Certified Occupational Health Nurse Specialists Practicing as Nurse Practitioners

Abstract

N urse practitioners (NPs) have been providing diagnosis and treatment, within their scope of practice, for work related injury and illness in California for more than 20 years. However, this NP care has been mostly "invisible" to policy makers because NPs are not specifically listed as treating providers in the California Labor Code. Additionally, since 1994 there have been several regulatory changes and administrative decisions that have provided greater visibility of NP practice in the California workers' compensation (WC) system, but have resulted in a narrow interpretation of the NP role. The interpretation is that NPs can provide care and get reimbursed in the WC system, but are limited in outlining or modifying a treatment plan, certifying disability, or signing a "Doctor's First Report of Injury" (DFR). These changes have caused confusion among insurance carriers, employers, attorneys, physicians, and occupational health nurses about the NP role in the WC system in California. This confusion comes at a time when there are limited data about NP outcomes in the WC system, and a

Expanding the Role of Nurse Practitioners: Effects on Rural Access to Care for Injured Workers

“…Although generalizability is limited by the variation between states in both NP scope of practice and workers' compensation regulations, there is little previous research regarding the role of NPs from a workers' compensation system perspective. 40 Our results suggest that authorizing NPs to function as attending providers for injured workers may improve provider availability (especially in rural areas), timely access to care, and system efficiency, which in turn may improve worker outcomes and system costs. Subsequent to the comprehensive evaluation of this pilot program, [41][42][43] legislation was passed that permanently authorized NPs to function as attending providers in the Washington State workers' compensation system.…”

Occupational Health Nursing and the Quest for Professional Authority

“…NPs can provide care and be reimbursed in the workers' compensation system but are limited in outlining or modifying treatment plans, certifying disability, or signing "Doctor's First Report of Injury" forms. A study of California NPs revealed problems with using nurses in these programs, finding that 72 percent of the NPs lacked standardized procedures documenting their roles and administrative functions [65]. But this may be a moot point since little evidence exists that NPs are penetrating the job market in competition with lesser-trained occupational health nurses.…”