Case Management Workers' Compensation Claims_TriState Occupational HealthCopyright 2014
City of Dubuque ITEM# 12.
ITEM TITLE: Case Management Workers' Compensation Claims
SUMMARY: City Manager recommending approval to enter into an Agreement with Tri-
State Occupational Health, L.L.C. effective October 6, 2014 through
September 30, 2015 to provide case management of workers
compensation claims and police and fire job related injuries and illnesses.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
❑ Case Management of Workers Compensation Claims -MVM Memo City Manager Memo
❑ Case Management Workers Comp Claims Memo Staff Memo
❑ TSOH & City of Dubuque Agreement Supporting Documentation
❑ Insurance Schedule Supporting Documentation
❑ AAOHN Documents Supporting Documentation
Masterpiece on the Mississippi
Dubuque
2007.2012 .2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Case Management of Workers Compensation Claims and Police and Fire
Job Related Injuries and Illnesses
DATE: September 18, 2014
In 2013, the City had 66 recordable injuries. Twenty-two of these claims are being
managed by Alternative Services Concepts, the City's workers compensation claims
administrator. In 2013, there were 111 non -recordable injuries that required care and
follow up. The management of these claims is done in the Personnel Office.
Tri-State Occupational Health provides a service that can assist in managing and
coordinating the City's workers compensation claims and police and fire job injuries and
illnesses. The case management service would be provided by Tri-State Occupational
Health employees who are trained and certified in occupational health nurse case
management. The cost of this service is $43.35 per hour. It is anticipated the City
would be using this service for approximately 8 hours per week. The estimated annual
cost would be $18,034. The person selected to provide the service would be located in
the Personnel Office. The cost associated with managing the workers compensation
claims would be charged to the workers compensation reserve. The cost associated
with managing police and fire job related injury and illness claims would be charged to
the respective departments.
Personnel Manager Randy Peck recommends City Council approval to enter into an
Agreement with Tri-State Occupational Health, L.L.C. effective October 6, 2014 through
September 30, 2015 to provide case management of workers compensation claims and
police and fire job related injuries and illnesses.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Micill,
al C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Randy Peck, Personnel Manger
2
Masterpiece on ti
TO: Michael C. Van Milligen, City Manage
FROM: Randy Peck, Personnel Manager
SUBJECT: Case Management of Workers Compensation Claims and Police and Fire
Job Related Injuries and Illnesses
DATE: September 17, 2014
In 2013, we had 66 recordable injuries. Twenty-two of these claims are being managed
by Alternative Services Concepts, our workers compensation claims administrator. In
2013, there were 111 non -recordable injuries that required care and follow up. The
management of these claims is done in the Personnel Office,
Tri-State Occupational Health provides a service that can assist us in managing and
coordinating our workers compensation claims and police and fire job injuries and
illnesses. The case management service would be provided by Tri-State Occupational
Health employees who are trained and certified in occupational health nurse case
management. The cost of this service is 543.35 per hour. I anticipate using this service
for approximately 8 hours per week. The estimated annual cost would be $18,034, The
person selected to provide the service would be located in the Personnel Office. The
cost associated with managing the workers compensation claims would be charged to
the workers compensation reserve. The cost associated with managing police and fire
job related injury and illness claims would be charged to the respective departments.
I have attached a copy of the Agreement for your review. One of the conditions
contained in the Agreement is that we would agree, for a period of two years from the
date of termination of the Agreement, not to hire, solicit or attempt to hire or solicit any
of Tri-State Occupational Health's employees who are providing this service. City
Attorney Barry Lindahl has reviewed the Agreement and finds the terms acceptable. I
recommend that the Agreement be approved. The requested action is for the City
Council to pass a motion approving the Agreement and authorizing you to sign the
Agreement. The Agreement would be in effect from October 6, 2014, through
September 30, 2015.
RP.Imh
Agreement
Between
Tri-State Occupational Health, L.L.C.
And
The City of Dubuque
Thi Agreement is made and entered into this day
of V,x'-2014, by and between Tri-State Occupational, L.L.C., a corporation
organized and established under the laws of Iowa, having its principal place of business
at 1940 Elm Street, Dubuque, Dubuque County, Iowa, ("TSOH"), and the City of
Dubuque, having its principal place of business at 50 West 13th Street, Dubuque,
Dubuque County, Iowa ("City").
f
Scope
A. TSOH is in the business of providing occupational medicine, worker's
compensation and related therapy services and as specifically relates to
this agreement, is in the business of providing onsite occupational health
nursing services through its physicians, providers and clinical nursing
staff.
Recitals
A. City will:
1. Provide a facility location for the provision of onsite occupational health
nursing services.
2. Assume all of the roles and responsibility for OSHA record-keeping
and related functions.
B. TSOH will:
1. Provide onsite occupational health nursing services to the City.
2. Provide employee supervision, including clinical and medical direction
oversight of the onsite occupational health nursing services.
3. Provide onsite occupational nursing services for eight (8) hours per
work week.
4. Recommend all referral and follow-up treatment services (e.g. therapy,
orthopedics, surgery, etc.), to optimize quality of care and case
management. TSOH will direct care according to City's wishes, and
City acknowledges that care coordination and treatment outcomes
outside TSOH recommendations may or may not meet TSOH's
standard of care.
5. Provide occupational therapy and rehabilitation services at City
request.
6. Manage the employee medical chart on-site, maintaining a separation
of occupational health and worker's compensation care notes from
personal health and medical care information. TSOH will retain
ownership of personal health information.
7. Abide by the following Attachments:
• AAOHN Code of Ethics and Interpretative Statements
• AAOHN Case Management: The Occupational and, Environmental
Health Nurse Role
• AAOHN Delivery of Occupational and Environmental Health
Services
• Standards of Occupational and Environmental Health Nursing
In consideration of the matters described above, and of the mutual benefits and
obligations set forth in this agreement, the parties agree as follows:
Section 1
Agreement Parameters
A. TSOH will provide onsite occupational health nursing services for an
average scheduled time frame of eight (8) hours every work week. Start
and end times for coverage will be agreed to in advance by TSOH and
City.
B. Onsite occupational health nursing services will be provided by an
appropriately qualified TSOH nurse.
C. The initial term of this Agreement shall from the 6th day of October, 2014,
to midnight on the 30th day of September, 2015.
Section 2
Reimbursement for Onsite Occupational Health Nursing Services
A. For onsite occupational health nursing services the City will pay TSOH
$43.35 per hour.
B. Onsite occupational health nursing services provided by TSOH to City will
be invoiced on a monthly basis.
Section 3
Compliance with All Applicable Laws
TSOH and City agree that they are bound by and will comply with all applicable
federal, state, local laws, ordinances or regulations. TSOH and City agree to defend,
indemnify and hold harmless each other against loss or damage, including, but not
limited to, reasonable attorneys' fees, resulting from their respective negligence in the
performance or nonperformance of this Agreement.
Section 4
Independent Contractor Relationship
The parties agree that the relationship between TSOH and City in one of owner -
independent contractor and nothing herein shall be construed or interpreted in any way
to create an employer-employee relationship between TSOH and City or between City
and any of TSOH's officers, agents or employees.
Section 5
City Responsibilities
A. City will provide a minimum one (1) week notice to TSOH if the regularly
agreed to City work schedule for the onsite occupational health nurse is to
be cancelled. Such notice shall be provided by contacting the TSOH
Manager or Clinical Manager.
B. City will pay TSOH invoiced fees within 30 days.
Section 6
Agreement Not To Hire Nor Solicit Employees
City agrees that for a period of two (2) years from the date of termination of this
Agreement, neither City nor any of its members shall hire, solicit, or attempt to hire or
solicit any of TSOH's employees that are or were subject to this Agreement. City and
its members further agree that the remedy at law for any breach by City and its
members of this Section 6 will be inadequate and that TSOH shall be entitled to
injunctive relief in case of any such breach, and TSOH shall be entitled to recover its
costs incurred in conducting any lawsuit, including reasonable attorneys' fees and
expenses. This provision can be waived by mutual agreement of TSOH and City,
received and acknowledged in writing.
Section 7
Payment of Taxes or Benefits
TSOH shall pay any and all employment-related taxes and benefits for the TSOH
employee(s) subject to this Agreement.
Section 8
Use of Trade Names and Signs
City shall not use in any manner directly or indirectly, or in whole or in part, the
signature, monogram or any other trademark or name that is now or may in the future
be owned by TSOH, except in a manner; and to an extent that TSOH may specifically
consent in writing. If any trademark or name is used in any way by City with the
express written approval of TSOH, City on the termination of this Agreement, shall
discontinue all such use and shall not subsequently use any name, title or expression in
connection with any business in which City may be engaged that, in the judgment of
TSOH, so nearly resembles any trademark or name, owned by TSOH as may be likely
to lead to confusion or uncertainty on the part of the public.
Section 9
Transferability
All benefits and duties of either party under this Agreement are non -transferable.
Section 10
Termination Notice Clause
This agreement may be terminated by either party, with or without cause, upon
thirty (30) days written notice to the other party.
Section 11
Liability Of Parties To The Agreement Upon Termination Of Agreement
Upon termination of this agreement, City shall remain liable to TSOH for any
payments then owed to TSOH.
Section 12
Modification
This Agreement reflects all the agreements, understandings, representations,
conditions and warranties by and between the parties. Neither party shall be liable for
any representation made unless it is expressly set forth in this Agreement, and this
Agreement may not be modified or amended except in a writing signed by both of the
parties.
Section 13
Severability
If any provision of this Agreement shall be declared by any court of competent
jurisdiction to be illegal, void or unenforceable, all other provisions of this Agreement
shall not be affected and shall remain in full force and effect
Section 14
Governing Law
This Agreement shall be governed by the laws of the State of Iowa.
Section 15
Arbitration
If a dispute arises with respect to this Agreement, it shall be decided finally by an
arbitrator in an arbitration proceeding conforming to the Rules of the American
Arbitration Association applicable to commercial arbitrations. The arbitrator shall be
selected in accordance to the Rules of the American Arbitration Association. The
arbitration shall take place in Dubuque, Iowa, and the decision of the arbitrator shall be
conclusively binding upon the parties and final and such decision shall be enforceable
as a judgment in any court of competent jurisdiction. The arbitrator shall assess the
cost of arbitration to the non -prevailing party, and award reasonably incurred attorney's
fees and costs, in favor of the substantially prevailing party at the arbitration.
Section 16
Acts of Governments, War, Terrorism, Natural Disaster Clause
If either party to this Agreement is affected in such a way by changes in law, acts
of war, acts of foreign governments, acts of terrorism, natural disasters, or similar
catastrophes, to such an extent that they cannot fulfill their obligations under this
Agreement, that party will be excused from performing under the Agreement, and the
Agreement will be terminated.
Section 17
Notice
Unless otherwise provided for in this Agreement, all notices which are required or
may be given pursuant to the terms of this Agreement shall be in writing and shall be
deemed duly given if delivered personally, mailed by registered or certified mail,
postage prepaid, return receipt requested, or sent by facsimile with confirmation.
Notices shall be sent as follows:
A. To: Tri-State Occupational Health, L.L.C.
Attention: TSOH Manager
1940 Elm Street Dubuque, Iowa 52001 •
Telephone: (563) 584-4600
Facsimile: (563) 582-7847
B. To:
City of Dubuque
Attn: Personnel Manager
50 West 13th Street
Dubuque, Iowa 52001
Telephone: (563) 589-4125
Facsimile: (563) 690-6025
Section 18
Insurance
TSOH shall at all times during the performance of this Agreement maintain
insurance as required by the attached Insurance Schedule.
Tri-State Occupational Health, L.L.C. City of Dubuque
By: /
Michael C. Van Milligen, City Manager
Insurance Schedule
City of Dubuque Insurance Requirements for Professional Services
l. TSOH
�~
Insurance Schedule *~
shall furnish a signed Certificate of Insurance to the City of Dubuque, Iowa for the
coverage required in Exhibit 1 prior to commencing work and at the end of the project if the term of work
is Ionger than 60 days. Providers presenting annual certificates shall present a Certificate at the end of
each project with the fina bfflung. Each Certificate shall be prepared on the most current ACORD form
approved by the lowa Departmnt of Insurance or an equivalent. Each certificate shall include a
statement under Description of Operations as to why issued. Eg: Project #__-~^orLease of premises
at or construction of
I. All policies of insurance required hereunder shall be with a carrier authorized to do business in Iowa and
all carriers shall have a ratin8 of A or better in the ciirrent AM, Bests Rating Guide,
3. Each Certificate shall be furnished to the contracting department of the City of Dubuque.
4, Failure to provide minimum coverage shall not be deemed a waiver of these requirements by the City of
Dubuque. Failure to obtain or maintain the requfred insurance shall be considered a material breach of
this agreement.
S. Subcontractors and sub subcontractor perforrning work or service shall provide a Certificate of lnsurance
in accord with Exhibit I.
6. All required endorsements to various policies shall be attached to Certificate o nsurance.
7. Whenever a specific ISO form is listed, an equivalent form may be substituted subject to the provider
identifying and listing in writing all deviations and exclusions that differ from the ISO form.
8. Provider shall be required to carry the minimum coverage/limits, or greater if required by law or other
legal agreement, n Exhibit 1.
9. Whenever an ISO form is efe enced the current edition of the form must be used.
Page 1 of 3 Schedule C, Professional Services October 2013
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C (continued)
Exhibit
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $7.000,000
Products -Completed Operations Aggregate Limit $1.000,000
Personal and Advertising injury Limit $1.000,000
Each Occurrence $1.000,000
Fire Darnage Limit (any one occurrence) $ 50.000
Medical Payments $ 5'000
a) Coverage shali be written on an occurrence, not claims made, forrn All deviations from the
standard 150 commercial general liability form CG 0001, or Business owners form BP 0002,
shall bcclearly identified.
b) Include 150 endorsement form CG 25O4"Designated Location(s) General Aggregate Limit"
or CG 25 03 "Designated Construction Project (s) General Aggregate Limit" as appropriate.
c) lnciude endorsement indicating that coverage is primary and noncontributory
d) Include endorsement to preserve Governmental Immunity. (Sample attached).
e) lnciude an endorsement that deletes any feliow ernployee exciusion,
f) Include additional insured endorsement for:
The City af Dubuque, including all its elected and appointed ofMdpb, all its employees
and volunteers, all its boards, commissfons and/or authorities and their board members,
employees and volunteers. Use ISO form [G2076.
B) AUTOMOBILE LIABILITY $1,000,000 (Combined Single Limit)
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on --�� by acciderit or disease as prescribed by
Iowa Code Chapter 85 as amended,
Coverage A
Coverage B
Statutory—State of iowa
Employers Liability
Each Accident $100,000
Each Employee -Disease $100,000
PolicyUmit-niscmr $500,000
Policy shall include an endorsement providing a waiver of subrogation to the City of Dubuque.
Coverage B limits shall be greater if required by Umbrella Carrier.
D) UMBRELLA UA8|LITY $1'000.00
^~~~
UmbreHa iabihty coverage must be at ieast following form with the underiying policies inclLJded
herein.
E) PROFESSIONAL LIABILITY $ 5,000,000
Page 2 of 3
Schedule C, Professionai Services October 2013
City of Dubuque Insurance Requirements for Professional Services
Preservation of Governmental Immunities Endorsement
1. of Governmental IThe insurance carrier expressly agrees and states that the
purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does
not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa
under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time.
2. Claims Coverage, The insurance carrier further agrees that this policy of insurance shall cover only
those claims not subject to the defense of governmental immunity under the Code of Iowa Section
670.4 as it now exists and as it may be amended from time to time. Those claims not subject to
Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy.
3. Assertion of Government Immunit'.The City of Dubuque, Iowa shall be responsible for asserting any
defense of governmental immunity, arid may do so at any time and shall do 50 upon the timely
written request of the insurance carrier.
4. Non -Denial of Coverage. The insurance carrier shall not deny coverage under this policy and the
insurance carrier shall not deny any ofthe rights and beneflts accruing to the City of Dubuque, lowa
under this policy for reasons of governmental immunity unless and until a court of competent
jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the City of
Dubuque, Iowa.
No Other ange in PolicyThe above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
SPECIMEN
Page 3 of 3 Schedule C, Professional Services October 2013
CODE OF ETHICS AND INTERPRETATIVE STATEMENTS
Preamble
The American Association of Occupational Health Nurses, Inc. (AAOHN) Code of Ethics has
been developed in response to the nursing profession's acceptance of its goals and values and
the trust conferred upon it by society to guide the conduct and practices of the profession. As
professionals, occupational and environmental health nurses (OHNs) accept the responsibility
and inherent obligation to uphold these values.
The Code of Ethics is based on the belief that the goal of occupational and environmental health
nurses is to promote the worker, worker population and community health and safety. This
specialized practice focuses on promotion and restoration of health, prevention of illness and
injury and protection from occupational and environmental hazards. The occupational and
environmental nurse has a unique role in protecting the integrity of the workplace and the work
environment.
The client can be workers, workers' families/significant others, worker populations, community
groups and employers. The purpose of the AAOHN Code of Ethics is to serve as a guide for
registered professional nurses to maintain and pursue professionally recognized ethical
behavior in providing occupational and environmental health and safety services.
Ethics is synonymous with moral reasoning. Ethics is not law, but a guide for moral action.
Professional nurses, when making judgments related to the health and welfare of the client,
utilize these significant universal moral principles.
• These principles are:
• Right of self-determination
• Confidentiality
• Truth telling
• Doing or producing good
• Avoiding harm
• Fair and nondiscriminatory treatment
Occupational and environmental health nurses recognize that dilemmas may develop that do
not have guidelines, data or statutes to assist with problem resolution; thus, occupational and
environmental health nurses use problem -solving, collaboration and appropriate resources to
resolve dilemmas. The Code is not intended to establish nor replace standards of care or
minimal levels of practice. In summary, the Code of Ethics and Interpretative Statements
provide a guiding ethical framework for decision-making and evaluation of nursing actions as
occupational and environmental health nurses fulfill their professional responsibilities to society
and the profession.
1)
1. Occupational and environmental health nurses provide health, wellness, safety and
other related services to clients with regard for human dignity and rights, unrestricted
by considerations of social or economic status, personal attributes or the nature of the
health status.
• Adhere to the obligation to treat clients fairly, respecting their dignity and worth, while
recognizing the existence of a vast spectrum of beliefs and values in society.
� Lemonstrate respect for these behefs and values nherent in ther chents and
themselves by providing services for and with that client accordingly,
Respect human dignity by recognizing clients' rights, particularly, the right of self-
de1errninoMon.
~ Be knowledgeable about clients' rights (as client advocates).
• Avoid abandonment, even in cases when the client refuses care or the nurse's personal
convictions prohibit participation.
�
Recognize that there are situations in which the rights of individual self-determination
may be outweighed or limited by the rights of othersOne must weigh the nsk of harm or
endangerment to self and/or others, particularly in relation to public health.
2. Occupational and environmental health nurses, as licensed health care professionals,
accept obligations to society as professional and responsible members of the
community.
• Adhere to all laws and statutes (localstatm, federal, and international), including those
governing occupational and environmental health practice.
°
Observe professional codes and uphold practice standards.
• Respect clients' and society's right to know and to receive factual information about
pctential and actual job and environmental hazards
m Be knowledgeable of issues and dilemmas affecting the hBa|th, safety and welfare of
socety and take appropriate action,
• Participate, as app[Opriate, in decision-making processes that pertain to occupational
and environmental health and safety.
� Reccgnize situations in which the interests of management and workers may ccnflict,
~ Demonstrate fairness in conflict resolution.
• Refer andlor delegate to appropriate services,
m
Strive to protect clients and the profession from incompetent professionals and
ndividuals who misrepresent themselves and the profession,
�
Report to licensing, accrediting and certifying aUtho[ihen, as may be appropriate, any
person or persons wbc exhibit incompetence or engage in unethical or illegal activities,
• Contribute to the growth of the professions body of knowledge through deve|oprnent,
implementation and evaluation af programs.
• Have moral obligations to self, dients, the profession and society to conduct sound
ethical research,
• Seek approval of appropriate bodies, such as institutional review boardS, in conducting
research activities,
• Communicate and dissemate research findings as appropriate.
3. Occupational and environmental health nurses strive to safeguard clients' rights to
privacy by protecting confidential information and releasing information only as
required or permitted by law.
• Maintain the confidentiality of health information,
• Adhere to the organizational, local, st8t8, federal and international laws, regulations,
Quide|ines, and policies governing access to confidential information,
|0
Have written policies and procedures to guide the access, release, transmittal, and
storage of health information, including electronic records.
Respect and protect the autonomy, rights and privacy of clientsdata and personally
identifiable information.
Respect and protect the autonomy, rights and privacy of research subjects through
mechanisms such as voluntary informed consent.
4. Occupational and environmental health nurses promote collaboration with other
professionals, community agencies, and stakeholders in order to meet the health,
wellness, safety and other related needs of the client.
• Function both interdependently and independently in promoting the welfare of clients.
• Contribute, through an interdisciplinary approach, to interdependent nursing practice by
working with members of the health and safety professions, human resources, benefits
and other related entities in the provision of services.
• Commit to collaborative planning with members of the health and safety team and other
representatives internal and external to the organization in providing services to clients.
• Collaborate by seeking assistance, expertise and resources from other recognized
health and safety professionals in the provision of services.
• Function within the scope of nursing practice and delegate responsibility appropriately.
• Adhere to the obligation to promote adequate distribution of health and safety services
and nursing resources to meet clients' needs.
Weigh professional responsibilities and obligations with values/perspective of multiple
parties (e.g. employer, management, supervisor, etc.) in protecting the health and safety
of workers, worker populations and community groups.
5. Occupational and environmental health nurses maintain individual competence in
nursing practice, based on scientific knowledge, and recognize and accept
responsibility for individual judgments and actions, while complying with appropriate
laws and regulations.
• Strive for excellence and maintain a level of knowledge, judgment, technical skills and
professional values necessary for delivering health services.
• Utilize professional and educational activities to improve professional practice.
• Engage in professional, educational and quality improvement activities, and
acknowledge the importance of continued and advanced educational activities beyond
the basic level of nursing education.
• Maintain competence in practice as a personal and professional responsibility.
• Be accountable for actions and for compliance with nurse practice acts standards of
practice and other laws/regulations governing occupational and environmental health
practice.
• Participate in the development of policies to promote competent, ethical, and legal
nursing practice.
• Utilize research findings within practice.
AAOHN acknowledges the contributions of the following owners/members in revising the
AAOHN Code of Ethics, The AAOHN Code of Ethics Task Force: Phyllis Berryman, Cha/rrnan
Kay Campbell, Michelle Korn Gochnour Kim Gordon, Margie Matsui, Barb Maxwell, Kim
Olszewski Diana Scott, Bill Thor -Hack, Dee Tyler and Janice White
Revised and approved January 2009
POSITION STATEMENT
Case Management: The Occupational and
Environmental Health Nurse Role
Occupational and environmental health nurse case
managers are the ideal professionals to coordinate
workershealth care services from the onset of
illness or injury to safe return -to -work or an optimal
alternative.
INTRODUCTION
Since the late 1800s, occupational and
environmental health nurses (OHNs) have delivered
primary care, managed occupational and non-
occupational illnesses and injuries, and
implemented and evaluated a myriad of programs to
benefit workers. To assist workers in achieving
optimal health outcomes, occupational and
environmental health nursing professionals use their
expertise in health care delivery, knowledge diverse
service options, experience in implementing return -
to -work policies, and detailed, site-specific
understanding of how workers interface with the
work environment.
Based on the complexities of health care and
business environments, case management services
must be delivered by qualified health care
professionals with sufficient knowledge and
expertise to perform this function competently
(CMSA).
Case management is a process of coordinating
comprehensive health care services, following
illness or injury, to achieve optimum quality care
delivered in a cost effective manner. The process
integrates assessment, planning, implementation,
and evaluation components. Occupational and
environmental health nurses as case managers
provide all or a portion of these services in addition
to coordination of all care delivered (American
Association of Occupational Health Nurses
[AAOHN1, Case Management Society cf America
[CMSA], and Mullahy & Jensen).
RATIONALE
Effective occupational and environmental health and
safety programs address overall health care,
disability and workers' compensation costs. These
programs:
• focus on primary, secondary, and tertiary
prevention and health promotion strategies to
minimize accidents and illnesses
• provide quality health care by knowledgeable
and experienced occupational and
environmental health professionals
• incorporate case management strategies
• facilitate effective communication between
management and injured or ill workers
• teach workers to be more knowledgeable,
responsible, and confident consumers of health
care services.
Skyrocketing increases in basic health care
premiums and workers' compensation costs have
forced employers to focus on cost containment
strategies. Many corporations now offer their
workers health benefit plans that include integrated
options. With an increasing focus on health care
cast containment, the case management function is
valuable to the employer and insurers (Mullahy &
Jensen), However, case management is complex
and requires well-prepared health care professionals
who possess necessary knowledge and skills (e.g.
occupational and environmental health and safety,
return -to -work policies, health care delivery systems,
payor systems, laws and regulations).
AMERICAN ASSOCIATION OF OCCUPATIONAL HEALTH NURSES, INC.
7794 Grow Drive, Pensacola, FL 32514 1 (800) 241-8014 1 FAX (850) 484-8762 1 www,aaohn.org
CONCLUSION
Today's proactive practitioners are cognizant of:
• the workersneeds and desired outcomes,
• the employer's priorities and focus on cost
containment strategies
• the many service options available.
Effective case management is one strategy for
employers to not only quantify their health care
costs but also savings through coordination of
services.
The 01 -IN professional, acting as a coordinator of
health services, rehabilitation, return -to -work and
case management, is the key to workers' health
care quality and cost containment strategies.
REFERENCES
American Association of Occupational Health
Nurses. (n.d.). Occupattonal and Environmental
Nurses Today: Case Management. Retrieved
from heingtiossis reirscartterst tiraression
esocritipatini tencinsime nt.'s-nits:se th-
nusai it triti
Case Management Society of America. (2010).
Standards of Practice for Case Management,
Retrieved from
www.crnsa crndrOlvidualiMentiberilogitiort
Stand a rdsotPracticettabstgegrarfouit
Mullahy, C.M. & Jensen, D.K. (2010). Case
Manager's Handbook (4th ed.). Sudbury, MA:
Jones & Bartlett.
Revised 04/1995; 05/1996, 12/12 (AAOHN Practice
Committee)
Reviewed 06/2003; 08/2004, 09/2012 (AAOHN
Practice Committee)
AMERICAN ASSOCIATION OF OCCUPATIONAL HEALTH NURSES, INC.
7794 Grow Drive, Pensacola FL 32514 1 (800) 241-8014 1 FAX (850) 484-8762 1 vvww aaohn org
POSITION STATEMENT
Delivery of Occupational and Environmental
Health Services
INTRODUCTION
Occupational and environmental health nursing is
the specialty practice that focuses an promotion and
restoration of health, prevention of illness and injury,
and protection from work-related and environmental
hazards. Tremendous changes have occurred in
recent years within the occupational and
environmental health care delivery system such as:
A focus on health care costs that result in
increased economic constraints, competition for
services, and outsourcing or displacement of
qualified health care providers
A proliferation of health care providers from a
variety of professional specialties offering
services
• A continued interest in alternatives to traditional
provider models
• Renewed interest in wellness initiatives and
worker productivity programs
• Emphasis an implementing evidenced -based
programs.
The American Association of Occupational Health
Nurses believes that the training, education and
experience -base of licensed occupational and
environmental health nurses (OHNs) prepares these
health care professionals to be in the best position
to deliver comprehensive occupational and
environmental health services in the workplace.
RATIONALE
The employment of well-qualified licensed
professional OHNs to develop and implement a
comprehensive occupational and environmental
health program promotes better worker health,
decreases health-related costs, improves employee
morale, increases productivity, decreases
absenteeism, and facilitates continuity of care.
Occupational and environmental health nurses work
within the guidance of the AAOHN Scope of Practice
to:
• collaborate with workers, employers, members
of the occupational and environmental health
and safety team, and other professionals to
Li. identify health and safety needs
• prioritize interventions
develop and implement interventions
and programs
evaluate care and service delivery.
The OHN is the key to the coordination of a holistic,
multidisciplinary approach to delivery of safe,
quality, and comprehensive occupational and
environmental health programs and services that
include:
• clinical and primary care, including assessment,
diagnosis, management, and documentation of
occupational and non -occupational illnesses
and injuries
• case management for occupational and non-
occupational illnesses and injuries
• health hazard assessment and surveillance of
worker populations, workplaces, and
community groups
AMERICAN ASSOCIATION OF OCCUPATIONAL HEALTH NURSES, INC.
7794 Grow Unve Pensacola. FL 32514 1 (800) 241-8014 FAX (850) 484-8762 www aaohn org
investigation, monitoring, and analysis of illness
and injury episodes and trends, as well as
methods to promote and protect worker health
and safety
• compliance with laws, regulations, and
standards governing health and safety for
workers and the environment
• compliance with laws, regulations, and
standards related to confidentiality and medical
records management
• management and administration of
occupational and environmental health services
• health promotion and disease prevention
strategies using primary prevention principles;
early detection, prompt treatment, and
prevention of disease progression using
secondary prevention principles, and restoring
worker health as much as possible using
tertiary prevention principles
• counseling, health coaching, and training
programs using adult learning approaches
• research related to occupational and
environmental health.
A coordinated and cost-effective plan that
maximizes the use of services for workers can be
best administered by a qualified OHN who has
knowledge of the needs and various services
available and works within the scope of practice
within his/her licensure state.
CONCLUSION/RECOMMENDATIONS
The American Association of Occupational Health
Nurses believes that well trained OHNs are
essential for cost effective management of the
workplace occupational and environmental health
program, and recommends that employers hire the
nurse on a full-time basis whenever possible.
The American Association of Occupational Health
Nurses (AAOHN) acknowledges that in some
situations it is not feasible or appropriate to hire full-
time OHNs to provide these services. In those
instances, AAOHN recommends that employers:
• conduct a feasibility study to prioritize the
worker health services needs and determine
the extent to which full-time and/or part-time
occupational and environmental health nurses
would be cost effective
• promote certification in occupational and
environmental health nursing among the nurses
employed at the facility
• establish partner relationships with adjunct
professions as part of an occupational and
environmental health services delivery plan
coordinated by the OHN
• hire contract providers who employ OHNs for
all or part of the delivery of occupational and
environmental health services when it is not
feasible to directly employ nurses on staff
• employ occupational and environmental health
nursing entrepreneurs and
address the overall health
employee population.
REFERENCES
consultants to
needs of the
Strasser, P.B. (2012). Occupational and
Environmental Health Nursing: The
Foundations of Quality Practice. Workplace
Health and Safety, 4(60), 151-157,
Virginia Department of Health. (2012). Transitioning
to the new national EMS scope of practice and
education standards. Retrieved from
rpm, impppv primptlm pprOEMS Trpowr
Revised 4/95; 1/96; 5/98; 10/12 (AAOHN Practice
Committee)
Reviewed 6/02; 6/03; 8/04, 9/12 (AAOHN Practice
Committee)
AMERICAN ASSOCIATION OF OCCUPATIONAL HEALTH NURSES, INC.
7794 Grow Drive, Pensacola, FL 32514 (300) 241-8014 1 FAX (850)484-8762 1 voNw aaohn org
«%t�nd��d�mf��^� Environmental Health Nursing
Occupational
Standard 1. Assessment
Theoccupationa| and environmental health nurse systematically assesses the health status of the
dient(s)
Standard 11. Diagnosis
The occupational and environmental health nurse analyzes assessment data to formulate diagnoses.
Standard 111. Outcome Identification
The occupational and environmental health nurse identifies outcomes specific to the client(s).
Standard IV. Planning
The occupational and environmental health nurse develops ogoal-directed plan that is comprehensive
and formulates interventions to attain expected outcomes,
Standard V. Implemeritation
The occupational and environmental health nurse implements interventions to attain desired outcomes
dentified in the plan
Standard VI. Evaluatian
The occupational and environmental health nurse systematically and continuously evaluates responses to
interventions and progress toward the achievement of desired outcomes.
Standard Vit, Resource Management
The occupational and environmental health nurse secures and manages the resources that support
occupational health and safety programs and services
Standard VIII. Professional Development
The occupational and environmental health nurse assumes accoLlrltability for professional development to
enhance professiorial growth and maintan competency,
Standard IX. Collaboration
The occupational and environmental health nurse collaborates with clients for the promotion, prevention
and restoration of health within the context of a safe and healthy env ronment.
Standard X. Research
The occupational and environmental health nurse uses research findings in practice and contributes to
the scientific base in occupational and environmental health nursing to improve practice and advance the
profession
Standard XI. Ethics
The occupa and eAv|/uhnenhy| healih nurse uses an eihica| fna/newo/haa a yuide for deubion
making in practice
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