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Occupational Safety and Health Professionals

ABSTRACT. Without a massive survey of U.S. employers, it is impossible to estimate or describe the full spectrum of those who provide occupational safety and health (OSH) services to the U.S. workforce. However, it was possible to assemble a description of the four traditional or core OSH professions (occupational safety, industrial hygiene, occupational medicine, and occupational health nursing) as well as three other disciplines likely to play a substantial role in the workplace of the future: employee assistance professionals, ergonomists, and occupational health psychologists.

Although each of the four traditional OSH professions emphasizes different aspects of OSH, members of all four professions share the common goal of identifying hazardous conditions, materials, and practices in the workplace and assisting employers and workers in eliminating or reducing the attendant risks. Occupational safety professionals, although concerned about all workplace hazards, have traditionally emphasized the prevention of traumatic injuries and workplace fatalities. Similarly, industrial hygienists, although they do not ignore injuries, have been a source of special expertise on the identification and control of hazards associated with acute or chronic exposure to chemical, biological, and physical agents. Occupational health nurses and occupational medicine physicians are distinguished by providing clinical care and programs aimed at health promotion and protection and disease prevention. These services include not only diagnosis and treatment of work related illness and injury, but also pre-placement, periodic, and return-to-work examinations, impairment evaluations, independent medical examinations, drug testing, disability and case management, counseling



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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel 2 Occupational Safety and Health Professionals ABSTRACT. Without a massive survey of U.S. employers, it is impossible to estimate or describe the full spectrum of those who provide occupational safety and health (OSH) services to the U.S. workforce. However, it was possible to assemble a description of the four traditional or core OSH professions (occupational safety, industrial hygiene, occupational medicine, and occupational health nursing) as well as three other disciplines likely to play a substantial role in the workplace of the future: employee assistance professionals, ergonomists, and occupational health psychologists. Although each of the four traditional OSH professions emphasizes different aspects of OSH, members of all four professions share the common goal of identifying hazardous conditions, materials, and practices in the workplace and assisting employers and workers in eliminating or reducing the attendant risks. Occupational safety professionals, although concerned about all workplace hazards, have traditionally emphasized the prevention of traumatic injuries and workplace fatalities. Similarly, industrial hygienists, although they do not ignore injuries, have been a source of special expertise on the identification and control of hazards associated with acute or chronic exposure to chemical, biological, and physical agents. Occupational health nurses and occupational medicine physicians are distinguished by providing clinical care and programs aimed at health promotion and protection and disease prevention. These services include not only diagnosis and treatment of work related illness and injury, but also pre-placement, periodic, and return-to-work examinations, impairment evaluations, independent medical examinations, drug testing, disability and case management, counseling

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel for behavioral and emotional problems that affect job performance, and health screening and surveillance programs. Approximately 76,000 Americans are active members of professional societies that represent the core OSH disciplines. The literature suggests that as many as 50,000 more are eligible for membership by virtue of their current employment. The committee therefore estimates the current supply of OSH professionals at 75,000 to 125,000. The committee could not locate good, independent data to support an estimate of demand (i.e., the number of available positions), but overall supply seems to be roughly consonant with employer demand. However, the committee notes that considerable need exists beyond the current demand for OSH professionals by employers. Doctoral-level safety educators are needed to maintain the supply of practicing safety professionals, and both occupational medicine and occupational health nursing need more specialists with formal training. Most importantly, a large fraction of the U.S. workforce is outside the sphere of influence of OSH professionals, particularly those whose focus is primarily prevention, principally because few are employed by small firms and establishments, and, in some sectors of the economy such as agriculture and construction, both the workplace and the workforce are transient. Those who provide OSH services to the U.S. workforce are an extraordinarily diverse group (see Box 2-1). Every business has some safety or health hazards and should logically have someone responsible for the safety and health of its workers. Those vested with some degree of OSH responsibility range from medical specialists with residency training, who bring 22 years of education to bear on the task, to the workers themselves, who may have only a high school diploma and a few words of caution upon starting the job. Many individuals with significant responsibility have no formal training at all. Some come from fields like engineering, psychology, business, or one of the sciences and have highly relevant technical or professional education. Many others developed the relevant skills on the job, as full-time OSH specialists or as human resource managers or line supervisors with an additional duty as health and safety officer. Allied professionals include highly trained individuals who provide important health or safety services to the general population, which of course includes numerous workers (occupational therapists, audiologists, and orthopedic surgeons for example) or who provide such services in highly circumscribed settings (for example, infection control practitioners in hospitals or health physicists in industries where radiation is a hazard). Short of an exhaustive survey of U.S. businesses, it is impossible to estimate or describe the full spectrum of OSH personnel, but it is possible to construct a snapshot of those with formal education

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel BOX 2-1 Occupational Health and Safety Pyramid This pyramid represents the sizes of various sectors of the population with de facto responsibility for OSH. It is not strictly proportional to the numbers involved, but the shape is intended to convey that the recognized professionals in the field constitute only a small portion of those involved. The triangular shape is also intended to convey the extent of contact with the general workforce. OSH professionals are concentrated in large firms, which employ a minority of U.S. workers.

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel and training. The traditional or core OSH professions are generally recognized as occupational safety, industrial hygiene, occupational medicine (OM), and occupational health nursing. In fact, the National Institute for Occupational Safety and Health (NIOSH) education and training programs have focused almost exclusively on these professions since their inception in the late 1970s. The existence and interest of very active professional societies associated with these disciplines enabled the committee to assemble comprehensive views of each of these OSH fields, which are summarized in this chapter. The chapter also includes a short section that describes three other groups of professionals likely to play a substantial role in the workplace of the future: employee assistance professionals, ergonomists, and occupational health psychologists. THE NATURE AND SCOPE OF OSH SERVICES Although each of the four traditional OSH professions emphasizes different aspects of OSH and educates and trains its members accordingly, in practice, members of all four professions share the common goal of identifying hazardous conditions, materials, and practices in the workplace and assisting employers and workers in eliminating or reducing the attendant risks. Hazard identification requires knowledge of relevant laws and regulations; the physiological capabilities of workers; the materials, equipment, and processes in use at the work site; and historical data on the work site, the industry or business as a whole, and the individual workers at the work site. It may require interviews, surveys, environmental sampling, and laboratory analysis or the assistance of other professionals. Hazard control may involve engineering or design changes, procedural or administrative changes, provision of personal protective equipment, or changes in worker behavior. It almost always involves education and training of both management and workers about the hazard and its control. Occupational safety professionals, although they are concerned about all workplace hazards, have traditionally emphasized the prevention of traumatic injuries and workplace fatalities. Similarly, industrial hygienists, although they do not ignore injuries, have been a source of special expertise on the acute and chronic effects of chemical, biological, and physical health hazards. Occupational health nurses and OM physicians, although they are concerned with hazard identification and control, are distinguished by providing clinical and preventive health care. These cover prevention, diagnosis, treatment, and referral, including preplacement, periodic, and return-to-work physicals, drug testing, disability management, counseling for behavioral and emotional problems that affect job performance, and health promotion and disease prevention programs.

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel In the biggest and best OSH programs, the special expertise of each is used in seamless coordination. OSH Practice Settings The settings in which OSH professionals practice are varied, but most can be classified into five major categories: industry and industry-like settings, including those associated with the military and government agencies, consulting firms including the insurance industry and some specialized government units, government regulatory agencies, educational and research institutions, and hospitals and outpatient clinics (nurses and physicians). The traditional setting for much of OSH practice is in medium-sized or large industries where the OSH professional serves in a line function and addresses occupational health issues for a well-defined set of workers. The role is rather similar whether the industry is petroleum refining, a large bank, or an aircraft carrier. In all cases, the OSH professional focuses on the particular hazards of the industry and methods of their evaluation, control, and management. In some cases the OSH professional is assigned to a particular facility, and in others he or she operates from a corporate center. An increasing number of OSH professionals work for consulting firms that provide OSH services to various segments of industry and government on a contractual basis. This includes those who work for insurance carriers that provide consulting services to the company’s various clients. In some cases these relationships are stable and allow the development of industry-specific expertise, and in other cases the OSH practice is very broadly based and varied. Consulting practice presents considerable challenges in influencing internal corporate culture and mounting stable prevention activities from outside the company. Nevertheless, many companies are outsourcing OSH functions, particularly OM and industrial hygiene functions. The current mode of practice for OM physicians, for example, has changed from one that is dominated by physicians who are hired by large corporations to one in which the majority of OM physicians practice in the private sector as clinicians. As the size of the U.S. manufacturing sector has been reduced, the number of local work site-based physicians has also decreased. Instead, increasing numbers of OM physicians have established practices in hospital- and clinic-based health maintenance organizations and group practices or in private solo practice. Sev-

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel eral companies have purchased individual clinics and have formed extensive networks of clinics that specialize in OM. An additional base from which OSH consulting activities are mounted are specialized government units, often linked to regulatory agencies, that assist small employers in addressing occupational and environmental health hazards. The principal federal regulatory agency that makes extensive use of OSH expertise is the Occupational Safety and Health Administration (OSHA) of the U.S. Department of Labor. In addition, various states enforce the Occupational Safety and Health Administration Act of 1970 (OSHAct) under agreements with OSHA, and various local jurisdictions undertake regulatory activities. Other industry-specific regulatory programs that call on OSH skills and training, notably, in the Mine Safety and Health Administration (MSHA) of the U.S. Department of Labor and the Nuclear Regulatory Agency. The U.S. Department of Defense and the U.S. Department of Energy, which are self-regulating, also employ substantial numbers of OSH professionals, both in-house and as consultants and contractors. The goal of workplace inspections in all of these settings is to verify that the employer has accurately assessed and effectively controlled the hazards faced by its employees and to ensure that the workplace is in compliance with the appropriate regulations. The educational efforts of compliance officers are limited to informal on-site discussions to help employers understand the hazards and regulations that affect their workplaces and to inform workers and union representatives of employees’ rights under the law. Research in or directly relevant to the OSH field is carried out in government laboratories, notably, those of NIOSH, universities, and the private sector and in institutions affiliated with organized labor. Researchers are often affiliated with departments or units with “occupational safety and health” in their name, but many are not, which makes it difficult to estimate the size and extent of the research enterprise in the field. For example, aerosol science research, which is of great relevance to industrial hygiene practice, is often found in engineering departments in universities, as are many aspects of the control technology that underlie the control of workplace hazards. In contrast to the professional practice of occupational safety, industrial hygiene, OM, and occupational health nursing, many researchers who make important contributions to the field have had no OSH training. Scientists investigating the pathophysiology of cancer, or of asthma, for example, may know little about OSH but nevertheless provide information highly relevant for occupational risk assessments. This separation carries over into graduate degree programs in the field, as will be discussed below, in which the curriculum has both a highly structured technical component and a component that relates to the professional aspects of the field, including, for example, the federal

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel regulatory system or the workers’ compensation insurance system. University faculty members who contribute to OSH teaching programs also reflect this separation. Some have training and experience in the field, and others have technical knowledge of great relevance to the field but little professional OSH experience. The latter individuals often come from backgrounds in chemistry or engineering or they are physicians or nurses specializing in fields such as epidemiology, toxicology, respiratory disease, and dermatology. It is very important to foster the application of a wide variety of specialties and fields of knowledge to OSH problems. NIOSH’s National Occupational Research Agenda illustrates the breadth and depth of the interdisciplinary research needs that must be addressed (National Institute for Occupational Safety and Health, 1998). In addition to teaching at the college or university level, a number of OSH professionals hold other positions with a significant teaching component, either in continuing education for working professionals or in programs aimed at orienting management personnel or workers themselves to the field. Maintenance of certification in any of the four traditional OSH professions requires participation in continuing education courses, which provides incentives for developing courses and recruiting qualified instructors to meet this demand. Environmental Health and Safety It should be noted that although the focus of this report is on workplace health and safety, the knowledge and skills of OSH professionals are applicable outside the workplace as well. OSH professionals are equipped to deal with safety issues and physical, chemical, and biological hazards, wherever they occur, and the injuries and illnesses that they cause, whether in workers, consumers, or the general public. As a result, OSH personnel are increasingly required to address environmental health and safety issues. Manufacturers may ask their industrial hygienists to monitor not only the indoor air being breathed by employees but the level of hazardous emissions being released into the air and water of the surrounding community. Public health agencies or environmental groups may hire or otherwise call upon OSH professionals to monitor pollutants in community air and water as well. Occupational health clinics are prepared to diagnose and treat lead poisoning whether its patients are refinery workers or children eating lead-based paint in old houses. Environmental issues have become sufficiently important for physicians that the American College of Occupational Medicine changed its name to the American College of Occupational and Environmental Medicine and the specialty area is sometimes referred to as occupational medicine and sometimes as occupational/environmental medicine. The education and

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel training of each of the four core OSH professions includes instruction on environmental health (see Chapter 7), and the occupational focus of this report should not be taken as ignorance of or a lack of appreciation for the importance of the contributions of OSH professionals to environmental health research and practice. SAFETY PROFESSIONALS The prevention of injuries, illness, and unexpected death for workers is the basic definition of occupational safety. Although occupational safety has historically focused on the prevention of acute traumatic injury, a broader definition generally includes the control of hazards and the prevention of accidents not only to protect the U.S. workforce but also to protect the general public and the environment. Therefore, the broad discipline of safety deals with the interaction between people and the physical, chemical, biological, and psychological effects, acute or chronic, that can adversely affect their well-being. The discipline of safety is the systematic application of principles drawn from engineering, physics, education, psychology, health and hygiene, enforcement, and management to prevent harm to people, property, and the environment. The safety professional (SP) normally deals with the physical aspects of the workplace and their interaction with the worker and is directly concerned with injuries caused by slips and falls or by being struck by or crushed under an object, cuts, crushes, burns, electric shock, or improper lifting, bending, or stretching. The SP must be knowledgeable about the effects of all types of uncontrolled energy, such as electricity, pressures, weights, fluids, temperatures, motion or moving parts, radiation (ionizing and nonionizing), fires, and explosions. The SP must see that workers are issued and wear well-maintained personal protective equipment such as hard hats and helmets, goggles, safety shoes, respirators, clothing that protects individuals from hazardous chemicals, and the like. The SP must understand and apply the OSHA General Industry, Construction, and Maritime standards, the American National Standards Institute and American Society for Testing and Materials standards, and, occasionally, international standards, as well as the specific standards of the mining, agriculture, and transportation sectors and those of product safety. Safety Professional History From the use and control of fire to early hunters protecting themselves from the hazards of wild beasts and reptiles, humans have recognized the need for occupational safety. Through the centuries, humans

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel have recognized the myriad hazards that arise out of an increasingly industrializing world economy, such as the unexpected dangers of using power to fuel rapidly developing industries (see Appendix C for a more detailed list of the key events and individuals in the last two centuries). In the United States, before the mid-18th century, a high percentage of work was done on family farms, which consequently became the location for most worker injuries and fatalities. Later, with the onset of the Industrial Revolution in the 1800s, factories began to replace smaller shops and the changing work environment created a challenge for the prevention of job-related injuries, illness, and death. In response to growing worker resentment toward the hazardous work conditions in factories, Massachusetts began using factory inspectors in 1867. Ten years later, additional legislation from Boston required the safeguarding of dangerous machinery. In the early 1900s, New Jersey, Wisconsin, and a number of other states enacted workers’ compensation laws that made the employer financially liable for workplace accidents. With this incentive, organized safety programs were initiated and the SP came into existence. Initially, the SP was a person who assumed the responsibilities of carrying out the goals and objectives of a safety program. Only the larger and more progressive sectors, in particular, the steel and insurance industries, had a dedicated SP on staff. Other businesses assigned the task of preventing injuries to an experienced employee who knew the plant layout, equipment, and functions. These early SPs were also known as safety practitioners. Safety Professional Services The American Society of Safety Engineers (ASSE) identifies four primary functions of a safety professional (American Society of Safety Engineers, 1996): Anticipate, identify, and evaluate hazardous conditions and practices. This function involves such activities as developing and applying methods for using experience, historical data, and other information sources to identify and predict hazards in existing or future systems, equipment, products, software, facilities, processes, operations, and procedures during their expected lifetimes; evaluating and assessing the probability and severity of losses and accidents that may result from actual or potential hazards; compiling and analyzing data from accident and loss reports and other sources to identify causes, trends, and relationships, ensure the completeness, accuracy, and validity of required in-

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel formation, evaluate the effectiveness of classification schemes and data collection methods, and initiate investigations; providing advice and counsel about compliance with safety, health, and environmental laws, codes, regulations, and standards; conducting research studies of existing or potential safety and health problems and issues; and conducting surveys and appraisals to identify conditions or practices that require the services of specialists such as physicians, health physicists, industrial hygienists, fire protection engineers, design and process engineers, ergonomists, risk managers, environmental professionals, psychologists, and others. Develop hazard control designs, methods, procedures, and programs. This function involves such activities as formulating and prescribing engineering or administrative controls to eliminate hazards, exposures, accidents, and losses and to reduce the probability or severity of injuries, illnesses, and losses when hazards cannot be eliminated; devising methods to integrate safety performance into the goals and operations of organizations and their management systems; and developing safety, health, and environmental policies, procedures, codes, and standards for integration into operational policies of organizations, unit operations, purchasing, and contracting. Implement, administer, and advise others on hazard controls and hazard control programs. This often entails preparing valid and comprehensive recommendations for hazard controls and hazard control policies, procedures, and programs that are based on analysis and interpretation of accident, exposure, loss event, and other data; directing or assisting in developing educational and training materials or courses; conducting or assisting with courses related to hazard recognition and control; advising others about communicating with the media, community, and public about hazards, hazard controls, relative risk, and related safety matters; and managing and implementing hazard controls and hazard control programs.

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel Measure, audit, and evaluate the effectiveness of hazard controls and hazard control programs. This function involves establishing techniques for risk analysis, cost-benefit analysis, work sampling, loss rate, and similar methodologies; developing methods to evaluate the costs and effectiveness of hazard controls and programs; and directing, developing, or helping to develop management accountability and audit programs. Specific roles and responsibilities vary widely, depending on the education and experience of the individual and the nature of the organization that employs him or her. SPs with a doctoral degree can be found teaching and doing research at colleges and universities, performing public service, and consulting. Most SPs have bachelor’s or master’s degrees, however, and work for insurance companies, a wide variety of industries, state and federal agencies such as OSHA, hospitals, schools, and nonprofit organizations. Safety Professional Education A number of community and junior colleges offer 2-year programs that lead to an associate degree or a certificate in safety or a related field. Some of these programs are designed to prepare students to enter the workforce as safety technologists, and others prepare students for transfer to a 4-year safety degree program. Over the last decade about 50 percent of those in the safety field have held a bachelor’s degree as their highest degree. About 30 percent of those who enter the field have a bachelor’s degree in safety, but many move into safety from other disciplines (e.g., engineering, business, and physical sciences) and later pursue safety studies. More than 30 colleges and universities offer a bachelor of science in safety. However, only six institutions, none of which receive support from NIOSH, offer safety degree programs accredited by the Accreditation Board for Engineering and Technology (ABET). Requirements for a major in safety typically include courses on safety and health program management, design of engineering hazard controls, system safety, industrial hygiene and toxicology, accident investigation, product safety, construction safety, fire protection, ergonomics, educational and training methods, and behavioral aspects of safety. To prepare for these courses, students are generally required to take courses in mathematics, chemistry, physics, biology, statistics, business, engineering, and psychology. Good computer skills are a necessity as well. Many safety degree programs

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel agers on the principles of ergonomics and how to apply them to their work sites. Ergonomists are often hired by industry, but only a few companies (typically, only very large companies) have in-house ergonomists. A small but growing number of ergonomists work for the government (above and beyond the human factors professionals who design equipment for the armed forces). Many teach and conduct research at universities. Most academic ergonomists also act as consultants to industry, as does the majority of ergonomists. Some consultants also supplement their practices by testifying as expert witnesses for OSHA, for injured workers in enforcement cases, in workers’ compensation cases, or in third-party liability cases brought by injured individuals against manufacturers for not designing their equipment or products properly. There is also another group of professionals, like physical and occupational therapists, who are most often brought in after a worker has been injured to help redesign the worker’s job so that the worker can get back to work sooner. Although they do not identify themselves as ergonomists, these professionals are also doing more and more preventive work of the sort that ergonomists do. The field has also attracted the attention of industrial engineers (the original designers of equipment and workplaces), industrial hygienists (who specialize in identifying and controlling hazards on the job), safety professionals (who have an engineering background), and OM physicians and occupational health nurses (who get involved through workers’ compensation cases and who must decide on work restrictions or return-to-work orders), all of whom are now exposed to ergonomics in their professional education and training. Education of Ergonomists There are more than 70 graduate programs in human factors and ergonomics (a directory is available from the Human Factors and Ergonomics Society, P.O. Box 1369, Santa Monica, CA 90406). Most are in engineering schools and result in a master’s or Ph.D. in industrial engineering. Only a few graduate programs (less than 30) specifically award a degree in ergonomics. The committee could not identify any undergraduate programs in ergonomics, although many programs, such as graduate and undergraduate programs in industrial hygiene, offer courses in ergonomics as part of a degree program. Ergonomists who are doing research generally have a Ph.D. in industrial engineering or, less frequently, in occupational or physical therapy or industrial hygiene. Practitioners often have had only limited course work in ergonomics and may have taken only a few short courses or continuing education courses of anywhere from 1 day to a few weeks in duration. These courses have become very

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel popular and are an important revenue source for ergonomists. Most practicing ergonomists have acquired much of their expertise from on-the-job training. Certification of Ergonomists The main accreditation body in ergonomics is the Board of Certification in Professional Ergonomics (BCPE), which only began in 1990. Qualified individuals are certified by this board as Certified Professional Ergonomists or Certified Human Factors Professionals. BCPE also has lower-level certifications for entry-level professionals, the Associate Ergonomics Professional and the Certified Ergonomics Associate. At present, there are 743 Certified Professional Ergonomists/Certified Human Factors Professionals, 72 Associate Ergonomics Professionals, and 13 Certified Ergonomics Associates. There are also competing certifications from the Oxford Research Institute: Certified Industrial Ergonomists (CIEs), Certified Associate Ergonomists (CAEs), and Certified Human Factors Engineering Professionals (CHFEPs). The Oxford Research Institute has certified about 400 people in the United States: about 180 CHFEPs, 220 CIEs, and about 30 CAEs. About equal numbers are certified outside the United States. Eighteen universities in the U.S. have been authorized to confer the Oxford Research Institute certification. The Oxford Research Institute does not require an examination like BCPE does, but the Oxford Research Institute does require that ergonomists take continuing education courses, which the BCPE does not. The Board of Certified Safety Professionals introduced an ergonomics specialty examination for certified safety professionals in 1999. Current Status of the Ergonomist Workforce The Human Factors and Ergonomics Society has about 5,000 members, of which approximately 700 are students and of which about 600 are from foreign countries. However, many of these members are not “ergonomists” as they have been defined here (focusing primarily on OSH issues), but are primarily designers who deal with consumer applications. About 750 ergonomists are certified by BCPE, and another 400 are certified by the Oxford Research Institute. There are many more ergonomists in other professions, like occupational and physical therapists. For example, the American Occupational Therapy Association has a special interest group of about 1,100 members who are interested in work programs, and many of them are doing ergonomic interventions. Physical therapists are even more involved in workplace ergonomics than occupa-

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel tional therapy. Many got involved in ergonomics through sports rehabilitation medicine. Interest in ergonomics is also very high among industrial hygienists, although only about 250 of AIHA’s 13,000-plus members claimed on their membership form that their primary responsibility was doing work in ergonomics. A reasonable estimate of the number of people in the United States who call themselves “ergonomists” or whose primary function is to do workplace ergonomics would be about 5,000. The number is growing as ergonomics has become an important topic in the workplace and because work-related musculoskeletal disorders are such an important part of the injury picture. OSHA has already published a proposed standard for ergonomics programs, and although it has stimulated intense debate, a final rule is anticipated in 2000 or 2001. This standard is expected to spur the demand for ergonomists tremendously. However, more and more workers are being trained to combine their shop floor knowledge with limited ergonomics training to help identify and correct hazards. This trend may reduce the demand for professional ergonomists somewhat, but many companies will still be hiring ergonomists or consultants to help set up and manage their programs, at least initially. In the long run, the committee envisions an increased demand for ergonomic advice and consultation that will be met partly by full-time professional ergonomists and partly by increased training in ergonomics in the curricula of all the traditional OSH professions. Employee Assistance Professionals An employee assistance program (EAP) is a work-site-based program designed to assist in the identification and resolution of productivity problems associated with employees impaired by personal concerns, including, but not limited to, health, marital, family, financial, alcohol abuse, drug abuse, legal, emotional, stress, or other personal concerns that may adversely affect employee job performance. It is most often an employment benefit independent of both workers’ compensation and any group health plan offered by the employer. Employee Assistance Professional Services The 7,000 member Employee Assistance Professional Association (EAPA) restricts full membership to persons who provide “core” employee assistance services 20 or more hours per week. These are: consultation with, training of, and provision of assistance to work organization leaders (managers, supervisors, and union stewards) seek-

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel ing to manage the troubled employee, enhance the work environment, and improve employee job performance and provide outreach education for employees and their dependents about the availability of employee assistance sevices; confidential and timely problem identification and assessment for employee clients with personal concerns that may affect job performance; use of constructive confrontation, motivational techniques, and short-term interventions with employee clients to address problems that affect job performance; referral of employee clients for diagnosis, treatment, and assistance, plus case monitoring and follow-up with organizations, insurers, and other-third party payers; provision of assistance to work organizations in managing provider contracts, in forming and auditing relations with service providers, managed care organizations, and insurers, and in providing employee health benefits that cover medical and behavioral problems; and identification of the effects of employee assistance on the work organization and individual job performance. Education of Employee Assistance Professionals As might be expected, the individuals who provide employee assistance are typically mental health professionals. A 1998 EAPA member survey reported that 46 percent of respondents were social workers, 27 percent were alcohol or drug abuse counselors, and 12 percent were psychologists (Employee Assistance Professionals Association, 1999). None of these disciplines provide formal training in employee assistance, but all provide training in at least some of the core services listed in the previous paragraph. The working degree for EAP social workers is a master’s in social work. A doctorate is the standard for psychologists. The educational requirements for alcohol and drug abuse counselors vary by state, and although states vary in their expectations, all require some combination of education, specific training in addiction, an internship, and paid counseling experience. Certification of Employee Assistance Professionals EAPA’s certification department administers a program that provides the certified employee assistance professional designation. Necessary qualifications for sitting for the 1999 examination are a graduate degree in an EAP-related discipline,

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel 2,000 hours of work experience in an EAP setting (over a minimum of 2 years and within 7 years of sitting for the examination), 15 “professional development hours” (continuing education), and 24 hours of advisement (supervision) by a certified employee assistance professional spread out over at least 6 months. or 3,000 hours of work experience in an EAP setting (over a minimum of 2 years and within 7 years of sitting for the examination), 60 “professional development hours” (continuing education), and 24 hours of advisement (supervision) by a certified employee assistance professional spread out over at least 6 months. Current Status of the Employee Assistance Professional Workforce The 7,000 members of EAPA include Canadian and international members, associate members (who provide employee assistance services less than half-time), student and retiree members, and organizational members (corporations, unions, government agencies, associations, and other groups with an interest in EAP). The number of individual U.S. members is approximately 4,500. The number of certified employee assistance professionals is about 4,400. According to the 1998 EAPA Needs Assessment Survey (Employee Assistance Professional Association, 1999), about half of the members are employed internally: 30 percent by a joint union-management arrangement, 25 percent by management alone, 8 percent by the union alone, 25 percent in an integrated model (their employer provides employee assistance both internally and to other organizations), and 10 percent in some other arrangement. The other half of the membership provides services from outside the organization: 67 percent as consultants and 33 percent as an employee of a contract EAP service provider. The committee was unable to locate any useful data on current demand for employee assistance professionals. Occupational Health Psychologists Occupational health psychology is an emerging specialty within psychology. In the broadest terms, occupational health psychology concerns the application of psychology to improving the quality of work life and to protecting and promoting the safety, health, and well-being of workers. The primary focus of occupational health psychology is on organizational and job-design factors that contribute to injury and illness at work, in-

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel cluding stress-related disorders. Family and societal factors are also of interest to the extent that they influence the safety and well-being of working populations. Individual characteristics, such as skills, abilities, and temperament, and their contribution to occupational illness and injury are also subsumed under the rubric of occupational health psychology. There are as yet no established curricula or credentials beyond a doctorate in psychology for occupational health psychology, which Quick (1999) describes as a convergence of preventive medicine and clinical and health psychology in an industrial-organizational context. The American Psychological Association and NIOSH are partners in a 5-year cooperative agreement to fund the development of graduate-level training in occupational health psychology. The purpose of this program is to develop and implement specialized graduate-level training through a course or series of courses in the area of occupational health psychology. Given that the ultimate goal is to promote occupational health psychology as a discipline within psychology, it is expected that the proposed new course(s) that is developed will be housed in the psychology department or, at a minimum, cross listed as a psychology course(s). Courses developed under this program must contain the expression “occupational health psychology” within their titles. It is anticipated that courses planned under this program will be fully developed, accredited by the university, and formally scheduled within a year of the funding date. Examples of appropriate training activities suggested by the program announcement include (1) expansion of curricula in organizational psychology with new courses on organizational risk factors for stress, illness, and injury at work and on intervention strategies; (2) expansion of curricula and practica in clinical psychology to improve the recognition of job stress and its organizational sources; (3) expansion of curricula in human factors engineering to provide courses with more of an exclusive focus on OSH; and (4) increased exposure of behavioral scientists to research methods and practice in public and occupational health and epidemiology. Programs at six universities were funded in 1998 and 1999, and additional applications are expected by May 2000. The six programs are at various stages of development, but descriptions of their proposed efforts and academic partners suggest that the field is likely to develop along the lines of industrial-organizational psychology, whose practitioners in the Society for Industrial and Organizational Psychology define themselves as scientists who derive principles of individual, group, and organizational behavior through research;

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel consultants and staff psychologists who develop scientific knowledge and apply it to the solution of problems at work; and teachers who train students in the research and application of industrial-organizational psychology. A recent membership survey by the Society for Industrial and Organizational Psychology (Burnfield and Medsker, 1999) found that 34 percent of its members are employed in academia, 31 percent are consultants or self-employed individuals, 16 percent work for organizations in the private sector, and 7 percent are employed in the public sector. SUPPLY, DEMAND, AND NEED Supply This chapter began by noting that without an extensive survey it would be impossible to describe the full spectrum of individuals who contribute to OSH programs in U.S. workplaces. In the absence of such a survey the committee relied on membership in the major OSH professional organizations and certification by appropriate professional boards as estimates of the current supply of OSH professionals. Table 2-8 summarizes the current OSH professional workforce described in this chapter, that is, safety professionals, industrial hygienists, OM physicians, occupational health nurses, ergonomists, and employee assistance professionals. None of those professional organizations claim to have as members 100 percent of those who are eligible, and it is doubtful that any of TABLE 2-8 Estimated Number of Active OSH Professionals in the United States, 1999 Type of Professional No. of Professional Association Members No. of Certified Individuals Safety professionals 33,000 10,000 Industrial hygienists 14,000a 6,400 Occupational medicine physicians 7,000 1,150 Occupational health nurses 12,500 6,400 Ergonomists 5,000b 1,000b Employee assistance professionals 4,500 4,400 Total 76,000a 28,950 aTotal includes AIHA membership plus ACGIH membership minus duplicates. bTotal includes an unknown number of industrial hygienists and safety professionals.

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel the organizations even have as members 100 percent of those certified in their field. The numbers in Table 2-8 are therefore a very conservative estimate of the OSH professional workforce and are very likely a gross underestimate. Some measure of the extent of the underestimate may be taken from the findings of a 1996 national survey (Bureau of Health Professions, 1997) of registered nurses. This survey of more than 25,000 nurses found that 1.0 percent of respondents reported occupational health as their primary employment setting, leading to an estimate of 21,575 nurses working in the field nationwide, about 73 percent higher than the AAOHN membership total. The committee had no way of estimating the undercount for the other OSH professions, but if the proportion is similar to that for occupational health nurses, the total of 76,000 in Table 2-8 might well be as much as 50,000 short as an estimate of the size of the current OSH professional workforce. Demand Demand for OSH personnel, that is, employment opportunities, is equally difficult to estimate without an extensive survey of current and potential employers. The committee had neither the resources nor the license for such a survey and could find no evidence for a recent survey of this sort in the published literature. Anecdotal evidence, average salaries reported by the professional societies, computer modeling of industrial hygiene positions, and an informal survey of NIOSH-supported training programs by the committee suggest that overall supply appears to be roughly consonant with market demand. It seems possible, if not likely, that this is due in large measure to the elasticity of employer demand, that is, a willingness to accept less educated or less experienced professionals rather than pay a premium for the most highly qualified individuals. Such elasticity may also partially explain the relatively low percentage of OSH professionals who are board-certified in their field (Table 2-8). Certification is certainly not synonymous with expertise, but it does serve as a notice to prospective employers that the holder has been judged competent by his or her peers. Employers are apparently not willing to pay a sufficient premium for this guarantee to induce the majority of OSH professionals to gain certification. Conversely, the fact that certification in any of the professions does command some additional pay and benefits might suggest that the market is indeed calling for more certified personnel. It is quite possible, however, that additional certified professionals would simply displace noncertified OSH personnel. That is, the number of positions for OSH professionals (demand) might well remain unchanged.

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel Need None of the earlier discussion should be taken to suggest that there are no unmet needs in the field. By this the committee means shortfalls or other deficiencies in the current OSH workforce that the committee believes ought to be corrected or ameliorated for workers to be protected to the extent that current knowledge allows. The continuing annual reports of 6,000 fatal workplace injuries and 6 million nonfatal workplace injuries and the estimated 60,000 annual deaths from occupational illness (Leigh et al., 1997) are ample evidence that the workforce needs more protection than its employers are providing. An earlier section of this chapter reports that although 3 percent of safety professionals in the American Society for Safety Engineers have doctorates, only nine U.S. universities offer a doctoral degree in safety, and the committee was able to identify only one dissertation since 1995 that focused on the traditional domain of safety professionals: prevention of sudden traumatic injury. This is discussed further in Chapter 7, along with a suggestion for action, but it should be clear that the current low level of doctoral graduates is not sufficient to maintain the faculty presently training the bachelor’s- and master’s-level safety workforce. A similar situation exists in OM, in which the small number of boardcertified OM specialists means that injured or ill workers must often obtain care from physicians who are not specialists in the area. A 1988 Institute of Medicine report that explored the barriers that are keeping primary care physicians from competently meeting the needs of patients with environmental and occupational problems pointed to a lack of specialty-trained physicians, that is, board-certified OM physicians, to serve as educators and consultants. Subsequent publications (Castorina and Rosenstock, 1990; Institute of Medicine, 1991) estimated this shortfall to be 3,100 to 5,500 positions. Although the authors suggested that 1,500 to 2,000 of those positions might require only primary care practitioners with “special competence” in occupational and environmental medicine (i.e., additional training but not a residency), they pointed out that closing that gap would require increases in the number of individuals undergoing graduate specialty training by a factor of three to five for a period of 10 years (as well as significant changes in the structure and funding of universities and public health departments). Ten years later, the number of board-certified OM specialists remains unchanged. Chapter 7 explores some non-monetary reasons for the persisting gap and provides a suggestion for a means of reducing it. The major shortfall in the field of occupational health nursing is similar to that in OM: not so much a shortage of practitioners as a shortage of practitioners with formal training in the field. In the case of occupational

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel health nurses this is a master’s degree. Because no residency is involved, a doubling of the annual number of master’s-level occupational health nursing graduates is not an unrealistic goal if established professionals are not required to abandon an ongoing career for a year or more. Chapter 8 explores some emerging means of accomplishing this. The distinction between demand and need is nowhere more aptly illustrated than by examination of the makeup of the U.S. workforce as a whole. Some 56 percent of U.S. workers are employed by firms with less than 100 employees (National Institute for Occupational Safety and Health, 1999). The majority of the traditional OSH professionals, however, are employed by midsize to large businesses and government agencies. Small businesses as a group apparently believe that they do not need OSH professionals or cannot afford them. Most workers will thus seldom, if ever, encounter one of these OSH professionals. Even when injured, they may receive treatment in emergency rooms or ambulatory clinics where the treating physicians and nurses have neither the time nor the training to deal with issues of causation and prevention of the injury-producing event. The training of traditional OSH professionals is considerably simplified by the nature of their practice in midsize and large industries and government agencies. To a large degree the framework is constructed around the regulatory system and the workers’ compensation insurance system. It is a top-down system that, for those segments of the economy, reaches all the way to the worker at risk. This part of the system includes professionals who operate from consulting practices and who play an increasing role in midsized industries. It is another matter entirely to address the development and the training of OSH personnel to deal with that large majority of the workforce who have no routine access to the OSH system. The few OSH professionals who do focus on small businesses and workplaces are likely to work for government or public interest groups. For these professionals, media and communication skills are likely to be the most important requirement. For example, the “right-to-know” concept was popular in the 1980s occupational and environmental health community as a means of stimulating a bottom-up demand (i.e., turning a need into a demand) for a safer and healthier environment among those directly affected. Putting that approach to work in the workplace, however, continues to be a challenge and, on the prevention side at least, the OSH system in the United States principally affects that portion of the workforce that is employed in large industry or by government or that is represented by organized labor. As subsequent chapters will elaborate, the workplace of the future will increasingly be dominated by small service-producing businesses that are widely distributed and that utilize an increasingly diverse and transient workforce. What is most needed

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Safe Work in the 21st Century: Education and Training Needs for the Next Decade’s Occupational Safety and Health Personnel now and will be needed even more in the coming decades, in addition to the traditional OSH professionals, is a new and different model of practice, perhaps one that even uses new categories of OSH personnel created by training managers, supervisors, and workers already employed in these small workplaces.