Occupational Health: Core Areas of Knowledge and Competence, Part 2

OHA’s can contribute by helping managers to manage sickness absence more effectively. The nurse may be involved in helping to train line managers and supervisors in how to best use the OH service, in how to refer staff, what type of information will be required, what to expect from occupational health. By developing transparent referral procedures, ensuring that medical confidentiality is maintained and that the workers’ rights are respected the OHA can do much to ensure that employees referred for assessment due to sickness absence are comfortable with the process.

OH nurses, with their close relationship with workers, knowledge of the working environment and trends in ill-health in the company are often in a good position to advise management on preventing sickness absence emaemj.org . In my experience referral to General Practitioners have a limited use for work related issues, and gain best results by as well as keeping the GP aware, referring to a specialist occupational physician.

Planned rehabilitation strategies, can help to ensure safe return to work for employees who have been absent from work due to ill-health or injury. The nurse is often the key person in the rehabilitation programme who will, with the manager and individual employee, complete a risk assessment, devise the rehabilitation programme, monitor progress and communicate with the individual, the OH physician and the line manager. Nurses have also become involved in introducing proactive rehabilitation strategies that aim to detect early changes in health before such conditions result in absence from work. Improving and sustaining working ability benefits many groups, the individual, the organization and society, as costly absence and other health care costs are avoided.

In many cases the OH nurse has to work within the organization as the clients advocate in order ensuring that managers appreciate fully the value of improving the health of the workforce. OH nurses have the skills necessary to undertake this work and may develop areas of special interest.

The occupational health nurse may develop pro-active strategies to help the workforce maintain or restore their work ability. New workers, older workers, women returning to work following pregnancy or workers who have been unemployed for a prolonged period of time may all benefit from health advice or a planned programme of work hardening exercises to help maintain or restore their work ability even before any health problems arise. Increasingly the problems faced by industry are of a psychosocial nature and these can be even more complex and costly to deal with. OH nurses, working at the company level, are in a good position to give advice to management on strategies that can be adopted to improve the psycho-social health and wellbeing of workers.

The United States is facing the largest shortage of healthcare practitioners in our country’s history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.

This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, “Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective.”

United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the “art of medicine” is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.

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