Chi-RN

Thank you. You have really helped me a great deal. I'll let you know how it goes over the next few days! -ga

I am not in the clinic at all. My position is strictly administrative and I am trying to work with clinic staff to improve/streamline the process. The most delay occurs when waiting for cadmium and/or lead levels to be returned from mail-out labs (2 weeks). Other labs are performed on-site. The cadmium standard requires a Physician's Written Opinion to be delivered to the employee, but I am not certain this needs to be included during the preplacement process.

I am employed in a large industrial activity by the federal government. One of my primary roles is as liaison between my command and the medical command that provides Occupational Health Services for our federal civilians. I have a dilemma I would like to share with other OHNs to see if anyone has run into this problem before. The Occupational Health Clinic I deal with performs preplacement physicals and surveillance/certification physicals (with the exception of respirator & hearing) on a 2-appointment basis. In other words, each employee must have a preliminary appointment with the nurse to complete tests (bloodwork, spirometry, EKG, etc.). Then, the employee is scheduled again at a later date to see the physician and complete the exam. This process was started by a clinic department head about three or four years ago. That department head has since retired. The result of the 2-appointment process for physicals is that surveillance examinations take up to two weeks to complete. Some of the surveillance lab results take a while to be returned from a mail-out lab. Physicians in the clinic will not perform the physical until all lab results are in the record. For new hires, it get worse. It takes longer for preplacement exams to be completed using the 2-appointment system. Then, once new hires are onboard, I must still request they be scheduled for required surveillance examinations, with a resultant delay of several weeks before the new hire can be productively working. This is very costly for my command. Until about 4 years ago, physicals were completed in this clinic during just one appointment. The same is true, of course, when you visit a private physician. Tests are performed, you see the physician, and you are called back for a second appointment only if there is a problem. The change to 2-appointments was made to accommodate clinic staff, but it was at the expense of customer commands. I understand there are circumstances when the clinic would want to see an employee twice, such as when a written opinion or a referral to a private provider is required. Those, however, are exceptions. My command would prefer the process be streamlined to save money in lost production time. For my command, as the customer command, the 2-appointment process means each employee requiring a physical must shut down processes, lock toolboxes, & report for the physical a miniumum of twice. In addition to cost savings for my command, I think my command's no-show rate would improve (not having to keep a minimum of 2 appts for each physical), which would result in a cost-savings for the clinic. Unfortunately, this 2-appointment process for physical exams seems firmly implanted at the clinic. They like the ability to organize this way. I would like to know if other Occupational Health Clinics use this 2-appointment process and if it presents problems for other OHNs. Thanks.

When I used to teach ADN students, I loved to have them explore the lesser-known nursing specialties. Here are some links from an Occupational Health Nurse's perspective that might be a bit unusual, but I think you'll find some interesting reading on them. Some deal with specific "nurse" safety issues, some are more "patient" safety focused, others "employee" focused. Not typical of what a nursing educator thinks about, but enjoy! http://lab.nap.edu/nap-cgi/discover.cgi?term=nurses+safe+patients http://www.diabetesatwork.org/ http://www.osha.gov/SLTC/healthcarefacilities/index.html http://www.osh.net/directory/hipaa/index.htm http://www.ergoweb.com/