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"The nurses who seem to like it the best have worked in the ER," Crenshaw said. "I want someone who is not going to panic when they hear on the radio, 'Man down.' Most of the time we put on Band-Aids and remove splinters, but every once in a while we get a call that's an emergency."

The Department of Energy site was built during World War II to produce uranium for the atomic bomb and later for commercial power plants. The facility closed in 1987 and is being torn down and decontaminated. The largest building scheduled for demolition covers 33 acres.

"In the summer you burn up, and in the winter you freeze," said Crenshaw, a former physical therapist who was teaching back safety classes for British Nuclear Fuels Limited when the company asked her to set up the clinic.

She staffs the project six days a week, 24 hours a day through a business she founded with her husband called C-Squared.

The night shift nurse, Devonne Togami, RN, left a stressful hospital job to work for Crenshaw at the encouragement of her husband, and discovered she was a good fit with both the work environment and the patients.

"The workers move around a lot, and they tend to be a little rougher," Togami said. "They're not like a shirt-and-tie worker who sits behind a desk all day. I'm an outdoor type, and I fit in a lot better here than in a hospital."

Togami enjoys working with the unpretentious group of guys. She once worked as the first woman paramedic for a county department, so she's used to operating in a male-dominated work situation. At first, she felt apprehensive at the Oak Ridge site because she knew nothing about construction. However, the workers tolerated her ignorance, she said, and were willing to teach her about their jobs.

"As a rule, they tend to be more straightforward with their thoughts, more blunt with their opinions," Togami said. "You have to have a thick skin."

You also have to be able to think on your feet and be flexible, said Marsha Baskin Romer. She is the founder of Case Management Connection Inc., which provides occupational health nursing and workers compensation case management to industrial and construction sites.

Buck stops here

Romer, RN, CCM, COHN-S, now has two contracts and plans on expanding her business as more employers realize the cost savings of having an RN in the workplace.

Romer provides nursing services to a metal fabricating plant in Oak Ridge, and to a $1.4 billion DOE construction project. When completed, the 75-acre Spallation Neutron Source facility will produce neutrons for scientific research. About 600 skilled laborers work on the project, she said.

"Industry is just realizing how much we save them in workers comp dollars and in OSHA recordable [injuries]," Romer said.

If a company has a high number of reported injuries, she said, it's not going to win many contracts. Having a nurse on duty can prevent the kind of injuries that must be reported to the Occupational Safety and Health Administration. For example, if a worker gets something in his eye, a nurse can flush it out immediately before it becomes embedded. The company saves money, Romer said, but also keeps workers comp costs down and protects its safety record.

In Cincinnati, the county saved more than $11 million in insurance and medical care costs on the construction of two new sports stadiums, in part because the projects had on-site nursing care, according to Carol Kennedy, marketing manager of the Health Alliance of Greater Cincinnati.

The company's occupational health arm provided nurses to the construction sites of Paul Brown Stadium, home of the NFL's Cincinnati Bengals, and the Cincinnati Reds' new Great American Ball Park. Of the 371 on-the-job injuries, nurses were able to treat 294, or about 79 percent.

"We had a guy sent out for sutures, and he was in the ER nine hours," said Mickey Dacey, RN, who worked on both stadium projects and still is stationed at the ballpark while a second phase of building continues.

Nurses considering this kind of work need to be comfortable working in emergency situations, she said, and be willing to conform to the environment.

"You don't wear your good clothes," Dacey said, "and you don't mind if you go home with mud all over your clothes."

Dacey, who has a background in cardiac intensive care and newborn intensive care, was happy to leave her high-stress hospital work behind. She took a pay cut of about $4 an hour when she left hospitals for construction nursing, but she said it's been worth it.

"The people down here appreciate and respect us," she said. "In the hospital, you don't get talked to as nicely."

Contact Donna Hemmila at dhemmila@prodigy.net