AAOHN says injury trigger is problematic for nurses
These are some highlights of the American Association of Occupational Health Nurses’ (AAOHN’s) comments on the proposed federal ergonomics standard:
• In principle, a proactive approach that does not wait for a musculoskeletal disorder (MSD) to occur is preferable. Employers should approach health and safety by implementing comprehensive health and safety programs. Identification of and control of ergonomic hazards are merely one component of an overall health and safety program, which could be addressed in an overall safety and health program standard.
To truly be effective, all the components of a program will need to be implemented. Even though the standard does not, per se, require implementation of a full ergonomic program, elements of the program are truly necessary to prevent problems related to ergonomics from occurring. In reality, even employers who have successful ergonomic programs continue to struggle with these issues.
The proposal presents a number of contradictions in taking a prevention-oriented approach to addressing ergonomic hazards. The agency describes on p. 65,827 [of the Federal Register notice] "proactive ergonomics," which is essentially what the whole standard should support. However, the proposal does not require job analysis and control strategies until after an employee has suffered from an MSD. Even in the case of manufacturing and manual handling jobs, these requirements do not "kick in" until after an MSD has occurred. These strategies go against a proactive approach to addressing hazards.
• Another example of how the standard uses backwards logic (in taking a prevention-oriented approach) relates to the requirement for employers (with manufacturing or manual handling jobs) to provide basic information on MSD signs and symptoms to encourage early reporting (p. 65,800). However, the proposal’s training requirements do not kick in until after an MSD occurs. This strategy also seems to go against the theory of prevention and does not support OSHA’s argument that "initial training is necessary to ensure that employees in problem jobs, their supervisors, and the individuals who set up and manage the ergonomics program are provided with the skills necessary to recognize MSD hazards in their workplace and to effectively participate in the ergonomics program" (p. 65,833). There is some question as to whether OSHA considers this (training) necessary or not. Is job analysis truly necessary, even though not required for the employer to be able to determine which jobs are covered by the proposal?
• There are inherent challenges for employers who do not have the benefit of the services of an on-site health care professional to apply the screening criteria that include 1) exposure to MSD hazard likely to cause or contribute to reported MSD and 2) the job activity is a core element of the job. In an effort to "keep it simple" for employers, the proposed rule may be asking employers to make determinations they are not qualified to perform.
Furthermore, OSHA needs to address the conflict, which is presented by having the employer determine work-relatedness of an MSD, with current workers’ compensation statutes and processes, which generally require work-relatedness of an injury or illness to be determined by a health care professional.
• Clarification is needed under 1910.945 paragraph two, for manufacturing or manual handling jobs. The question is whether all three criteria necessary for determining whether an MSD is covered, that is, 1) employer knowledge, 2) job with physical conditions likely to contribute, and 3) activities or conditions that are a core element of an employee’s job. Further, it is uncertain whether it would be necessary for the employer to conduct a job analysis to make those determinations. If a job analysis were not conducted, the question is whether the employer would be violating the requirements of the standard if 2) and 3) were met, but not 1)? Does this provide a disincentive for employers to conduct voluntary audits to identify hazards?
• The use of a recordable MSD as a trigger is a concern in that it has the potential of establishing a disincentive for employers to report MSDs. OSHA argues that it has implemented the work restriction protection (WRP) provision to prevent employees from fearing economic consequences of reporting; however, the disincentive to report by employers may exist, whether WRP is implemented or not.
• It is extremely disappointing that OSHA has entertained the question as to whether it is appropriate for OSHA to recognize or promote the role of the nonphysician provider with respect to the ergonomics standard. The association is discouraged that it is forced to comment on this issue in yet another proposal by the agency. OSHA administrator Charles Jeffress verbally assured the nursing community at the November 1999 meeting of the Nursing Organizations Liaison Forum and National Federation of Specialty Nursing Organizations in Washington that this language would continue to be used by the agency in health standards.
At the very least, OSHA should require that the health care professional be knowledgeable about ergonomics issues. OSHA could assist employers in choosing professionals by providing outreach materials that educate employers about the qualifications of health care professionals and ways to select an appropriate provider. OSHA already has a document that provides employers guidance in choosing health and safety professionals (OSHA 3160).
Even more offensive to nurses as licensed health care professionals is the fact that this question is raised and yet there are provisions within this standard that essentially allow individuals with no health care training or experience to make health assessments and decisions about health effects.
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