Tool Time
RNs who care for constuction crews find they've nailed their niche in the variety and unconventional rewards of industrial nursing

By Donna Hemmila
October 1, 2003


Catherine Snyder never considered steel-toed boots, safety glasses and a hard hat as essential nursing tools-until she went to work at a defunct nuclear power plant.

Since 1995, the former maternity and obstetrics nurse has been ministering to the construction crews tearing down the Yankee Nuclear Power Station in western Massachusetts.

Working in a tiny clinic on the site, Snyder, RN, OHC (occupational hearing conservationist), takes care of emergency and health maintenance needs for about 230 workers, many of them contract laborers who travel around the country doing demolition and cleanup work.

The plant is outside Rowe, Mass., a town where the population swells to 360 during the summer. The nearest hospital is 30 miles away.

Although her work environment may be dirty, noisy and laced with hazards like asbestos and lead, Snyder, like other nurses who traded hospital scrubs for a hard hat, said she loves the variety and challenges. "I think I've found my niche," she said.

The only downside has been finding a replacement when she wants to take a vacation. Last year, she could find a nurse willing to fill in for only three hours a day.

"We were even offering a free B&B," Snyder said. "This was in October. We thought people would be into the fall foliage. I wish more nurses would go into this work."

Full attention

In many ways, running a clinic on a construction site is a nurse's dream job: no holiday or weekend shifts, a chance to develop education programs, independence and, most importantly, time to get to know the patients.

"People can be here for a few months to several years, and you can be a part of their lives," Snyder said. "You can make it what you want. You don't have to be that involved with your employees, but my door is always open."

That kind of personal contact is something nurses don't find in a hospital, said Lynda Moore, NP, RN, COHN-S (certified occupational health nurse specialist), who operates the on-site health center at an oil refinery north of San Francisco.

"Because health care exists the way it does today, you're lucky to get 15 minutes with your health provider," Moore said. Many workers at the Valero Benicia Refinery have been on the job 30 to 35 years. Moore, who has worked at the refinery since 1987, said she is able to deliver better care because she knows the workers and their medical history.

She likes working independently and if she needs professional input, Valero has clinics at 10 of its 13 refineries, and the nurses and nurse practitioners teleconference regularly. Moore also contracts with a physician who visits the site for two hours every month.

Like all nurses who work in an industrial setting, she dons a hard hat, overalls and boots when she walks around the plant. It's not the kind of work where you stay inside all day, and the work can sometimes require a display of bravery. Once, as part of an ergonomics assessment, Moore climbed a 300-foot vertical ladder to get an idea of the physical movements involved in the task.

"It's a whole different way of working to be out in a blue-collar environment on a daily basis," she said.

Such adventurous nursing practice isn't for everyone, though. Gwen Crenshaw, FNP, RN, COHN-S, who runs a health clinic at a nuclear facility undergoing decommission in Oak Ridge, Tenn., said she hired one nurse who worked for a day and refused to return.

"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