2007 Salary Survey Results

Occupational health nurses must prove their worth by measuring and demonstrating outcomes

Long hours are common in occupational health; more than half of respondents (55%) to the 2007 Occupational Health Management Salary Survey work more than 45 hours a week, with only 20% putting in 40 hours or less.

The survey, which was administered in August and tallied, analyzed, and reported by AHC Media, publisher of Occupational Health Management, identifies some of the factors impacting salaries and benefits in occupational health. For the 2007 report, 170 surveys were disseminated. There were 20 responses, for a response rate of 12%.

But putting in long hours isn't enough if occupational health nurses (OHNs) really want to get ahead, according to Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, clinical instructor in the Occupational Health Nursing Program at the University of North Carolina at Chapel Hill. "You will need to show outcomes from your work goals and objectives," says Randolph. "This could be done annually or quarterly — whatever is the norm for your industry."

There has been "meaningful upward pressure" on occupational health salaries in the last couple of years, says William Patterson, MD, MPH, assistant vice president of medical operations for Concentra Health Services' Northeast Zone. "Physician's assistants and nurse practitioners have seen the greatest increase in the community-based setting, but physicians are earning more as well," he says.

According to the survey, 35% of respondents fell into the $60,000 to $69,000 range, with 25% earning less than that amount. Another 30% earn between $70,000 and $89,000, and just 10% make more than $100,000. More than half of respondents (55%) reported a 1-3% increase in salary in the last year, and 25% received a 4-6% increase.

Some OHNs are able to use return on investment to show their value, and this action can result in increased clout, says Monika Fischer, MN, RN, APRN BC, CCM, COHN-S, FAAOHN, health services administrator for the city of Glendale, CA, and president of the California State Association of Occupational Health Nurses. Also, many companies are paying more for OHNs with certifications such as COHN or COHN-S, she adds.

Other key findings of the survey:

Although the field is still predominantly female (80% of respondents), more males are emerging (20% of respondents).

Half of respondents said they had no changes in the size of their staff in the past year, while 35% had gained positions.

Show your impact

There is a trend toward tying salary increases to the productivity of the occupational health division, says Randolph. When designing new programs or services, or evaluating existing services, you need to build in some type of way to measure the outcome or impact, she advises.

For example, to determine if a health promotion program was successful, you'll need to identify measures. These may include the number of employees who attended, the number of referrals, whether there was a change in behavior, whether there was sustained risk reduction or cost containment, or how much was saved in workers' compensation settlements, says Randolph. She points to the American Association of Occupational Health Nurses (AAOHN) Standard of Practice, which states that the responses to interventions and progress toward achievement of desired outcomes be systematically and continuously evaluated, through immediate and long-term outcomes, quality of the intervention, and cost-benefit analysis.

Here are other ways to increase clout and demonstrate worth, advises Randolph:

Volunteer for special projects to demonstrate willingness to go "over and beyond." For example, do a cost-benefit analysis of offering different services in-house vs using community resources, or give the health and safety perspective on pandemic flu planning, suggests Randolph.

Attend key meetings, and don't wait to be asked to attend. "The occupational health nurse should give the health perspective at management meetings and relate that to business goals," says Randolph. At the meetings, underscore the fact that you need healthy and productive employees to be able to produce quality product, she adds.

Integrate health protection with health promotion activities.

Anticipate areas of focus, such as healthy aging workers, globalism, benchmarking, or cost-effectiveness of programs.

Examine areas to reduce health care costs and relate these to occupational health services.

New roles emerging

One significant new role is case management, for small and large companies, says Richard Kowalski, RN, MSA, COHN-S, current AAOHN president and an occupational health professional at Northern Michigan Occupational Health Consultants.

"A lot of businesses and hospitals want case managers, because they have a lot of workers comp injuries. They want to get those people back to work because it's a lot of lost dollars," says Kowalski.

Going into case management is a "great transition" for OHNs, adds Kowalski. "You are dealing with workplace injuries, which is what occupational health nurses have always done," he says. "It's a natural move."

Another emerging role is nurse practitioners, which are being hired by companies because it's more cost-effective than to hire a physician, says Kowalski. "Nurse practitioners are very competitive with physician's assistants in regard to salary and job roles," he adds.

Employee wellness programs continue to be a significant area of opportunity in occupational health, says Kowalski. "There is documented return on investment on wellness, so that is another thing they are doing to demonstrate their value and worth," he says.

More larger companies are switching to outsourcing and shutting down their internal occupational health departments, Kowalski says. They are choosing instead to buy services from another company or a local hospital, he says. This switch cuts down on the OHN's salary and benefits as they are working for a hospital instead of a major corporation, he says.

"Unfortunately, companies are making business decisions based on what they think is a reduction in cost," he says. "But you get what you pay for. I don't believe that the nurses have as much buy-in for that company, because they are not employees. They might not do all the other extra things that a full-time employee working for that company would."

Many OHNs are moving away from direct care of employees to case management and safety roles or they have a variety of extra human resources duties included with their job such as the Americans with Disabilities Act interactive process and the Family and Medical Leave Act, says Fischer. "Increasingly, we are seeing integration of health protection with health promotion programs," says Randolph. "We are also seeing a focus on healthy work being accepted as mainstream, and a focus on stress and mental health of workers."

Gain business skills

Occupational medical units will need to be run like businesses within a company or management won't respect their value, says Fischer. "There will also be an increased need for computerization and knowledge as to what is available on the Internet concerning medicine," she says.

You will need to be able to apply research findings to practice and develop understanding of how conclusions from research can inform responsible decision making, says Randolph. You also will need to show that you can integrate and communicate with the business and financial teams with the shared goal of producing quality product with healthy and productive employees, says Randolph.

Occupational health professionals must acquire more business skills, emphasizes Annette B. Haag, RN, BA, COHN, a Simi Valley, CA-based consultant specializing in education for occupational health nurses. "They need to understand the importance of gaining the necessary business skills to talk management's language," she says.

These skills include writing strategic and business plans; conducting a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis to determine a strategy; understanding and gaining control of budgets; benchmarking; and understanding the concepts of balanced scorecards, says Haag. "My concern is that as occupational health nurses retire, they are not being replaced because of the lack of these skills," she says.

According to the survey, only 5% of respondents were age 35 or under, and 64% are older than age 45.

Unfortunately, the OHN population is a graying one so many of the nurses are retiring, and there aren't always others to step in," says Fischer. "Hopefully down the road this will cause a greater demand for OHNs and increase salaries."

The survey indicated that more than half (55%) of respondents have worked in occupational health more than 13 years, with 20% having 19 or more years in the field.

In addition to longevity, however, you must understand business strategies, says Haag. "I hope it will someday take hold and naturally be a part of what the occupational health nurse finds important to include as part of her everyday practice," Haag says. "I am amazed when I ask my attendees to tell me the dollar amount their company pays in workers' compensation premiums and in group health care coverage. Very few can answer this question."

You also should know the top cost drivers at your company for workers' compensation costs and group health insurance, advises Haag. For workers' compensation, nurses usually say that ergonomic issues are the top cost, but many do not know where the money is going in regard to non-occupational illness and injuries, she says.

"Often, high-risk pregnancy is a top cost driver. Many do not know this, and about 99% of the nurses do not have a program to address high-risk pregnancies," says Haag. "Other programs needing development are sleeping disorders that I am sure lead to injuries, and presenteeism, or what we call the 'working wounded.' They are at work but are not functioning well," she says. "I instruct nurses that they cannot manage what they do not measure."

Calculate where your time is spent, and don't spend time on programs and activities that do not bring value to the company, says Haag. "Often occupational health is considered a 'cost item' to the company," she says. "What is often forgotten is to calculate the 'cost avoidance' by occupational health being there."

Find ways to "toot your own horn," urges Haag. "You are out of sight, out of mind if you do not get involved in the health and medical issues of the company," she says.