Supplement-Salaries remain flat as EHPs stay afloat in health care turmoil

Be prepared to meet the challenges ahead

Salaries have largely remained flat over the past year for employee health practitioners, which is not surprising in the current climate of budget cutbacks and minimal raises in health care.

The numbers revealed in the exclusive 1999 Hospital Employee Health salary survey reflect the scene in health care today. Of those EHPs who received salary increases in the past year, the majority (54%) saw only between 1% and 3% more on their paychecks. For 17%, salary levels remained exactly the same in 1998-99 as in the previous year.

Each year, HEH sends subscribers a confidential salary survey form to complete and return. This year's results show that most annual earnings hover in the $35,000 to $50,000 range, the same as last year. An examination of the numbers by job title — employee health nurse, coordinator/manager, and director/administrator — indicate that most of those who earn salaries of $60,000 or more are employee health directors/administrators.

Most survey respondents work between 41 and 45 hours per week, supervise between one and three people, have worked in employee health between one and six years, and have earned a bachelor's degree. The highest proportion work in medium-sized nonprofit hospitals.

"Nobody's job is secure in health care today," says Kathleen VanDoren, RN, BSN, COHN-S, former executive president of the Association of Occupational Health Professionals in Healthcare (AOHP) in Reston, VA. "The health care system is in such turmoil that hospitals are trying to operate with the bottom line in mind. There will be more major changes in health care in the coming years, and nobody's seat is secure."

In the 21st century, employee health departments will continue to be caught up in "cost-crunching," she adds, unless they can start proving their worth. On the other hand, the need for surveillance programs and immunizations will not decrease.

"In fact, I just attended a conference at which an employee health physician suggested that hepatitis A vaccine be part of routine immunizations for hospital plumbers and food handlers," she notes. "It is something I can see coming, and something I have recommended myself."

If employee health professionals feel overwhelmed by responsibility, VanDoren suggests prioritizing.

"We're nurses; ideally we like to do everything for everybody, but we may not be able to continue to offer some of the nice things, such as doing blood pressure checks for volunteers. We might have to look for what we can eliminate. When OSHA comes up with an ergonomics standard, you will have to fit that into your schedule. If you can't add on to your own staff, you'll have to look for help by bringing other departments onto your team," she says.

During the latter years of the 20th century, VanDoren has seen greater employee appreciation for the services of the employee health department. She hopes that hospital administrators will adopt the same viewpoint as the new millennium unfolds. Many administrators see EH departments as "a necessary evil," she says, because they don't understand the department's value.

While administrators often recognize that the department helps keep them from OSHA citations, they tend to be unaware of other aspects of the employee health service's value. However, with more OSHA regulations due to be issued in the next year or two and with the Joint Commission on the Accreditation of Healthcare Organizations taking a closer look at employee health functions, that could change. (See Hospital Employee Health, October 1999, pp. 115-117.)

"If the Joint Commission would really scrutinize employee health — either by separate standards or more employee health applications of existing standards — and focus on employee health when they do their surveys, that would be a terrific asset in showing the value of what employee health is doing," VanDoren says. "It would wake up administration and show them they need this department, what an advantage it is, and how much money they're saving the hospital, for example, in bringing employees back to work from injuries in modified duty positions."

MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S, newly installed executive president of the AOHP, agrees that the Joint Commission, OSHA, and the CDC are all becoming more aware of the EHS's role.

"There will be continuing opportunities for employee health as we go forward into the 21st century," says Gruden, who also is an employee health nurse practitioner at Sewickley Valley Hospital in Sewickley, PA. "We've begun to develop a national presence with the government and regulatory agencies that we need to comply with. There are challenges, too. In some areas of the country, employee health departments are closing due to downsizing, but in other areas, [employee health practitioners] are gaining more responsibility."

EHPs need to become more visible within the organization, she advises. This can be accomplished by participating on safety and infection control committees, joining professional associations, becoming certified, and staying current with developments in the field.

"We must demonstrate our ability to be cost-effective and productive in what we do," Gruden says. "That's a challenge, because we don't have clear-cut measures for that. How do you show how productive you are when you're trying to juggle clinical and administrative duties?"

In the past, employee health nurses tended to be in that position simply because they were close to retirement or were placed there for lack of another assignment in the hospital, but that isn't true for the majority anymore, she notes.

"Especially since the bloodborne pathogens standard, there is a need for professionals to have more knowledge and experience. People are going back to school to learn more about occupational health and to get advanced degrees. There are more opportunities now for that than there were 20 years ago," she states.

If organizations such as the Joint Commission start scrutinizing employee health functions within hospitals, they will be looking for a "competency-based practice," says Jeanne Culver, RN, COHN-S, clinical manager of employee occupational health services at Emory University Hospital in Atlanta.

However, this does not mean that only a separate occupational health department can provide employee health services. In many hospitals, infection control departments do a good job with those responsibilities, as long as they employ nurses with appropriate experience and expertise, she says.

"If a hospital has the resources and a large number of employees, it certainly behooves them to have specialists who are evaluating employees' fitness to do a job and monitoring their health. It does take specialists to be able to do that," Culver states. "The reality of it is that we're not living in an ideal world. It requires well-educated practitioners, no matter what department they're affiliated with. The only factor they're going to be judged by is whether the people who have the responsibility for employee health are qualified and competent."

EHPs of today and the future must be familiar not only with OSHA standards but also with the various state health department regulations, she adds.

"Hospitals are not just going to be able to put a nurse [in charge of employee health] who's close to retirement, who has no idea about occupational health hazards in a hospital environment. They wouldn't recognize an adverse event if they saw one," she says.

For employee health departments to continue to exist, they must become "collaborative," Culver asserts. "They must team up with other people who make their jobs easier. Their value will be found in being able to assume some responsibilities for things that are tangentially associated with the health and safety of employees. Cost containment is absolutely a priority for non-revenue-generating departments in hospitals. They have to demonstrate in concrete terms what their contributions are to the bottom line or they're not going to survive."

What does the future hold for employee health departments? "My hope is that we will be alive and well," Gruden says. "There's a lot of potential, but it will take a lot of work as well. In health care today, there are many external issues we have no control over, so that's why it's important to focus on the areas where we can really help the organization."