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)

What Issues Should be Considered in Selecting a Health Care Professional?

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 surveillance 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.

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

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

Health care professionals are uniquely qualified to assess and treat illnesses and injuries. Health care professionals must have the appropriate 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 maintenance 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 recommendations 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.

Who Are Qualified Occupational Health Care Professionals?

Health care professionals qualified to design, manage, supervise, and deliver health care in occupational settings include a variety of practitioners. It is imperative, however, that the legal “scope of practice” unique to each state be considered 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 examinations 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 Association. 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 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 successfully 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. Additionally, 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 Occupational Health Nurses after meeting rigorous qualifying educational and experience standards and successfully passing an occupational health nursing examination.

Physician Assistants

Physician Assistants (PAs) provide services with the supervision of a doctor of medicine or osteopathy. PAs may perform physical examinations, diagnose and treat illnesses, order and interpret tests, prescribe medications in most states, and plan and implement therapeutic interventions. PAs must graduate from an accredited physician assistant’s program, pass a national certification exam, and be licensed by the state. Some PAs specialize in occupational medicine.

Other Health Care Providers

Other health care providers include licensed practical or vocational nurses and emergency medical technicians. Traditionally, these individuals are not licensed to practice independently. They have specific training and are usually certified or licensed by the educational institution where they received the training. Sometimes the state licenses or certifies these providers and usually the state’s scope of practice outlines the specific work restrictions for these individuals. For example, usually these providers are required to work under the supervision of, or implement orders given by, licensed health care professionals such as MDs, DOs, RNs, PAs, and NPs, except when delivering first aid.

Licensed Practical/Vocational Nurses (LPN/LVNs) graduate from a program of practical nursing and must pass the state board examination. They are licensed by the state to perform certain specific health care activities, under the direct supervision of a physician or registered nurse.

Emergency Medical Technicians/Paramedics (EMTs) are prehospital providers trained to provide specific and limited emergency care. Some EMTs receive advanced training to become paramedics, which allows them to perform more advanced emergency procedures. EMTs are authorized to perform their duties by standing orders or protocols from physicians. They respond primarily to injuries and acute illnesses on a temporary basis and are not independently licensed to provide other medical care.

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

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. Generally, 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 occupational health.

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 Certification 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 Emergency 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.

What Qualifications Should an Employer Look for in an Occupational Health Care Professional?

An occupational health care professional evaluates the interactions between employees’ work and health in the workplace. To do this effectively, the occupational health care professional should possess the following skills and competencies:

• General knowledge of the work environment, including worksite operations; familiarity with the toxic properties of materials used by employees as well as the potential hazards and stressors of work processes and jobs or tasks.
• Ability to determine an employee’s physical and emotional fitness for work.
• Ability to recognize, evaluate, treat, and/or refer occupational illnesses and injuries.
• Knowledge of workers’ compensation laws; local, state, and federal regulatory requirements; and systems for maintaining health records.
• Ability to organize and manage the delivery of health care services.
• Knowledge of legal and ethical issues related to occupational health care practice.

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

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

• 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?
  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.

What Is the Difference Between Occupational Health Care Professionals and Other Occupational Safety and Health Professionals?

All occupational health and safety professionals are educated to have a proactive, preventive orientation, with the health and well-being of the employee as their primary focus. As mandated by each individual state, however, only health care professionals, within the scope of their practice, can assess and treat illness and injury beyond first aid. Additionally, health care professionals, based upon their education and training, can provide high-quality preventive health care information and programs.

The following descriptions highlight the overall skills and areas of competency of other occupational safety and health professionals who might be part of an effective safety and health program at your work site.

Industrial Hygienists

Industrial hygiene focuses on the identification and control of occupational health hazards arising as a result of or during work. The industrial hygienist focuses on the recognition, evaluation, and control of chemical, biological, or physical factors or stressors arising from the workplace, that may cause sickness, impaired health and well-being, or significant discomfort and inefficiency among workers or in the community. Professional industrial hygienists possess either a baccalaureate or master’s degree in engineering, chemistry, biology, physics, or industrial hygiene.

The industrial hygienist monitors and uses analytical methods to detect the extent of occupational chemical, biological, or physical exposure and implements engineering controls and work practices to correct, reduce, or eliminate workplace hazards. Industrial hygienists can give expert opinion as to the magnitude of chemical, biological, or physical exposure, and the degree of associated risk. Certified industrial hygienists have passed a rigorous qualifying examination.

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 knowledge 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 advanced 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 environment. 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.

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

The following OSHA General Industry Standards 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 20402.

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

All About OSHA - OSHA 2056
Access to Medical and Exposure Records - OSHA 3110
Asbestos Standards for General Industry - OSHA 3095
Chemical Hazard Communication - OSHA 3084
Consultation Services for the Employer - OSHA 3047
Employee Workplace Rights - OSHA 3021
Hearing Conservation - OSHA 3074
How to Prevent Needlestick Injuries: Answers to Some Important Questions - OSHA 3161
How to Prepare for Workplace Emergencies - OSHA 3088
Occupational Exposure to Bloodborne Pathogens - OSHA 3127
Occupational Exposure to Cadmium in the Construction Industry - OSHA 3139
Process Safety Management Guidelines for Compliance - OSHA 3133
Respiratory Protection - OSHA 3079
Working with Lead in the Construction Industry - OSHA 3142