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The Occupational Health

Professional’s Services

and Qualifications:

Questions and Answers

U.S. Department of Labor Occupational Safety and Health Administration

OSHA 3160

1999 (Revised)

Occupational Health Professional’s Services and Qualifications: Questions and Answers

This informational booklet is intended to provide a generic, non-exhaustive overview of a particular standards-related topic. This publication does not itself alter or determine compliance responsibilities, which are set forth in OSHA standards them- selves and the Occupational Safety and Health Act. Moreover, because interpretations and enforcement policy may change over time, for additional guidance on OSHA compliance require- ments, the reader should consult current and administrative inter- pretations and decisions by the Occupational Safety and Health Review Commission and the Courts.

Material contained in this publica- tion is in the public domain and may be reproduced, fully or partially, without permission of the Federal Government. Source credit is requested but not required.

This information will be made available to sensory impaired individuals upon request. Voice phone: (202) 693-2120;

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Page

The Occupational Health Professional’s Services

and Qualifications: Questions and Answers ...................... 1

What Issues Should be Considered in Selecting

a Health Care Professional? .............................................. 2

What Unique Contributions Can an Occupational

Health Care Professional Make to Workplace Safety

and Health? ........................................................................ 3

Who Are Qualified Occupational Health Care

Professionals? .................................................................... 5

Physicians ........................................................................ 5

Registered Nurses ............................................................ 6

Physician Assistants ........................................................ 7

Other Health Care Providers............................................ 7

How Can an Employer Verify the Scope of Practice

for Health Care Professionals in the Licensing State? ..... 8

Medical Doctor ................................................................ 8

Doctor of Osteopathy....................................................... 8

Registered Nurse and Nurse Practitioner......................... 8

Physician Assistant .......................................................... 9

Emergency Medical Technician ...................................... 9

Licensed Vocational/Practical Nurse............................... 9

What Qualifications Should an Employer Look

for in an Occupational Health Care Professional? ............ 10

Is There a Good Way to Evaluate the Qualifications

of an Occupational Health Care Professional? ................. 11

Contents

Occupational Health Professional’s Services and Qualifications: Questions and Answers

What Is the Difference Between Occupational Health

What OSHA Standards for General Industry Require

• and Health Professionals Care Professionals and Other Occupational Safety
  • Industrial Hygienists
  • Industrial Engineers
  • Safety Professionals
• Health Services? Screening and Surveillance or Occupational
  • General Industry Standards
    • Health Services? Some OSHA Standards that Require Occupational
• Resources
  • Medical Doctors
  • Osteopathic Doctors
  • Occupational Health Nurses
  • Nurse Practitioners
  • Registered Nurses
  • Physician Assistants
  • Emergency Medical Technicians.....................................
  • Industrial Hygienists
  • Safety Professionals
• References
• Related OSHA Publications
• States with Approved Plans
• OSHA Consultation Project Directory.................................
• OSHA Area Offices

Occupational Health Professional’s Services and Qualifications: Questions and Answers

A variety of health care professionals are available to employers. Selecting an appropriate provider for the worksite depends on a number of factors, including:

• The Occupational Safety and Health Administration’s (OSHA) screening and surveil- lance requirements for specific substances or hazards associated with the worksite;
• The number, diversity, size, and seriousness of the hazards involved at the worksite(s); and
• The level of resources committed to an occupational health care service as part of a comprehensive safety and health program; and
• Distance to the closest trauma center or health care facility.

At a minimum, workplace safety and health involves management support, employee involvement, worksite analysis, hazard prevention and control, occupational health care management (including screen- ing and surveillance for disease and injury), and training and educa- tion. Qualified occupational health care professionals can assist the employer in achieving a safe and healthful work environment. Along with other safety and health professionals, health care profes- sionals work collaboratively with labor and management to:

• Identify potential hazards and to find ways to prevent, elimi- nate, minimize, or reduce hazards;
• Develop and manage training programs to promote workplace health and safety; and
• Enhance the accuracy of OSHA recordkeeping.

2 What Issues Should be Considered in Selecting

a Health Care Professional?

Health care professionals are uniquely quali- fied to assess and treat illnesses and injuries. Health care professionals must have the appropri- ate licensure, registration, or certification. Additionally, they should have occupational health experience and expertise in management and be available on a full- or part-time basis, depending on the nature and size of worksite(s). They may be a permanent employee or hired on a contractual basis.

In addition to working collaboratively with other safety and health professionals, a qualified health care professional may be selected to:

• Provide screening related to specific chemicals or exposures, including preplacement (post-offer) physical examinations, job placement assessments, periodic examinations, and mainte- nance of confidential employee health records, including individual screening results.
• Manage and/or treat work-related illnesses and injuries, with emphasis on early recognition and intervention; make recom- mendations about work restrictions or removal; and follow up and monitor workers as they return to work.
• Develop and implement health promotion programs.
• Provide guidance for case management of employees who have prolonged or complex illnesses and injuries.

For small employers, or those with limited resources, one of several models for delivering occupational health care at the work- place can be considered. This might involve sharing the services of health care professionals within a business or industrial park, or contracting with a larger firm whose occupational health service includes an occupational health care professional as part of its total safety and health program. (See References : B. Burgel Innovation at the Worksite. )

WhatUnique Contributions Can an

Occupational Health Care Professional

Make to Workplace Safety and Health?

What Unique Contributions Can an Occupational Health Care Professional Make to Workplace Safety and Health?

Health care professionals qualified to design, manage, supervise, and deliver health care in occupational settings include a variety of practitio- ners. It is imperative, however, that the legal “scope of practice” unique to each state be consid- ered prior to hiring or contracting for services. The “scope of practice” refers to the credentials, responsibilities, and legally authorized practice of health care professionals.

Physicians, physician assistants, and registered nurses, including nurse practitioners, receive standardized educations with core curricula (individualized to their profession) necessary to pass national or state boards and to be licensed in a particular state. Physicians and registered nurses are then eligible to become certified in a specialty practice, such as occupational medicine (physicians and physician assistants) or occupational health nursing (registered nurses and nurse practitioners), through a combination of additional specific education and experience. The additional educational training in occupational health typically includes course work in epidemiology, toxicology, industrial hygiene, recognition and management of occupational illnesses and injuries, research, and general management of a comprehensive occupational health program.

Physicians

Medical Doctors ( MDs) have completed study at the college level and training at an accredited school. Licensed MDs have passed the National Medical Board Exam or equivalent examina- tions and have a license to practice within a given state(s).

Doctors of Osteopathy (DOs) graduate from college and an osteopathic school approved by the American Osteopathic Asso- ciation. They must pass a state board examination to qualify for a license to practice within a given state(s).

Occupational Medicine Physicians are medical doctors or

Who Are Qualified Occupational Health Care 5

Professionals?

Who are Qualified Occupational Health Care Professionals?

Occupational Health Professional’s Services and Qualifications: Questions and Answers

doctors of osteopathy who have completed additional occupational medicine training or acquired on-site experience. Completion of additional residency training and further practice in occupational medicine enables physicians to pursue certification in occupational medicine after meeting rigorous qualifying standards and success- fully completing an examination in occupational medicine given by the American Board of Preventive Medicine (ABPM).

Registered Nurses

Registered Nurses (RNs) receive training and education at the college level and graduate from a state-approved school of nursing. They pass a state board examination and are granted a license to practice within a given state(s).

Nurse Practitioners (NPs) are registered nurses who are licensed in their state and have completed formal advanced education, usually at the master’s level. NPs practice under their state Nurse Practice Act. Some NPs are certified in occupational health as a specialty area. NPs independently perform many health evaluation and care activities—including physical exams, common diagnostic and laboratory tests—and diagnose and treat employees who are ill or injured. They also can prescribe medications in most states. Addi- tionally, NPs work collaboratively with physicians.

Occupational Health Nurses (OHNs) are registered nurses and nurse practitioners with experience and additional education in occupational health. Certified occupational health nurses (COHN or COHN-S) obtain certification from the American Board for Occupa- tional Health Nurses after meeting rigorous qualifying educational and experience standards and successfully passing an occupational health nursing examination.

Occupational Health Professional’s Services and Qualifications: Questions and Answers

Each state has a unique legal description of the scope of practice for health care professionals. When it is necessary to verify a health care professional’s scope of practice for the occupational setting, the individual state’s licensing or certification board should be contacted, as follows:

Medical Doctor

State boards of medical examiners and professional licensure can provide information about an occupational physician’s educational training and type of practice. The American Board of Medical Specialties (ABMS) publishes an annual list of certified occupational medicine specialists. The employer may refer to the ABMS listings in the reference department of most public libraries or call the Office of ABMS at (800) 776-2378.

Doctor of Osteopathy

Doctors of osteopathy are licensed by a board in each state. Listings may include Board of Medical Examiners, Licensing Examiners, Board of Osteopathic Examiners, Board of Medical Practice, or Medical Licensing Board of (name of particular state). The American Board of Medical Specialties (ABMS) publishes an annual list of certified occupational medicine specialists (see MD listing above).

Registered Nurse and Nurse Practitioner

The National Council of State Boards of Nursing [(312) 787-6555] has information on the regulation of nursing in each state. Gener- ally, the American Nurses Association (ANA) [(202) 651-7000] certifies NPs. The American Board for Occupational Health Nurses (ABOHN) [(630) 789-5799] certifies RNs in the specialty of occupa- tional health.

How Can an Employer Verify the Scope

of Practice for Health Care Professionals

in the Licensing State?

Physician Assistant

All states except Mississippi license physician assistants. PAs are licensed by the state medical board or by a separate licensing board. PAs are certified by the National Commission on Certifica- tion of Physician Assistants (NCCPA) [(770) 734-4500].

Emergency Medical Technician

The scope of practice for emergency medical technicians (EMTs) also varies from state to state. There are several practice levels of EMTs each determined by the number of hours of training and the range of procedures authorized. Each state has a director of EMTs listed in the telephone directory under State Government. The appropriate office may be contacted under the telephone directory subheading listed as either the Department of Health, Department of Public Health, or Department of Emer- gency Medical Services.

Licensed Vocational/Practical Nurse

The state board of nursing in each state is listed in the telephone directory and defines the scope of practice issues for licensed vocational or practical nurses LVNs/LPNs.

How Can an Employer Verify the Scope of Practice for Health Care Professionals in the Licensing State?

During the interview process, the following kinds of questions and issues are appropriate to evaluate prospective occupational health care professionals:

Is There a Good Way to Evaluate the Qualifications of an Occupational Health Care Professional?

Is There a Good Way to Evaluate the Qualifica-

tions of an Occupational Health Care

Professional?

• What type of education/training does the candidate have?
  • Note graduation date and all degrees and type of specialty certification;
  • Titles of continuing education courses taken in the last 2 years;
  • Where and when licensed, registered, or certified (ask for documentation); and
  • Years of experience in occupational health.
• In what type of industries has the candidate had experience?
• What kind of management experience(s) has the candidate had? For how long?
• What does the candidate know about OSHA recordkeeping requirements?
• Has the candidate ever prepared for and/or participated in an OSHA inspection?
• Does the candidate know about workers’ compensation laws in your state?
• Is the candidate familiar with the Americans with Disabilities Act?
• What kind of information does the candidate want to know about your business?
• How can the candidate develop or improve your safety and health program?

Occupational Health Professional’s Services and Qualifications: Questions and Answers

You should expect the candidate to ask you about the following:

• Facilities (type, location)
• Number of employees
• Work processes
• Known or potential hazards
• Application of standards and/or regulations
• Current method of providing occupational health care services
• Other health care providers involved in providing services
• Existence and specifics of a safety and health program
• Medical surveillance programs
• Collective bargaining contracts
• Previous OSHA citations
• References from current/previous employers or educational institutions should be requested.

Occupational Health Professional’s Services and Qualifications: Questions and Answers

Industrial Engineers

Industrial engineering is the design, installation, and improvement of integrated systems of people, material, information, equipment, and energy. Industrial engineering draws upon specialized knowl- edge and skills in the mathematical, physical, and social sciences, together with principles and methods of engineering analysis and design to specify, predict, and evaluate the results obtained from such systems.

The Institute of Industrial Engineers has a special division devoted to ergonomics, and many industrial engineers elect to receive ad- vanced training in this increasingly complex and growing specialty.

Safety Professionals

Safety professionals focus on developing procedures, standards, or systems to achieve the control or reduction of hazards and exposures that would be detrimental to people, property, and/or the environ- ment. Certified safety professionals (CSPs) graduate from accredited college or university programs with a baccalaureate degree in safety and must have at least 4 years of professional safety experience prior to taking the Safety Fundamentals exam.

The following OSHA General Industry Stan- dards regulating toxic and hazardous substances have specific medical surveillance requirements in Title 29 Code of Federal Regulations, Part 1910. Copies of OSHA regulations are available at cost from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC

Please be advised that this list is subject to revision and expansion. It is the employer’s responsibility to know the general and specific OSHA standards that apply to the industry and workplace.

General Industry Standards

2-Acetylaminofluorene 1910. Acrylonitrile 1910. alpha-Naphthylamine 1910. 4-Aminodiphenyl 1910. Arsenic, Inorganic 1910. Asbestos 1910. Benzene 1910. Benzidine 1910. beta-Naphthylamine 1910. beta-Propiolactone 1910. bis-Chloromethyl Ether 1910. Bloodborne Pathogens 1910. 1,3 Butadiene 1910. Cadmium 1910. Coke Ovens 1910. Cotton Dust 1910. 1,2-dibromo-3-chloropropane 1910. 3,3' Dichlorobenzidiene 1910. (and its salts) 4-Dimethylaminoazobenzene 1910. Ethylene Oxide 1910. Ethyleneimine 1910. Formaldehyde 1910. Hazard Communication 1910.

What OSHA Standards for General Industry

Require Screening and Surveillance or

Occupational Health Services?

What OSHA Standards for General Industry Require Screening and Surveillance or Occupational Health Services?