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A s financial resources have become progressively more scarce and the competition for health-related allocations has increased, the focus of health policy has shifted from issues of availability, accessibility, and adequacy to that of cost containment. The result of this shift is an alteration of organizational, financial, and professional structures which has the potential of dramatically influencing all practice areas (Burner, 1986). The challenge to occupational health nursing is great and immediate: quantifying and articulating the contribution of occupational health nursing to a business organization's "bottom line" is the most critical task facing the specialty today. Occupational health nursing has enjoyed a period of relatively unquestioned support, credibility, and high acceptance for the value of its practice. With the escalating fiscal constraints experienced by most industries, however, every cost center is receiving scrutiny from the perspective of the financial return provided on the company's investment. The goals of this article are to summarize the current research that supports the claim of cost-effectiveness of occupational health nursing and to identify the work that is yet to be accomplished in providing evidence of the economic contributions of occupational health nursing.

Workers' compensation case managers and adjusters have increased their use of practice guidelines recently, partly in response to state regulations. However, informally reported rates of use are not as high as desired for the best managed care practices and the greatest reductions in lost work time. Although there are several studies of physicians' use of guidelines, there are few if any studies about case managers' and adjusters' beliefs about, and utilization of, either general medical or occupational medical practice guidelines. Information about attitudes, beliefs about practice guidelines, and actual use should help developers make the guidelines more usable and bring about more effective interaction among case managers, adjusters, treating physicians, and other health professionals. This article reports on pre- and post-training surveys of a cohort of case managers and adjusters who participated in a case-based guideline training course. It then compares their responses to those of the physicians whose cases they might manage.

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