AS AN RN and an occupational health case manager, I'm called to assist in diverse situations. Here's one example of a case that required many different skills.
Early one morning, Billy Armstrong (not his real name), an employee at an electric power-generating plant, was responding to a break in a steam line when he collapsed. When a coworker found him, he was in cardiac arrest.
The first-aid team responded with an automated external defibrillator (AED). When they attempted to use it, they found that because it was so noisy in the area, they had difficulty hearing the commands from the AED. The team had to carry Billy down several flights of stairs to a quieter location so they could use the AED. By the time the emergency medical services (EMS) arrived, cardiopulmonary resuscitation had been in progress for over 15 minutes, and the team was following the AED commands. The EMS took Billy to the hospital, where subsequent efforts to revive him failed and he was pronounced dead.
My role in the case
As soon as a manager notified me about what had happened, I stopped what I was doing and drove to the plant. I spent the morning debriefing the first-aid team members who had responded to the emergency. I also spoke with other employees who were shaken by the death of their coworker. I observed different coping mechanisms and made notes of those employees who I believed might have more trouble processing this sad event.
Working with the company counselor, who's well versed in dealing with these situations, I provided a listening ear for anyone who wanted to share stories about Billy. We provided counseling over the course of several days and nights to meet the needs of the crews.
Sizing up the response
In another duty related to this case, I took the AED to the company physician so that he could download and review the data. A medical review is required after an AED has been used; reviewing the data ensures that everything was done according to established procedures.
After the physician reviewed the data, he recommended that we replace our AED with a model with a text screen. I drove to company headquarters to look over the newer model, and we decided to replace each older-model AED with a newer model with a text screen for the commands, an important advantage in noisy settings. Having a background in critical care helped me to critique the newer model. I also field-tested this type of AED in a factory in extreme noise and vibration conditions, ensuring that the new AED would perform in this type of environment.
Different workplaces, different injuries
Having experience in occupational health nursing helps me to understand the mechanisms of injuries that can occur on the job. I formerly worked in a can manufacturing plant where many injuries were lacerations. Now I work with those who climb poles and perform dangerous electrical repairs, but their most common injuries are strains and sprains from slipping on uneven terrain.
What background do you need?
If you're interested in going into occupational health nursing, you'll need a clinical background in medical/surgical nursing and emergency care. Having experience with rehabilitation nursing may be useful when you're helping an injured worker return to work. If you also have some counseling or psychiatric nursing skills, these can help you to recognize an employee who isn't coping well with life's difficulties. Such an employee may be a danger to himself or his coworkers if he violates safety procedures or acts out his aggression.
Preventive care is another important part of occupational health nursing. I often tell my clients that when I first became a nurse, many people were dying prematurely of the very conditions companies screen for today, such as heart conditions and strokes. For example, an employee in my company who wants to obtain a commercial driver's license must have a medical exam to meet the requirements of the Federal Motor Carrier Safety Administration. These exams can pick up disorders that the client can be treated for or counseled about through the network referral system for employers. Medical clearance for driving a commercial vehicle, as well as other job duties such as wearing a respirator, must be renewed and documented regularly.
Keeping up with regulations
An occupational health nurse must be familiar with the Occupational Safety and Health Administration, which provides laws and guidelines for a safe work environment. You can become certified as an occupational health nurse by taking courses specific to this specialty. Contact your state board of nursing for course locations and requirements.
My duties also include administering the Family and Medical Leave Act and being knowledgeable about legal requirements under the Health Insurance Portability and Accountability Act. Knowing state and federal workers' compensation laws is another must. You'll be working closely with a panel of providers for work-related injuries, so it's important to become familiar with the local medical community outside of a hospital environment.
More resources
If you want to be an occupational health nurse, I suggest that you join the American Association of Occupational Health Nurses, which has local chapters. Continuing- education programs are just one of this organization's benefits. For more information, visit http://www.AAOHN.org.
Some occupational health nurses become case managers. Such case managers oversee an employee's health care services from the time of injury to his return to work (or to an alternative situation). Nurses performing duties as case managers may be required to obtain certification in occupational health nursing. One textbook I recommend is The Case Manager's Handbook by Catherine Mullahy. The book describes the profile and role of a case manager and the agencies with which we interact, such as workers' compensation boards, insurance companies and the Social Security Administration. The author defines legal and ethical responsibilities, financial considerations, and future trends, along with case manager credentialing.
Helping workers every day
Another focus in this job is interacting with supervisors and managers to promote a safer and healthier work environment. Occupational health nurses also provide educational programs and training sessions on various wellness topics and safe work practices to improve the work environment. For instance, I might coordinate and promote a health fair with outside vendors to teach healthy lifestyle habits.
I'm also a resource for employee health issues. Some days, employees call or come to my office to discuss personal medical problems or to seek advice about caring for aging or ill family members. Being familiar with the local agency for the elderly has let me tap into various community resources.
While no 2 days are the same, this practice specialty would suit a nurse who likes working with people in various settings, has a strong desire to listen to employees, and knows when and where to refer clients for further care when appropriate. In the past, I've been a nurse in labor and delivery, the operating room, a medical/surgical unit, critical care, EMS, and home health care, and I believe I use all of these experiences to perform my job as an occupational health nurse and case manager.
If you like variety and can bring your own smorgasbord of experiences to your next job, you may want to look into becoming an occupational health nurse and case manager.