It’s safety first for a growing number of occ-health nurses, say observers

Whether in new positions or current ones, the trend is clear

Mirroring an overall trend in health care quality, employee safety increasingly is taking center stage for occupational health nurses, say the experts. And this trend is growing in two parallel directions: an expanding role for current occ-health nursing positions, as well as potential new job opportunities.

"I think this [shift] is true in both areas," asserts Deborah Roy, MPH, RN, COHN-S, CET, CSP, president of SafeTech Consultants Inc. in Portland, ME. "From a data standpoint, we may not have it yet, but anecdotally we do."

Given current downsizing trends, "in many workplaces, the OHN may be the only safety, health, and environmental professional — they are sometimes it," adds Marcella Thompson, CSP, RN, COHN-S, principal safety engineer for ON Semiconductor Corp. in East Greenwich, RI.

And Annette B. Haag, RN, BA, COHN, president of Annette B. Haag & Associates in Simi Valley, CA, has seen the trend slowly evolving among nurses. "Nurses have started to take on more safety responsibility," she asserts. "We began to see more discussion about it two to three years ago; I started getting a lot of calls from nurses about liability insurance and whether AAOHN [American Association of Occupation Health Nurses] would cover them [in a safety position]." Haag says she’s always advocated that safety be ingrained in the job description of an occ-health nurse, "since their main role is preventing injury and illness."

Surveys show trend

Thompson points to a 2002 trend by the American Board for Occupa-tional Health Nurses (ABOHN) as indicative of the importance of safety in occupational health. "ABOHN asked all certified OHNs whether in their present or most recent position they had responsibility for some aspect of safety, and 82% answered yes," she reports. "Of those who answered yes, they indicated that, on average, 28.7% of their job functions were related to safety."

While she says ABOHN might have been a bit surprised by the answers, Thompson surmises that one of the reasons they asked the questions was that they suspected what the answers might be. In addition, she notes, when asked whether a credential in safety as a subspecialty might make them more marketable to employers, 79% of the respondents said yes.

An ongoing survey may contain even more interesting information, says Roy, who sits on the ABOHN board of directors, as well as on their practice analysis committee.

This survey, which deals with practice analysis, is conducted every four or five years, she reports.

The survey "validates the certification exam, looks at what functions the nurses perform, and then the certification exam in turn is oriented based on the functions that nurses actually perform in real life," Roy explains.

Preliminary data from this latest on-line survey, completed March 1, was to be reviewed in Chicago in early April. In a previous, less formal ABOHN survey, it found that "a very high percentage" of occ-health nursing activity was devoted to safety.

In this particular survey, the analysis survey of the Board of Certified Safety Professionals was incorporated, as well as ABOHN’s own. "So, from this new survey we can tell whether occ-health nurses are performing the same functions as safety professionals, or whether they are doing something different," notes Roy.

She anticipates that if there is a close match, in the fall, ABOHN will be offering a safety certification exam for nurses.

"Obviously, based on that, they think there’s a market," she observes. "This will be a terminal certification for nurses who want to be certified in occ-health and safety. You can only sit for the exam if you are already certified as an occ-health nurse or an occ-health nurse specialist."

Another sign of the times is the fact that this year’s AOHC [the joint meeting of the AAOHN and the American College of Occupational and Environmental Medicine (ACOEM)] will devote an entire track to safety. "I will be teaching a full-day course in safety engineering for people who need to see what they know and what they don’t know, and Marcy [Thompson] will teach one on fire protection," says Roy.

In addition, notes Haag, more of the questions on the COHN and COHN-S exams now fall in the safety area. "AAOHN has sought input from safety and hygiene medicine," she notes.

A natural fit

This growing trend is not surprising, say observers, because there is a natural connection between occupational health and safety. What’s more, occ-health nurses are well positioned to assume greater responsibility for employee safety.

"Safety is a very broad discipline; there’s a long continuum between nursing and safety," says Thompson. "The largest overlap is in communication and education, including all the mandatory training under OSHA [Occupational Safety and Health Administration] — anything from first aid to Hazmat communications to bloodborne pathogens. It all depends on where the nurse is in her knowledge base."

Thompson’s own entry into the area was through education, as she possesses two master’s degrees. When she left hospital clinical nursing, she received advanced degrees from both the Harvard School of Public Health and from Boston University.

"It was a multidisciplined education," she notes, which brought her into contact with safety professionals, occ-health physicians, ergonomists, industrial hygienists, public policy experts, and attorneys. "I also inherited the security role for chemicals as a result of 9-11, which in turn, rolled into emergency planning," she says.

The kinds of safety positions to which occ-health nurses can aspire depend on their background, Thompson notes.

"To be qualified to be a safety engineer, for example, you must have preparation in safety on the bachelor’s level and/or some related field, or as an engineer who receives training in safety," she notes. "The requirements are most rigid."

For those who do not have such a background, they often begin with a position in occ-health nursing and gain entrée into safety through areas like loss control prevention (workers’ comp). "Being a manager could also possibly open the door," she says. "There’s not one sole way of doing this."

Roy concurs. "In some cases, the occ-health nurses can just assume some of the safety roles in the organization; in others, they move into a new position," she says. "If a company downsizes, they might not feel they need an occ-nurse, a safety professional, and an environmental professional. From a company standpoint, it’s an advantage [to give the added responsibilities to the nurse] because the nurse is licensed, and thus can perform his or her own role plus the safety role."

Nurses also often have the people skills and technical skills needed to deal with training, facilitating committees, and so on, Roy continues. "These other skills are a benefit for an employer," she emphasizes. "And their problem-solving skills really apply to the prevention piece for safety."

Haag also stresses the importance of prevention. "It’s true that supervisors or safety professionals conduct accident investigations, but they must also be keenly aware of what happened, and how it can be prevented in the future," she asserts. "The occ-health nurse’s whole mission is to be proactive, not reactive; it involves really digging into the real causes.

"AAOHN’s latest survey says that the nurse’s greatest responsibility is in case management, but that, unfortunately, is after the fact," she continues. "As with any illness, if you prevent it or catch it early, it’s a lot less costly."

Rising workers’ comp costs make a proactive approach more important than ever, Haag emphasizes. "According to the March issue of Insurance Networking News, average workers’ comp costs have risen 50% in the last three years," she reports.

In addition, she notes, AAOHN also is emphasizing prevention in this area. "One of their courses is looking at root cause analysis," she observes.

Views on future mixed

Will this current trend continue? Will ever-increasing numbers of occ-health nurses take on safety positions? On that, the experts are divided.

"As far as we know, there are currently only 12 nurses with both the CSP [Certified Safety Professional] and COHN-S designations," says Thompson. "If more nurses choose to pursue the safety angle, that would be great, but you have to keep in mind the economic reality of the workplace and the future of industry in America."

Currently, says Thompson, what she sees is job erosion. "Safety professionals who work on that level may also be displaced," she says. "In light of the current marketplace, if nurses are diligent in their education, they may very well qualify for a job, but it may not be a given that such a job will be available."

Roy is more sanguine. "One advantage is if nurse have the credentials to sit for the CSP, we could see an increase in those numbers [of nurses who have both designations]," she says.

What might really be required, she offers, is an attitude adjustment. "A lot of people would be eligible; in many cases, they just need to have the courage," Roy says. "Many nurses are math- phobic; they are concerned that the safety engineer piece would be too much for them, but the reality is most of these people have the skills. They had to have good enough math skills to perform well in other sciences like physics. They know it; they just don’t think they do."

She sees nurses having an advantage in areas such as accident investigation and ergonomics.

"They can not only treat the injured individual, but they can look at the job, see the problems, and come up with a solution; they can do both sides," she notes.

"On a smaller scale, that’s how they assume the safety role — by expanding their role in activities they already do."

Such a move holds a strong attraction for many nurses, says Roy. "Most of us are looking for more of an intellectual challenge," she explains.

"With downsizing, there may actually be more job opportunities," adds Haag. "We need to articulate back to our bosses how our efforts impact on premium dollars."

With the aging workforce, safety becomes even more important, she continues. "If a company has a fleet of cars, it’s critical that they have a defensive driving course and target it to high-incident repeaters, just like [you would target obese employees] in disease management."

Once the crossover has been made, says Haag, nurses will need to find more creative ways of selling safety to ensure success. "One area I think is very important is marketing," she offers.

"If your organization has a marketing department, use it to help you develop your safety and health programs. They have the finesse. You’re already spread so thin; you need to tap into the resources of your company as these jobs become available," Haag adds.

[For more information, contact:

Deborah Roy, MPH, RN, COHN-S, CET, CSP, President, SafeTech Consultants Inc., One Monument Way, Second floor, Portland, ME 04101. Telephone: (207) 773-5753.

Marcella Thompson, CSP, RN, COHN-S, Principal Safety Engineer, ON Semiconductor Corporation, 355 Grandview Road, East Greenwich, RI 02818. Telephone: (401) 886-3342. E-mail:

Annette B. Haag, RN, BA, COHN, President, Annette B. Haag & Associates, P.O. Box 2098, Simi Valley, CA 93062. Telephone: (805) 581-3234. E-mail:]