[MCOH-EH] Pre-Placement Physicals

Fred Fung MD Fred.Fung at sharp.com
Thu May 12 16:16:22 PDT 2016

As a physician-attorney, I think this issue does not have a "final" answer. The US Supreme Court's recent ruling regarding dental hygienist's scope of practice did not address this question so the controversy continues.
There are several factors as ANA noted that determine the scope of practice for APRN, but state law and regulations are most authoritative from legal perspective regardless of institutional policy, professional organization advocacy etc. There are several good resources including a good book by Ms. Buppert (see below) that you may consult.
If you have access to legal journals and literature (unlike PubMed, almost all legal journals require subscription to even read the abstracts), you could find more opinions about this issue.

Christian, Beth<http://heinonline.org/HOL/AuthorProfile?action=edit&search_name=Christian,%20Beth&collection=journals>; Ciesla, Frank<http://heinonline.org/HOL/AuthorProfile?action=edit&search_name=Ciesla,%20Frank&collection=journals>: New Frontier: Expansion of Non-Physician Practitioner Scope of Practice,<http://heinonline.org/HOL/Page?handle=hein.barjournals/nwjrylr0060&div=30&start_page=69&collection=barjournals&set_as_cursor=10&men_tab=srchresults> New Jersey Lawyer, Vol. 2016, Issue 299 (April 2016)

Sharon Christian & Catherine Dower: Scope of Practice Laws in Health Care: Rethinking the Role of Nurse Practitioners, ISSUE BRIEF (Cal. HealthCare Found., Oakland, Cal.), Jan. 2008



Nurse Practitioner's Business Practice and Legal Guide, Fifth Edition
Carolyn Buppert, ANP-BC (retired), JD<http://www.jblearning.com/catalog/searchresults.aspx?search=929>, Attorney, Boulder, Colorado

  *   ISBN-13: 9781284050912
  *   ISBN-10:1284050912
Product With Access Code    520 pages      © 2015

From: MCOH-EH [mcoh-eh-bounces at mylist.net] on behalf of Hodgson, Michael - OSHA [Hodgson.Michael at dol.gov]
Sent: Thursday, May 12, 2016 2:25 PM
Subject: Re: [MCOH-EH] Pre-Placement Physicals

Thanks, yes, OSHA relies on professionals to know their own scope of practice and to adhere to it.  We are increasingly seeing deviations from that good practice, as those of you who were at the recent AAOHN meeting, where my chief, Dr David Michaels, did a really nice talk about this issue…  In fact, we are increasingly seeing events in the corporate world that appear to jeopardize clinician licenses, failing to understand those very scope of practice issues.  So far we’ve issued only hazard alert letters.

We’ve just finished a systematic review of the nurse licensing standards in a set of States, in follow up to a survey some years by the National Council of State Boards of Nursing.  Some States define the scope of practice through an algorithm, others through a detailed list of tasks.  As one of our interns looked systematically, it appears that the distinction really comes down to “focused” versus “systemic” assessments.  Interestingly we saw no comments on the topic that drove this chain: physical examination.

Some years ago, based on a formal assessment project, Bill Buchta (where are you, Bill) on this list pointed out that assessment without detailed physical examinations were generally adequate in health care systems.  In fact, if you have a safe patient handling program implemented, that is true…

Michael Hodgson, MD, MPH

From: MCOH-EH [mailto:mcoh-eh-bounces+hodgson.michael=dol.gov at mylist.net] On Behalf Of Nadine Jones
Sent: Thursday, May 12, 2016 5:09 PM
Subject: Re: [MCOH-EH] Pre-Placement Physicals

Each state has their own Board of Nursing which regulates the RN and LPN licenses.  Some categories may not be allowed under the regular RN/LPN license but based upon certain criteria, the RN may be able to perform additional duties.  Also, OSHA has the category of Licensed Health Care Professional now to include more than physicians, ANP and PA’s, but again each state BON regulates the standards of practice for the RN/LPN.

Nadine Jones, RN, MPH, COHN-S/CM
Occupational Health Nurse Consultant
Clariant Corporation | 625 E. Catawba Avenue | P.O. Box 866 | Mount Holly, NC 28120
Phone: 704-822-2246 | Fax: 704-822-2252 | Mobile: 704-231-0199 | E-Mail: nadine.jones at clariant.com<redir.aspx?REF=JHf3XzHW22F9jgKCYYf1NVQ10QYWhJuTBZjp8xjh4BK0G1YftXrTCAFtYWlsdG86bmFkaW5lLmpvbmVzQGNsYXJpYW50LmNvbQ..>

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net<redir.aspx?REF=D-NxeLFjOAWugVyvfuN8NXNsh9ND5xKIKtwsE9K65P20G1YftXrTCAFtYWlsdG86bWNvaC1laC1ib3VuY2VzQG15bGlzdC5uZXQ.>] On Behalf Of Thanassi, Wendy
Sent: Thursday, May 12, 2016 4:48 PM
To: MCOH/EH <mcoh-eh at mylist.net<redir.aspx?REF=-H8y0uLUUvFyyZmT5E8-iq4vyxdIbDa0zmat4HM1noi0G1YftXrTCAFtYWlsdG86bWNvaC1laEBteWxpc3QubmV0>>
Subject: Re: [MCOH-EH] [EXTERNAL] Re: Pre-Placement Physicals

What license categories fall under the “advanced practitioner”? Does an RN?

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net<redir.aspx?REF=D-NxeLFjOAWugVyvfuN8NXNsh9ND5xKIKtwsE9K65P20G1YftXrTCAFtYWlsdG86bWNvaC1laC1ib3VuY2VzQG15bGlzdC5uZXQ.>] On Behalf Of Hodgson, Michael - OSHA
Sent: Thursday, May 12, 2016 10:55 AM
Subject: [EXTERNAL] Re: [MCOH-EH] Pre-Placement Physicals

For people who don’t pay attention to or get the modern terminology, the ANA now prefers the term “advanced practitioner” to “midlevel” although the latter term is still use din some ergulatory environments…  It’s come up as we’ve been trying to work with ANA and AOHN around the LPN / RN focused and complex assessment skills under the scope of practice issues.  For people who haven’t followed the topic, it has risen to the level of awareness of the various licensing councils and boards …

Michael Hodgson, MD, MPH

From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net<redir.aspx?REF=D-NxeLFjOAWugVyvfuN8NXNsh9ND5xKIKtwsE9K65P20G1YftXrTCAFtYWlsdG86bWNvaC1laC1ib3VuY2VzQG15bGlzdC5uZXQ.>] On Behalf Of Sampson, Deborah
Sent: Thursday, May 12, 2016 10:53 AM
Subject: Re: [MCOH-EH] Pre-Placement Physicals

We do not have anyone here who is a ‘mid level’.
We do have professional registered nurses who are responsible for pre-employment screening and a seasoned OH APRN for any complex or unusual situations.

Deborah A. Sampson, PhD, APRN, COHN-S, FAANP
Employee Health and Wellness Services
Southern New Hampshire Health   P.O.Box 2014   8 Prospect Street   Nashua, NH 03060
p(603) 281-8583  f (603) 577-5665
deborah.sampson at snhhealth.org<redir.aspx?REF=x_hzGNGZvGplj18t9garT9XtbGlWm3ussfqJVbXCLtG0G1YftXrTCAFtYWlsdG86ZGVib3JhaC5zYW1wc29uQHNuaGhlYWx0aC5vcmc.>

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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net<redir.aspx?REF=D-NxeLFjOAWugVyvfuN8NXNsh9ND5xKIKtwsE9K65P20G1YftXrTCAFtYWlsdG86bWNvaC1laC1ib3VuY2VzQG15bGlzdC5uZXQ.>] On Behalf Of Durand, David
Sent: Thursday, May 12, 2016 10:47 AM
Subject: [MCOH-EH] Pre-Placement Physicals


Who performs pre-placement physicals at your facility (physicians, mid-levels, nurses)?

If physicians or mid-levels perform your physicals, why not nurses?

Thank you.

David Durand DO, MPH, MBA
Company Care
5000 North 26th Street, Suite 200
Lincoln, NE 68521
Telephone: (402) 475-6656
Fax: (402) 742-8419

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