NORA - AAOHN comments on researchable sectors for the Second Decade of NORA, which serves as a framework for moving research to practice in workplaces. (2005)

December 27, 2005
Docket NIOSH-047
Robert A. Taft Laboratories (C-34)
4676 Columbia Parkway
Cincinnati, OH 45226

Via: e-mail

RE: National Occupational Research Agenda (NORA): The Second Decade

The membership and leadership of the American Association of Occupational Health Nurses, Inc. (AAOHN) actively participated in the first decade of the National Occupational and Research Agenda (NORA) by providing input at NIOSH town hall meetings and written testimony. Occupational and environmental health nurses continue to use the research agenda as a framework to guide occupational safety and health research and professional practice. As the primary association for the largest group of health care professionals serving workplaces and communities, AAOHN is pleased to provide input on the Second Decade of NORA (National Occupational Research Agenda).

The association targeted five out of eight sectors to provide comments including agriculture, health care, retail, transportation and utilities. Comments were developed by soliciting input on the following questions from occupational and environmental health nurses who worked in these sectors.

• What or why should the sector be researchable?

• What are the 2-3 major researchable issues of the sector?

• How would you apply research evidence to practice?

Specific Comments

1. Agriculture

The agriculture industry has ranked among the top three industries for fatal and non-fatal injury rates among U.S. workers. Agriculture is an area that has not been addressed in recent years although there were several initiatives implemented in the 1990s. Today agriculture continues to have some of the same issues it had in the 1990s. These initiatives were only a beginning. Much more needs to be done.

External forces that make this an important sector to research are the changing nature of the workforce (increased diversity) and lifestyle and general health issues such as obesity, aging, etc. The migrant worker has always been a component of the agricultural workforce since agriculture is viewed as entry-level work for inexperienced workers. The agricultural sector also experiences high turn over within the ranks because the jobs are filled with inexperienced and transient workers. The health status of the American workforce in general is becoming older, more obese, etc. One can assume that it is true of the agricultural workforce.

Possible researchable topics could include the following:

• Which group of workers has the most exposure to hazards?

• Have the hazard to farm work been adequately defined?

• What are the precursors to tractor rollovers?

• Has training made a difference in the incidence of tractor rollovers or other farm equipment type injuries?

• How does lifestyle/general health status affect farm workers?

• What prevention strategies are most effective in dealing with aging, weight, etc.?

• What are the implications of increasing cultural diversity in prevention of farm accidents? In seeking care?

By knowing precursors to tractor rollovers or other farm equipment type injuries, education can be developed and conducted that is relevant and more effective in preventing injuries. Surveillance of farm injuries would also be useful to identify which population group is at risk so effective prevention strategies can be tailored to the task performed. The same approach would apply to culturally diverse work groups and lifestyle issues.

2. Healthcare

   Although numerous attempts have been made toward ergonomic/musculoskeletal disorders (MSDS) prevention, MSDS continue to be a major problem among healthcare workers as well as exposures to latex, bloodborne pathogens, violence, etc. But, there is also the threat of emerging airborne infections, i.e., SARS, multi-resistant tuberculosis, etc. and many questions such as "fit-test or not fit-test"? And, "what respiratory protection to wear for what exposure?" Now the healthcare worker is faced with the threat of avian flu and flu pandemic.

   Because the healthcare environment varies (occupational and community health, jails and correctional facilities, hospices, hospitals) and is always changing (air care, global care, nanotechnology, aging workforce), there will always be researchable topics in healthcare, i.e., the effectiveness of education/training and workplace changes on MSDS injuries, workplace violence, environmental exposures; the health and safety impacts of traditional vs. non-traditional workplaces; the impact of shift work, increasing acuity of workloads, contract and immigrant workers. And, in the current unsettling global environment, the impact of bioterrorism and emerging infections, i.e., pandemic, etc., the health and safety of health care providers should have an increased research priority.

   As a research sector category, healthcare is very important and should be given the emphasis warranted due to the nature of the recruitment and retention issues of registered nurses and other health care professionals. An appropriate level of staffing within the health care system is imperative to achieve quality client care, improvement in the health status of the nation and cost effectiveness in health care delivery.

3. Retail

   Employees working in retail often experience repetitive injuries (wrists, shoulders, etc.) even with use of ergonomic engineering and restructuring. These injuries result in lost productivity and lost or modified days, which result in higher economic costs.

   A possible research approach would be to look at the effects of body weight, body type, grasping strength, posture, etc. on injuries. Other approaches would be to consider the effects of routine exercise programs and/or stretching programs on repeat injures, i.e., a cost-benefit and intervention analysis of changes in work conditions.

4. Transportation

   Long-distance truck drivers are one of the unhealthiest groups of workers: sitting for hours in the cab of a truck; eating fast foods or truck stop foods that are high in fat and salt; dealing with stress of meeting deadlines, traffic, etc.; and having low to no activity. Therefore, the truck driver meets the criteria of development of cardiovascular disease (CVD), stress related illness, and deep vein thrombosis (DVT).

   Although research may be difficult for this segment of workers, there can be economic gains such as the employee and his/her family could live longer with improved health, healthier lifestyles could reduce insurance costs for the employer, and could reduce driving accidents potentially caused by CVD, DVT, stress, etc., thereby decreasing work related compensation as well as saving lives.

5. Utilities

Utilities should in a category of its own because utility workers have exposures not always shared with other workers, i.e., weather, electrical and nuclear hazards. Utility workers also face the possibility of falls while working from very high lifts, musculoskeletal disorders from working overhead and in contorted positions, and sleep deprivation. Because of the specific type of work performed, the utility worker’s work can range from sedentary (nuclear plant worker) to high stress (lineman).

The potential for research would focus on lifestyle changes and/or recommendations or regulations on number of hours worked, effective ergonomic strategies, i.e., the cause-effect intervention relationship.

AAOHN appreciates the opportunity to review and comment on the Second Decade of NORA (National Occupational Health Agenda). As always, we will continue to provide our support and assistance to facilitate safe and healthful workplaces and communities.

Sincerely,

Susan A. Randolph, MSN, RN, COHN-S, FAAOHN
President

cc: Sid Soderholm, NORA Coordinator
Anita Schill, Deputy Associate Director for Science
AAOHN Board of Directors
Ann Cox, Executive Director