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Occupational health nursing: what does the role entail?

Greta Thornbory
MSc RGN OHNC DiPNOH PGCEA MIOSH
Consultant Occupational Health Nurse
Oxfordshire
E:g.thornbory@btinternet.com

Occupational health is part of primary care and generally available only to people working for large organisations. A survey conducted by the Health and Safety Executive in 1995 suggested that over two million people a year in the UK were suffering from an illness caused by their work.(1) Government public health initiatives focus on working in partnership to save lives,(2) promoting healthier living and reducing inequalities in health. The working environment is an ideal setting in which to address these issues,(3) so consequently the occupational health team will continue to take an active part.
The occupational health team is multidisciplinary and usually led by either an occupational health physician or a nurse. Occupational health nursing is a specialist branch of nursing, and a postregistration qualification has been available in the UK since 1934, although there have been occupational health nurses (OHNs) as far back as the 19th century working in areas such as industry and mining. The most famous of these is Phillipa Flowerday from Coleman's Mustard.(4) Today occupational health nursing is a postregistration specialist practitioner qualification at degree or masters level. But what exactly does the role entail?

The job
Occupational health services are provided at the workplace to address the primary healthcare needs of the working population, not to replace the services provided by GPs with regard to healthy lifestyle and secondary care, but to protect and promote the health of the working population. (5) Whitaker and Baranski state that OHNs are the largest single group of healthcare professionals involved in delivering healthcare in the workplace,(5) so it follows that they need to have an understanding of the workplace itself and to be aware of what effects the workplace and work may have on health, as well as the effects of health on work.
The workplace can be divided into four distinct areas - premises, plant, processes and people. Premises are the places in which people work; some may work in the open air and be exposed to the elements, while others may work in enclosed spaces, in tunnels or mines, factories, offices, shops and so on. Others may be exposed to extremes of temperature, such as those who work in food storage areas at -20°C, or blast furnaces at the opposite extreme. Wherever people work, the environment can have an effect on their health. Therefore an understanding of the ­environmental effects on health is essential.
What matters too is what people have to do in that environment, or the "process", and what equipment or "plant" they have to do it with. The whole interaction between man and machine introduces a new science to nursing - the science of ergonomics. Occupational health professionals need an understanding of ergonomics or the man/machine relationship. An example of this today is the increased use of computer technology, where almost everybody uses a computer terminal in some way in their job.
Back in the 1980s, when computers started to become the norm in every office, people were asked to use them on desks and at workstations not designed for computer use. Eventually some people developed pain in their arms, wrists and sometimes even their shoulders and neck, often resulting in time spent off work and in rare cases meaning that they could no longer do the job. They had developed what is known today as "work-related upper limb disorders" (WRULDs), often termed RSI or repetitive strain injury. The process they were engaged in was typing or processing of data into a computer (the equipment or plant).
Occupational health professionals, especially OHNs, are well suited to helping prevent workers developing WRULDs. Employers have a statutory duty under current legislation to provide a safe and healthy workplace,(6,7) and OHNs play a significant role in supporting both the employer and employee in providing that healthy workplace. Solving the WRULD problem led to OHN involvement in the training of staff and management of "job and workstation design". This may be by helping management in development of policies, attending health and safety meetings as a professional adviser, involvement in training programmes, advising individuals with specific concerns, thereby empowering them to make more informed choices about their workstation and work practices. This is just one example of the many hundreds of different types of work that may require the help of the occupational health service and in particular the OHN.
Other hazards found in workplace processes include:

  • Chemicals, many of which are extremely toxic.
  • Heavy machinery and equipment.
  • All forms of radiation.
  • The full range of biological hazards.
  • Psychosocial hazards: stress, bullying, harassment.

Working with human resources, health and safety departments and other specialists in the occupational health team is an essential part of the OHN role. Much is laid down in individual legislation, and a qualified OHN should have a sound knowledge of legislative requirements as well as evidence-based best practice. He or she is regarded in legislation as a competent person to deal with such things as health surveillance.
However, the clinical role of the OHN is not forgotten. Many workers are exposed to specific hazards and require regular health surveillance, such as testing respiratory function, audiometry or immunisation. OHNs need to understand how a specific work environment or process can affect the workers and what health effects will be demonstrated by surveillance interventions. Any technician can be trained to carry out audiometry or spirometry using a machine, but it takes a knowledgeable professional, such as an OHN, to read, understand and apply the results, then decide on further action such as referral to an occupational health physician. Health surveillance is required by law following an adequate risk assessment that identifies a need - OHNs are trained to undertake risk assessments in many areas and to seek the advice of occupational health professionals, such as occupational hygienists, radiological protection officers and infection control officers, in specific areas. Many workers are exposed to biohazards and may require immunisation, as do those whose work involves foreign travel. OHNs play an active part in the preventive healthcare of these workers by running travel clinics with immunisations being administered by following Patient Group Directions.
The role of the OHN is clearly stated in the WHO document The Role of the Occupational Health Nurse in Workplace Health Management (see Box 1).(5) These roles fit with the RCN core definition and six defining characteristics of nursing (see Figure 1).(8)

[[NIP13_box1_74]]

[[NIP13_fig1_75]]

For large companies and organisations, an occupational health service not only provides for the health and welfare of the employees but also enables the organisation to fulfil its statutory requirements towards its workforce. In turn this may have a knock-on financial saving - the end justifying the means. For small- and medium- size enterprises (SMEs) it is not always possible to employ an occupational health professional, let alone a team. Consequently there are now a number of companies offering professional occupational health services, many set up and run by qualified and experienced OHNs. The increase in the field of nurse entrepreneurs has meant that the RCN booklet Information for Would-be Nurse Entrepreneurs is now in its 3rd edition, as more and more OHNs offer professional services to SMEs.(9)
The field of occupational health and occupational health nursing is exciting, dynamic and offers wide and diverse experience. In these days of ever-changing science and technology and increasingly stressful demands, occupational health offers nurses the opportunity to work with an overall goal of empowering both employers and employees to maintain a healthy workplace with a healthy workforce.

References

  1. Jones JR, Hodgson JT. Self reported work-related illness 1995: results from a household survey. London: HSE Books; 1998.
  2. Department of Health. Saving lives: our healthier nation. London: HMSO; 1999.
  3. Health and Safety Executive. Securing health together. London: HSE Books; 2000.
  4. Available from URL: http://www.norfolkesinet.org.uk/pages/viewpage.asp?uniqid=1235
  5. Whitaker S, Baranski B. The role of the occupational health nurse in ­workplace health management.Geneva: WHO Europe; 2001.
  6. Great Britain Parliament. Health and Safety at Work etc Act 1974.
  7. HSE. Work with display screen ­equipment: guidance on regulations. London: HSE Books; 2003.
  8. RCN. Defining nursing. London: RCN; 2003.
  9. RCN. Information for would-be nurse ­entrepreneurs: turning initiative into ­independence. London: RCN; 2003.

Resources
First Aid Cafe Sells information on first aid and has lists of ­training providers. A?commercial site
W:www.FirstAidCafe.co.uk
British Occupational Hygiene Society Offers ­qualifications in hygiene. Has links to related websites
W:www.bohs.org
Institute of Occupational Safety and Health Provides good information that can be ­understood by the general public and healthcare ­professionals
W:www.iosh.co.uk
The Work Foundation
W:www.theworkfoundation.com
Health and Safety Executive
W:www.hse.gov.uk
HSE Bookfinder
W:www.hsebooks.co.uk