Worker Assessment, Health Surveillance, and Clinical Care
Assessment across the employment cycle
Worker assessment spans pre-placement, periodic, and exit evaluations. Understand the purpose of each: pre-placement establishes baseline fitness and detects conditions that could be aggravated by the job (it is not a screening tool to exclude applicants), periodic surveillance detects early change from exposure, and exit evaluation documents end-of-exposure status and supports claims. Know the components: occupational and exposure history, medical history, medications, physical exam, targeted screening (audiometry, spirometry, vision, blood/urine biomarkers, TB testing), and fitness-for-duty documentation.
Clinical care in the workplace
OHNs manage first aid, minor illness, and chronic disease support, and they recognize work-relatedness. Master the exposure pathways (inhalation, skin absorption, ingestion, injection) and the sentinel-event concept: one case may signal a broader hazard. Know when to use the hierarchy of controls versus individual protection, and how to document objectively.
Surveillance principles
- Compare results to the worker's own baseline, not only population norms.
- Standardized, calibrated equipment and trained technicians matter for validity.
- Follow-up abnormal results with referral and tracking, not just filing.
- Respect privacy: share only conclusions needed for placement or accommodation.
Traps
Questions confuse screening (detect disease early in asymptomatic people) with surveillance (detect exposure effects over time in a defined group) and with diagnosis. Another trap: interpreting a single abnormal result as disease. Also watch for pre-placement exams used to discriminate - the correct answer emphasizes job-relatedness and the ADA.
Worked example
A worker's spirometry drops 12% across the shift. The nurse should not diagnose asthma; she should document, compare to baseline, notify per protocol, arrange medical evaluation, and review exposure controls - assess, document, refer, advocate.