• http//www.safetycenter.navy.mil/training/coursede
  tail05-nsc.cfm?IDNavy20Ergonomics20Program
• Workers Compensation FECA
• http//www.dol.gov/esa/regs/compliance/owcp/fecaco
  nt.htm
• Environmental Exposure History
• http//www.atsdr.cdc.gov/HEC/CSEM/exphistory/docs/
  exposure_history.pdf

And many others
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REGULATIONS AND INSTRUCTIONS
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To everything there is a season and an
instruction (or regulation, law, policy.)
(These are not listed by level of importance nor
is this is by no means an all inclusive list!!)

• CFRCODES OF FEDERAL REGULATIONS (MANY TITLES
  I.E.) Title 29 CFR 1910, Occupational Safety and
  Health Standards
• OCCUPATIONAL MEDICINE PROGRAM ASSESSMENT (OMPA)
  IMPLEMENTATION GUIDE
• OPNAVINST 5100.23 series Navy Occupational Safety
  and Health (NAVOSH) Program Manual for Ashore
• OPNAVINST 5100.19 series, Navy Occupational
  Safety and Health (NAVOSH) Program Manual for
  Forces Afloat
• DOD Instruction 6055.5
• NEHC Technical Manual, Industrial Hygiene Field
  Operations Manual, latest revision
• AIHA A Strategy for Occupational Exposure
  Assessment, latest revision
• PC MATRIX Medical Surveillance Procedure Manual
  and Medical Matrix, latest revision.
• NAVMED P-5010, Manual of Naval Preventive
  Medicine
• NEHC 6260 TM-96-2 Occupational and Environmental
  Medicine Field Operations Manual
• Department of Labor Publication CA-810, Injury
  Compensation for Federal Employees
• Public Law 106430
• NAVMED P-117 MANMED, Manual of the Medical
  Department
• NAVMED P-5055--Radiation Health Protection Manual
• AND MANY, MANY MORE..

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OVERWHELMING?
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THE BASICS(You MUST have access to these EASILY)

• OPNAVINST 5100.23 series Navy Occupational Safety
  and Health (NAVOSH) Program Manual for Ashore
• YOU SHOULD HAVE THIS ON YOUR COMPUTER AND AS A
  HARD COPY!
• Have this one if NO OTHER!!!!
• NEHC 6260 TM-96-2 Occupational and Environmental
  Medicine Field Operations Manual
• YOU SHOULD HAVE THIS ON YOUR COMPUTER AND AS A
  HARD COPY!
• PC MATRIX Medical Surveillance Procedure Manual
  and Medical Matrix, latest revision.

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The REST

• You do not need copies of the rest of the
  important instructions or regulations.
• BUT
• YOU SHOULD KNOW WHERE AND HOW TO ACCESS THEM
• HINT.HINT
• If you go back three (3) slidestry the
  hyperlinks ?

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So with this many rulesWho really is charge
here?THE PECKING ORDER
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You are here
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That is a lot Who do you really need to know
and why?

• NETWORKING

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Essentially the RISK MANAGER helps protect the
command or organization both internally and
externally from things that threaten its
integrity. That includes the property, the
assets, and the people. Applying the risk
management model of risk identification,
assessment, measurement, mitigation and
monitoring to the satisfaction of management and
governance makes risk management a vital
corporate function. Risk Management evaluates
and trends the mishaps and results of safety
investigations. They can put numbers to how
effective your clinic is handling injuries and
illnesses.
MEDICAL SUPPORT PERSONNEL provide you with the
ancillary and support services you need to
complete your examinations. They may also be
your ANP, PA, or MD Medical support is vital.
In emergencies and just to ensure that you are
compliant with all of your required needs.
employee also employe     ( m-ploi , m-, m
ploi- ) NOUN A person who works for another
in return for financial or other compensation.
Your patient!
YOU!! THE STAR, THE BRIDGE BETWEEN ALL OF THE
TEAM MEMBERS!!

• Industrial Hygienists evaluate health hazards in
  the work environment and make recommendations in
  an effort to keep employees safe from any
  potential health hazard. They use their
  specialized training to anticipate, evaluate, and
  control any health hazard that may exist in
  industry, government organizations, the
  community, or the environment.
• INDUSTRIAL HYGIENE SURVEYS DETERMINE WHICH
  EMPLOYEES ARE ON YOUR MEDICAL SURVEILLANCE
  PROGRAMS.

A safety professional is a person engaged in the
prevention of accidents, incidents, and events
that harm people, property, or the environment.
They use qualitative and quantitative analysis of
simple and complex products, systems, operations,
and activities to identify hazards. They evaluate
the hazards to identify what events can occur and
the likelihood of occurrence, severity of
results, risk (a combination of probability and
severity), and cost. They identify what controls
are appropriate and their cost and effectiveness.
Safety professionals make recommendations to
managers, designers, employers, government
agencies, and others. SAFETY PROFESSIONALS
DETERMINE WHICH EMPLOYEES ARE IN YOUR MEDICAL
CERTIFICATION PROGRAMS. THEY ALSO INVESTIGATE
WORK-RELATED INJURIES AND ILLNESSES.
Injury Compensation Program Administrator
(ICPA) Identify partially recovered employees
through review of medical documentation. Request
and advise on restructuring positions from
supervisors and managers. Coordinate with Office
of Workers' Compensation Program (OWCP)
Nurse Intervention (when assigned) to assist in
position design. Coordinate with Safety
Occupational Health (SOH) as necessary to assist
in position design based on treating physician
restrictions (unless OWCP Nurse Intervention is
assigned.) Offer the position to the employee in
writing (a verbal offer is appropriate only when
followed up with a written offer.) Report on a
quarterly basis, the status of each employee
funded through the Program ICPA manages your
employees that have filed any type of workers
compensation. They are the purse string holders.
UNION REPS
LABOR RELATIONS
RISK MANAGMENT
ICPA
OHN
HRO
One team...One mission
HUMAN RESOURCES are the experts in applying
personnel recruitment and placement procedures,
policies, rules, regulations, laws and practices
to provide advice/guidance to managers and
employees. They handle employee benefits and
personnel record management HRO request pre-hire
or pre-placement examinations. They also help
with fitness for duty and processing workers
compensation documents.
Labor-Management Relations regularly consult at
the national level with labor organizations,
agency managers and labor relations officials in
the development of human resource policy and on
Government rules, regulations, and binding
directives affecting conditions of
employment. Labor Relations will request fitness
for duty examinations. They determine that
employee and employer rights responsibilities
are adhered to in disputes.
supervisor     (s p r-v z r)  NOUN One
who supervises. One who is in charge of a
particular department or unit, as in a
governmental agency or school system. One who is
an elected administrative officer in certain U.S.
counties and townships. Supervisors support and
enforce your needs and requirements and findings
to ensure their employees safety and health!!!
In general, most UNION REPS perform the following
functions Monitor and enforce the provisions of
the collective bargaining agreement (labor
contract) to ensure both the firm and union
worker are not violating the terms of the
agreement. Ensure that the firm is in compliance
with all federal, state and local laws and
regulations. Represent and defend fellow workers
whom the firm believes violated company policy or
the terms and conditions of the collective
bargaining agreement, often through the grievance
process. Communicate and disseminate official
union policy, memos and directives to workers in
the shop. Popularize and promote union
consciousness and values in the workplace. UNION
REPS ADVOCATE FOR THE EMPLOYEES COVERED UNDER
YOUR COMMANDS BARGAINING AGREEMENTS. THEY ARE
VITAL RESOURCES TO ENSURE THAT YOU HAVE LOOK IN
ALL THE CORNERS.
SUPERVISORS
EMPLOYEES
INDUSTRIAL HYGIENE (IH)
SAFETY
MEDICAL SUPPORT
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Know the industry you serveHey, I thought it I
was a Navy OHN?
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You are a Navy OHN

• Just as in the private sector, The US Navy has
  many different industries

• Shipyards
• Airbases
• Maintenance Facilities
• Schools
• Explosive Handling Units
• Hospitals
• Construction Units
• Police and Security
• Intelligence and Electronic
• Administrative offices
• And many more

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Know the commands and the Industries that
perform

• Get familiar with the Commands you serve.
• Know their governing instructions and regulations
  and laws.
• Marine Corps Orders
• Sealift Instructions
• Coast Guard.
• NCIS.
• Manage your programs to fit their needs.

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And most IMPORTANTLYKNOW YOUR POPULATION
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Definition of Population

• population
• 2 entries found.
• Main Entry
• population
• Pronunciation
• \?pä-py?-'la-sh?n\
• Function
• noun
• Etymology
• Late Latin population-, populatio, from Latin
  populus
• Date
• 1612
• 1 a the whole number of people or inhabitants in
  a country or region b the total of individuals
  occupying an area or making up a whole c the
  total of particles at a particular energy level
  used especially of atoms in a laser2 the act or
  process of populating3 a a body of persons or
  individuals having a quality or characteristic in
  common b (1) the organisms inhabiting a
  particular locality (2) a group of interbreeding
  organisms that represents the level of
  organization at which speciation begins4 a group
  of individual persons, objects, or items from
  which samples are taken for statistical
  measurement
• populational \-shn?l, -sh?-n?l\ adjective
  

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What are your populations?

• Engineers
• Welders
• Heavy Mobile Mechanics
• Office Workers
• Health care workers
• Food Service
• Divers
• Pilots
• Explosive handlers
• etc

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Important things to remember about your
populations

• Make your job easier and come up with a standard
  template for each group type and their needs.
• Be sure that you consider IH surveys for all
  surveillance exams and check with Safety for
  certification needs.
• Take Firefighters as an example
• PC MATRIX PROGRAMS (MAY INCLUDE)
• 722 OR 707FIREFIGHTER
• 720EXPLOSIVE HANDLER/OPERATOR
• 711HAZARDOUS WASTE WORKER EMERGENCY RESPONDERS
• 716RESPIRATOR USER CERTIFICATION
• 178BLOODBORNE PATHOGENS
• 503NOISE/HEARING CONSERVATION
• 510SIGHT CONSERVATION

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More to come..

• Navy
• Occupational Health Nursing
• 102
• Proceed to next slide for Certificate

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NAVY OCCUPATIONAL HEALTH NURSINGCertificate of
Completionis hereby granted to to
certify that he/she has completed to
satisfactionNAVYOCCUPATIONAL HEALTH NURSING
101Granted_______________________________
Denise M. Mullins, RN, COHN
DENISE M. MULLINS, RN, COHN