Interview
Eileen Lukes, MS, RN, eOHN-S, eeM, FAAOHN
Mary K. Salazar, EdD, RN, COHN-S,
FAAOHN, FAAN-
Editor, Core Curriculum for Occupational
and Environmental Health Nursing
ary K. Salazar has been
M a leader in occupational
health nursing for more
than 20 years. Her current position as
Professor at the University of Wash-
ington School of Nursing enables her
to prepare future leaders in occupa-
tional health nursing and to conduct
research to strengthen the practice of
occupational health nurses and other
occupational health professionals. In
1995, she was selected to edit the first
edition of the Core Curriculum for Oc-
cupational and Environmental Health
Nursing, produced by the American
Association of Occupational Health
Nurses, Inc. (AAOHN). It was pub-
lished by W. B. Saunders in 1997.
Eileen Lukes: Mary, how did
you become an occupational health
nurse?
Mary Salazar: I really didn 't
know much about occupational health
nursing until I became interested in
return ing to school for my graduate
degree in the early 1980s. I was look-
ing for a program that could support
my interest in health promotion and
disease prevention. I was also inter-
ested in program and policy issues.
I met with faculty at the University
of Washington School of Nursing to
discuss my options, and they told me
ABOUT THE INTERVIEWER
Ms. Lukes is a doctoral candidate in the
College of Public Health atthe University of
Arizona, Tucson.
140
about the occupational health nursing
program. I talked to Susan Holland,
the program director at the time, who
bubbled with enthusiasm about the
possibilities for nurses who entered
this field. On the basis of her descrip-
tion of this specialty, I concluded it
was a perfect fit-and I was hooked. I
applied for and was accepted into the
occupational health nursing master's
program and have never regretted it
for a single moment!
Lukes: Tell us about some of
the research you've conducted or
are currently involved in.
Salazar: When I began my re-
search career, health education and
training were emphasized as prima-
ry strategies to ensure the health and
safety of workers and other popula-
tions . There was a lot of emphasis
on individual responsibility. In the
course of my early studies, I noted
that even when workers knew how
to be safe, there were other factors
that influenced their choices and be-
haviors. As a result, [ performed a
series of exploratory studies in an
effort to get a better sense of what
these factor s might be. For example ,
one of the studies examined barriers
to the use of respiratory protective
equipm ent. We determ ined the most
negative influence s on workers' suc-
ces sful use of this equipment related
to comfort issues and ability to com-
municate when using the equipment.
These workers were well trained and
well aware of the import ance of re-
spiratory protection. They knew all
about the toxic exposures in their
work settings. However, when "you
get hot and sweaty," "your nose
itches," or you can't talk to your co-
worker, it's very difficult to use the
equipment as intended. To ensure
worker protection , these issues must
be addressed.
For the past few years, my re-
search has focused on the health and
safety of agricultural workers, partic-
ularly migrant Hispanic farm work-
ers. Many of my studies are qualita-
tive, consisting of interviews or focus
sessions. I often use an ecological
model as a framework for my work.
For example, I recently worked with
Dr. Linda McCauley's research team
to develop a strategy to examine mi-
grant adolescent farm workers' per-
ceptions about pesticide exposure.
These young workers participated in
focus sessions conducted by the re-
search team. Through our use of an
ecological model, we determined that
there were multiple barriers to their
ability to protect themselves, but the
most compelling concerns were in
the area of the organizational or work
environment. Such barriers included
uncaring or demanding bosses, lack
of resources at the worksite (i.e.,
washing facilities and water), and the
working conditions. I ju st completed
another study examining health and
safety issues among orchard work-
ers. Some of the same concerns were
found in this adult population of mi-
grant workers. Another key concern
AAOHN JOURNAL

expressed in both studies was lack
of compliance with regulations such
as the Worker Protection Standard
(in the adolescent study) and ladder
safety requirements (in the orchard
study) .
My current work, which I am
enjoying immensely, involves agri-
cultural workers in a different way. It
is a community-based participatory
research study focusing on the health
and safety concerns of agricultural
workers in central Washington State.
We are working with health care
providers and members of the ag-
ricultural community to define the
hazards identified as most important
by the farm worker community. The
community will then guide us in the
development of an intervention to ad-
dress the hazards . I enjoy the study
because it has enabled us to learn so
much from the farm workers them-
selves, and, ultimately, I believe it
will lead to more sustainable and
meaningful interventions.
Lukes: Some occupational health
nurses are not familiar with the Core
Curriculum. Tellus about that book.
Salazar: The Core Curriculum
for Occupational and Environmental
Health Nursing was the brainchild
of the AAOHN, specifically the Pro-
fessional Affairs Committee. The
AAOHN wanted to develop a text
that could serve as a practical and
comprehensive sourcebook for occu-
pational health nurses. The core cur-
riculum that resulted from this effort
provides an overview of the many di-
mensions of occupational health nurs-
ing practice. It has three primary sec-
tions. The first section describes the
foundations of practice including the
foundational sciences ; legal, ethical ,
and business issues; and principle s of
management and leadership. The sec-
ond section provides a description of
strategies and approaches to service
delivery, including specific examples
of programs commonly delivered by
occupational health nurses. The third
section emphasizes issues such as re-
search and professional development.
It also includes several resource s and
references that can serve as tools for
practicing occupational health nurs-
APRIL 2006, VOL. 54, NO.4
Interview
es, such as a glossary of terms com-
monly used by occupational health
and safety professionals, a list of
relevant websites, and occupational
health and safety resource s.
Lukes: Why was the Core Cur-
riculum written, and who is the
target audience?
Salazar: Many nursing asso-
ciations have a core curriculum that
nurses use not only to guide their
practice, but also to assist them in
preparing for certification in their
specialty. Our core curriculum was
also developed to serve these purpos-
es-that is, to reflect current practice
in a general way and to clearly define
the basic elements that underpin our
specialty-and to assist nurses who
are taking the certification examina-
tion. In addition to serving as a frame-
work for practice, it was also intended
to introduce emerging trends that had
the potential to affect future prac-
tice. The Core Curriculum was one
of a series of document s developed
by the AAOHN, which included the
Standards of Practice and the Code of
Ethics for occupational health nurses.
The Core Curriculum was designed
to expand on these other documents
in defining the scope of practice. The
target audience is essentially all occu-
pational health nurses, regardless of
work setting, educational preparation,
or level of experience (i.e., its content
is intended to serve novice to expert).
Lukes: How did you decide
what to include in the book?
Salazar: Well, that was a chal-
lenge . Occupational health nurses
perform such an enormous array of
roles and functions, and we wanted
to be sure that this text was com-
prehensive and would meet varying
needs and interests. So one of the
first things we did was assemble a
group of occupational health nurs-
ing experts with a range of skills
and knowledge to brainstorm about
content areas . We met in-person for
an entire day, discussing potential
content. We then continued this de-
liberation through group and indi-
vidual discussions for the duration
of the first edition's development,
continually expanding and refining
the content. Ultimately, these nurses
served as chapter authors .
Our next challenge was to de-
termine how we could present this
huge range of content logically and
coherently, in a way that maximizes
its usefulness to occupational health
nurses. To get formatting ideas, we
reviewed core curriculum texts that
had been developed by other associ-
ations; however, because these other
specialties were more physiological-
ly and disease oriented and because
they focu sed on individual rather
than population-based service de-
livery, their format and content were
different from what we envisioned
for our text. In fact, we realized that
ours was probably the first nursing
core curriculum text that would fo-
cus on a publi c or community health
nursing specialty. This made the
process even more exciting-and
challenging. In terms of format, we
eventually agreed on three critical
areas we wanted to cover in some
depth , which I mentioned earlier:
foundational information about our
practice, the various aspects of ser-
vice delivery, and research and pro-
fessionalism .
These three areas served as our
organizing framework and we have
retained this format for all three
editions. The Professional Affairs
Committee (under the direction of
Mary Lou Wassel, AAOHN Direc-
tor, and Liz Lawhorn, Committee
Chair) was actively involved in ev-
ery stage of this process and com-
mittee members served as primary
reviewers for the first edition. For
subsequent editions, oversight was
provided by the AAOHN's Direc-
tors of Professional Affairs (Geral-
dine Williamson for the second edi-
tion , and Marcia Noble and Dean
Burgess for the third edition) along
with Ann Cox, AAOHN's Execu-
tive Director.
Lukes: AAOHN has announced
the third edition of the Core Cur-
riculum. What's new with this edi-
tion?
Salazar: Yes, indeed, the third
edition has just been released. All of
141

the chapters have been updated and
an excellent new chapter focusing
on disaster planning and manage-
ment (authored by Marilyn Hau) has
been added. Other examples of new
content include the addition of an in-
novative management model (by Joy
Wachs and Frances Childre), newly
implemented regulations such as the
Health Insurance Portability and Ac-
countability Act (HIPAA) of 1996
and the Clinical Laboratory Improve-
ment Amendment (CLlA) (by Diane
Knoblauch and Patricia Strasser),
and advanced safety measures such
as containment approaches (by Mari-
lyn Hau). In addition, the resource
lists and websites have been updated,
and AAOHN's competencies in oc-
cupational health nursing have been
added as an appendix.
Lukes: You've been involved
with the American Board for Occu-
pational Health Nurses (ABOHN)
for several years. Tellus about your
experience on the ABOHN Board.
Salazar: I'm glad you asked
about this. I really want occupa-
tional health nurses to know the
inside scoop about this remarkable
organization that does so much on
their behalf. I say this because, I
must admit, I had no idea regarding
the scope and breadth of ABOHN
activities until I became a member
of the board. Several things particu-
larly impressed me. First, great care
goes into the development of the ex-
amination and, associated with this,
equal care goes into scoring and es-
tablishing pass rates. Every single
examination taker is important to
ABOHN, and they make an excep-
tional effort to ensure that scoring
is fair and accurate; they are always
responsive if any problems are iden-
tified by either the Board or a test
taker. Every meeting includes a ses-
sion when any and all problems are
reviewed and recommendations for
resolution are agreed on. Second,
they continually seek input from oc-
cupational health nurses to be sure
that they are meeting their certifica-
tion needs. During my tenure with
ABOHN, the case management cre-
dential was developed, so I was able
142
Interview
to observe firsthand the care and
thought that went into that process.
Third, they are constantly watch-
ing for opportunities to expand
their outreach for the betterment
of certificants and for occupational
health nursing as a profession. For
example, in recent years, they have
been very active internationally by
providing opportunities for our in-
ternational colleagues to replicate
their role delineation study and by
developing methods for occupation-
al health nurses in other countries
to obtain certification (of course,
maintaining the standards required
for occupational health nurses in the
United States). We are very proud
that Dr. Oi-Saeng Hong will be
representing ABOHN at this year's
International Commission on Occu-
pational Health (ICOH) conference
in Milan, Italy. She will be present-
ing a collaborative paper describing
the results of these role delineation
studies. Having said all this, I guess
you can surmise I have thoroughly
enjoyed my involvement and many
interactions with ABOHN. It truly
has been a highlight of my profes-
sionallife.
Lukes: How are ABOHN Board
members selected?
Salazar: The Board strives to
have diversity of practice and geo-
graphic location among its members.
Therefore, a first step in adding new
members is to evaluate where there
might be gaps. The majority of the
Board consists of occupational health
nurses from across the country; how-
ever, there is always one occupation-
al health nurse from Canada and one
public member who is not a nurse.
Potential members are identified by
current or former Board members or
interested individuals can inform the
Board of their interest. Being a mem-
ber of the Board is an incredible pro-
fessional experience. I am so grateful
for what I learned and for having the
opportunity to work with such excep-
tional professionals. I was, and con-
tinue to be, amazed at the dedication
of the individuals who agree to this
commitment and who work selflessly
on behalf of our specialty. I highly
recommend this experience to any-
one who might be interested.
Lukes: You've been in the pro-
fession for quite a while. How have
you seen the profession change
over the years?
Salazar: In my opinion, occupa-
tional health nursing has flourished
and matured these past 20 years.
Some of the changes are consistent
with the development of nursing in
general, such as more nurses with
a bachelor's degree or higher, more
working as independent contractors
or case managers, and, overall, more
management responsibilities. The in-
troduction of Education and Research
Centers funded by the National In-
stitute for Occupational Safety and
Health more than 25 years ago has
resulted in more occupational health
nurses with graduate degrees; thus,
much more nursing-initiated research
focuses on occupational health and
safety problems. The Education and
Research Centers have also fostered
and stimulated more interdisciplin-
ary interaction and activities among
occupational health and safety pro-
fessionals.
In terms of the nature of occu-
pational health nursing practice, one
obvious and notable change is the
expansion of practice to include the
environment. Who better to attend
to environmental health issues than
occupational health nurses? After
all, they are well versed in epidemi-
ology, toxicology, and exposure as-
sessment-sciences that are critical
to both occupational and environ-
mental health practice. The focus of
practice has changed as well. I be-
lieve occupational health nurses cur-
rently have a better understanding of
the "big picture" in their organiza-
tions, are much more business savvy
than in the past, and are on the fore-
front of new developments. Just look
at the topics that are presented in the
AAOHN Journal-information man-
agement systems, organization of
work, emerging infectious diseases,
nanotechnology, emotional labor,
and so on. All reflect the breadth and
depth of knowledge of our peers in
this field. Quite amazing!
AAOHN JOURNAL

Lukes: What lies ahead for oc-
cupational health nurses? How do
you see the future of occupational
health nursing?
Salazar: Well, I think we can
expect the workplace to look quite
different in the coming years. First
of all, the workers are changing-
they are becoming older and more
multi-ethnic, which is already start-
ing to affect how services are de-
livered. Trends such as outsourcing
and telecommuting are likely to con-
tinue, and we are likely to see more
and different uses of technology in
the future. These trends affect how
occupational health nurses practice
,
. ~9
Quality
Beyond Expectation
Interview
and, in many ways, have increased
workers' and management's expec-
tations of them. Clearly, it is criti-
cal that occupational health nurses
keep up with changes and trends
by reading the AAOHN Journal
and other relevant publications and
participating in continuing educa-
tion. Certain roles will continue to
expand; for example, occupational
health nurses will continue to have
more safety responsibilities, they
will likely be called on to develop
and deliver management programs
for both natural and man-made di-
sasters, and they will have responsi-
bilities related to infection contro!'
Superior Product
Performance
Indeed, the delivery of occupation-
al safety and health services has
changed over the years and will no
doubt continue to change. I believe
that occupational health nurses are
up to the challenges that face them
and will continue to thrive. I have
had the opportunity to work with
some remarkable nursing profes-
sionals these past 20 years, and I
never cease to be inspired and awed
by their dedication and their many
contributions to the advancement
of our specialty. I am so proud to
be an occupational health nurse.
Thank you for this opportunity to
share my thoughts with you.