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Access to occupational health services for primary prevention and control of work-related injuries and illnesses by the global workforce is limited (World Health Organization [WHO], 2013). From the WHO survey of 121 (61%) participating countries, only one-third of the responding countries provided occupational health services to more than 30% of their workers (2013). How services are provided in these countries is dependent on legal requirements and regulations, population, workforce characteristics, and culture, as well as an understanding of the impact of workplace hazards and worker health needs. Around the world, many occupational health services are provided by occupational health nurses independently or in collaboration with other disciplines' professionals. These services may be health protection, health promotion, or both, and are designed to reduce health risks, support productivity, improve workers' quality of life, and be cost-effective. Rantanen (2004) stated that basic occupational health services must increase rather than decline, especially as work becomes more complex; workforces become more dynamic and mobile, creating new models of work-places; and jobs become more precarious and temporary. To better understand occupational health services provided by occupational health nurses globally and how decisions are made to provide these services, this study examined the scope of services provided by a sample of participating occupational health nurses from various countries., (Copyright 2014, SLACK Incorporated.)

Occupational and environmental health nurses play a key role in raising awareness, advocating for public health and safety, and preventing deleterious health consequences for individuals who consume energy drinks., (Copyright 2013, SLACK Incorporated.)

This article provides an overview of ethical issues related to the practice of occupational and environmental health nursing and possible strategies for resolution. Also, professionalism related to professional growth and advancing the specialty is discussed., (Copyright 2012, SLACK Incorporated.)

This article discusses select characteristics of the aging work force, health-related issues that can impact work productivity, and strategies and resources that can foster a more productive work environment. The older work force is vital to the future of the U.S. economy. Employers should recognize the value of older workers. Occupational health nurses can assist older workers in maintaining and optimizing their health., (2011, SLACK Incorporated.)

This descriptive cross-sectional study was conducted in 2005 and 2008 to evaluate self-reported competency achievement by occupational health nursing program graduates. Twelve competencies were evaluated at three levels: competent, proficient, and expert. In 2005, most graduates believed they were at the proficient level in 10 of the 12 competencies, with three competencies approaching the expert level. In 2008, all graduates rated their competency achievement at the proficient level for all 12 competencies, with nine competencies approaching the expert level. Graduates entering the program with experience had higher competency scores compared to those without experience. Distance education learners had higher competency scores compared to on-campus graduates. From 2005 to 2008, reported competency achievement increased in all areas except research, which was only marginally reduced by a 0.1 score. Based on competency findings, curriculum and course assignments related to leadership role, policy development, professional development, and research were modified., (Copyright 2011, SLACK Incorporated.)

Occupational health nursing academic education is generally provided at the specialty level through master's and doctoral degree preparation. This graduate education provides preparation for administrative, occupational health specialist, practitioner, academician, and researcher roles. Guided by nursing science, this specialty education encompasses a comprehensive curriculum that requires occupational health and safety coursework, practicum experience, and interdisciplinary learning.

Although preventable, hearing impairment is one of the most prevalent disabilities in Western societies. In the United States, approximately 30 million individuals are at risk for noise-induced hearing loss and 22 million individuals between the ages of 20 and 69 have permanently damaged their hearing by exposure to loud sounds or noise in their environment. Both work-related and recreational noise exposure affect an individual's hearing. Legislation in 1969 and later in 1983 established standards mandating that all workers exposed to noise levels at or greater than 85 dBA time-weighted average be placed in a hearing conservation program that includes provision of hearing protective devices. This article discusses components of an effective hearing conservation program, and the roles and functions of interdisciplinary team members in making a hearing conservation program successful.

The Family and Medical Leave Act (FMLA) was enacted in 1993 to balance the demands of the workplace with the needs of families. Balancing work and family responsibilities will affect most workers as they experience their own serious illness or care for a child or a parent. The FMLA continues to present challenges regarding medical certifications, recordkeeping, intermittent leave management, and lack of understanding by employees and employers about rights and responsibilities under the law. This article discusses the rights and responsibilities of both parties. It also discusses how the occupational and environmental health nurse can bridge the gap between meeting the needs of the employee and those of the employer by serving as educator, advocate, and liaison/collaborator, leading to measurable cost savings for the employer and immeasurable benefits for the employee.

This study explored the elements of the occupational health services model in Thai primary care units. Seven focus groups with nurses and public health professionals working in primary care units, employees, employers, and occupational health service-related authorities were conducted. Content analysis of the focus groups revealed 15 practical elements in five domains: system inputs, throughputs, services, outputs, and feedback. Examples of existing elements in the five domains were occupational health staff competencies (inputs), collaborative network building (throughputs), on-site occupational health services (services), number of activities performed as on-site occupational health services (outputs), and evaluation (feedback) of occupational health services delivery. The findings have implications for further development of the occupational health services model in Thai primary care units, such as training the staff of primary care units to become competent in delivering effective occupational health services.

Heat-related illnesses can occur in workplaces where hot environments pose a threat to at-risk workers. Operations involving high air temperatures and humidity, radiant heat sources, direct physical contact with hot objects, or strenuous physical activities have potential for inducing heat stress in employees engaged in job functions in specific industries. Exposure to high temperatures can lead to a progression of symptoms in the body, which can result in widespread tissue damage, organ damage, and even death if not treated in a timely and effective manner. Strategies to reduce the effects of heat in the workplace include engineering controls, administrative controls, and personal protective equipment. Occupational and environmental health nurses must be able to recognize and treat the broad range of symptoms that can result from exposure to high temperatures. They must work together with interdisciplinary teams to provide training and education to the work force so that workers are able to take appropriate measures to prevent the onset of a heat-related illness, recognize the early symptoms, and seek treatment. Interdisciplinary teams must ensure that appropriate controls in the work environment reduce the risk of heat exposure and related heat stress disorders. Education and early intervention are key to avoiding heat-induced illness and eliminating or minimizing the effects of high temperature environments.

In disaster-related events such as these, this survey demonstrates clear need for improved preparedness efforts and communication strategies to help reduce health risks for at-risk populations. The role of occupational health nurses and occupational and environmental medicine physicians requires knowledge and skills in many areas. This includes not only clinical skills related to illness and injury that will occur, but also skills in such areas as surveillance, management, community coordination, risk management and risk communication, and health protection. The psychological impact of disasters will have far-reaching effects resulting in emotional and behavioral changes requiring both immediate and long-term interventions. Comprehensive disaster management guidance should be in place to assist health care providers and workers in pre-event, event, and post-event phases of the disaster.

Occupational health nursing practice is broad and encompasses surveillance, screening, and prevention activities as part of the scope of practice. While there has been some controversy about who is responsible for these activities, it is clear occupational health nurses play a pivotal role in overseeing, managing, implementing, and evaluating these programs. In fact, recent OSHA standards have included broad language that permits licensed health care professionals acting within their legal scope of practice to conduct medical and health surveillance activities. While the contributions of occupational health nurses are well documented, little is known about the degree and emphasis in practice related to surveillance, screening, and prevention programs. This study examined the scope of independent and interdependent practice by occupational health nurses related to these activities and found 71% of occupational health nurses had overall responsibility for program management, and the majority performed surveillance, screening, and prevention functions as independent practice. Physician supervision for any of these activities ranged from only 0% to 8% in reporting. The results of this study validate the independent functioning in scope of occupational health nursing practice related to surveillance, screening, and prevention activities while recognizing the contributions all providers make to a healthy work force.

This article reports a study to reexamine and update the research priorities in occupational health nursing. In this investigation, a 15% geographically proportionate random sample of AAOHN members was surveyed using a two-stage Delphi technique to determine important occupational health related areas needing targeted research. Research participants evaluated 37 potential research priorities in relation to impact on worker health and value to the profession, and 12 priorities emerged.

1. Environmental hazards are ubiquitous. Many exist in the workplace or occur as a result of work process exposures. 2. Environmental health is a natural component of the expanding practice of occupational health nursing. 3. AAOHN's vision for occupational and environmental health will continue to set the standard and provide leadership in the specialty.

This article is third in a series of three articles addressing credentialing to appear in AAOHN Journal. The first article, "Credentialing: Concerns and Issues Affecting Occupational Health Nursing," by Olson, Verrall, and Lundvall, appeared in the May 1997 issue [45(5):231-238]. The second article, "Certification and Occupational Health Nursing: An Historical Perspective," by Verrall appeared in the June 1997 issue [45(6):283-289].

1. The occupational health nurse is in a key position to recognize environmental and occupational exposures and assess potential interactions to reduce risks. 2. Hazardous exposures may emanate from chemical, physical, and biological agents that can be found in the workplace, home, and community. Synergistic reactions may pose greater harm than is apparent. 3. Multidisciplinary efforts with community involvement and coalition building can be a successful approach to minimizing environmental/occupational risks from toxic exposures.

1. AAOHN's strategic plan for 1993-98 was developed through a collaborative effort with emphasis on member input. 2. A model for the strategic plan which emphasized data acquisition and analysis was developed. 3. A revised mission statement and standards for occupational health nursing practice, along with expanded scope of practice, were developed.

It is important that occupational health nursing content be offered in academic institutions to support the scope of practice in the specialty. Less than 50% of the schools responding (N = 215) included content specific to occupational health nursing concepts and practice, related fields of knowledge, and management of the occupational health unit. Occupational health nurses in practice settings and educational institutions should collaborate on the development of occupational health content in nursing school curricula.

The practice of occupational health nursing has expanded enormously and is influenced by company culture and forecasts as well as external factors such as population trends, technology, and the profile of the work force. Future trends include the provision of nurse managed occupational health services. Education and research in occupational health nursing must be strengthened to advance the practice of occupational health nursing. The occupational health nurse as the primary health care manager must take the lead in the development and implementation of a concept of health at the worksite.