The State Cansu Itant Frances A. Martin, R.N., M.P.H., C.O.H.N.
Miss Martin Is Occupational Health Nursing Consultant, Occupational Health Branch, North Carol/na Division of Health Services.
I am
really pleased to have been invited to participate with you in this Workshop because I think State occupational health nursing consultants and nursing educators share a common goal. We both are seeking to have better prepared nurses working in the field and we both know that the only way to achieve this goal is to incorporate occupational health nursing content into the basic nursing curriculum. A little over a year ago while I was a student in the Occupational Health Nursing Program at the School of Public Health in Chapel Hill, another student and I did a study to identify whether occupational health nurses were carrying out the core functions of occupational health nursing and what effect outside program guidance in the form of continuing education and consu Itation had on their performance. We defined ten core activities of occupational health nursing. All ten functions studied showed a positive association between outside program guidance and performance adequacy. But more important than this finding was the number of nurses who were found not to be performing some of the functions at even the minimal level. Another interesting, but not surprising finding of the study, was that only eight of the 105 nurses returning questionnaires said that occupational health content had been included in their basic nursing education and seven of these eight said it was only mentioned.
Presented at the Duke University School of Nursing Conference, "Work, Society, and Health," Durham, North Carolina, September 19 and 20, 1974. 14
The one remaining stated that she had had 20 contact hours in the area. My reason for going into some detail regarding this study is that one of the recommendations that came out of it was to encourage the integration of occupational health nursing into basic nursing curricula. But now, how does the State occupational health nursing consultant fit into the picture? Perhaps a little background into the history of occupational health nursing in the United States is indicated at this point We often hear it said that occupational health nursing is a new field, but is it? The first occupational health nurse in the United States was Ada Mayo Stewart who was employed by the Vermont Marble Company in 1895. The first occupational health nursing consultant was hired by the Indiana State Board of Health in 1939. Currently, there are only about 20 states who have occupational health nursing consultants and in most instances she (or he) is the only occupational health nursing consultant in the state. And believe me, this at times can be quite overwhelming. In North Carolina alone, according to my latest figures, there are about450 RNs and 50 LPNs working in approximately 300 establishments. Most are in companies that are not big enough to have their own in-service education programs. There are still limited resources as far as continuing education is concerned, although this is improving. A Iso occupational health materials are still sparse. The last book written on occupational health nursing was Mary Louise Brown's and it was written in 1956 and is no longer in pri nt. So what does a State consultant do? Basically, State consu Itants find themselves in one of two employment
situations. One, she can be a part of a State Department of Labor and most likely find herself in the position of a regu latory authority or she can be a part of a State Board of Health and be in the position of making recommendations to the nurse and management. but without the authority to implement these recommendations. I will be speaking from the point of view of the State consu Itant who makes recommendations. but has no regu latory authority. There are six major areas of consultation which are: 1. Construction and Design of the Health Unit - this may be with management and/or the occupational health nurse and may be regarding new space or making the best use of existing available space. 2. Staffing of the Health Unit making recommendations based on ru Ie-of-thumb measures and needs of the individual establishment 3. Nursing Service - working with the occupational health nurse regarding the scope of the occupational health program and her role in the program particu larly in regard to the core functions of occupational health nursing. 4. Education for Occupational Health Nurses - this would include helping develop and implement continuing education programs and setting priorities for program development and serving as a resource person to schools of nursing. 5. Research and Studies - assisting with research and studies conducted by the occupational health team (l.e., the physician. industrial hygienist, and occupational health nursing consultant). 6. Evaluation of the Health Service - making site visits to evaluate the occupational health program and making recommendations on program needs. The areas covered in evaluating a health service would include the ten core functions of occupational health nursing. Although we have talked a lot about these during this conference. they have not been clearly defined. So. in conclusion, I would like to identify these core activities for you: 1. Administration of the nursing service: including the keeping of records and reports. maintaining a policy and procedure manual, obtaining current written. signed and dated medical directives (standing orders). maintaining an up-to-date toxicology chart where applicable, and ordering and maintaining of supplies and equipment. 2. Assisting with health examinations or doing health assessments: including pre-placement or preemployment. post-disability. periodic health maintenance, and periodic special hazard examinations.
Occupational Health Nursi ng, February 1975
3. Providing or supervising emergency care for occupational illness or injury: inclUding continuing care, follow-u p, and rehabi litation. 4. Providing or supervising palliative or emergency care for non-occupational illness or injury: palliative care is that care given to an employee as a temporary relief measure to get him through the work day. Also includes follow-up on care given. 5. Counseling: as provided during visits to the health unit for other reasons. through self-referrals. referrals by others. or from record evaluation. Also included would be referrals to others and utilization of community resources. 6. Health education: provided both formally or informally. individually or in groups. and utilizing aids such as pamphlets. posters. fi lms, bu lIetin boards. or articles in the company papers. 7. Cooperating with others in the plant or consu Itants who also have some responsibi Iity for the health and welfare of the employees: including personnel. safety. industrial hygiene. and the public health sanitarian. 8. Cooperating with and utilizing health. welfare. and social services available in the community: includes knowing what resources are available and developing a twa-way referral system. 9. Making plant rounds: this is done to become familiar with the potential environmental health problems and controls used within the plant. to develop an understanding of the plant processes and materials used that will improve medical assessment of illness and injury, and to insure that medical and engineering controls are adequate. 10. Participating in special health programs required because of inherent health problems within the employed popu lation or potential hazards in the work environment: depending on the industry involved. this might include such programs as alcohol or drug rehabi litatlon, hearing conservation. i mmu nlzattons, respiratory disease control. sight conservation, or various programs for control of chronic disease. or for the protection of employees working at risk. l.e.• with chemicals. gases, lead. mercury, radioactive materials. As the Occupational Health Nursing Consultant for the State of North Carolina. I am grateful for the challenge of providing service within the six areas I've outlined for you. The impact of the consultant might be much greater if more cooperative ventures such as this workshop are forthcoming. Again. thank you for recognizing our goals in common by inviting me to participate in this Work. Society. and Health meeting.
15
Miss Martin Is Occupational Health Nursing Consultant, Occupational Health Branch, North Carol/na Division of Health Services.
I am
really pleased to have been invited to participate with you in this Workshop because I think State occupational health nursing consultants and nursing educators share a common goal. We both are seeking to have better prepared nurses working in the field and we both know that the only way to achieve this goal is to incorporate occupational health nursing content into the basic nursing curriculum. A little over a year ago while I was a student in the Occupational Health Nursing Program at the School of Public Health in Chapel Hill, another student and I did a study to identify whether occupational health nurses were carrying out the core functions of occupational health nursing and what effect outside program guidance in the form of continuing education and consu Itation had on their performance. We defined ten core activities of occupational health nursing. All ten functions studied showed a positive association between outside program guidance and performance adequacy. But more important than this finding was the number of nurses who were found not to be performing some of the functions at even the minimal level. Another interesting, but not surprising finding of the study, was that only eight of the 105 nurses returning questionnaires said that occupational health content had been included in their basic nursing education and seven of these eight said it was only mentioned.
Presented at the Duke University School of Nursing Conference, "Work, Society, and Health," Durham, North Carolina, September 19 and 20, 1974. 14
The one remaining stated that she had had 20 contact hours in the area. My reason for going into some detail regarding this study is that one of the recommendations that came out of it was to encourage the integration of occupational health nursing into basic nursing curricula. But now, how does the State occupational health nursing consultant fit into the picture? Perhaps a little background into the history of occupational health nursing in the United States is indicated at this point We often hear it said that occupational health nursing is a new field, but is it? The first occupational health nurse in the United States was Ada Mayo Stewart who was employed by the Vermont Marble Company in 1895. The first occupational health nursing consultant was hired by the Indiana State Board of Health in 1939. Currently, there are only about 20 states who have occupational health nursing consultants and in most instances she (or he) is the only occupational health nursing consultant in the state. And believe me, this at times can be quite overwhelming. In North Carolina alone, according to my latest figures, there are about450 RNs and 50 LPNs working in approximately 300 establishments. Most are in companies that are not big enough to have their own in-service education programs. There are still limited resources as far as continuing education is concerned, although this is improving. A Iso occupational health materials are still sparse. The last book written on occupational health nursing was Mary Louise Brown's and it was written in 1956 and is no longer in pri nt. So what does a State consultant do? Basically, State consu Itants find themselves in one of two employment
situations. One, she can be a part of a State Department of Labor and most likely find herself in the position of a regu latory authority or she can be a part of a State Board of Health and be in the position of making recommendations to the nurse and management. but without the authority to implement these recommendations. I will be speaking from the point of view of the State consu Itant who makes recommendations. but has no regu latory authority. There are six major areas of consultation which are: 1. Construction and Design of the Health Unit - this may be with management and/or the occupational health nurse and may be regarding new space or making the best use of existing available space. 2. Staffing of the Health Unit making recommendations based on ru Ie-of-thumb measures and needs of the individual establishment 3. Nursing Service - working with the occupational health nurse regarding the scope of the occupational health program and her role in the program particu larly in regard to the core functions of occupational health nursing. 4. Education for Occupational Health Nurses - this would include helping develop and implement continuing education programs and setting priorities for program development and serving as a resource person to schools of nursing. 5. Research and Studies - assisting with research and studies conducted by the occupational health team (l.e., the physician. industrial hygienist, and occupational health nursing consultant). 6. Evaluation of the Health Service - making site visits to evaluate the occupational health program and making recommendations on program needs. The areas covered in evaluating a health service would include the ten core functions of occupational health nursing. Although we have talked a lot about these during this conference. they have not been clearly defined. So. in conclusion, I would like to identify these core activities for you: 1. Administration of the nursing service: including the keeping of records and reports. maintaining a policy and procedure manual, obtaining current written. signed and dated medical directives (standing orders). maintaining an up-to-date toxicology chart where applicable, and ordering and maintaining of supplies and equipment. 2. Assisting with health examinations or doing health assessments: including pre-placement or preemployment. post-disability. periodic health maintenance, and periodic special hazard examinations.
Occupational Health Nursi ng, February 1975
3. Providing or supervising emergency care for occupational illness or injury: inclUding continuing care, follow-u p, and rehabi litation. 4. Providing or supervising palliative or emergency care for non-occupational illness or injury: palliative care is that care given to an employee as a temporary relief measure to get him through the work day. Also includes follow-up on care given. 5. Counseling: as provided during visits to the health unit for other reasons. through self-referrals. referrals by others. or from record evaluation. Also included would be referrals to others and utilization of community resources. 6. Health education: provided both formally or informally. individually or in groups. and utilizing aids such as pamphlets. posters. fi lms, bu lIetin boards. or articles in the company papers. 7. Cooperating with others in the plant or consu Itants who also have some responsibi Iity for the health and welfare of the employees: including personnel. safety. industrial hygiene. and the public health sanitarian. 8. Cooperating with and utilizing health. welfare. and social services available in the community: includes knowing what resources are available and developing a twa-way referral system. 9. Making plant rounds: this is done to become familiar with the potential environmental health problems and controls used within the plant. to develop an understanding of the plant processes and materials used that will improve medical assessment of illness and injury, and to insure that medical and engineering controls are adequate. 10. Participating in special health programs required because of inherent health problems within the employed popu lation or potential hazards in the work environment: depending on the industry involved. this might include such programs as alcohol or drug rehabi litatlon, hearing conservation. i mmu nlzattons, respiratory disease control. sight conservation, or various programs for control of chronic disease. or for the protection of employees working at risk. l.e.• with chemicals. gases, lead. mercury, radioactive materials. As the Occupational Health Nursing Consultant for the State of North Carolina. I am grateful for the challenge of providing service within the six areas I've outlined for you. The impact of the consultant might be much greater if more cooperative ventures such as this workshop are forthcoming. Again. thank you for recognizing our goals in common by inviting me to participate in this Work. Society. and Health meeting.
15
