Competencies

Competencies in Occupational and Environmental Health Nursing
The American Association of Occupational Health Nurses (AAOHN) has delineated nine categories of competency in occupational and environ¬mental health nursing. Within each category, three lev¬els of achievement or competence are identified. The competent level is considered the core for practice in the specialty. The code of ethics, standards of practice, core curriculum, and competencies provide the basis for scope of practice, knowledge, skill, and the legal and ethical framework in occupational and environmental health nursing.

The association considers the competent level in each category to reflect the core competencies for the specialty. The assumption is predicated on the fact that the nurse is competent in general nursing because the individual is a licensed registered nurse and has general nursing experience.


Competent
Nurse whose confidence and perception of the role is one of mastery and an ability to cope with specific situations. There is less of a need to rely on the judgments of peers and other professionals. Work habits tend to stress consistency rather than routinely tailoring care to encompass individual differences (Benner, 1984).
Occupational and environmental health nursing example: A competent occupational and environmental health nurse recognizes a range of practice issues, functions comfortably in such roles as clinician, occupational health services coordinator, and case manager following company procedures, and uses assessment checklist and clinical protocols to provide treatment.
Proficient
Nurse who has an increased ability to perceive client situations as a whole based on past experiences, focusing on the relevant aspects of the situation. The nurse is able to predict the events to expect in a particular situation and can recognize that protocols sometimes must be altered to meet the needs of the client (Benner, 1984).
Occupational and environmental health nursing example: A proficient occupational and environmental health nurse quickly obtains the information needed for accurate assessment and moves quickly to the critical aspects of a problem within priority setting and structured goals in response to the client situation. The nurse usually possesses sophisticated clinical or managerial skills in the work and/or community environment.
Expert
Nurse who has extensive experience and a broad knowledge base and is able to grasp a situation quickly and initiate appropriate action. The nurse has a sense of salience* grounded in practice guiding actions and priorities (Benner, 1984).
Occupational and environmental health nursing example: At the expert level, the occupational and environmental health nurse provides leadership in developing occupational safety and health policy within the organization; functions in upper executive or management roles; serves as a consultant to business and government; and designs and conducts significant research.

AAOHN revised the competencies in 2007 and will review them for update in 2013. At that time, the LPN/LVN will be considered in the competencies.

CATEGORY 1: CLINICAL PRACTICE
Competent
  1. Documents the nursing process in care management.
  2. Assesses, diagnoses, and treats clients consistent with appropriate standards and laws.
  3. Counsels clients on reduction of health and safety risks.
  4. Initiates and maintains an accurate, comprehensive recordkeeping system, while maintaining confidentiality.
Proficient
  1. Demonstrates technical and clinical proficiency in conducting comprehensive health and injury assessments.
  2. Interprets results of clinical tests and initiates appropriate interventions.
  3. Develops and evaluates clinical protocols and practice guidelines.
  4. Functions as a clinical preceptor or mentor.
Expert
  1. Facilitates and supports the clinical development of other occupational and environmental health providers.
CATEGORY 2: CASE MANAGEMENT

Competent
  1. Identifies the need for case management intervention.
  2. Conducts a thorough and objective assessment of the client’s current status and case management needs.
  3. Uses and evaluates available health care resources to achieve optimal outcome(s).
  4. Collaborates with the client and others using a multidisciplinary approach to achieve desired outcome(s).
  5. Initiates and maintains an accurate, comprehensive recordkeeping system, while maintaining confidentiality.
  6. Identifies the need for and implements changes in case management practices that would result in appropriate care and cost-effective outcomes.
Proficient
  1. Develops case management programs.
  2. Manages case management programs.
Expert
  1. Functions as a case management expert to internal and external audiences.
  2. Designs, manages, and evaluates integrated disability case management systems.
  3. Facilitates and supports the professional development of other case managers.
CATEGORY 3: WORK FORCE, WORKPLACE, AND THE ENVIRONMENT

Competent
  1. Coordinates client health screening and surveillance programs and services.
  2. Monitors the work environment to protect the health and safety of workers.
  3. Fosters compliance with current laws and regulations governing work force and worksite safety, health, and environmental issues.
  4. Interacts with community organizations that provide health and safety resources.
Proficient
  1. Analyzes the risks associated with worksite hazards.
  2. Develops, manages, and evaluates population risk reduction and health surveillance programs and services.
  3. Identifies internal and external resources, assets, and capabilities, which may be used during a local, regional, or national emergency and/or disaster incident.
Expert
  1. Serves as an occupational and environmental health and safety expert to businesses, government agencies, the community, and other groups.
  2. Influences policy relating to occupational and environmental health risk reduction.
CATEGORY 4: REGULATORY/LEGISLATIVE

Competent
  1. Demonstrates compliance with laws and regulations governing nursing practice.
  2. Monitors legislative activities that may impact nursing practice, workers, workplaces, and the environment.
Proficient
  1. Engages actively to affect policy making and practices governing nursing practice, workers, workplaces, and the environment.
Expert
  1. Leads initiatives to influence legislative and regulatory public policy.
CATEGORY 5: MANAGEMENT, BUSINESS, AND LEADERSHIP

Competent
  1. Coordinates cost-effective occupational health services and programs.
  2. Monitors the quality and cost-effectiveness of vendor products and services.
  3. Collaborates with multidisciplinary teams to foster the provision of effective health, safety, and environmental programs and services.
  4. Employs ethics and critical thinking in decision making.
  5. Uses information management systems.
  6. Contributes to financial management and the budgeting process.
  7. Communicates effectively regarding programs and services.
Proficient
  1. Designs, manages, and evaluates health, safety, and environmental programs and services consistent with business/work culture, business objectives, and the needs of workers, workplaces, and community populations.
  2. Develops and manages a budget for programs and services.
  3. Negotiates vendor and provider services and evaluates the effectiveness of programs and services.
  4. Designs, implements, and evaluates quality improvement strategies.
  5. Provides professional growth opportunities for occupational and environmental health personnel.
  6. Contributes to strategic planning and long-range business plan development.
Expert
  1. Consults in a leadership/executive role to internal and external groups.
  2. Establishes and communicates mission, vision, values, and goals for occupational and environmental health programs and services within the framework of the organization.
  3. Develops and monitors strategic plans and long-range business plan.

CATEGORY 6: HEALTH PROMOTION AND DISEASE PREVENTION

Competent
  1. Assesses the health needs of workers and worker populations.
  2. Plans, implements, and evaluates health promotion and disease prevention strategies and programs.
  3. Uses adult learning concepts in health education programs.
Proficient
  1. Develops health promotion and disease prevention programs and services.
  2. Evaluates the health outcomes and return on investment of health promotion and disease prevention programs and services to workers and the workplace.
  3. Communicates the outcomes and effectiveness of health promotion and disease prevention initiatives.
Expert
  1. Serves as an expert on health promotion and disease prevention for businesses, government agencies, the community, and other external groups.
CATEGORY 7: HEALTH AND SAFETY EDUCATION AND TRAINING

Competent
  1. Implements occupational and environmental health and safety education and training.
  2. Uses adult learning concepts in health education programs.
Proficient
  1. Develops and evaluates occupational and environmental health and safety education and training programs and services.
  2. Communicates the outcomes and effectiveness of health and safety education and training initiatives.
Expert
  1. Serves as an expert on occupational and environmental health and safety education and training for business, government agencies, the community, and other external groups.
  2. Educates occupational and environmental health professionals and others.
CATEGORY 8: RESEARCH

Competent
  1. Identifies resources and uses applications that support relevant evidence-based practice.
  2. Assists in identifying opportunities for research.
Proficient
  1. Enhances research skills using mentoring and preceptorship opportunities.
  2. Uses evidence-based practice to promote quality outcomes.
  3. Identifies need for and initiates and/or participates in research.
  4. Collaborates with others on research.
Expert
  1. Builds and validates the scientific knowledge base and conceptual models for occupational and environmental health and safety.
  2. Performs independent research and disseminates results.
  3. Serves as a mentor for occupational and environmental health and safety professionals in the research process.
  4. Influences occupational and environmental health policy and research-related decisions.
CATEGORY 9: PROFESSIONALISM

Competent
  1. Develops and implements a lifelong learning plan, including strategies for academic education, certification(s), and continuing education.
  2. Maintains scientific, regulatory, and business knowledge appropriate to the nursing profession and to the specialty.
  3. Implements an ethical framework for practice.
  4. Evaluates performance of self and others based on professional practice standards and other quality improvement mechanisms.
  5. Supports evidence-based practice.
  6. Participates in professional associations.
Proficient
  1. Serves as a role model and mentor.
  2. Assumes leadership roles in advancing the profession.
Expert
  1. Collaborates with others in advancing the profession.
  2. Advocates for policy initiatives that impact occupational health and safety