Management needs open doors for occ-med nurses

Delivery, business emphasis take center stage

In the dynamically changing world of occupational health, new opportunities are opening up for the occupational nurses who are prepared to recognize and pursue them. While those who remain in more traditional roles face incredible job demands and potential burnout (see "Employment decisions affected by health, safety," in this issue), professionals willing to "think outside the box" may find careers that prove much more rewarding — both emotionally and financially.

"Companies are taking a much closer look at the cost of doing business, and through the recent downsizing trend, they are seeing an erosion of the corporate knowledge base," notes Deborah V. DiBenedetto, MBA, RN, COHN-S, ABDA, president of the Atlanta-based American Association of Occupational Health Nurses (AAOHN). "To help fill that gap, some nurses have had to expand their role from a more traditional one into benefits, insurance, risk management, or case management. In today’s business environment, working in teams is important. In many cases, nurses have become the gatekeeper on anything that impacts the return to work process."

The new paradigm, she asserts, is the delivery of services — providing services and information that will impact on the health, safety, and productivity of the work force.

"We’ve seen a broader focus on occupational and environmental health programs — disease management, the diversity of products and services that are required, case and care management, and roles have become more generalized with a business model approach, vs. a specialized role," adds Ann R. Cox, MN, RN, CAE, executive director of AAOHN.

What has caused the change?

Cox identifies several forces at work that have dramatically changed the environment in which AAOHN members now work:

• A dynamic business environment: Reorganization, downsizing and mergers have put demands on everyone to do more with less, and to deal with the impact of those changes on the worker population. Ironically, this could also be a threat to employment.

• Technology: It has dramatically changed the way we do business. The occupational health nurse must be able to use technology to become both more efficient and more effective, to track trends, and to use the Internet for health information. "They will also be required to give more information more quickly to employees," Cox adds.

• The changing profile of the occupational and environmental health nursing population: It is an aging population, notes Cox, but some people are selecting the profession as a second career. This requires additional education in order to meet the expanded job requirements. "There are still the issues of pay inequities, high customer demand, and who will come in and fill these roles in the future," she notes.

What’s out there?

So exactly what opportunities have been created by this new reality’? They’re almost too numerous to count, say the experts. "It has provided opportunities such as self-employment, consulting, and other horizons people have not even thought of — real cutting-edge work," says Cox.

"The traditional model is alive and well, but companies and nurses have to start thinking out of the box to provide value for employees," adds DiBenedetto. "Nurses can help manage wellness, unscheduled absences, compliance, manage [Family Medical Leave Act], [Americans with Disabilities Act], or manage both occupational and nonoccupational absences, and oversee integrated disability management. They may expand into work/life programs — anything from EAPs [employee assistance programs] to legal services, child care, and elder care."

Some may look forward to acquiring the title of productivity manager, or return-to-work coordinator, notes DiBenedetto. "A growing number are becoming consultants, hanging out their own shingle. Our consultants group is probably one of our largest growing specialty areas. I would think that includes about 10% of our members — including me."

"There are a lot of occupational health nurses doing consulting now, and that can range anywhere from Occupational Safety and Health Administration (OSHA) compliance to disability management and integrated disability management," adds Merrie L. Healy, RN, MPH, an implementation manager in Minneapolis for Sedgwick Managed Care, part of Sedgwick Claims Management Services (SCMS) Inc., based in Nashville, TN. SCMS is a third-party administrator for workers’ comp and short- and long-term disability and liability.

The current trend can often lead to responsibility for total absence management, Healy notes. "Employers realize it costs money not to have employees at work," she says. "They are starting to expand the same case management approach into the nonoccupational arena."

"There are also a lot of members who volunteer in other areas — a small population are becoming parish nurses," says DiBenedetto.

Positioning for change

Of course, most occupational health nurses were not trained for these new and changing roles. Quite often, a combination of more education and an attitude adjustment are required to be well positioned for the transformation. "It would certainly require one to be knowledgeable about how businesses think and operate," says Cox. "If you don’t have a particular area of expertise, ongoing education is also important. In other words, stay as competent as you can."

"You don’t learn finance in nursing school — not even in your occupational health training," adds DiBenedetto. "It’s important to know the financial impact of your services, and that is a big part of our mission now." This is not as easy as it sounds, she admits. "A lot of times you don’t have access to the numbers — such as unscheduled absences, the cost of health care, related benefits like work/life programs, or what the company’s workers’ comp costs are. Usually, they are managed by other stakeholders," says DiBenedetto. "You have to break through the silos, get everyone to the table and say, How can we act together to negate these problems?’"

Healy’s path to her current position has been "a real progression," she observes. "Each job has led to a new learning experience, which in turn led to enhancing my skills and moving me to get a higher level of functioning. Each phase has been rewarding — a learning experience on which to build."

Healy came to her career relatively late in life. She got married first, and took 13 years to get her degrees. "I did surgical nursing, then went back to school to get my BSN, worked part time in home care and hospice work," she recalls. "I got my four-year degree and worked for a hospital in northern Minnesota that asked me to be coordinator of health management services. Half of that job involved coordinating health education programs for the community; the other half was employee health and safety, which included workers’ comp."

Today Healy is responsible for implementing all of the managed care components of her company’s services — utilization review, bill review, telephonic case management, field case management, the pharmacy program, and PPO networks. (Are there any limits to the expanding role of the occupational health nurse? Read about the incredibly complex management position one occupational health nurse currently occupies and draw your own conclusions. See "Position offers diversity, responsibility," in this issue.)

Future filled with promise

Observers say the future holds more of the same for occupational health nurses, although recent events have added a new dimension — at least for the short term. "After Sept. 11, it’s a whole new ballgame," says DiBenedetto. "You have employees going on military leave, you’ve got to be dealing with the potential for violence and its psychological impact. People need to adjust and cope. Companies may have to cut off travel so the occupational health nurse can help all these people deal with those issues."

DiBenedetto foresees more reliance upon occupational health nurses in the future. "Companies recognize the value of their work force — especially after 9-11," she says. "Many nurses have responded by coordinating EAPs or briefing sessions, so their traditional role is being reinforced."

The typical role of the occupational health nurse in the future will be much more broadly focused, addressing environmental health issues, and families as well as individuals, says Cox. "You will need strong business skills, you will be programmatically oriented — a member of the team," she says. "Occupational health nurses will be leveraging their skills to be a business partner." The challenge will always be the measurement of worth, contribution and value, she adds. "Nurses will have to demonstrate competencies and values," Cox asserts.

"There is another huge issue on the horizon, and employers are just beginning to realize it; it’s the impact of the aging work force," notes Healy. "This will provide a new niche for occupational health nursing. Traditionally our role had been to take a look at occupational health and safety risks of the employee population. Now, we will have to factor in an aging work force — and help keep them working, promoting their health and well-being, preventing absences. Employers need this population for productivity reasons."

Nevertheless, these new responsibilities will not be handed to anybody, warns DiBenedetto. "Occupational health nurses will have to sell [the concept] to their management," she says. "They must come forward and say, There are issues and opportunities that I can help you solve.’ They’ll have to work with human resources, risk management, operations, safety, legal — whatever it takes." There will always be turf issues, she concedes, but people can come together and see the commonality, and "check their egos at the door." "We are very good at communication and collaboration, so we can put these skills to work," DiBenedetto offers.

Finally, she advises, "Position your practice for the 21st century. Look at where your company is, what its drivers are, what its business issues are, and see how you can be of service in terms of impacting the health, safety, and productivity of the employee population. What can you do that has positive effect and yields a positive return on investment?"

[For more information, contact:

• Deborah V. DiBenedetto, MBA, RN, COHN-S, ABDA, and Ann R. Cox, MN, RN, CAE, American Association of Occupational Health Nurses, 2920 Brandywine Road, Suite 100, Atlanta, GA 30341. Telephone: (770) 455-7757. Fax: (770) 455-7271. Web:

• Merrie L. Healy, RN, MPH, implementation manager, Sedgwick Managed Care, 7905 Golden Triangle Drive, Suite 150, Eden Prairie, MN 55344. Telephone: (952) 826-3844.]