3rdcareerRN

Hurrah! Occ health can vary more than many specialties, depending on what the client needs -- anything from urgent care to OSHA-regulated medical surveillance to wellness programs to safety programs, or a mix of these and more. I really like it -- slower pace, get to know your "patients"/employees very well, wide range of duties, lots of variety. I've worked as an employee of a company with the medical contract, with the same holiday/pay situation as you describe. For me, it was a small annoyance but the autonomy far made up for it.

Try systems analysis, instead of educating: Determine the highest-value person or job role, whether it is by salary or impact on the rest of the clinic. Sometimes fixing reception/check-in -- the lowest paid position -- has the highest effect on the entire clinic. Look at the big picture to identify bottlenecks between job roles. Find the worst bottleneck, then figure out why it is a bottleneck -- who is not doing what when, and why. After the top two or three system-wide bottlenecks are fixed, start on the individual job roles. Work with that job role to help them identify the most time-consuming thing they do, whether it is on the EHR or something else. Figure out why it is the most time-consuming, by breaking down the steps. Then see whether any of the steps or the entire task can be changed/eliminated. Then make that change and see if it helped. Then repeat for the next most time-consuming task. Then when that job role is performing so they can keep up, do this analysis on the next job role. I know this seems like the responsibility of the practice manager or maybe the EHR manager, but as the educator you can play a key role as the person who sees both the whole system and the details. I guarantee you if you can step outside the pure education role and fix processes, you'll have your job for life.

I agree with prior post, that COHN is a must-have and in many positions, the spiro/fit-test/audio training and certificates are a must-have/must-get-upon-hiring. Coming from the ER, I looked at CEN before going into occ health. Iin an occ health job, the vast majority of CEN will useless. It is mostly about handling emergencies in an ER, using ER equipment and ER meds.

" CCNs- certified cubicle nurses" -- that's great! I agree that doing the onsite chart reviews (such as for HEDIS QI/QA) is a good intro to seeing medical records and the patient encounter in a broader way.

A phlebotomist can successfully use a 23- or even 25-gauge needle. I myself often use a 23-gauge butterfly and have never had lab reject my specimens due to hemolysis. If there is evidence-based guidelines about hemolysis when using small-gauge needles, can you point me to it please? I'm not being snarky, I want to improve my practice.

Occupational health. Most often 1:1 or sometimes 1:2, with time to actually do teaching and focused care. Although... there was that chemical exposure incident, when it was 1:45. One then learns the true meaning of "field triage". But just try to find an occ health job...the best specialty but virtually no open positions.

Ambulatory clinic patient w/ triglycerides of >2500. Blood looked like thick milk.

A key problem I see with a new grad choosing occ health is the lack of preceptorship for learning those common hands-on skills that are needed in all clinical nursing positions. Whatever you learned in school, it is not enough to do it as the sole nurse on-site unless you get more training. If there is more than one occ health nurse at your site and/or you can have a multi-week preceptor, then you might be OK. I learned my skills mostly in the ER prior to becoming an occ health nurse. That is extremely helpful as an occ health nurse -- I'm the only one on site during my shift, and I have up to multi-hundreds of employees to care for (depending on the day of the week). Many other postings state this, and I will echo: If you decide to go into acute care later without that magic one year of acute experience, you probably won't get in. However, I like occ health so much I may never go back to acute. Good luck with whatever you decide.

Gosh, I worked in 2006 at a Midwestern US hospital where we used all these: - Gerichair with locking tray - Posey vests - Gomco suction - Kardexes (in addition to Meditech online charting -and- paper charting...!) - Taping drips for timing because there were not enough pumps for every patient to have one - M&M enemas - Red rubber straight caths Are such things actually antiquated now?

South Midwest: "Call in" / "pop" / "peaCAHn" (pecan) Fond memories of my grandfather asking "Y'all want a sodee pop?"

Let me introduce a little bit of science into the discussion, by quoting a research representative: "...The risk of musculoskeletal disorders resulting from patient handling results from the high internal forces created in the spine when a person lifts a heavy object. Musculoskeletal disorders are a high risk for patient handling because it can require lifting a patient who is far away from the worker which puts heavy loads on the spine. Repeated lifting of this type can result in scarring that causes more damage. Studies have suggested that that there can be risks of injury even when two people are lifting a 110 lb patient from a bed to a chair.[8] NIOSH {National Institute for Occupational Safety and Health} recommends that no caregiver should manually lift more than 35 lbs of a person's body weight for a vertical lifting task.[9] NIOSH further recommends that when the weight to be lifted exceeds this limit, assistive devices should be used. These recommendations have been adopted by the Veterans Health Administration (VHA) and incorporated into its current patient handling recommendations and patient handling algorithms. Moreover, other major interest groups, such as the American Nurses Association (ANA), National Association of Orthopaedic Nurses (NAON), and Association of Perioperative Registered Nurses (AORN) have all adopted similar patient handling guidelines that recommend use of technology-based solutions for patient handling and movement.[10],[11],[12] ..." Source: http://www.hhs.gov/asl/testify/2010/05/t20100511a.html {boldface added} As an occ-health nurse, I want to protect caregivers' backs!

They will not mind...in fact, they are required to provide them to affected employees free of charge by Federal regulation! (OSHA Standard: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051 Personal Protective Equipment -- 1910.1030(d)(3)(i) Provision. When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. ...The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued to employees. As an occ-health nurse, I want other nurses to know their occupational rights! (at least in the USA)

Kudos for thinking! What I like to see nurses here and at work do is recognize what might happen, because then they can plan a better response than whatever their immediate reaction would be. Spending an hour looking at the policy manual exposes you to lots of things that might happen, and how you should react. I had a nursing school instructor who told me to imagine the worst that could happen to my patient or family, and plan what I would do. I've found that to be useful advice. Also I find these forums hugely useful to enlarge my imagination of such things, which I hope makes me a more prepared and better nurse. (yes, I'm a former Boy Scout -- the motto was "Be prepared.") We're all in this together, so let's support each other in becoming better.

I have very similar responses to this other poster, except #8 (I have much worse benefits/security as a nurse, a worse work schedule, less than half the pay as my prior two careers, but am usually satisfied or even happy daily now.)

Whether RNs need special training appears to be an entity-specific or geography-specific policy. However, the Centers for Disease Control offers free training here: http://www.cdcnpin.org/scripts/tb/kit.asp In that training, the CDC states "There are several different methods for reading the Mantoux tuberculin skin test, and they can vary among facilities. For each facility, everyone reading the skin test should receive training in and use the same method. " Can a non-RN can perform the reading? Yes, according to that course...although the interpretation of the reading results must be performed by "a trained health care provider".