President's Message: Professional Engagement--A Look Back to 1920

December 2015

CECRAOHN President's Message: Professional Engagement—A look back to 1920

Barbara Burgel

This is my final President's message, after two years of serving as your CECRAOHN President. I wish to acknowledge and thank my colleagues on the Board of Directors and the Nomination Committee, and warmly welcome Nonie Devens as President, and Matt DeAngelis as President-Elect. And, I want to thank you as members for being a part of this wonderful organization and our innovative specialty. Have a wonderful holiday, and I hope 2016 brings you and your family joy.

I wanted the theme of this message to be professional engagement, looking back to 1920 and looking forward to 2016, almost 100 years later. I was given a wonderful gift from Paul Blanc, an occupational medicine colleague and friend. For those of you who know Paul, you know he is deeply interested in history, and also a wonderful physician with expertise in pulmonary conditions; Paul directs the Occupational and Environmental Medicine Residency at UCSF. Paul gave me a 1920 copy of the first text on occupational health nursing, authored by Florence Swift Wright, RN, and entitled: "Industrial Nursing: For Industrial , Public Health, and Pupil Nurses, and for Employers of Labor." This book was published by the MacMillan Company. I have not found out much about Ms. Wright, but she worked at the Bureau of Child Hygiene in the New Jersey State Department of Health at the time this text was published. Ms. Wright was formerly the Secretary of the Benefit Association of the Employees of John Wanamaker in New York (John Wanamaker's was a mercantile/department store). She was also formerly in charge of industrial nursing for both the Cheney Brothers' Silk Mills in South Manchester, Connecticut, and the Clark Thread Company in Newark, New Jersey.

As a brief overview of the book, it is 174 pages of wonderful guidance, with several appendices and some recordkeeping forms that look surprisingly similar to our forms of today! In the attached pdf version of this message, there is a table of one month counts of First Aid Rooms from June 1918 (p.97). Please note the number of employees by department, the number of injuries, who is in the Benefits Association, the number of sick employees, the number of home visits, and the numbers of employees in the young mother's and prenatal clubs...a true public health model, integrating both primary care and occupational health. 

In the book there is a discussion of economics, health insurance and workers' compensation benefits. Immigration and the diversity of employees is discussed, recognizing the role of the industrial nurse and school settings in helping families become part of the community... "With workers from many lands and from all parts of our own country gathered together in industrial centers, it becomes necessary for the far-sighted employer to do his part in making these heterogeneous elements into an American community (p.4)." Wright also noted the importance of the industrial nurse attempting to learn the languages of her workers, noting, "Even one word of a sick man's tongue makes him feel he is with friends (p. 11)." Moving the sick worker to the well worker is also a common theme, recognizing that one of the benefits of industrial nursing is "the continued contact with people of all sorts, most of whom are not ill, (which) gives the nurse who can see through the eyes of others, a wide view point (p. 156)." Our complex role was recognized by Ms. Wright back in 1920, observing that the employer sometimes "expects (the industrial nurse) to take upon her shoulders work which is not exactly nursing but which is of such nature as to aid in the prevention of illness and accident (p. 10)." There is understandably a large focus on first aid in this text, outlining the importance of the nurse "losing no time in making herself familiar to her surroundings...doing a tour of inspection (p.33)." Cultivating positive relationships with both supervisors and company doctors are described, noting the importance of marketing our services. Home visits are also discussed in detail. In the first aid appendix, a brief schematic is presented on assisted respiration in the event of electric shock or "arrested respiration." The patient is rolled onto their abdomen, arms extended over their head (p. 163). The nurse straddles the patient, applying an upward thrusting pressure to the posterior lower thorax 12 times/minute, timed to respirations, if present. As another example, diluted white wine vinegar is recommended for nosebleeds. What fun!

What does Wright observe about professional engagement for industrial nursing? There is acknowledgement of having the skills and training needed to be an industrial nurse, recognizing that each plant and industry is unique, requiring an "elastic and flexible nursing service." The industrial nurse must have a "ready familiarity with all the provisions existing in community, state and nation for the care of the sick or for the education of the public in matters of health and safety (p. 12)." Furthermore, she recognized the necessity of "constant stimulus to renewed effort, obtainable by reading and study...Attendance at meetings of the National Organization for Public Health Nursing, the National Safety Council and frequent contact with other nurses doing similar work make for increased interest, enthusiasm and ability (p.13)." "...the industrial nurse, with others, will gain strength and inspiration by membership and active participation in the various nursing, public health, social welfare, and safety organizations, state, local and national...(p.158). " "She owes a duty...she can only discharge this duty by taking an active part in meetings, serving on committees and doing whatever else lies in her power to further the broader cause of public health nursing (p.158)."

I believe these observations are still true almost 100 years later. Linking to the broader professional issues of our specialty requires active professional engagement—I also like the concept of being flexible and elastic, responding to the changing needs of our employers and workforce. We are each individually responsible to protect our own RN license and to ensure that we have continued and ongoing competence to safely perform our role. This requires "ready familiarity" about emerging changes in regulations affecting both our license, and the latest Cal-OSHA standard and CDC guideline. This requires "active participation"—either through membership with a professional organization, but also maintaining certification in our specialty. I am hoping and trusting that your experiences with CECRAOHN have led to increased "interest, enthusiasm and ability!" I certainly have gained strength and inspiration from my contact with you. Thank you!!