need help--new to occ med

sasha · Nov 15, 1998

Anne Michelle, thanks for the information. I will try to locate this site. If you or anyone else has any pointers for me I would appreciate the help. Is there anything that I need to focus on in the OSHA manuals so that I will not miss anything??? Again, thanks a mil.

Anne Michelle · Nov 15, 1998

Sasha,

I have been working in an Occ Med clinic that is part of a community hospital for about 18mo. The clinic I work in is very small, we have about 280 companies that we offer services to. There is a profesional organization for Occ Med, I believe that it is calleed the American Association for Occupational Health Nursing (AAOHN), they have a website that offers information about the organization. Check it out.

Anne Michelle · Nov 15, 1998

Sasha, I know that we reference the state DOT standards extensively, as that relates to a large number of our clients. OSHA, that is a different story, sorry can't help with that one. What is the focus of this clinic? Examining their philosophy may be helpful too. I know when I entered Occ Med I was trained extensively on the job. Let me know if you have any other concerns, maybe I can help. Will you please check out the topic I am addressing under quality improvement, and give me your input? I would appreciate it.

Sharon · Nov 18, 1998

Sasha,

What type of industry or worksite will you be doing occupational health nursing? It will help to narrow the field if we know what area you will be working.

sasha · Nov 19, 1998

The type of clinic I will be working in is an ambulatory clinic affiliated with a state university hospital who has contracts with several different employers in a town of about 110,000. The employers range from manufacturers of chemicals to the Dept of Transportation employees since it is state and many other varied employers. I will be doing physicals, breath analyzer tests, drug screens, hearing and vision screens, teaching etc. I will have to be certified in some of these tasks, but I am just unsure as to what I need to focus on to lessen that "new, gee, I sure am dumb--feeling that one gets when doing something new and very different." Hence any help or advice Sharon will be greatly appreciated. Thank you for responding.

Sharon · Nov 19, 1998

Sasha,

If you will be doing primary care the first thing is to be very comfortable with assessments and very quick. If you can not do a physical assessment in under thirty seconds you will need to work on that first. A good resource for the simple 60 second assessment is Caroline's Emergency Care in the Streets. This is a text used by some Paramedic programs. The next step is to be able to do advance first aid blind folded and with no thought. Again a good resource is Caroline.

Next determine which job categories you will be seeing frequently for; Occupational Injury/Illnesses; Pre-employment and fitness for duty exams; Surveillance and Conservation exams.

Once you have determine what positions those categories are then review the job descriptions and clinic records for unique characteristics that put the workers at risk.

Become familiar with the signs and symptoms of those injuries and illnesses as well as emergency and tertiary care. For example are some of the truck drivers at risk for rotator cuff tear from steering the vehicles.

Next become familiar with the pre-employment and fitness for duty criteria for the positions you examine. An example would be a pre-employment exam for law enforcement officer who flunks the titmus vision screening but in such a pattern you suspect dyslexia.

Some surveillance and conservation exams are a no brainer. In other words if they are around loud noises the worker will need to have their vision tested. But what about the medical researcher who is working with viruses? Have they ever had baseline T cell counts? This area will require more critical thinking skills to determine the areas to be monitored. (FYI medical researchers are the last to want to have surveillance exams done.)

For resources I use a pocket Harrison's Principals of Internal Medicine, Work-loss Data Institute's Official Disability Guidelines, and The Merk Manual. I monitor many websites including OSHA, CDC, and DOT.

sasha · Nov 19, 1998

Sharon,

Thanks for your prompt reply. Caroline's is a book? Your resources I have except for the Work-loss Data Institut's Official Disability Guidelines, have not went to DOT website yet, did not know they had one.

The points that you bring up are exactly like what I was asking for...I know from working in ER that there are certain ways to treat certain injuries/illnesses. This is what I was trying to determine for occ med; what sorts of injuries/illnesses/occupations will I expect to see in a primary care ambulatory care clinic vs. an ER?? Also the terminology, ie: surveillance and conservation exams??? I know you said it was a no-brainer maybe mine is gone but you described a vision test for a worker in a loud work environment? Did you mean hearing test? The medical research tip was wonderful also, since this is a teaching hospital who conducts many research projects and grants at all times. It is the critical thinking criteria that I am searching for since you only learn this stuff by experience in a new field. Thank you again for your input and suggestions and I will certainly put to use each suggestion...which has set me to thinking of other inherent occupational hazards to look for.

Sincerely,

Sasha

[This message has been edited by sasha (edited 11-19-98).]

Sharon · Nov 19, 1998

Sasha,

Well my brain was going faster then I can type. The example I gave about working in a loud environment should have said hearing testing not vision.

I think you should think of the level of care you can do in your clinic as equal to not more then a Level II ED if you can suture and have full ACLS capabilities. If you do not have the ACLS and suturing capabilities, then think of your clinic as an advance first aid stand with additional medical expertise. The types of injuries and illnesses you will see depends on the clients. That is why I suggested the record review to see what you need to be prepared to handle. You will probably see everything you saw in the ED but more of a specific type of injury or illness associated with the specific work environment. For instance, I see more dirty needle sticks now then I did in the hospital. The reason is that one population I am working with is law enforcement who get stuck with dirty sharps while conducting searches of suspects.

Conservation exams are done when you know that a worker is exposed to an agent that will cause damage if not controlled and a program exist to control the agent. Surveillance exams are when you know an agent is in the environment but do not know which workers are in contact with the agent. Lead screening for children is a surveillance exam. In adults who repair radiators and should be wearing respirators, blood lead levels are an exam that is part of a conservation program.

With conservation exams you have identified the highest risked individuals and are monitoring them. In surveillance exams you are monitoring a population that could manifest exposure to an agent in different ways. Also testing in a conservation program can be diagnostic but testing in surveillance program can only be screening not diagnostic.

Critical thinking skills are transferable from one area of nursing to another. If you have already developed the skills then you will find that they will work in occupational health as well as emergency care. Unfortunately many nurses do not have critical thinking skills to recognize a potential problem and understand the value of correcting the situation before it becomes a problem. I suspect you do have critical thinking skills because you know to ask for information and clarification. Identifying unsafe conditions and correcting them before a worker is injured is very import to occupational health.

Yes Emergency Care in the Streets is by Caroline.

sasha · Nov 19, 1998

Thanks for clarifying conservation and surveillance for me, that was new terminology for me, the explanation makes sense. And, okay I feel better now, loud noise=hearing test. Will definitely do a record review once I am on the job and will also try to locate Caroline's book. If I run into anything I don't understand later, I will post the question, if I cannot ask through regular routes. If you know of anyone who has resources for a certain cardiac arrythmia, please have them read my post under cardiac nursing. Thanks a mil!!!

JeanthePHN · Nov 25, 1998

Don't forget you will have to become an expert at immunizations!!and pre and post exposure prophylaxis.

I wish I had your job. Got any openings for a RN?

EMAIL ME ANYTIME WITH QUESTIONS ON VACCINES.

JEAN THE NURSE AT [email protected]

publisher and owner of the Embassy Project Chart-immunzations in 24 languages translated!

sasha · Nov 25, 1998

JeanthePHN,

Please elaborate, what are some examples of pre and post exposure prophalaxis???(sic) I know about TB if you test positive or how to prevent if you know an active case is your patient. What else? It's late and my brain quit a couple of hours ago.

Where are you located, and why do you like the sound of my job...I think I'm gonna like it too.

Sasha