Document V3R4x6XmZVqNzL4JaVN3bGyN4

Industrial Nursing WEDNESDAY AFTERNOON SESSION October 18,1939 i . The session on industrial nursing con vened with Joanna M. Johnson, R.N., of the Nursing Service, Employers Mutuals, Milwaukee, Wis., and Chairman of the In dustrial Nursing Section, N.O.P.H.N., pre O siding. Miss . Johnson welcomed the dele gates, spoke briefly of some interesting in dustrial nursing problems coming under her recent observation, and then introduced the first speaker. The Industrial Nurse's Records and Reports By MRS. ISABEL POOLE, R*N. Bigeiow-Sanford Carpet Company, New York City This discussion will cover records and reports of the industrial nurse; who is working without the supervision of a full ; time medical director, and who is personally responsible for the organization and admin istration of her department Records and reports form a very impor tant port of die nurse's work, vital to her self as well as to management Too often, the nurse fails to realize this and loses a golden' opportunity to present a pertnaJnt, if incomplete picture of the service she renders. We all know that much of a nurse's efforts and accomplishments cannot be tabulated; but onthe other hand, a care ful summing up of her activities should lead to wider activity. While ah' nursing. positions require ac curate; intelligent record keeping the in dustrial nurse must also compile her records into comprehensive reports, for business is interested in..trends and costs. Although she may have her position because her employer knew that her professional training, and ability' to handle people and their problems, would benefit his organization, an under standing of business aims and practices will enhance her value to the industry. By keeping records that will' provide a basis of comparison for future years, she will soon Prove her worth in dollars and cents, even as any other department. Although records and reports perforce " ill vary, dependent upon the type and size of the industry,. the scope 6f the nurse's work, and the problems and aims of in dividual management; there axe certain standards dot should remain constant and applicable to all. Records should be ac curate, concise and confidential A simple, but easily accessible filing system is indis pensable. The minimum record keeping for efficiency should include an individual record for each* employee, daily, monthly antLannual reports: The individual record, which will assure constructive nursing sendee for both the employee and the employer, should contain the following: A. Pre-employment medical examination report B. Morbidity experience: 1. Date. 2. Ailment. 3. Emergency treatment and advice. 4. Disposition. _ G Accident experience: 1: Date; 2. Emergency treatment 3. Disposition. 4. An accurate account of the cause of accident,, recording the employee's . own words. . 5. A detailed description of the injury' and condition of th'e surrounding area. 6. Any additional remarks made by the . employee, which may have bearing on the case. 109 jwTraintraffi 110 28th National Safety Congress 7. Any persona! observations, which - her employer will be interested in reports would tend, to present a better pic* that classify injuries by 'cause, nature, de ture of die employee's genera] con* partment,.and amount of lost time. dition and attitude. This type of analysis will do miich to Tke daily report, which provides the basis reduce "accident incidence and severity, mid for the monthly and annual reports, should lost time, for it will point out the location contain die following: of hazards, and emphasize where lack of A. Names of employees who visited the cooperation exists. Such information is in dime. valuable . to the safety, director. Further B. Classification of the visits: 1. Medical aid. more, accurate accident reports will pre vent exorbitant costs, in cases involving 2. Surgical aid. litigation. ." 3. Physical examination. The office nurse is moody occupied xcith 4. Absence interview. the problem of absenteeismShe should 5. Follow-up for correction of defect have a daily report .of absence from all 6. Others. departments and should interview all em The monthly and annual reports, which ployees upon their return to work follow present a summary of the nurse's activities ing illness. She thould make an analysis to management, should contain the follow of the absence experience of each individual. ing: by department, showing the number of ab A. The number, type and disposition of cases handled. B. Pertinent facts relative to accident and illness experience. C Polides established and recommenda tions for future procedure. D. A comparison of the findings of each report with those of corresponding reports of previous years. sences, the number of days' lost and the. cause. This type of report will increase her knowledge of the general health of the per sonnel, and point out a lapse in good hygiene in. any particular department showing a high incidence of absence due to a common ailment It will also bring to light chronic malingerers. Therefore, the nurse will be better equipped to help the employee and (These comparisons will determine the the department manager with their problems effectiveness of the existing program and and thus reduce the absence experience. All enable die nurse to plan improved methods.) ' of which reflects favorably in dollars and The wise nurse will remember that execu rents to both employee and employer. tives are busy people, who prefer to sec Many nurses, who'know better, have trends at a glance. A few well planned neglected to compile statistical data owing to graphs are far more effective than pages the many demands of their job and the conr of written explanation. However, a brief sequent lack of time daring the working narration ' concerning aid given to a de day. If, at first, reports must be done on serving employee, occasionally added to the - your own time, fay all.means do them on tabulated report, is of extreme interest your own time. Soon the management will For although the nurse's statistical data may become interested in them and may request be valuable to the employer, the nurse's additional statistics. If the nurse can arouse first and most important duty is the welfare this .interest and demonstrate the value .of of the employees, from both the employer's her reports, she will eventually be able to viewpoint and hers. obtain the necessary clerical assistance. Most industrial nurses, whether engaged in a factory or an office, are called upon to give medical and surgical aid, to assist with or arrange for physical examination, to follow up for correction of impairments, and totake a small or large part in per sonnel management The factory nurse's chief problem is acci dents, their treatment, their cause and pre vention, and getting the injured employee back on the job. Therefore, it is logical that Experience has proved that the nurse must be certain that her reports reach the person with managerial authority, or much of her effort and work will be wasted. The nurse's reports, in their entirety, should be routed to management's attention and not be abstracted or subordinated to other re ports, such as safety and personnel. It 4s advisable that this matter be clarified at the start of her employment Intelligent records and reports will tend to . m depot basis, Th to tw a tal Lydia Metn York one o ing t "Man found `The Tb cussic which swtre Presu Pro To indnst to rtt "iropn the th the fit physic Rama; rellent he rel chose of the of the time, i ment Ran cine, it daily physic probal (client Industrial Nufsing Ml to make industry realize that the medical ' Then it will no longer be the first departilepartment can be run on a .business-like ment to be dispensed with in . times of econasis, without the loss of humane attitude. nomic depression. The renuunder of the session was devoted to two interesting features.' The- first was a talk, "Living' With Your Job," by Dr. Lydia G. Giberson. Industrial Psychiatrist, Metropolitan Life Insurance Company, New York City. Dr. Giberson also presented one of the striking addresses delivered dnrtng the Early Morning Classes, entitled "Man's Mental Attitudes," which will ,be found in this volume, under the section. `The Human Side of Safety." The second feature was a general discussion period, called "Your Hour" in which a group of selected consultants an- swered Questions from the audience on prob- lems of industrial nursing and related topics, The consultants consisted of the following: Grace Anderson, Territorial Supervisor of Nursing, Metropolitan Life Insurance Cornpany. New York City; Francis Bethnne, R. N., Firestone Cotton Mills, Gastonia, N. C; Mrs. Lillian L. Brewer, R. N., Industrial Nurse, Oswego Falls, Sealright Division, Fulton, N. Y.; Catherine R. Dempsey.R. N., Simplex Wire and. Cable Company, Cambridge. Mass., and President, New England Industrial Nurses' Association; and Marion Dowling; R. N,, Lowe Paper Company, Ridgefield, N. J. e .. tIhursday luncheon session . October 19,1939. Presiding, Grace E. McVay, R. N., Pyrene. Manufacturing Co.-, Newark, N. J., and President. New Jersey Industrial Nurses' Qub.- Improving the Health of Industrial Workers ) By DR; DONALD M. SHAFER ' __ * **? . Committee on Healthful Working Conditions, National Association of Manufacturers, New York City To talk about "improving the health of the nature's physical laws and human health. industrial worker" we have, of necessity, He understood the association between stone to review the past to see if there is any cutting, mining, and lung disease, as well as "improvement" to talk about. I skip over between-cleanliness and dermatitis. the third , century observations of Galen and the fifteenth century work of the German physician Ellenbog, to land squarely on Kamazzini. He has been quoted for his ex cellent treatise on industrial'disease which he released in .1710 with these words: "I chose to publish this treatise for the good of the Republic, or.at least for the benefit of the tradesmen." Possibly, even at that time, there was some debate about Govern-" ment ownership versus private enterprise. However, from the time of Ramazzini till the twentieth century there was little prog ress in industrial health,. except for the minor benefits derived in England from the Factory Acts passed during the late 1800's. By this time, the United States was con scious of the industriaLjiealth .problem and, even as early as 1837, literature on the subject was published -here. The industrial accident toll, however, was a more dramatic and appealing subject than was health, and Ramazzini, who held the Chair oLMedi- ~ it. found the public's interest and recogni cine, in the University of Padua, was espe tion about 1913, when the National Safety cially interested in the relationship between Council was organized. Physics, meteorology, and medicine, and The progress of the safety, movement has. probably found industrial workers to be ex extended into many fields. A vivid example cellent examples of fhe conflict 'between is the complexity and varied interests of the 112 28th National Safety Congress many sessions at this Congress. In the in' can prosper arid have a successful working dnstrial field there has .beat a redaction in employee-employer relationship. fr it? fatalities of well over 50 per. cent since 1913. However, there is evidence that the accident rate of industry was becoming fixed,'and, since 1928, the number of deaths in industry has been practically parallel to. the number of men employed. Additional evidence is that there was a redaction of. only about 10 per cent in the severity rate, and prac tically no change at all in the frequency of accidents, from 1932 to. 1937. This would, indicate that under the 1932 to 1937 meth That health is one of the most insist ent problems of a laboring man cannot be doubted. Without it; his income drops, or stops altogether, and he and his. family lose their home and gradually thetrindependence itself. It is therefore, vital to him to leefcft' bus health,. The interest of labor bait ben demonstrated in several ways. One Is the establishment of labor union health centers^ some of them handling thonsaods of cases per year.. Recently, sin automobile workers* m- ods of prevention, industrial safety was reaching its saturation point Without some basic change in approach, the 1937 loss of approximately 19,000 industrial workers was well on the way to becoming an armual tolL However, in 1938 the frequency of indus union established a medteri center: to. deter mine the physical conditibtt of its: men and to determine the presence of .occupa tional disabiGty. -Anotber way that labor, signifies its. interest in health is through the employee representatives to the employing trial accidents again declined, and I feel companies. that the improved record may 'in no small part be due to a broader, safety approach- As an .example of. this, one company one that includes health. found that of several thousand cases dared with the-men's representatives, 73.per .cent Concentrate on Health were with reference to the plant working conditions. Another company found - that during a seven months^ period, 24.per . cent Probably the most promising way of con of the grievances of^the employees were doe tinuing the.downward trend in industrial to wages and 8 per cent doe to hours, but accident rates in the future is to concentrate 68 per cent were due to woriting conditions.' more effort on the health of the workman. This was in-spite of the fact that both of Tins approach is perfectly logical, for it is these companies pay at least average atten obvious that a rid; workman is more likely tion to the woriting environment of their to have, or to cause; an accident titan is' a , men. healthy man. This has been proved by care- ' fol analyses showing that98`j>er cent of all industrial accidents are preventable, and that only 10 per cent of the. injuries are doe to mechanical hazards, while 90 per cent are caused in whole or in part by man failure, either supervisory or otherwise. It is apparent that labor is greatly inter ested in health, so it seems fitting that this subject should be firmly stressed in any company's labor relations program. .An ef fective operating plan to improve the health and woriting renditions can canto a decided heightening of the employee-employer rela The great improvement that can be real tionship, mid will work to . the advantage ized by additional attention to the health of of both. the then has been demonstrated repeatedly . . under actual operating conditions. ' ; - Why Not a Health Program? , Along with further accident reduction, a Both topics that have so far-been men second great need i* industry Is apparent tioned, namely, accident prevention mid labor today. It is an improved employer-employee rdations, are not the primary, remits of relationship. Probably at no time .in the in improved employee health bat they .are in dustrial history of America has there been reality by-products. The man's, health itself so much, discussion and controversy be is both the means and the end. It makes 3 tween .the worker and the employer. We all possible the lower accident rate; the better are cognizant of the disturbances that have labor relations, the improved production of arisen all over the country, and. likewise goods, and, just as important, the .improved we all have felt that honest assistance and consumption of those goods. Why then does 8t understanding of the other's problem would not every company have a health program produce practical cooperation so that both in operation? { Pr, thee his y only view In ing com} attiti tiota holt com] help It gran or tl to **i is in inter Tl Industrial Nursing 113 The answer requires consideration.of two ers, who play a part in toe development of undaroental points--lack of understanding factory health programs, frequently maintain and economics--as applied to three groups: an attitude of hesitancy or suspicion because the employees, the private practitioners, and of- the fear of economic joss; To tins is thetthplgyers. Innone of'.these groopsis occaisionrily added a.lade jbf. understanding there cohiplcte oiq>ositidn. It is rather a of the ethical arrangement between a com feeling of hesitancy, or inertia, or suspicion pany doctor.and himself.v Because of this Railways based; on misunderstanding or misunderstanding and hesitancy, a factory ignorance of the potential benefits that, each health program of real ment is sometimes group can derive from factory health pro* handicapped. grains. . Tliis situation can ultimately be solved by Within tiie .-first, group, the employees, education by such an agency as . the Gonad] there.is considerable interest in healtfa,.as I on Industrial - Health of' , toe American have, already mentioned,, but it is sometimes, Medical Association. . One huge part of tins colored by a he$itancy or suspicion of par education consists of enlightenment in indus ticipating in a factory health plan for fear trial health work itself, both to interest of economic loss. . Some, men .feel that pre- more doctors in the field- and to have them employment physical examinations will pie*'' realize that an "on call for emergencies" vent men from getting a job.and. that check arrangement is. not a factory health pro up, examinations will, cause cider workers to gram. Furthermore, they shotdd be shown lose their, jobs.- They-do not know that the that a factory heafthprogram still mayhave best type of health plan rarely excludes emergencies-and that the two. are not neces even 5 per cent of the applicants and that sarily incompatible. The true picture of the even without examinations the physical, con* contribution that a factory'health plan can dition of' this 5 per cent , woald. soon cause make^to^the wdfare of the community's them to be out of work because of illness, privqteydoctors must - he presented before accident, or inability to do -toe job.. Also, thdr inertia can be overcome. they do not realize that the examination is in reality an inventory of their ability to work and can freqoently show them a way Two Classes of Employers {O hfaprove their conditions and consequently eir ability to work and earn. r The third and final group that can pro long factory health development is .the em Practically the same situation is true with t, ployer. Within this group there are two the older worker, who tfarongh the physical, 'diasses of' employers, as we all know; one examination and health correction can mafc&- (dass.has not only developed excellent health his years of earning power last longer. It is programs in its own plants but also actively only through education that these points of and willingly supports industrial health and view can bealtered hygiene research and education. The second Education Effective class has not rmtife^aiiy. advance in factory health and frequently has no conception of hi addition there is, on occasion, the feel ing that since the doctor is paid by the company he must, be against the men. This attitude, likewise, must be met by educa tion which honestly demonstrates that a healthy worker is toe most'valuable to toe company and that the "doctor's job is to help him be healthy. toe part that a health program csm play in the company's, prosperity. This second class is, in general,-made np of the smaller sized companies and is in great need of education on the entire subject, especially on the eco nomic aspects. I will speak of them m more detail later, as it is with tbem.tfaat the Com mittee on Healthful Working Conditions is dealing. * It must be added that any health pro gram that does discriminate against the men, or that is using the physical examinations to "weed oqt" men, is pour labor policy and is in its short-sighted way defeating the best interests ofthe company. To answer my earlier question of why doesn't'.every company have a health pro gram, wefind j^t toese three groups must be educated:--rWbdxv' thef private practition ers, and the employers; The first-labor^sterns most approachable through the general The second group, toe private practition public at the present time, possibly through- 114 28th National Safety Congress Government agencies; the second, through , The committee has also prepared pam national, regional, and industrial medial phlets of instruction for the manufacturer, societies; and the third--employers--by showing Mm exactly what he can do in his means of trade and manufacturers' associa plant to. set up a health program. A new tions- Until each component fully realizes pamphlet shows very briefly and to the point, die value of industrial health to itself and its how a health program can bolster tbe safety future, the work will.be incomplete. work in the plant and how the company can The work of Dr. Heiser and myself in this endeavor is directed toward the manu facturer. Through the National Association of Manufacturers' Committee on Healthful be benefited in a practical maimer by such a health plan. We hope to have this new pamphlet available vety soon for those re questing it. Working Conditions, the more progressive companies of its 7500 members are trying to assist the manufacturers of the country, especially those in die small plants, to recog nize the value of an employee health pro gram and to put such a program to work in their plants. In addition to the production of such edu cational material, the committee is seeing active service as a source of information on specific health problems in industrial plants. One day's mail contained one inquiry on how to prevent the so-called "cyanide rash", from a mill in the state of Alabama, and another Small Plant Problem The consensus of die Committee's opinion is that the small plant,' employing over 0 on the identical problem among mine work ers 150 miles north of the end of the rail road in Canada. per cent of the nation's industrial workers, The- public has been interested in the is the crux of the present factory health activities of the committee, and this has re problem. This, I believe, coincides with your sulted in publication of numerous articles in own, and has been supported by repeated magazines and in'the press. One. feature analyses of the situation by the American article, containing the aims and work of the College of Surgeons; state industrial hygiene committee, was syndicated and went to a departments, and others. guaranteed circulation of six million read For the past year, the committee, assisted by its advisory committee of industrial phy sicians, has been compiling all available in formation on the subject of small plants, and has endeavored to find just what the "key log" in the jam has been. After setting ers. We fed that "the maintenance of each of these activities--education of manufac turers, a clearing bouse of factory health problems, and public information--cannot help but assist the work of improving the health of industrial workers. aside the hindrances that I have mentioned above, we. have found two such key logs. The first has been obvious--cost; the sec ond is not so readily defined. Primarily, it is lack of education, but it is entangled in a feeling held by manufacturers,, as laymen, that "this is a doctor's problem" and that they don't know anything about it Further more, the}' are not sure that they, as individ uals, should know anything abc>ut it It is probably the converse of the feeling that, because a man has a medical degree, he can't be a business man or anything but a doctor. In summary, a concentrated effort to im prove the health of industrial workers ap pears to be the most promising way of fur ther reducing industrial accidents in the fu ture and, in addition, cam be a major con tribution to labor relations at a time when a good empiqyee-employer relationship is of prime importance. This improvement, however, is slowed down by the inertia of many employees, private physicians, and smaller employers, and can only be acceler ated by thorough education of each group. Education of the employer group is the goal The best answer to tins seems to be a of the Committee cm Healthful Working straight dollar and cents statement of fac Conditions. It is actively encouraging em tory health as a business proposition. In this ployers to improve toe health of their men, way, we believe, it is closer to tbe manu and is providing direct educational material, facturer's interest and experience and should advice on factory health problems, and pub receive more consideration from him. lic information toward that end. Prt and F Industrial Nursing .y THURSDAY AFTERNOON SESSION October 19,1939 President, Grace E. McVay, RN.,Ityrene Manufacturing Company, Newark, N. J. and'President, New Jersey Industrial Nurses' Club. Health Education Methods Used by Industrial Nurses By ALMA M. BALMER, RN. T. A. Edison Inc.. Belleville, N. J. Most of the industries today have pre- knowledge of dietetics and more confidence employment examination; the eyes, teeth, in his doctor. gums, throat, .heart and lungs, blood pres sure; as well as predisposition to hernia are carefully examined. In many instances minor defects are accepted, but the em ployee is given a reasonable length of time in which to have these corrected.' These findings, when recorded by the examining physician, are followed up by the nurse and if necessary a re-examination by the doctor ismade. Health is the prime asset of the worker. We take him into the plant with a clean bill of health, and through our efforts must help him to maintain it. Today conditions in our factories are sanitary; washrooms, showers, and toilet facilities, are provided; often these are under the supervision of the nurses, particularly where large numbers of women are employed Restrooms are com fortable and a nurse will see to it that The employee usually makes his first con tact with the nurse and this is perhaps one of the best ways--the nurse will put bim those returning from illness do rest during the lunch hour, explaining if necessary why they should at his ease. He learns early where the . Group insurance provides money for the dispensary is located, and while waiting his doctor and drug bills. To obtain this a Jim he sees there preparations to meet doctor's certificate of diagnosis is necessary, emergencies. As he departs she says with and if needed one can have, the services of a smile, "Don't forget to bring me your the visiting nurse for bedside care, laths,, little cots, scratches, braises." Therefore treatments and etc. as prescribed by the he feels that is the place, to come, and she physician in charge. In some cases, where is the person who is going to be his friend. a total disability occurs, the patient may During dressings, the topic turns to health in general; this seems to be the most pop ular way of advising the employee. He will ask many questions on various subjects, which she can answer.'This personal con need further care and medication. Along with this the plant nurse keeps in touch with him and advises him as to clinics, or organizations intended for his particular illness. tact gives him information that he passes Many early cases of tuberculosis have or to others. Often the employee asks about been arrested.' When an employee has re diets and wants to know the reason some ported, often with colds the nurse* will particular member of his family has been question him about night sweats, loss of advised to use certain' foods by his phy wight, and general fatigue, as well.as any sician. pains, etc, and tactfully advise him to go I.assure you, this puts the nurse on the to the clinic where'he can be examined and spot. Her professional ethics comes to her advised. She,, herself, makes the appoint aid when tactfully she reptys to the effect ment for him, which we know, if left alone the doctor must think that is the diet most he probably would not. do for himself. The needed Then by explaining how each food report is returned to the plant nurse for is meant for certain needs, how it may be - further reference prepared and made appealing to the patient It may be only frequent colds due to a at home, she gives that employee,a little - rundown condition; and again, it may be 116 28th National Safety Congress an active case of tuberculosis, needing a They are referred to their own physician, sanitarium for rest and treatment Many community nurse or clinic; all this infor have returned in good health and have con mation is ever available from the nurse. tinued to earn their living. Their absence and return assure the others that we are interested and show what can be done--it alone is a lesson. Pregnant women are instructed when leaving employment about thrir group insur ance which pays for a number of weeks of disability, thus enabling them to have some Many plants carry their own benefit in necessary money to meet their expenses. surance and here the nurse.visits the ab They are also advised about the dirties and. sentees to see that they are receiving proper told about pamphlets to be obtained from care and arranges - for hospitalization if /insurance companies as^wpH as those from necessary. the government These instruct them about Salt tablets are- placed in dispensers throughout the plants, particularly in de partments operating at exeremely high tem peratures. One case of heat exhaustion is care ofthemselves and their babies. One of the first calls the new citizen makes is on the nurse bade at the plant, the young mother beaming with gratitude. enough to convince all others of the.neces First aid dasses are conducted by many sity of salt No nurse is ever too busy to nurses,, open to all who are interested, explain to individuals the benefits to be de modeled on the Red Cross courses. rived from' this simple preventive; every kitchen shelf has its salt box. Recreation as well as athletics, while not directly under the nurse's supervision, also One nurse, after reading the article on .touch her department as she arranges with salt in. tiie "National Safety News" some the plant physician to examine members of years ago decided it was the most sensible the various teams. The activities help to thing she had ever heard, and secured au keep them healthy, anti the minor casualties thority to make use of salt among the are always brought to the nurse for dress employees. In her plant it was common ings.. practice to send many home after giving hot ginger and providing rest until they Employees who have been absent with serious illness, operations etc. are-examined were able to be taken home;.then it usually by the plant physician before returning took, two or three days before the worker to work. The nurse also advises them about was able to return.- Imagine the surprise of taking care of themselves, explains m detail an employee who, within fifteen minutes about diets, rest, and proper deep. She after a small dose of salt had been taken, watches on their return that they do not was able to return to his job and work overdo, thereby guarding their health. better than he had before. That discontinued loss of time from heat exhaustion. Many The nurse in industry "works with the could hardly believe that ordinary common doctor; he may be full time,.'on call, or salt was keeping them on their. feet As part time.' She instructs on deanliness, ex soon as dispensers appeared this nurse, put ercise and diet; and other matters that make on a sales campaign. Today the tablets are for a healthy happy employee. .She has his accessible at the drinking fountains and heat interest constantly in mind and her attitude exhaustion has been conquered. makes it easy for the employee to come to In all factories handling food a health card is necessary certifying as to Wasser- .her for advice as well as for first aid dressings. mann and general health. Periodical re In some industries it is necessary for the examinations and new certificates are re nurse to tour tire plant and note general quired by law. conditions; disorder and untidiness, tactfully m Posters on the bulletin boards carry a message of safety and health. mentioned in privacy, are cheerfully cor rected; . Most plants require the; nurse to he ever present in the -dispqisaiy, which is Various plants have their own cafeterias; located at some central point easily acces here a hot nourishing lunch is obtained at sible to all departments. The dispensary small cost This often is under the super must be equipped to meet all characteristic vision of the nurse. emergencies. It need not be large nor pre Many consult the nurse about their fam tentious but sbould be on a par with the rest ilies as well, as their own health problems. of the plant In under to fo hospi howe with tntil room at all fed is di: labor aurs some bene Industrial Nursing 117 * In factories handling and packing food : several non-productive hours. between cases under sanitary conditions, one would expect or requests for services to be rendered by lofind a first aid room second only to a the nurse! Yet at any time, there may be a hospital operating room.' In a chemical plant case in which the services of a nurse may however, where workers become covered , mean much--either in a life saved, lost time with materials of many colors and leave a reduced, or a .saving in compensation paid trail behind every footstep, the first aid out room need not be too forbidding, yet dean The young nurse recently graduated is at all times. The worker must be made to not quite as well suited to industry as one fed he is ever welcome, and if his work who has acquired some other nursing ex is dirty he is getting .dean money for his . perience. The older nurse. has a better labors. knowledge and understanding of people and Nurses in general are versatile; .they can working conditions. She is^better qualified and sue willing to do other things beside - to recognize the early symptons of cases the routine' of the plant dispensary. Some that may not reach the hospital until they -.wore commercially trained before entering are well advanced and require drastic treat their chosen profession and can perform ment other duties along with their own work; In industry a nurse must take an entirely provided it does not interfere with the different attitude toward her work than need of the employee. Some nurses super- . that to winch she was previously trained. vise the plant cafeteria, others relieve at. The hospital training school taught her that the switchboard, while some attend to the the patient was sideband therefore not re group insurance or keep production rec sponsible or able (to suggest Ids needs, that ords, etc.' All these, along with their pro- it was up to her'-tD do his thinking for ' fessional duties, make them valuable ad him. But in industry the employee is usu juncts to any . plant personnel. Their duties ally a normal person, one who is earning bring them in contact with the employee and often in an ordinary conversation the nurse can give a hint bn health and teach someone how to take ample precautions to benefit himself. his living, one whose wishes cannot be denied. It is, therefore, sometimes against her better judgment that she is willing to please him. A pleased employee is a better v We are looking forward to the day when worker and it is part of the nurse's work /even a fairly small concern will .realize the to keep him happy on the job. She accepts nurse is a necessity in its organization. his suggestions, as far as possible, and Those of us who are already in industry with tact manages to persuade him that her can readily understand that from the pay way is best after his own has proved not roll point of View there are sometimes to be what he wanted. Management's Attitude on lndustrial Nursing Service . By J.M. CONWAY President, Hoberg Pqper Mills, Green Bay, Wis. The qualities going to make up. a good nurse or good doctor are not given to all of tts--so to those of us oh the outride is delegated the duty of. assisting wherever and whenever we can. As employers we appreciate the good work doctors and nurses have done,., both within and without our plants--we appreciate the opportunity to be of some service and hope that as time goes on we can he of more assistance in this great work of reducing industrial accidents and sickness. We need help and guidance--and if doctors and nurses unit point out the way, I am sure industry will follow. * I am sure that both the nurse and the worker have found the attitude of the em- pfoyer regarding industrial nursing service a constructive one. Certainly it is the duty and obligation of management to provide adequate facilities for the safety of life and limb of those who make it possible for him & y .a: ill'f.!- I ip 118 28th National Safety Congress to remain in business. If insurance com the establishment of an adequate first aid panies, based on years and years of experi and industrial nursing staff, but to me, these ence, find it profitable to spend millions are the most, important. I would place the each year to lengthen the lives and better question of qualifications for a good nurse the health of their policyholders, certainly in first place. The selection of the proper we in industry should find it more profit individual to carry on this goodwill work able because we have a larger stake, a larger and to practice her profession with efficiency investment per worker than the insurance is the difference behyeen success and fail company. ure.- The easiest way to define the qualifi Every successful company takes great pride in its tools--oiling and repairing them constantly--discarding junk. When a machine approaches'obsolescense they re cations of an ideal industrial nurse would be to paraphrase a one time popular song, "You've got Everything." She must have everything. place it promptly witifa modern machine. How much more important it is to take care of the human power without which the machinery would be of no value--how much more important it is to take care of those lives and limbs which cannot be re paired or replaced. In speaking of these qualifications, there Is' one which is >going to be side-tracked and that is the question of age. Some like them young--some old-some like them single and some married--this is not the major issue.: Other qualifications are much more important Let us, foe the moment Industrial nursing service should have the make believe that we are workers In a large unqualified support of every forward-look industrial plant and that we have been in ing executive. It is one of the greatest jured and are being taken to the first aid builders of goodwill in existence, and God station. 'What kind of a place would you knows we need all the goodwill of our like to be taken.to? What kind of an in employees we can muster. The value of the dividual would you like to meet upon your personal contact between the nurse--a com pany representative--and the employee at the time he or she needs help and care and advice is of inestimable value. There is no substitute for this persona! contact. The benefits to industry through indus trial nursing can be summarized as follows: arrival? I` 'r * On the way down our minds would work something like this. "Gee, I'm glad Miss Smith is here instead of that substitute nurse we had for the past two weeks. Everyone said she was a terror--blamed you for everything--said you were careless-^ 1--Builder of goodwill. indifferent--didn't care. Miss Smith isn't 2--Makes a satisfied employee. like that. She is tough on us wh.en the 3--Increases efficiency of workers. accident ratio slips, but her approach takes 4--Reduces cost of production. the sting out of it She has tact and she These are all very* desirable results and really likes all of us--works hard to keep us worth going after. The big question, how and our families safe and healthy. She is ' ever, is not so much the assurance of the a graduate nurse and keeps up on all the benefits which flow from a well-organized latest methods. It won't take-her long to industrial nursing staff, as it is a question fix me up. She won't say much, but I know of how to acquire one. We all know what what she will be thinking, because just last we want, but how do we go about obtaining week at the safety meeting she told us. to the results desired? Here are a few of the be careful of loose clothing--oeckties--large problems confronting management on which cuffs, etc." its attitude, will be of immense Interest to you: 1--How big shall the department be? a--Complete First Aid Room. b--Fall Time Nurse. 2--What are the qualifications of a good nurse? 3--Where can I obtain such a person? . 4--To whom shall she be responsible? You would begin to fed sorry--not for yourself--bat for that kind, gentle, friendly nurse who has tried so hard to keep you from injury. You let her down--you broke her record-yon caused a lost-time accident in her department If Miss Jones, the tem porary nurse, were on duty, your blood pressure would probably rise to tremendous heights, but knowing Miss Smith is on Th6re are many 'other question marks in du^y, you are naturally a bit excited, but in Industrial Nursing 119 a much better mood and position for re the worker is out of employment--they covery. You. are much more receptive to must be taught and made to feel that an ' correction and your determination not to be ounce of prevention is better than a pound a second offender will be miich stronger if of cure. the approach--the time--andsetting are just right, and these three conditions are present from , the time you rfeach/a well-organized first aid department until you leave it A good nurse will rise above petty things and will be impartial in her dealings with the employer and employee. She is the socalled "go-between'* for both the employer Now you enter the first:aid room. Miss Smith is there to greet you--she knew you were coming and has everything ready. No bawling out--no unnecessary conversation. That can come later. Now there is a job to do. Miss - Smith, < as you watch her, is a young, woman of a certain age and without and the insurer. As contact woman, she must have their confidence that they will be justly treated and willing to do what she asks them to do.' She must be familiar with every department in the mill--every hazard--every peril and every piece of ma chinery. a doubt in the best of health. She is neat . These qualifications can be summarized in her appearance add housekeeping. She into six divisions, as follows: is cheerful--loyal to-her employer and at the same time tolerant toward the worker. She knows her duty and goes about it with ah air of professional dignity to be mar veled at SHe makes you comfortable, dresses your wound, and when everything is done, sits down beside you to h&r your story, and takes notes which will be used, not to crucify you at the next safety meet ing, hut to study , and consider, in (he light of what lias happened and how it Jean be avoided in the future. An accident to her means a. failure on the part of someone or something to act in accordance with expec tations--this failure must not reoccur. 1--She must be interested in and be able to understand people. 2--She must have personal strength and character. 3--She must have initiative--be demo cratic and perform her job with en thusiasm and geniality. 4--She must have common sense and good judgment--be smiling and en couraging. 5--She must-have an inquiring mind to find the facts:' without submitting the patient to a third degree. 6--She must think objectively--from the point of view of herself--the company . This ability to win your confidence en and the employee. ables you to tell your story truthfully--you Now--where can we obtain such an in don't have to lie to Miss Smith, or put the. dividual?. Obviously this is not an easy task blame on someone else--she understands and one which the ordinary employer can that people do get hurt; but her job is not undertake. Such women are found to find but why and correct it as soon as through specialized agencies or through the possible. -You are now ready to leave, but company physician who has numerous con her work has just begun. tacts. In this line of work especially, ex This is a rather long story, but to me it brings out much more vividly those things which are so necessary in a successful in dustrial nurse. Let us say that, she should have tact--that she should be forceful, and yet. command respect of the worker and employer. She must be efficient and keep abreast of latest developments in safety and medicine. She should never feel that she is set for life with an industry and that she knows enough to handle the ordinary in juries in a day's work. She must without doubt have the full loyalty and cooperation perience is a prime essential. It is not al ways necessary, but it does relieve the management of the responsibility of de veloping an industrial nurse and allows more time for establishing policies and getting . things done. My only suggestion wonld be to proceed cautiously--don't be in a hurry.- If you haven't had a first aid department for the past ten years, a week or longer won't hurt you any. Take your time and be sure you have the right individual or you are just wasting your money. of the employees--they must be convinced To whom shall the company nurse be re- - that she is' there for their good and for the sponsible? There doesn't seem to be much good of their families, who suffer when doubt that a department of such importance B. i KJ5?*vo7y' 120 28th National Safety Congress should be directly responsible to the presi employees and their families--others prac dent of die organization. That is a problem tically take care of everyone and everything. of personnel and. organization and a com Each firm should study its own situation pany policy which cannot be decided by any and draw a line somewhere. Many em other individual This also allows it the ployees still feel that-their home is their maximum of freedom from business politics kingdom and they and they alone reign and enables it to act free of the influaice supreme after the quitting whistle blows. of department heads or superintendents. Otiters welcome the helpful service and ad This does not mean that all individuals vice. (Maybe a happy, medium of giving concerned are not consulted on industrial advice and help when asked, and letting the nursing policy, but it does mean that the private practice take care of private cases first decision on ary matter rests squarely will prove the best.) upon the president of the corporation. The future of industrial nursing is what Now we come to what is probably least important What shall' be the size of the first aid department and personnel? All I can say is that if an organization has the you make it If you can take up your job in earnest and dig in and get results, the profession is bound to grow. If you take the lines of least resistance and limit your right land of a president and hires the right work to dressing wounds and giving out individual for the industrial nurse, the size pills, you are just as surely doomed to of die department will take care of itself, failure. because it will be conducted with intelli You have the hacking of management-- gence and foresight with a view to talcing they have confidence in your ability to help care of all necessities, and that in the end them--what yon do with this backing and is all that matters. confidence--what yon do with the future of - Millions of hours of work each year are your profession is entirely op to yon. lost through minor accidents, both on and So far we have considered the industrial off the job--colds and sicknesses of various nurse from the attitude of the employee and sorts, industrial injuries, according to the the attitude of the management Now, let U. S. Department of Labor statistics, cost us consider the attitude , of the industrial industry five billions of dollars each year. nurse towards the employee and the man According to the Medical Aid information agement the advent of industrial nursing has. de--- :~--NThe employees should give their whole creased accidents by 50 per cent--compete . hearted support to the safety and first add sation payments 30 per cent and absenteeism program and. cooperate in every way with 50 per cent everything that is bring done for them. Our experience and results with industrial They should not resent constructive criti nursing- have been very gratifying. The sav cism or suggestions. They should be eager, ing in insurance premiums more than off and willing to come to the muse with their sets the cost of operating the department ideas and suggestions for improvement and we have the satisfaction of knowing As far as management goes, the indus that our employees like their work. We trial nurse has a right to expect the follow have the satisfaction of knowing that they ing help and cooperation: work for us because they want to and not because they have to. Our safety and health program, which has won more than one trophy for us, is a big contributing factor in the peace and frame of mind of our employee. Remember--a- man who is hurt or who has been injured is a scared worker for quite a while and during this time his efficiency is greatly impaired. 1--Definite scope of duties and responsi bility of her department 2--rComplete freedom of action within those limits. 3--Complete cooperation in enforcing safety roles and regulations. 4--Insofar as it is posable she should be fumished-with comfortable, convenient quarters^ largevenough for the needs There is, however, one controversial prob- of the plant lera which arises in regard to industrial Without these^requirements. she cannot nursing. How far should it go? Some in hope to succeed and management cannot ex dustries do not believe in being paternalistic pect results. Management wants, and has a and extending the nursing services to the right to expect, results, but it must also be willing suits po I hat to indt because would < Their j the n< view, e to em| men, tl virion much n To i ganizat from.: compai your c the sar tor. Y ployee feel A tion. ' success Now what t Industrial Nursing 121 willing to do`those things which make re- all of us along the road to better health. /" "'Its possible. The Industrial Commission of Wisconsin, 1 have purposely avoided any .reference in conjunction with the Industrial Hygiene to industrial doctors and personnel -men, Division of the State Board of Health, to because to inject them into the problem gether with the hdp xd-labor and industry, would only complicate it and solve nothing. have designed a pb&igd examination , pro Their problems are die same as those of gram for the state. So for as we know, it the industrial nurse from all points of is the only, venture of its kind. It is by view, except that in a concern large enough no means perfect;- but it is a start in the to employ nurses, doctors and personnel right direction. Briefly it provides for the, men, the problems of coordination and di following: _ vision of authority and responsibility are much moredifScolt 1--Mandatory pre-employment and sub sequent periodical physical examina To. those doctors, who are not on the or tion. ganization payroll, and who are selected 2--Provides manner of deriding on a from.a panel authorized by the insurance panel. satisfactory to employer, em company, let me say that your duties and ployee and insurance carrier. your obligations to die employee are just the same as those of a company paid doc tor. -You must get the company and em ployee viewpoint--you must make yourself fed that you are a part of the organiza tion. Without this attitude you cannot be successful in handling industrial cases. 3--Cost of examination-rLost - time -be-- cause of examinations--transportation costs in connection therewith are borne by the employer. -1--Provides standard forms for records of examinations and follow-up. 3--Defines the scope of examination. Now let me tdl yon something about 6--Defines area of disqualification from what the state of Wisconsin is doing to hdp work. ADJOURNMENT