OBTAINING A WRITTEN STATEMENT FROM THE STATE BOARD OF NURSING ON RN SCOPE OF PRACTICE
As you may know, the OSHA respiratory standard allows "other licensed health care professionals" acting within their licensed scope of practice to fulfill the health/medical surveillance requirements of the standard. This is good news for occupational and environmental health nurses and the entire nursing community. However, the battle over this issue is far from over. The language in the standard defers to state law to determine scope of practice issues surrounding the surveillance activities required by the standard.
Because the language in the standard defers to state licensure laws, nursing boards in each state will have to make determinations about whether the surveillance requirements of the standard will fall within the scope of nursing practice. Therefore, it is important that we continue to be proactive and involved at the state level as these determinations are being made. For these reasons, grassroots activity from members is the key to success.
It is very important to have a written determination from your state board of nursing on the health surveillance requirements of the standard. AAOHN encourages state chapters to coordinate this effort, to combine forces and to prevent duplication of efforts. We have already received determinations from 18 states.
Many state regulatory agencies are not fully aware of the unique specialty of occupational and environmental health nursing. Therefore, it is imperative that they be educated. If you do not have a relationship with members of your nursing board, set up an introductory meeting to help them get to know more about the specialty of occupational and environmental health nursing before asking for a determination on the standard.
It may also be helpful to find out the time and location of their next meeting and ask to be on their agenda. Another great way to help educate board members is to invite them to spend a day with you at the worksite.
Because of the importance of this issue, it will be helpful to schedule a meeting with a representative from the board of nursing to discuss the details of the standard and to ensure that they have a clear understanding of the requirements. Because the language in the standard uses the word "medical," this often is misinterpreted to assume that nurses are being asked to make a medical diagnosis, which is not the case.
It is also important that your request be in writing and that you ask for a written determination from the board. Some states have specific procedures for getting a written ruling. The contact information for your state board of nursing can be found online at .
Below, you will find a sample letter for sending to the board that includes specific requirements of the standard and questions you should ask. AAOHN recommends that you do four things:
- Develop a relationship with your state board to help them gain a better understanding of occupational and environmental health nursing
- Arrange a meeting to discuss the Respiratory Standard.
- Send a letter to the nursing board requesting a written determination on whether the activities required by the standard fall within the scope of nursing practice.
- Share a copy of any responses with AAOHN. FAX to (770) 455-7271.
AAOHN staff is available to assist you in this effort. Please feel free to contact AAOHN Executive Director, Ann Cox at Ann@aaohn.org or (800) 241-8014 x117, or AAOHN Director of Professional Affairs, Dean Burgess at Dean@aaohn.org or (800) 241-8014 x104.
SAMPLE LETTER:
REQUESTING A WRITTEN STATEMENT FROM THE STATE BOARD OF NURSING REGARDING RN SCOPE OF PRACTICE
Date
Chairman/Executive Director
State Board of Nursing
Dear ______:
I am requesting, as a nurse practicing in the area of occupational and environmental health <as a representative of the state association of OHNs if approved in advance>, a written, declaratory statement from the State Board of Nursing regarding the health surveillance requirements of the Occupational Safety and Health Administration’s (OSHA’s) respiratory standard. The standard (29 CFR 1910.134) permits "physician or other licensed health care professional" (PLHCP) to administer the "medical questionnaire" or to conduct the "medical examination" as long as it is within the scope of the PLHCP’s license. OSHA’s use of the term "medical" is not intended to limit the performance of these tasks to physicians only. Details on the requirements of the standard are as follows:
The OSHA Respiratory Standard, 29 CFR 1910.134, allows any Physician or other Licensed Health Care Professional (PLHCP) to administer the medical questionnaire or to conduct the medical examination, if doing so is within the scope of the PLHCP’s license. Employers are permitted to select any PLHCP they wish to satisfy this requirement, provided that the PHLCP is qualified by license to do so. In some cases, the medical condition of the employee or the conditions of respirator use may warrant physician involvement, and OSHA is confident that the LHCP faced with such a situation will seek such medical advice.
Source: -Federal Register Vol. 63, No.5, January 8, 1998, Rules and Regulations, page 1212. ()
We are specifically requesting review of the following activities as required by the standard. Please specify which of the following activities can be performed by the registered nurse within the scope of practice as defined under the state nurse practice act. Additionally, we request a determination of whether the activities fall within the scope of practice for the advanced practice nurse.
1. Administering OSHA's mandatory questionnaire related to respirator use,
2. Maintaining confidentiality of the questionnaire contents,
3. Reviewing the respirator use information on:
a. Hazard requiring respiratory protection (i.e. use of a respirator at work);
b. Type of respirator to be worn, pending a successful fit test;
c. Duration and frequency of respirator use;
d. Expected physical work effort while wearing a respirator;
e. Other personal protective equipment (PPE) to be worn concurrently;
f. Extremes of temperature and humidity;
4. Integrating the questionnaire answers with the review of respirator use information described in 3-a through 3-f, above,
5. Performing a basic nursing assessment of the health of the employee related to respirator use,
6. Determining if there is sufficient information to reach a reasonable and prudent nursing judgment related to the employee’s safe use of a respirator without health or medical limitations,
7. Referring the employee to a licensed physician if there is not sufficient information to reach the necessary judgment of the employee's ability to safely use a respirator without limitation.
The points below are provided to illustrate the role of the occupational and environmental health nurse. Please consider these as you make your decision:
- As the largest group of health care providers at the worksite, occupational and environmental health nurses are heavily involved in health surveillance activities. First and foremost, it is important to understand that many of the activities deemed to be "medical surveillance" by the OSHA standard are really "health" surveillance activities. Administration of the questionnaire constitutes a health screening activity. Health screening is almost always an activity falling within the scope of nursing practice.
- Occupational and environmental health nurses play a pivotal role in both occupational health surveillance and screening programs. Screening and surveillance activities are often directed, managed, and implemented by occupational and environmental health nurses.
- Determining whether someone can wear a respirator does not necessarily involve making a medical diagnosis, but rather conducting an assessment of the workers health status to determine if any health responses would limit their ability to wear a respirator at work.
- A survey commissioned by the American Association of Occupational Health Nurses (AAOHN) found that more than 90 percent of the occupational and environmental health nurses are involved in health surveillance, screening and prevention activities, and in 71 percent of the worksites, the occupational and environmental health nurse has overall responsibility for these activities, regardless of the presence of other types of occupational health and safety professionals.
- Occupational and environmental health nursing professionals are not only well prepared to make appropriate decisions and manage health surveillance, screening, and prevention programs, but these professionals also judge when to refer for medical intervention, as is stipulated in the AAOHN study findings.
I <We> believe the activities required by the standard fall within the scope of practice for registered nurses. Therefore, I <we> request that the State Boards of Nursing officially recognize occupational and environmental health nurses as "other licensed health care professionals" under the standard. Currently, the boards of nursing in 18 states (Arizona, Florida, Hawaii, Illinois, Kentucky, Louisiana, New Hampshire, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Virginia, Tennessee, Texas, Wisconsin and Washington) have made official rulings.
I <We> would welcome the opportunity to elaborate on the points outlined above. Please feel free to contact me at ________________ for clarification or additional information. Thank you for your consideration.
Sincerely,
