AAOHN rips proposed ergonomic standard, wants more proactive approach’
OH nurses want broader role
The debate over the proposed ergonomics standard is heating up, with the American Association of Occupational Health Nurses (AAOHN) in Atlanta weighing in with a number of serious complaints about how the rule is constructed. As currently proposed, the AAOHN says, the rule does not go far enough in trying to prevent ergonomic-related injuries and it does not adequately recognize the role of occupational health nurses.
AAOHN supports the overall effort to establish an ergonomics rule, but the current proposal needs work, says President Deborah DiBenedetto, MBA, RN, COHN-S, ABDA.
"A lot of employers need that guidance, but a lot of components of this rule will be very burdensome and challenging," she tells Occupational Health Management. "It can be made workable with some changes."
DiBenedetto points to a number of problems with the current proposal, all described in detail in the group’s official 29-page comment submitted to OSHA in February. The comments will be considered by OSHA, along with comments submitted by individuals and by other organizations, before the rule is finalized. (See p. 40 for highlights of the AAOHN comments submitted to OSHA.)
The overall problem with the proposed standard is that it does not promote a proactive approach to preventing ergonomic problems, she says. The proposal outlines a process that does not even begin until an injury is reported, and DiBenedetto says that is just not good occupational health.
"And there are other problems, too," she says. "The rule calls for wage replacement for musculoskeletal injuries, with recommendations for replacing wages at a certain level for six months. We already have a workers’ compensation system in place, so there’s no need to duplicate that."
Though the official comments to OSHA outline a number of such problems and questions, Kae Livsey, RN, MPH, public policy and advocacy manager with AAOHN, says the injury trigger remains the biggest concern.
"You have to wait until someone is hurt before triggering the elements in this proposal," she says. "That violates the concept of prevention. And who makes that determination that it is a work-related musculoskeletal disorder (MSD)?"
The current proposal says the employer is responsible for making that determination, which Livsey says is not necessarily a problem as long as the employer has access to health care professionals who can provide guidance. But for smaller companies, she says, it is not appropriate for a supervisor to make that decision.
"We believe they should have access to a health care professional to make this assessment about whether they have a covered MSD," she says. "It’s not appropriate for someone off the street to decide that."
Livsey and DiBenedetto say the proposed rule should be much more explicit in requiring a health care provider’s assessment, and the comments submitted to OSHA call the proposal "offensive" in the way it allows a lay person to make decisions better left to occupational health nurses or other medical professionals. The AAOHN has argued this point with OSHA in the past and received assurances that the agency would recognize the need for qualified nurse input for any future rules, so DiBenedetto says the wording in the proposed ergonomic rule was a surprise.
The response to the proposed standard from the American College of Occupational and Environ mental Medicine (ACOEM) was expected in March, but officials from the ACOEM were unavailable for comment. However, they have confirmed their general support for a federal ergonomic program standard in earlier statements. Because of limited scientific data available, Edward Bernacki, MD, ACOEM vice president, cautioned OSHA in 1999 to adopt a standard that limits ergonomic assessment and controls to areas where medically diagnosed work-related musculoskeletal disorders truly exist.
Bernacki says the standard should encourage an assessment of the workplace by professionals trained in ergonomics, industrial hygiene, or safety engineering; accurate diagnosis of potential work-related musculoskeletal disorders by physicians with the ability to make causal diagnoses utilizing ergonomic, epidemiologic and clinical data; and the treatment and medical removal of individuals with medically diagnosed work-related musculoskeletal disorders.
Rule is too complex
Overall, DiBenedetto says, the proposed ergonomics rule is too complex and burdensome for employers. The irony is that the complexity appears to be the result of OSHA’s attempts to make the rule flexible and palatable to everyone who fought so hard against previous efforts to create an ergonomics standard, she says.
The checkered history of the ergonomics rule goes back more than 10 years. The first major defeat was in June 1995, when the first proposal from OSHA failed with a resounding thud. The administration had been promising an ergonomic standard since 1990 and had released proposed versions of the standard, progressively weakening the proposals in response to employer protests. A 1994 draft would have covered all U.S. employers — about 6.1 million employers with 96 million employees — but the 1995 proposal would have covered only employers with evidence that hazards exist, about 2.6 million employers with 21 million employees.
The strongest criticism came from business leaders who felt the proposed standard would put too much of a burden on employers, even after the standard was greatly watered down. Those complaints were well-received by congressional leaders, who exerted extraordinary pressure on OSHA, and OSHA withdrew the proposal. The current version has survived as long as it has perhaps because it is a much less ambitious rule than those proposed earlier, DiBenedetto and Livsey say.
Parties to the issue disagree on whether the proposed rule is considered complex. OSHA officials contend that it is relatively simple and presents as small a burden as possible to employers, but the AAOHN leaders say the practical application of the rule would be very difficult for many employers.
David Cochran, PhD, PE, CPE, professor of industrial engineering at the University of Nebraska and special assistant for ergonomics at OSHA, says the ergonomics proposal is among the first to avoid the formal, highly complex format that occupational health professionals have come to expect from OSHA. In addition, the proposed ergonomic rule would be considered simple when compared to most OSHA standards, he says. Cochran says the proposal can be boiled down to these two points:
• Employers must have a system for recording ergonomic-related injuries and illnesses.
This is the heart of the proposed standard, and for many employers, this will be the entire requirement. Employees would have to be educated on MSDs and understand how to report hazards and injuries to the employer. If there are no injuries, the employer’s burden stops there.
"The injury would have to be something directly related to what they’re doing in that job," Cochran says. "If the employee slips and gets a back injury, that may not trigger any other obligations under this rule because it’s not directly tied to the job activities."
• If a musculoskeletal disorder occurs, the employer must respond.
Employers will be expected to investigate the hazard, develop ways to address it, and implement the solutions.
That supposed simplicity is misleading, Livsey says. The proposed rule actually leaves so much up to the employers that many will not know whether they are required to do anything at all, and if so, just what they have to do. The fact that OSHA does not require the intervention of health care professionals in the decision-making process only makes the problem worse, she says.
"It’s sort of a shame that in an attempt to be flexible they’ve really made it complex," Livsey says. "The employer will be challenged to sort all this out and know what to do. And it’s unfortunate because of all of this debate has made ergonomics a four-letter word for some people."
Even though they have significant concerns, DiBenedetto and Livsey say they are optimistic that OSHA will respond well to the concerns outlined by OSHA and other groups and change the rule appropriately.
"This is a very good standard in some ways, but OSHA is just overreaching, and what they want may be unattainable by a majority of employers," DiBenedetto says. "OSHA is really trying hard, and we support that effort, but the content is so detailed that a useful application of this rule will be unattainable by a lot of employers. "We don’t want it to die. It just needs to go back to the drawing board for more work."
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