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It has previously been shown that occupational exposure limits (OELs) for the same substance can vary significantly between different standard-setters. The work presented in this paper identifies the steps in the process towards establishing an OEL and how variations in those processes could account for these differences. This study selects for further scrutiny substances for which the level of OELs vary by a factor of 100, focussing on 45 documents concerning 14 substances from eight standard-setters. Several of the OELs studied were more than 20 years old and based on outdated knowledge. Furthermore, different standard-setters sometimes based their OELs on different sets of data, and data availability alone could not explain all differences in the selection of data sets used by standard-setters. While the interpretation of key studies did not differ significantly in standard-setters' documentations, the evaluations of the key studies' quality did. Also, differences concerning the critical effect coincided with differences in the level of OELs for half of the substances.

Neonatal nurse practitioners are frequently confronted with ethical dilemmas in the NICU. This article reflects on the historical basis of ethical decision making and the issues some novice NNPs face today regarding their participation in the decision-making process. It examines various educational strategies that can be used to help NNPs to develop the skills they need to participate collaboratively in ethical decision making in the NICU. It concludes with recommendations for further research.