As the workplace has undergone dramatic changes over the years, it’s not surprising that occupational health nursing has changed significantly as well. In this issue, the Tracker features Roberta Moore, RN, COHN-S of Workplace Health in Augusta, Maine, who has personally experienced many of those changes. Roberta has been a registered nurse for thirty years, seventeen of those in occupational health. She was well prepared to enter the field of occupational health nursing: her prior experience was in intensive care, coronary care, emergency room, and rehabilitation nursing. She has used SYSTOC^® since 1988.

Some may be surprised to learn that in 1988, occupational health nursing celebrated 100 years of practice.¹ In the intervening 15 years, there have been many changes. Occupational health nurses formerly practiced primarily on-site in companies. It wasn’t until the mid-eighties that hospitals began developing occupational health programs as a means of diversifying in response to a declining inpatient population. By developing relationships with business and industry, hospitals were hoping to improve their admission rates for both occupational and non-occupational health cases.

There was a large occupational health market in 1985, with injury rates of 7.9% and an average of 8.2 lost days per injury.² The occupational health programs at that time concentrated on acute injury treatment and follow-up. They offered other programs such as employee screenings, health promotions, and worksite nursing and rehabilitation. The American with Disabilities Act became law in 1990.

The military introduced random drug testing in the 1970s, resulting in a reduction in drug use. Following this success, large corporations began drug testing. The Drug Free Workplace Program led to the development of guidelines adopted in 1988 by NIDA (National Institute on Drug Abuse) within the Department of Health and Human Services (DHHS). Based on these guidelines, the Departments of Transportation, Defense, Energy, and other federal agencies issued their regulations in 1988. Then the Omnibus Transportation Employee Testing Act of 1991 mandated testing for alcohol as well as controlled substances in most transportation sectors.³

This was the field when Roberta entered it. In 1988 she joined Yankee Healthcare in Gardiner, Maine as a staff nurse. In 1991 she became manager of the occupational health clinic.

Yankee Healthcare was one of the original ten clinics to use SYSTOC software. It was a member of the Maine Occupational Health Program (MOHP), a pioneering user group whose members discussed occupational health issues and influenced how the SYSTOC software was developed. Workplace Health, originally known as Yankee Healthcare, has participated in all of the changes in the software since that time.

While Roberta has provided services for the same employer for many years, those duties have changed, regulations have changed, SYSTOC has changed, and her employer has undergone an evolution that is common in the field of occupational health. She agreed to be interviewed by the Tracker to discuss the transformations she has seen during her practice of occupational health nursing.

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Tracker: "Describe the major changes that you have seen as an occupational health nurse since you entered the field."

Moore: "Companies have come to realize the financial impact of appropriate work for the injured worker. By assisting employers to find safe alternate duty for the injured worker, both the employer and the injured worker have benefited.

"When I started in this field there weren’t as many regulations: ADA, DOT Drug and Alcohol Testing regulations had not been introduced.

"In Maine the law changed to allow an employer to choose a provider for the first ten days of treatment following an injury. This allowed the employer and providers to establish a partnership in treating workplace injuries through improved knowledge of the workplace on the part of the provider and the employer’s understanding of the recommended treatment.

"In today’s economy injured workers are more worried about losing their job."

Tracker: "The organization that you work for underwent several changes. Please describe those changes and the challenges that accompanied them."

Moore: "Initially, Yankee Healthcare was organized as a physician practice division of Kennebec Valley Medical Center. When the clinic moved to Augusta, the name changed to Kennebec Valley Occupational Health Clinic. In 1998 Kennebec Valley Medical Center in Augusta, Maine and Mid Maine Medical Center in Waterville, Maine merged. The new entity became known as MaineGeneral Medical Center, the third-largest medical center in Maine.

"The clinic became known as Workplace Health, which had been the name of the occupational health program in Waterville. The clinics were centrally managed yet twenty-one miles apart. At the same time, the medical director of the Waterville clinic assumed medical leadership. A contracted administrative director was hired and billing was centralized. In addition to all the name changes that needed to be instituted on forms and marketing material for the second time, the protocols and billing fees had to be merged. There were customers who had used both clinics and were used to practices and fees that were somewhat different.

"This transition took great effort on the part of all the staff, as well as the understanding of our customers. In addition, we were competing in a business environment with other providers, but as a hospital department, we had to adhere to the regulations of a larger, more complex medical center."

Tracker: "Case management has become a more important component of an occupational health program. Has your program reacted to that change?"

Moore: "Yes. Our clinic has an established policy for those cases that are to be case-managed. We have more registered nurses to provide case management for the selected cases. The multi-disciplinary team treating the patient meets with the physician on a regular basis to discuss those cases that will benefit from that approach. Progress with the care plan is reviewed and changes made as necessary."

Tracker: "Has your relationship to other professionals treating the patient changed over the years?"

Moore: "Because of the team approach and the increased communication among the providers there is more respect and recognition of the occupational health nurse and his or her role."

Tracker: "Has your relationship with the employer changed?"

Moore: "The employers see the value of a healthy work environment and communicate more with the clinic about their needs."

Tracker: "Describe the difference in the information you track today versus when you started to use SYSTOC."

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Moore: "There are many changes in the information that is available. We have a Case Management module now. The Injury Management Tracking report allows us to review closed cases to determine length of time in treatment, lost days, days at restricted duty and cost of cases by diagnosis, provider, location, and company. The Orders module allows us to monitor orders and track any orders that may have been missed. The Recall module allows us to recall those patients who need repeat DOT or immunizations. The Billing module allows us to track our financial performance and aging of bills. In 1988, the software wasn’t that sophisticated. There wasn’t a need for the drug testing module when SYSTOC was first released."

Tracker: "When did you become certified in occupational health nursing?"

Moore: "In 1993, and I have maintained my certification since that time. I had already become certified in rehabilitation nursing as a CRRN in the early 80s."

Tracker: "What skills do you recommend for a registered nurse who is considering entering the occupational health field?"

Moore: "An RN needs very good assessment skills and must be able to consider the impact the work environment has on the health and safety of the patient. An occupational health nurse needs to consider the whole patient, not just the presenting injury. S/he must acquire skills that provide a broad understanding of injury prevention and wellness behaviors and be able to teach either one-on-one or in groups. Teaching has taken on a more important role for the occupational health nurse, and it is one that I really enjoy!"

Tracker: "Thank you for taking the time to share your experiences with our readers."

Footnotes:

1 Parker-Conrad, J.E., "A Century of Practice: Occupational Health Nursing," AAOHN Journal, Vol.50 No. 12.

2 Newkirk, W.L. and Jones, L.D., Editors, Occupational Health Services: A Guide to Program Planning and Management, American Hospital Publishing, Inc., 1989.

3 Newkirk, W.L., Editor, Occupational Health Services: Practical Strategies for Improving Quality and Controlling Costs, American Hospital Publishing, Inc., 1993.