History,Passion,and Performance

Abstract

History, Passion, and Performance was chosen as the theme for the 75th anniversary of the American Association of Occupational Health Nurses (AAOHN) kickoff. The American Association of Occupational Health Nurses has a long history created by passionate, dedicated members. This article highlights historical foundations of the Association, describes the occupational health nurse’s passion to drive quality care for workers and discusses future professional and organizational challenges.

The theme History, Passion, and Performance was chosen for the annual meeting to kick off the 75th anniversary of the American Association of Occupational Health Nurses (AAOHN). The American Association of Occupational Health Nurses has a long and proud history, created and maintained by passionate members. As the Association looks forward, it is clear the future will be challenging but occupational health nursing’s potential is limitless. What a privilege to be an occupational and environmental health nurse—then and now! I often speak with young adults questioning their future careers; I never miss the opportunity to discuss our specialty nursing practice. Having the opportunity to make a profound impact on the lives of employees and their families makes our nursing specialty the best. We can honestly say, we keep America healthy, safe, and productive.

Currently, AAOHN, the premier professional organization of occupational and environmental health nurses, is composed of 36 state chapters including the District of Columbia; AAOHN has members in all 50 states and 18 other countries. In total, 106 chapters—local, state, and one regional—represent occupational and environmental health nurses. The American Association of Occupational Health Nurses currently has approximately 4,200 members and is growing at a modest but steady rate (AAOHN, 2017).

History

Early in the 1900s, nurses working in industry recognized the need for the exchange of information. In 1915, industrial nurses in the Boston area organized the first industrial nurses’ association. Three years later, the group expanded to include nurses from throughout New England. Over the next 10 years, associations were organized in heavily industrialized areas in Detroit (1920), New York (1921), Philadelphia (1924), and New Jersey (1930). In 1942, the American Association of Industrial Nurses (AAIN), led by dynamic and forward-thinking nurses, was inaugurated with some 300 members. In 1952, 3,300 nurse members of the AAIN chose to continue as an independent organization to meet the specialized needs of industrial nurses while establishing the purpose of the organization to

constitute the professional association of nurses engaged in the practice of industrial nursing. To maintain the honor and the character of the nursing profession; to improve community health by bettering nursing service to workers; to develop and promote standards for industrial nurses and industrial nursing service; to stimulate interest in and provide a forum for the discussion of problems in the field of industrial nursing; to stimulate industrial nurse participation in all nursing activities, local, state, and national and to do within the limits of the law all things necessary, proper, incidental, suitable, useful and conducive to the complete accomplishment of the foregoing purposes. (AAIN, 1965, p. 1)

True to its purpose, the organization provided services to members through professional exchange (i.e., the exchange of ideas, experiences, and knowledge during meetings and programs at the local and state constituent level). Professional growth was achieved by providing educational opportunities through workshops, seminars, lectures, and publications. Through national, state, and local committees, the Association studied legislative actions related to the field of industrial nursing and kept members apprised of these actions and the AAIN response. The AAIN information and publication program provided every member a regularly published journal that included technical articles, features, policy statements, and news of local and state activities. Special manuals, brochures, and guides were published to promote professional standards (i.e., proactively drafted to improve and expand the specialty) for industrial nursing. The Association became the recognized source of guidance regarding ethical practice, privileged communication, and legal responsibilities.

Education prepared nurses to enter the field of industrial nursing and supported nurses actively practicing. The Association kept members informed of college and university educational activities related to industrial nursing. The American Association of Industrial Nurses promoted the integration of industrial nursing content into the curricula of undergraduate and graduate nursing programs. The American Association of Industrial Nurses sponsored educational lectures, symposia, institutes, and workshops including the annual national conference. Annual conferences were held with the American Industrial Hygiene Association until 1960 and the Industrial Medical Association (later, the American College of Occupational and Environmental Medicine) at the American Industrial Health Conference (later, the American Occupational Health Conference) until 2003. These conferences provided opportunities for formal and informal exchanges among nurses, physicians, hygienists, and other specialty groups concerning the health of workers. Each year, presidents of local, state, and regional associations meet, offering a forum for the exchange of ideas including strategies for organizational growth and leadership development. The American Association of Industrial Nurses formed Medical, Management, and Nurse Educator Advisory Councils on the national and state levels.

The American Association of Industrial Nurses’ mission included the belief that the only effective, responsible way to promote economic security for its members was to improve the services provided by industrial nurses. The Association did not believe that collective bargaining was appropriate for nurses in industry. The effectiveness of industrial nurses depended on maintaining their roles as impartial professional workers. The American Association of Industrial Nurses was always concerned with increasing nurses’ economic opportunities and security. Association members believed that professional competence was the basis for economic security. Published in 1965, “Facts on American Association of Industrial Nurses, Inc.” described how the initiation of the Association laid the foundation for its future (AAIN, 1965).

Passion

This emotion is an intense, driving, or overmastering feeling or conviction about something (Passion, 2017). The definition describes the dedication which drives the daily work of occupational and environmental health nurses. Passion is the emotion that sets us apart. It “is the most powerful source of our motivation, perseverance and direction. It is the connection to a deeply held set of values and to a purpose beyond our self-interest” (Loehr & Schwartz, 2003, p. 2). Working in organizations or communities, identifying work processes, describing how that work is accomplished, and knowing the employees who come to work each day to do that work encourages occupational and environmental health nurses to passionately use their knowledge, skills, and talents to ensure the health and well-being of these workers. As advocates for workers and employers, nurses use problem-solving skills to manage cultural, work, management, and worker challenges to protect individuals and accomplish business objectives.

Performance

Performance refers to the outcomes or results of doing something. Passion drives the skills and knowledge to effectively accomplish a task. For occupational and environmental health nurses, accomplishing tasks affects the lives of workers and their families. Not many individuals’ work is this diverse, resulting in a significant sense of accomplishment when tasks are performed well. Because of the potential impact, occupational and environmental health nurses shoulder an immense sense of responsibility to always perform at their best. The history, passion, and performance of AAOHN and her members have moved the profession to its current state in 2017, but how will history, passion, and performance serve AAOHN in the future, especially when the United States faces unique health care delivery challenges?

Today’s health care system is changing rapidly and in ways not imagined in previous decades. Occupational and environmental health nurses may not have seen the impact of health care changes in their practice (e.g., Affordable Care Act [ACA]) because most employees work for larger companies that provide insurance coverage. However, future changes may affect workers and the organizations in which they work.

Prior to World War II, most Americans paid for their own health care. Beginning in the 1930s, through the Blue Cross nonprofit health insurance system, workers bought fixed-fee service which paid for high expense health services such as hospitalizations. Other expenses were paid by workers directly to providers. During World War II, the federal government, concerned about postwar inflation, instituted wage and price controls which continued after the war ended. Many labor groups protested and threatened strikes, so the War Labor Board exempted employer-paid health benefits from wage controls and income tax. This tax advantage drove the demand for employer-provided health insurance plans, replacing individual plans. Employers received a 100% tax deduction and employee benefits were exempt from federal, state, and city taxation.

Over the years, many attempts to end these tax breaks and reform the health care system were unsuccessful. By the mid-1960s, employer-provided health insurance was almost universal. This model worked well as long as health care costs remained low and employees worked for the same companies until retirement. However, today, that system is less viable, mainly due to the current trend of double-digit rising health care costs, the erosion of employer–employee mutual loyalty, the mobility of the workforce, and lack of long-term employment relationships (Lindquist, 2014).

The history of employer-provided health benefits may explain why occupational and environmental health nurses must stay abreast of changes in the health care industry (e.g., ACA), so they can fully engage in conversations with management and human resources colleagues on the cost, needs, and impact of benefits offered to employees. Nurses should leverage health plans for maximal use by employees to ensure return on investment for the company.

With this background knowledge, it is interesting to investigate whether employers will discontinue their health care benefits for other options and the specifics of those options. Currently, more favorable benefit options may be unclear, so occupational and environmental health nurses must “sit at the table” when these issues are discussed. Often, nurses are the only health care providers employed by the organization who understand the complexity of the health care system and how health benefits can affect employees’ productivity. Discussions should focus on the impact of benefits on employee health, productivity, and performance, and return on investment, especially related to the prevention of injuries and illnesses. Occupational health nurses can address the needs of aging workers and cost-effective health and safety programs for all workers with chronic diseases (e.g., diabetes, hypertension, arthritis, cardiovascular disease, and mental health conditions; Reinhard & Hassmiller, n.d.).

The health care system is fragmented; workers must seek services at numerous locations and with many providers, often with varying quality of care and outcomes. Would worker health and safety improve if occupational health clinics delivered primary care to workers and their families? Should occupational and environmental health nurses advocate for this model of care delivery? Occupational health nurses already provide access to quality care for employees which sometimes includes primary care at the workplace for employees and their families, treatment and subsequent monitoring to ensure appropriate care, health coaching to prevent or resolve health issues, and long-term monitoring for chronic health conditions. In so doing, occupational and environmental health nurses add another level of complexity to care coordination, ideal for a health care home. Being a health care home, sometimes called medical home, improves care coordination to ensure workers receive high quality evidence-based health care, have the opportunity to consult with health care providers onsite, and are at less risk of overmedication and unnecessary care. This level of health care also instills employer confidence in the quality of care they are purchasing for their employees, knowing that quality care should lower health care costs. This model challenges occupational health nurses to ensure confidentiality given the proliferation of electronic medical records and transmission of records to other health care providers. It is imperative that worksite health records remain the exclusive property of employees, not employers, to ensure employees will continue to seek care at the occupational health clinic

In addition, occupational health nurses can inform company management and benefits colleagues that the use of technology, whether individualized personal wearables or social media, can enhance employee health (Quindazzi, 2015). These technologies, whether for health care communication or health monitoring and covered by employee benefits, will support more personalized care and better self-care. Personalization, connectivity, and accessibility will be the key to the use of technology in the future (Riley, 2017). As more of these technologies are available and shown to be trustworthy, their use will become commonplace. Access to telehealth services is becoming more frequent, and occupational health nurses should advocate for this cost-effective delivery mechanism, especially for remote workforces (Saxena, 2015).

Most importantly, occupational health nurses must partner with management and other health care colleagues to create a culture of health and safety at the workplace. This culture is essential to maintaining and improving the health of workers and fully engaging the entire workforce to promote healthy lifestyles, manage chronic health conditions, and sustain the productivity of the workforce.

To embrace future health care system challenges and perform with continued passion, today’s occupational and environmental health nurses, similar to nurses practicing in diverse health care settings, must continue their education to meet changing job and role demands. Professionally, the fundamental skill of the occupational and environmental health nurse is the ability to lead. However, leadership at the workplace can be more diverse and complex than leadership in the health care industry. Not only must nurses manage, problem solve, think critically and creatively, communicate, and advocate, occupational and environmental health nurses must also develop business acumen and understand how worker health and safety affects the bottom line of every employer and the U.S. economy in general.

This changing occupational and environmental health nursing role and the potential need for new skill sets pose future challenges for AAOHN. The purpose of the Association as defined by past dynamic nurse leaders has not waivered. Interestingly, the Association’s current mission and purpose for AAOHN is consistent with the mission and purpose envisioned by early leaders:

the professional association of licensed nurses engaged in the practice of Occupational and Environmental Health Nursing so our members are seen as the authority on health, safety, productivity and disability management for worker populations. (AAOHN, 2016)

The Association defines the scope and sets the standards of practice, responds to critical practice issues, develops ethical standards of conduct, promotes lifelong learning, facilitates research to practice, and advocates for occupational and environmental health nurses (AAOHN, 2016). The Association’s mission is to provide education for its members so they can provide quality care to workers who entrust nurses with their health and safety. Today, quality education must be delivered in varied formats (e.g., live and virtual conferences, webcasts and on-demand, online offerings) to meet the needs of members. The American Association of Occupational Health Nurses will continue to collaborate with other associations to highlight the roles of occupational and environmental health nurses (e.g., clinician, nurse practitioner, case manager, risk and safety manager, wellness and health coach, and business leader). One such collaboration is the Association’s recently becoming a NIOSH (The National Institute for Occupational Safety and Health) Total Worker Health® Affiliate. This relationship will support occupational and environmental health nurses becoming more involved in all aspects of workers’ lives, some of which have not traditionally been labeled health and safety concerns but definitely affect workers’ health. Other relationships ensure members are informed about legislation and regulations that may affect their practice, and provide input into decisions employers make about benefits, available health care services, and the role occupational and environmental health nurses will play in this new health care arena.

In summary, occupational health nurses are well positioned to offer prevention services in a new health care system, currently being developed by Congress. By assuming leadership roles in nursing and business, occupational health nurses can create a secure environment for future practice. The American Association of Occupational Health Nurses is optimistic about the future of the profession and the Association’s role in ensuring that members are prepared for the challenges ahead.

In Summary

AAOHN has a long and proud history, created and maintained by passionate members. As the Association looks forward, it is clear the future will be challenging but occupational health nursing’s potential is limitless. Understanding our roots as an association had driven us to our present practice but learning from the past will help us meet the challenges of future change. This knowledge will sustain our association and see our profession thrive.