It’s my first day on the job as an occupational health nurse at one of the largest automobile factories in America. The Tesla Fremont factory encloses 5.5 million square feet and has around 15,000 workers on site at any one time. At the moment I’m hired, the factory is in overdrive to meet quotas and workers are pulling five twelve-hour shifts per week.

I’m overwhelmed by the factory floor. Spinning robots, automobile bodies on overhead assembly lines, herds of forklifts, and an incredible noise assaults my senses. The floors are covered with painted walkways, traffic safety barriers, and bollards to separate vehicles and pedestrians. Every 20 feet or so there is a sign on the floor stating “HEADS UP, PHONES DOWN” to encourage safety in this dangerous environment.

I’m working for a subcontractor. Tang and Company is a provider of occupational health services for 40 years serving such disparate industries as petroleum production, electrical generation, construction, and automobile manufacturing. They provide drug testing, respiratory mask fitting, employee health surveillance, safety education, and first aid services with the goal of keeping workers healthy and productive.

Most of my career has been in emergency room and ambulatory care. I feel well prepared for the clinical part of this job. I’m not so well prepared for some of the other functions. Fortunately, my employer has a well designed training program. I’m interested in the population health aspect. Mitigating the dangers in the workplace requires data. What are the injuries? How are they happening? What can be done to prevent them in the future? The benefits to the employees are obvious. Nobody wants to be injured on the job. The benefits to the employer include increased compliance with regulatory bodies and rules such as OSHA, FMLA, ADA, DOT, HIPAA, etc. The employer also enjoys decreased costs associated with insurance, lost production, potential fines, and the staggering expense of caring for the injured worker. In 2017, the cost of workplace injuries was $161.5 billion. This includes lost wages and productivity, medical cost, and administrative cost.

During my training period I’m instructed on how to perform routine workplace tests such as drug and alcohol testing, respiratory mask fitting, spirometry, and hearing tests. I work

Fast Facts about Occupational Health

  • Occupational health nurses work in a variety of settings to keep workers healthy and safe.
  • The typical occupational health nurse would be baccalaureate prepared and may have an advanced degree.
  • This nurse might enter the field with experience in community health, emergency room, critical care, or ambulatory medicine.
  • The American Board for Occupational Health Nurses, Inc. offers the following certifications for this specialty of nursing: Certified Occupational Health Nurse (COHN) and Certified Occupational Health Nurse-Specialist (COHN-S).
  • The professional organization is the American Association of Occupational Health Nurses.
  • There are certifications available for ADN-prepared nurses, BSN-prepared nurses, and advanced practice nurses wishing to enter the field.

closely with EMTs, Physician Assistants, LVNs, and ancillary personnel working to keep the clinic running. The EMTs are trained to respond to workplace incidents on the factory floor. They are ready at a moment’s notice to respond to medical emergencies in the vast reaches of the factory. Typical responses I’ve seen so far are falls, cuts, and even a heart attack. They respond with a shoulder carried first aid pack, oxygen, and an AED.

Medical care beyond first aid is provided by physician assistants on site or through a video conferencing system. The range of services is pretty broad. Management of repetitive motion injuries, evaluation and treatment of traumatic injuries, and referrals for non-occupational conditions are typical. The clinic is well stocked with equipment and supplies, an EKG machine, nebulizer machines, various notions and potions for symptomatic relief of sprains, headaches, and bruises. The goal is to keep the factory moving with healthy workers.

Each day is a new and interesting experience. My nursing skills are being used productively and I’m learning about this expanding and well-paying field of nursing.

Spencer Miller, RN
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