Occupational health nursing applies nursing and public health to workers and workplaces. Its goals are to prevent work-related injury and illness, promote and maintain workers' physical, mental, and social well-being, place workers in jobs suited to their abilities, and support return to work after illness or injury.

Workplace hazards

Routes of exposure to chemicals: inhalation (most important at work), skin absorption, ingestion, and injection.

Occupational disease is caused mainly by exposure at work (for example, silicosis, lead poisoning, noise-induced hearing loss). Work-related disease is a common disease that work contributes to or worsens (for example, back pain, hypertension).

Noise-induced hearing loss is permanent sensorineural loss that begins in the high frequencies (around 4,000 Hz), often with tinnitus. Noise exposure is assessed as an 8-hour time-weighted average (TWA) measured at the worker's actual position and compared with the legal exposure limit.

Hierarchy of controls — the most effective controls act at the source, before the hazard reaches the worker:

Levels of prevention at work

• Primary: hazard control, ergonomic redesign, immunization (hepatitis B for health workers), health education, safety orientation.
• Secondary: pre-placement and periodic medical examinations, biological monitoring (for example, blood lead), audiometry, early treatment.
• Tertiary: rehabilitation, modified duty, and return-to-work programs.

Occupational Safety and Health Standards Law (RA 11058, 2018) — strengthens compliance with OSH standards in private-sector establishments, projects, and sites (including PEZA zones) and is enforced by the Department of Labor and Employment (DOLE). The public sector is excluded (Sec. 2): government workplaces, such as DOH and public hospitals and rural health units, follow Civil Service Commission and other government rules.

• Employer duties: provide a workplace free from hazards that cause or may cause death, illness, or injury; give safety orientation and inform workers of all hazards; use only approved equipment; comply with OSH standards; involve workers in developing the OSH program; and provide emergency and first-aid arrangements.
• Workers' rights:
  • Right to know — to be informed of all workplace hazards and trained on safety.
  • Right to refuse unsafe work — without retaliation when an imminent danger situation exists, as determined by DOLE.
  • Right to report accidents, dangerous occurrences, and hazards to the employer and to government agencies.
  • Right to PPE — personal protective equipment and safety devices provided by the employer free of charge.
• Occupational health services: covered workplaces must have qualified occupational health personnel — physicians, nurses, certified first-aiders, and dentists — with supplies and facilities proportionate to the number of workers and the hazard level, following DOLE ratios.
• Safety and health committee: chaired by the employer or representative, with the safety officer as secretary and physicians, nurses, first-aiders, dentists, and workers' representatives as members.
• Safety officers complete DOLE-prescribed OSH training appropriate to their level.
• Penalties: administrative fines of up to ₱100,000 per day for willful noncompliance, with separate penalties for obstruction, misrepresentation, and retaliation against workers.

Common injury statistics (standard formulas; recalculate every example)

• Frequency rate = number of disabling injuries × 1,000,000 ÷ total hours worked (injuries per million hours worked).
• Severity rate = total days lost × 1,000,000 ÷ total hours worked.
• Incidence rate (per 1,000 workers) = number of injuries ÷ average number of workers × 1,000.

Worked example: a plant with 500 workers each working 2,000 hours a year has 1,000,000 hours worked. With 12 disabling injuries and 240 days lost:

• Frequency rate = 12 × 1,000,000 ÷ 1,000,000 = 12 per million hours
• Severity rate = 240 × 1,000,000 ÷ 1,000,000 = 240 days lost per million hours
• Incidence rate = 12 ÷ 500 × 1,000 = 24 per 1,000 workers

Assessing the workplace (walk-through survey)

1. Observe processes, materials, and work practices; review safety data sheets.
2. For chemical exposure, the most objective method is measuring airborne concentrations of the agent (work environment monitoring) and comparing them with exposure limits.
3. Interview workers about symptoms, PPE use, and near misses.
4. Identify immediately dangerous conditions — for example, an oil spill on a walkway must be removed at once (elimination) before less urgent hazards.

Worker health examinations and records

• Pre-employment/pre-placement examination establishes a baseline and matches the worker to the job.
• Periodic examinations follow the hazards (audiometry for noise, spirometry and chest imaging for dusts, blood lead for lead work).
• Return-to-work and special examinations after illness or injury.
• Health records include examination results, exposure history, and work environment monitoring results; they are confidential medical records.

Targeted programs

• Painters and solvent users: teach the symptoms of solvent exposure (headache, dizziness, skin irritation) and correct respirator and glove use, while pushing for ventilation and substitution.
• Noise: measure noise, apply engineering controls, provide hearing protection, and schedule audiometry. A worker with tinnitus and high-frequency hearing loss after years in a noisy area needs assessment of workplace noise levels and hearing-protector use as well as referral.
• Lead: when blood lead exceeds the action level, the first action is to remove the worker from further exposure; then investigate the source, check co-workers, and arrange medical management.
• Welding fumes: local exhaust ventilation at the source is the key control.
• Work at heights: guardrails and harnesses prevent falls; mats that only cushion a fall are not an adequate preventive measure.
• Musculoskeletal disorders: primary prevention is engineering redesign (workstation height, tools, lifting aids) rather than exercise or painkillers alone.
• Shift workers: teach circadian rhythm effects, sleep hygiene (dark, quiet room; consistent sleep period), meal timing, and safe commuting; provide rest areas for short naps; forward-rotating schedules are easier to adapt to.
• Work-related stress: start at the organizational level — analyze and reduce stressors such as workload, role ambiguity, and low control — then add individual stress management.
• Emergency preparedness: reliable emergency lighting with scheduled testing, clear exits, drills, and first-aid capability.

1. Clinician — first aid and emergency care, treatment of minor illness per standing orders, and referral.
2. Health surveillance — conduct and track medical examinations, biological monitoring, and injury and illness records.
3. Hazard identification — join walk-through inspections and the safety and health committee; recommend controls following the hierarchy.
4. Health educator — orientation of new workers (hazards and safe handling of chemicals), PPE training, healthy lifestyle and NCD screening, mental health promotion.
5. Case manager — return-to-work planning, modified duty, and follow-up of chronic conditions.
6. Record keeper and reporter — accurate, confidential records; report work accidents and occupational illness as required by DOLE.
7. Advocate — support workers' rights to know, to refuse imminent danger, to report, and to free PPE.

• RA 11058 protects workers from retaliation for refusing imminent-danger work or reporting hazards; the nurse must not discourage reporting.
• Confidentiality: medical information is shared with management only as needed for fitness-for-work decisions (for example, "fit with restrictions"), not diagnoses — consistent with the Data Privacy Act (RA 10173).
• Non-discrimination: HIV status may not be used for hiring or firing decisions (RA 11166).
• Dual loyalty: the nurse is employed by the company but owes primary ethical duty to the worker's health and safety.
• Documentation: record injuries, exposures, and treatment objectively and promptly; records support compensation claims and legal compliance.

Case 1. A worker's blood lead level exceeds the action level on a periodic examination.

Action: Remove the worker from lead exposure immediately, then investigate the source and screen co-workers. Why: stopping further absorption is the first priority.

Case 2. A factory with a solvent-dipping process asks how to protect workers' skin.

Action: Recommend enclosing or automating the process (engineering control) before relying on gloves. Why: controls higher in the hierarchy remove contact at the source.

Case 3. A worker refuses to climb scaffolding with a broken guardrail during a storm; the supervisor threatens suspension.

Action: Support the worker and report the hazard to the safety officer and committee (and to DOLE if it is not corrected). Why: RA 11058 gives the right to refuse work in imminent danger without retaliation.

Case 4. An occupational health nurse finds oil on a walkway and boxes stacked in a corridor.

Action: Clean up the oil immediately, then clear the boxes. Why: the oil is an immediate slip hazard; both need correction, but the most direct cause of falls comes first.

• Choosing PPE as the "best" control — it is the last resort; engineering controls come before it.
• Counting a cushioning mat as fall prevention — prevention stops the fall (guardrails, harnesses).
• Addressing work stress only with individual relaxation training instead of fixing organizational causes.
• Using the number of workers instead of hours worked in the frequency rate.
• Sharing diagnoses with supervisors instead of fitness-for-work conclusions.
• Believing workers must pay for their own PPE — the employer provides it free.

• Hazard categories: physical, chemical, biological, ergonomic, psychosocial, plus mechanical safety hazards.
• Hierarchy of controls: elimination → substitution → engineering → administrative → PPE (last).
• Welding fumes: local exhaust ventilation; chemical processes: enclosure or automation.
• Noise: 8-hour TWA at the worker's position; hearing loss starts near 4,000 Hz.
• Excess blood lead: remove from exposure first.
• RA 11058 (DOLE; private sector only): rights to know, refuse imminent danger, report, and free PPE; OH personnel (physicians, nurses, first-aiders, dentists); fines up to ₱100,000 per day.
• Frequency rate = injuries × 1,000,000 ÷ hours worked; severity rate = days lost × 1,000,000 ÷ hours worked.
• Musculoskeletal primary prevention = ergonomic redesign.
• Shift work: circadian disruption → sleep and digestive problems; sleep hygiene and rest areas.
• Nurse's primary duty is to the worker's health; keep medical records confidential.