Mikkie Nakamura,

Project title: Workplace Medical Unit Staffing: Appropriate Management of Musculoskeletal Disorders

Degree: MPH | Program: Environmental and Occupational Health (EOH) | Project type: Practicum
Completed in: 2016 | Faculty advisor: Arnold de Castro


Background: From recent OSHA investigations, many injured workers received inappropriate treatments from workplace medical units, which most of them are run by Licensed Practice Nurses (LPNs). This including delaying referral to higher care, withholding appropriate physical evaluation by physicians, providing exceeding over-the-counter medications without physician’s direction. Those injured workers are more likely unable to return to their work, physically damaged and became dysfunction/disable for temporally or permanently. I focused occupational clinicians’ credential, scope of their practices, and level of assessment skills.
Methods: Using following steps to identify and to compare different scope of practice by level of licensures. 1) List common occupational injuries associate with pain based on the previously identified body sites 2) Identify examination elements required to distinguish the various injuries, based on common recourses 3) Identify the practitioner whose scope of practice supports appropriate triage 4) Evaluate what proportion of injuries can likely be managed by typical workplace medical staffing. For this project, I chose ankle using assessment as an example.
Results: Certain licenses limited only assess for Grade I ankle sprain. In addition, when injured workers don’t heal from acute ankle sprain within 5 days with aggressive first aid, they need to refer to higher care for the treatment for potential serious health issue.
Conclusions: It is employer’s responsibility to determine what level of medical unit at worksite. It is depending on level of the employer needs, but medical personal at the clinic must follow the OSHA’s first aid definition and scope of practice from each licensure standards.