Scope of Practice
- 0May 13, '13 by strivingformoreI have recently started a new job as an OHN (I am doing my OHN coursework at the same time) And have had a few scenarios where I feel I have been put in a "sticky" situation. I am looking for some advice on where to find detailed information for scope of practice. One situation in particular that I had trouble with is if an RN or OHN is able to assign what modified work/light duties an employee can perform. Or what duties an employer should not perform.
Anything would be helpful! This is a whole new world I am discovering one day at a time!
- 1May 14, '13 by KelRN215Doesn't your employer have guidelines for this? I am not an occupational health nurse, but I had my own experiences dealing with that department when I worked in the hospital. I had a note from my doctor that outlined the restrictions, the NP who worked in OH approved them and emailed them to my manager. The recommendations for my restrictions came from my doctor, OH just determined whether they were compatible with my job.
- 0May 22, '13 by lovethecrazylifeAt my company I can assign restrictions if needed. I usually won't as then the employee becomes recordable according to OSHA. (If work injury) I figure if I'm going to have to put it on the log, they might as well see a provider. Check your company policy to verify their process though.
Welcome to OHN world. I'm fairly new myself and I love it!
- 0May 23, '13 by 42pinesScope of Practice questions should be referred to--yup, your state nursing board "Scope of Practice." Each state has its own. If after reading it you are still confused write to the BON and ask. Even if they don't answer directly they will put you in touch with someone who can.
This being said, I find it doubtful that you'll find much in the SOP because the question is too specialized to Occ Health Nursing.
As an RN you should have a relationship with a Medical Director which might be an MD, or if allowed a ANP or PA. If you do not have such a relationship in your company which might be the case, well this would make me cringe as you need Standing Orders even to give aspirin in the case of a suspect heart attack as well as Tetanus Immunizations, oxygen, etc. I would not work for a company without such a line of command though the strength and ease of the connection varies. I've worked where I have a MD (Medical Director, who is an MD) available at all times and have worked where I theoretically had one available (but getting a response was difficult).
To turn back to restrictions. I've (following protocols handed down to me) have been able to create restrictions for 24 hours and could extend them for good reason (inability for the EE to see a Practitioner) and have always felt comfortable with that. Restrictions like "no push/pull" or "no lift more than 5lbs" or "no work more than 8 hours for the day," as well as "you're out'a here right now." (That's a CYA move when I have an EE who is not taking an issue as seriously as I want him/her to do). I'd generally (at most places) follow that up with a call or note to the covering Practitioner explaining what and why I've done what I've done, and I've never been called back to change such a short term set of restrictions. But as for creating modified/light duty work specs for more than a day I'll say right out "no way."
As Aarakoto pointed out creating restrictions can create recordables though prophylactic same day restrictions is not medical treatment and does not. Create work restrictions for a longer period of time may create a recordable and in my opinion is not w/in your realm.
Often I'd have a form connected to that company that listed what that EE did on what job, a "Job Analysis" it had a series of questions from "does EE drive," to "lift 0-5lb," "5-10lb," etc. It included climbing, running, kneeling, and had check-off spaces for "never," "occasionally," "frequently," etc. With the EE and the Supervisor (if needed) I'd utilize this tool and give the EE a copy of it to take with him/her to see their Practitioner with a request that specific restrictions or limits be returned. Often with the EE's permission I'd communicate with the Practitioner as to enable that person to see the complete picture.
The EE is often (but not always) the best source of what to do for temporary restrictions and if I thought a worker could lift 0-5lbs but the worker said: "no." Well, that's a warning to go up the chain, even if the worker is a slacker--there is too much risk to do otherwise. I've always found most workers quite willing to be vocal about what they can do and can't do. True abusers/slackers are rare, but they do occur and can be a pain--though be careful for someone who is clearly abusing the system may have other reasons that need to be teased out that in fact point to medical necessity such as panic/anxiety attacks.
Very short term restrictions are generally accepted with good reasoning and documentation and with a required "do not come back until you have a Practitioner's ok unrestricted or with restrictions. But document well and be conservative and if in doubt--don't. Just my thoughts--good luck.Last edit by 42pines on May 23, '13
- 1Jul 19, '13 by RNBScNOHNHi there - I'm Canadian OHN (RN) required by my provinicial licensing authority to practice under direction of an MD. Therefore, I would obtain any work restrictions for an ee from the ee's doctor. The exception to this would be if a company protocol existed which was created by me and an MD that specified the conditions under which I could write work restrictions. The protocol needs to include a document signed by the MD that certifies I have adequate specialty training and demonstrated competence to perform skills & tasks in the protocol.
- 0Jul 23 by ASAYLERIn my experience being an Occupational Medicine Nurse it is always the provider, whether it be a NP, PA, MD, and/or a Physical Therapist to set restrictions. It's often we nurses get a phone call from the patient asking if the provider will change or remove their restrictions because they are feeling better. This hardly ever, if at all happens over the telephone. In order to have restrictions be changed or removed the patient must be evaluated by the provider. I'm not sure if this is set in stone, because we work a lot with Workman's Compensation claims, or because it is what we call "best practice" where I work. I would say know what your state BON has in writing and/or what your facilities protocol(s) are. I would rather those decisions be riding on the provider and not myself. Without a full and detailed exam you may return a patient back to regular duty before they are actually ready and cause further and perhaps worse issues down the road due to not fully finalizing the initial issue. As a nurse, when I'm interviewing a patient and they state that they want their restrictions removed because they are resolved, I often probe and ask why they feel that way. Another question I ask is, "Are you really feeling better and ready for regular duty or are you just done with being on light duty and want to go back to work?" I feel you have to be real and realistic with your patients. I think some patients feel like they are a bother and just want to be released from restrictions. I tell them, "I don't want you back on regular duty until you are truly ready. It might sound good right now, but in the long run it's not worth it. I'm sure you want to get back to work, but don't rush it. If you need time to heal, then allow it."