Abstract
Introduction
The American Association of Occupational Health Nurses (AAOHN) strongly supports the utilization of licensed healthcare professionals with occupational and environmental health specialty training, competency validation, and, ideally, certification to provide clinical care as well as leadership and oversight in workplace healthcare settings. There is a diverse array of healthcare personnel available to provide occupational and environmental healthcare services at worksites, including: Physicians, Registered Nurses, Nurse Practitioners, Advance Practice Nurses, Licensed Practical Nurses, and Licensed Vocational Nurses, Physician Assistants, Emergency Medical Technicians, Paramedics, Physical Therapists, Physical Therapy Assistants, Athletic Trainers, and Medical Assistants. These occupational healthcare personnel have a wide range of scopes of practice, education, training and experience; many have specific supervision requirements and legal scope of practice limitations. Employers who hire, contract with, and/or supervise healthcare personnel must be familiar with their state’s legislation regarding scope of practice (e.g., dispensing over-the-counter medications with or without physician approved standing orders), verify and validate licenses and certifications, and ensure compliance with supervision and scope of practice requirements.
Depending on the occupational health management program in the workplace, there may be single-provider units or larger, collaborative units that incorporate various types of healthcare personnel, as mentioned. AAOHN supports the utilization of licensed healthcare professionals who are trained within the specialty of occupational and environmental health, practicing within the scope of practice of the state in which they are licensed, and within an organizational structure that ensures proper staffing, supervision, and quality healthcare to ensure best practice. Furthermore, AAOHN endorses the use of Occupational Health Nurses (OHNs) to provide clinical services, leadership, management, and oversight to ensure delivery of high quality, comprehensive occupational and environmental health services in the workplace.
Rationale
The American Association of Occupational Health Nurses recognizes OHNs as the largest single group of healthcare professionals providing healthcare in the workplace. As such, they are critical to the delivery of high quality occupational and environmental health services to working populations across the world (WHO, 2001). OHNs are licensed health professionals employed in business, health care, industry, academia, government, and other industries to preserve, protect, and restore the health and safety of workers, their families, and their communities. Occupational Health Nurses are historically at the frontline protecting and promoting the health of worker populations and are uniquely qualified to apply the nursing process and formulate nursing diagnoses to ensure a safe and healthy work and community environment.
Occupational Health Nurses have established themselves as experts and leaders in the occupational and environmental healthcare field by combining their unique training, education and experience with practice resources such as (AAOHN, 2019):
The AAOHN Competencies in Occupational and Environmental Health Nursing,
The AAOHN Code of Ethics and Interpretive Statements,
The AAOHN Standards of Occupational and Environmental Health Nursing,
Fundamentals of Occupational and Environmental Health Nursing: AAOHN Core Curriculum – 4th Edition, and
Peer-reviewed, evidence-based research publications, supporting occupational health nursing practice.
More than 3500 practicing OHNs have demonstrated their occupational health expertise by passing a specialty examination and completing the rigorous qualifying educational and experience standards required of certification through the American Board for Occupational Health Nurses, Inc. (ABOHN, 2019).
In situations where professional clinical judgment, direction, and occupational health program management is required, it is prudent to utilize occupational and environmental health specialty-trained and certified healthcare professionals to assume positions of leadership and accountability when overseeing healthcare personnel without specialty occupational and environmental health training. This will enable the occupational health team to work collaboratively and in a coordinated manner to ensure workers are seen by healthcare personnel whose scopes of practice are appropriate to the level of care being provided, ensuring quality care delivery by the interdisciplinary team.
Healthcare professionals qualified to design, manage, supervise, and deliver healthcare in occupational settings include a variety of personnel. The range of personnel available to deliver healthcare in occupational settings continues to evolve with new fields of study and training. It is imperative that businesses who employ these personnel consider the legal scopes of practice unique to each discipline and state of practice prior to hiring or contracting them for services (US Department of Labor OSHA, 1999). Physicians (Medical Doctors (MDs) and Doctors of Osteopathy (DOs)), Physician Assistants (PAs), and Registered Nurses (RNs), including Nurse Practitioners (NPs) and Advance Practice Nurses (APNs), receive standardized educations with core curricula necessary to pass national or state boards and to be licensed in a particular state; they are then eligible to become certified in a specialty practice, such as occupational medicine (Physicians and PAs) or occupational health nursing (RNs, NPs and APNs), through a combination of additional specific education, experience and examination (US Department of Labor OSHA).
Healthcare personnel are trained at varying levels of practice and provide variable levels of care according to protocols (standardized procedures). Many are not licensed to practice independently and require oversight or supervision as defined by the state in which they work. Physician Assistants provide services with the supervision of MDs or DOs. Other healthcare personnel include: Licensed Practical or Vocational Nurses, Emergency Medical Technicians, Paramedics, Medical Assistants, Physical Therapy Assistants, and Athletic Trainers. Traditionally, these individuals are not licensed to practice independently and may be required to work under the supervision of, or implement orders given by licensed healthcare professionals such as MDs, DOs, RNs, NPs, APNs, and PAs, except when delivering first aid (US Department of Labor OSHA).
For more details regarding legal regulations and descriptions of the scopes of practice of the varied healthcare personnel, it is best to consult the applicable state’s licensing and certification board and the relevant professional organization. More information, particularly for businesses planning to hire or contract healthcare personnel to deliver occupational health services, is available in the Occupational Safety and Health Administration’s guide The Occupational Health Professional’s Services and Qualifications: Questions and Answers (US Department of Labor OSHA).
Further details regarding AAOHNs position on the delivery of occupational and environmental health services and the various scopes of practice of RNs, NPs, APNs, and Licensed Practical and Vocational Nurses within the field of occupational and environmental health can be found by reviewing the relevant Position Statements at the AAOHN Resources web page (AAOHN).
Recommendations
The scope of practice for the OHN is broad to include activities beyond those provided by non-nursing healthcare personnel (i.e., emergency medical services by Emergency Medical Technicians and Paramedics). In addition to providing specific clinical and emergency services, OHNs use specialized nursing skills to prevent, recognize, and treat worker’s illness and injury, provide effective incident investigation, and direct subsequent worker rehabilitation. Additional OHN services may include program management, occupational health surveillance, health education, professional counseling, case management, research, health hazard identification and management, direct care and responsibilities related to managing environmental health and safety, and more. As part of the larger multidisciplinary team, OHNs use their expertise to develop and implement comprehensive occupational and environmental health programs to improve the health and safety of workers, their families, communities, and businesses served.
AAOHN endorses the use of OHNs as they are licensed healthcare professionals that possess the specialized training, education, competency validation, and clinical expertise to provide the leadership, management, and oversight necessary to deliver high quality, comprehensive occupational and environmental health services in the workplace. The OHN is the key to the coordination of a holistic, multidisciplinary approach to deliver safe, quality, and comprehensive occupational and environmental health programs and services.