The Licensed Practical/Vocational Nurse in Occupational and Environmental Health

POSITION STATEMENT

Introduction

The American Association of Occupational Health Nurses (AAOHN) posits that the specialized training, education and experience of professional occupational and environmental health nurses (OHNs) effectively prepares these professionals to continue to deliver high quality, comprehensive occupational and environmental health services in the workplace. The contemporary approach to workplace health management requires close cooperation and collaboration among the healthcare team, company management, and employees (World Health Organization, 2001). Nursing roles continue to evolve with today’s dynamic healthcare system, challenging the system to define and differentiate the roles of various healthcare professionals. Delineating these roles is important not only from a regulatory and compliance standpoint but also for ensuring patient safety, positive health outcomes, and promoting nursing excellence. Each state possesses legal authority to regulate and define the practice of nursing, including the roles of Registered Nurse (RN), Advanced Practice Registered Nurse (APRN), Licensed Practical Nurse (LPN) and Licensed Vocational Nurse (LVN). The AAOHN LPN/LVN Competencies provide guidance for practice in the specialty of Occupational Health Nursing (AAOHN, 2015).

It is the stance of AAOHN that the LPN and LVN possess the skills, knowledge, and competencies to provide technical nursing services in the occupational health setting, while the Registered Nurse possesses the skills, knowledge and competencies essential for the development and implementation of comprehensive health programs.

Rationale

LPNs/LVNs serve as collaborative members of the interdisciplinary healthcare team with the goal of assisting clients to attain or maintain optimal health, implementing a strategy of care to accomplish defined goals within the context of a client centered health care plan (North Carolina Board of Nursing, 2020). This health care plan encompasses use of a systematic problem-solving process utilizing the basic components of the nursing process to provide individualized, goal-directed nursing care (Texas Board of Nursing, 2021). The Standards of Practice and Educational Competencies of Practical/Vocational Nursing Program graduates are outlined by the National Association for Practical Nurse Education and Service, Inc. (2009) and are intended to better define the range of capabilities, responsibilities, rights and relationship to other health care providers. These include the basic components of the nursing process: Assessment, Planning, Implementation and Evaluation, as well as the following essential skills (North Carolina Board of Nursing, 2020; Texas Board of Nursing, 2021):

• demonstration of professional behaviors of accountability and professionalism according to the legal and ethical standards for a competent LPN/LVN,

• effective communication with patients, significant support person(s), and members of the interdisciplinary health care team incorporating interpersonal and therapeutic communication skills,

• collection of holistic assessment data from multiple sources, communication of the data to appropriate health care providers,

• evaluation of client responses to interventions using clinical reasoning skills,

• collaborative planning with the RN or other members of the healthcare team to organize and incorporate assessment data to plan/revise patient care and actions based on established nursing diagnoses, nursing protocols, and assessment and evaluation data,

• demonstration of a caring and empathic approach to the safe, therapeutic, and individualized care of each client, and

• implement patient care, teaching, counseling, reporting and recording, as appropriate, at the direction of a RN, APRN or physician. Perform nursing interventions as a collaborative member of the healthcare team which manages care through effective communication and a systematic process of planning, organizing, and directing.

The LPN/LVN working in an occupational health setting needs to possess knowledge, skills, and competencies beyond those acquired through initial nursing educational preparation and licensing procedures to ensure worker safety, positive health outcomes, and promote nursing excellence.

The AAOHN LPN/LVN Competencies (2015) state that LPN/LVN practice should adhere to the applicable state legal and regulatory requirements when practicing within the field of occupational health nursing. LPN/LVNs working in occupational health can, with supervision and appropriate additional training, provide valuable assistance to RNs and physicians (definitions of supervision may differ from state to state). This requires:

• supervision of nursing care under the direction of a RN, APRN, or physician with assignment of duties and responsibilities in line with the skills, knowledge, and competencies defined within their state licensure requirements and specialty organization (e.g., AAOHN),

• the assumption that the LPN/LVN is competent in general nursing because the individual has met the requirements of licensure as a LPN/LVN and possesses general practical experience, and

• demonstration of specialized training within the field of occupational and environmental health.

The occupational health nursing competencies (AAOHN) for LPN/LVNs may include:

• training in the use of personal protective equipment,

• training in the practice of effective infection control measures when providing direct care in a clinical setting,

• training in ergonomics, hazard assessment and identification; ability to collaboratively develop and implement programs to deal with identified problems and hazards,

• training in first aid and cardiopulmonary resuscitation (CPR),

• training in vaccination consent and administration,

• designing, implementing, evaluating, and monitoring outcomes of workplace health screenings that meet the health needs of employees and employers and facilitate continuity of care,

• verifying that health programs comply with federal, state, and local regulations, and

• developing professional rapport with employees and assisting them in selecting appropriate and cost-effective health care resources.

Disease prevention and promoting the health of the working population form the cornerstones of an effective occupational and environmental health program. This requires a range of skills to identify, accurately assess and devise strategies to control workplace hazards, and promote the health of the working population (World Health Organization, 2001). As members of the interdisciplinary occupational health care team, LPNs/LVNs play an essential collaborative role:

• promoting improved employee health,

• decreasing health-related costs,

• improving employee morale,

• increasing productivity,

• decreasing absenteeism, and

• facilitating continuity of care.

Conclusion

The role of the licensed professional nurse in occupational and environmental health nursing continues to evolve and expand. The LPN/LVN continues to play a critical role in this expansion through the assumption of technical responsibilities and by acting as a collaborative member of the interdisciplinary health care team.