AAOHN turns 60: A new world of occ-med nurses
More job responsibilities, advancement
As the American Association of Occupational Health Nurses Inc. (AAOHN) turns 60, it looks back on a long history of promoting worker health and safety. But one also can see a significant shift in the very nature of the Atlanta-based organization — an incredible change in the makeup of its membership.
In 1942, the organization was founded as the American Association of Industrial Nurses (AAIN). Its members provided physical exams, treated accident victims, and controlled communicable diseases such as tuberculosis.
Today, AAOHN members are solo practitioners, managers, educators, consultants, nurse practitioners, case managers, and corporate directors. But many longtime members still remember what the profession was like then. For more on the history of the AAOHN, visit the association’s web site: www.aaohn.org.
Job duties limited
Even as recently as the 1960s, both the job description of occupational health nurses and their prospects for advancement were extremely limited.
"Many RNs worked in a solo practice, where they were responsible for providing occupational and nonoccupational medical services," recalls Ellen Anderson, RN, MS, COHN-S, CCM, a telephonic nurse case manager for CNA New York in New York City, and past president of the Greater New York Association of Occupational Health Nurses. "They determined appropriate employee interventions. Health education and motivating employees to maintain good health practices were priorities at every encounter."
Multinurse units provided services such as pre-employment exams and periodic exams — which included glaucoma screening, audiometry, and spirometry, says Anderson. "Preparation for international travel included vaccination programs, securing local medical services in foreign countries, and providing annual medical exams on their return home."
When Addie Caputi, RN, COHN-S, a retired nurse in Ramsey, NJ, first got into occupational health nursing around 1965, she mostly took care of injuries, insurance, and some health issues. "It was basic nursing and dispensary. The nurse was under the doctor’s orders, sort of like a gofer."
What could a nurse aspire to?
"The only advancement or promotion then was to head nurse in the unit or the medical department," says Caputi. "You always had to have directives — standing orders — from the physician."
Suzanne Smith, RN, COHN-S-CM, FAAOHN, vice president of operations for Liberty Healthcare Corp., a medical management firm based in Bala Cynwd, PA, graduated from nursing school in 1966. She worked in an emergency department through 1972, and got her first occ-health position in 1974 in the shipbuilding industry.
"I was a second-shift nurse — the nurse for a population of about 4,000 people," she says. "We took all the lead levels, provided blood draws, did chest X-rays and physicals, and responded to emergency calls."
In terms of advancement, a nurse in her position could possibly look forward to becoming the administrative nursing assistant to the manager, or the manager in the nursing department. "You absolutely could not aspire to what nurses are today," Smith asserts.
The seeds of change
The 1970s saw the first significant changes for occupational health nurses. The enactment of the Occupational Safety and Health Act of 1970 placed greater emphasis on worker safety, putting management in the position of needing expert advice in this area. Observers agree, however, that the broadening of responsibilities and opportunities was due to the convergence of a number of forces — not the least of which were nurses.
"Basically, back in the day, education was primarily for nurses who provided care in hospitals," Smith says. "As they came out of schools and became more experienced, they took different courses. For example, you may have had some education in management. When I was with the shipbuilding industry, there were middle-management courses you could take and, because I was interested, I personally set my own markers as to where I wanted to go."
Smith’s second position was with a large oil and chemical company.
"Changes started at the company in about 1985, with people being targeted there for fast-tracking. You not only could take courses in your field of expertise but you also could be put on management teams," she recalls.
However, she notes, not every nurse was allowed onto that fast track.
"You had to be hand-picked for something you had done. I was the first nurse to work on standard operating procedures for incoming chemicals to the plant. Because of that, the broad net the company cast picked me for middle management."
Smith was taken from her local plant up to the corporate level and continued to use her nursing expertise. She gives her employer a lot of the credit for this advancement.
"I believe the company was very forward-thinking at that time. They didn’t see your incoming level as a dictation," she says.
Still, the individual nurse was an important part of the mix.
"I’ve always been unusual and had forward roles," notes Deborah V. DiBenedetto, MBA, RN, COHN-S/CM, ABDA, president of the AAOHN and a successful consultant. "I had my bachelor’s, my college-based preparation, and I came in with workers’ comp and management background."
DiBenedetto attributes the radical changes in the profession to, among other things, businesses recognizing the need to respond appropriately in areas ranging from benefits to the Occupational Safety & Health Administration, and the realization that having nurses involved in the process was good for business.
"They realized they could capitalize on their internal resources and expand their delivery of services and programs," she says.
Businesses had some help
Of course, employers had some help in recognizing the importance of occupational health nurses. Organizations like AAOHN advocated strongly for their members and also helped prepare them to take on the newer, more demanding roles.
"Over the years nurses became more autono-mous and involved in decision making in terms of employee health, work status, employee health education, and monitoring," says Caputi. "They could make more decisions about treatment and follow-up referrals."
She credits AAOHN with helping to make this expanded responsibility possible.
"The picture continued to change. You didn’t see all the nurses in white dresses and caps. Some were being brought into the business aspects of the operation," Caputi says. "AAOHN was very instrumental in getting the information out to nurses that in order to find a place in the corporate world your appearance, your dress, and your knowledge of the business world were just as important as taking care of the workers. They pursued the need for nurses to get more involved in continuing education and learning to be autonomous rather than remaining under the thumb of physicians and managers."
Anderson says she also has benefited from participation in the AAOHN.
"I first got involved in 1968 when I was hired by a major corporation in New York City," she recalls. "At that time, the medical director was a past president of the American Academy of Occupational Health Physicians, and he was very proactive about nurses becoming involved with their professional organization, which at that time was AAIN."
Continuing education programs were also co-sponsored by occupational physician and nurse organizations, which helped strengthen relationships between the two professions, says Anderson. "There was mutual respect for the knowledge base of both professions and how they enhanced each other."
The local AAOHN chapter meetings always have been an excellent resource for education and networking, she adds. "Many lifelong friendships have been made through this professional organization."
How high is up?
Today, myriad opportunities are available to occupational health nurses. DiBenedetto summarizes a few:
- Manager: The position involves coordinating and directing occupational health and safety programs for corporations. "It’s like being an orchestra leader," she says.
- Consultant: Providing occupational health and safety expertise to organizations as an external resource. "In a few companies, they call some of their more senior managers consultants because they consult with an organization or a division," DiBenedetto adds. "It’s a great opportunity for those with an entrepreneurial point of view."
- Case Manager: Coordinating and managing the professionals who care for those who have been injured and lost work time due to disability and injury.
- Corporate Director: Having overall policy accountability and responsibility. Smith holds such a position in her company, which provides nationwide primary care services to large businesses, primarily in rural areas.
"I set up programs for occupational health units, provide policies and procedures for programs, hire staff, manage staff from home, set parameters of care and medical guidelines," says Smith, who adds that her company provides the full range of occupational health services.
"As vice president of operations, I’m probably the OSHA go-to person companywide as well," Smith continues, noting that she also prepares the budget for contract companies such as labs and pharmaceutical firms.
Where do we go from here?
"The role [of the occupational health nurse] is still expanding in many areas. I see changes coming, and the need for nurses to keep in touch with all their local, state, and national associations, so they can have their voices heard in terms of legislation in occupational health issues," says Caputi. "Nurses also need to be open to change; we weren’t for many years. We also need to learn how to negotiate."
"The sky’s the limit," adds Smith, "And you have to be ready to meet challenges presented to you. Each challenge is individualized and unique."
AAOHN also will continue to change and evolve.
"As an organization we’re now looking at business drivers — what’s impacting our stakeholders, whether it be the regulatory framework or the financial, be it clinical or managerial," says DiBenedetto. "Our organization and its members must be very assertive in expressing what the opportunities are for our businesses, and what the occupational health nurse can do for the organization. We will become an even stronger advocate for the profession."
[For more information, contact:
- Deborah V. DiBenedetto, MBA, RN, COHN-S/CM, ABDA, President, American Association of Occupational Health Nurses, 2920 Brandywine Road, Suite 100, Atlanta, GA 30341. Telephone: (770) 455-7757. Web site: www.aaohn.org.
- Addie Caputi, RN, COHN-S, Ramsey, NJ. Telephone: (201) 327-5658.
- Ellen Anderson, RN, MS, COHN-S, CCM, Telephonic Nurse Case Manager, CNA New York. Telephone: (212) 440-3909.
- Suzanne Smith, RN, COHN-S-CM, FAAOHN, Vice President of Operations, Liberty Healthcare Corp., Bala Cynwd, PA. Telephone: (610) 617-3699, ext. 178. E-mail: [email protected].]
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