Reflecting on the OH role
Related posts:No related photos. Reflecting on the OH roleOn 1 Mar 2004 in Personnel Today Course director Anne Harriss discusses the disparity betweenthose with traditional OH qualifications and the new generation of OHgraduates, and the careers advice she would offer to newly-qualifiedoccupational health nurses. By NicPaton What should an occupational health nurse (OHN) be? It is a big question, andone that doesn’t have a right, or wrong, answer. But, for OHN Anne Harriss,course director at London South Bank University, and who maintains professionalcompetence via consultancy, it is a question that gets to the very heart of thedebate about where the OH profession has come from and where its future lies. Leadership, competence, fitness to practice – these are themes carriedthroughout her work and her teaching. At a time when the profession is changingrapidly, and is faced with the prospect of daunting challenges ahead,particularly the possibility of changes in the way sickness certification iscarried out, they are themes that are hugely relevant. “I don’t think OH nurses can rely on a job for life in a companyanymore,” says Harriss. “You have got to be adaptable and you have tostay one step ahead of the game the whole time. You have to identify whatknowledge and skills you need to carry out your job competently.” Harriss has led London South Bank University’s OH course since 2000 andbefore that was initially a lecturer/practitioner and then course director forthe BSc OH nursing degree at the Royal College of Nursing. With stints in thefield, notably at InterContinental Hotels and, as it was, Glaxo Holdings, underher belt, she is more than qualified to have a view on the state of theprofession. “When I was a student undertaking my occupational health training therewas not such a focus on doing things such as risk assessment. Now, the breadand butter of a lot of occupational health work is not necessarily doing thatassessment for people, but teaching them how to do it,” she says. “There has been a move towards health and safety management,occupational health management, and away from treatment services. The more weget involved in doing risk assessment, the more we can use all our skills. Weare a very holistic bunch of people, we have lots of skills. One thing that OHnurses are very good at is identifying what a problem is and the, if they can’tresolve it themselves, finding somebody who can,” she says. It was while working in the Sultanate of Oman for the Royal Oman PoliceForce Medical Unit in the early 1980s that Harriss caught the OH bug. The forcehad its own hospital, including a treatment room, where police personnel andtheir families were treated. “At first, I was working in the treatment room and, for me, it washeaven. I was being a nurse practitioner, occupational health, A&E clinicand well-baby clinic – everything rolled into one. It was fantastic. “Then I was told they wanted to allocate me to the paediatric ward.When you take a job you go where you’re told but, compared with the treatmentroom, there was no comparison. I told them I really wanted to stay therebecause one day I might like to be an OH nurse – and that was it,” shelaughs. So, where does she stand on the specialist practitioner/OH nursepractitioner debate? Can the profession have it both ways, and how canemployers be better educated about what occupational health can and cannot do? “We can have both,” says Harriss. “To call yourself aspecialist practitioner, you have to be qualified as a specialist nurse.However, there is also room to have a practice nurse. But you do not need aqualified OH nurse to do a vaccination service. What you do need is somebodywho understands about vaccines,” she explains. “At Glaxo, we ran a comprehensive travel health clinic for people goingoverseas on business. I really enjoyed doing it but, with hindsight, did Ireally a need a qualification in OH to do it? No, I didn’t. We could have had apractice nurse doing that just as effectively, who could have called in an OHnurse if there had been an occupational health issue that neededaddressing.” OH nurses are unusual among health professionals in that they need tounderstand business, to ‘add value’. As Harriss puts it: “If youunderstand what the business needs are, you can help your employer addressthose needs. But we should not be a tool of the employer.” While fewer and fewer services do now adopt the ‘sticking plaster’ approachto OH, it has not disappeared altogether. Yet most OH services are now movingon to a more proactive, strategic level, and that can only be welcomed. “One of the other movements is that a lot of companies are not havingOH services anymore and are bringing in consultancies. This can be good, butthe quality of the occupational health service you get depends on thecontinuity of the people who are providing that service,” Harriss warns. Within this, there is strong evidence too that more and more services arebecoming nurse-led. While undoubtedly a recognition of how far the professionhas come, being required to lead a service, and having the skills and trainingto do so effectively, can be daunting. It is at this level that the professionneeds to recognise the need for greater management and leadership training,Harriss suggests. “More and more places have nurse-led services, which is brilliant. Thebest person to manage an OH service is the person who’s best placed to manage,and that does not have to be a doctor,” she says. “One of the things we want to develop in our students is leadershippotential. We have a whole unit on leadership. We cover things like developingleadership potential, but also the nitty gritty of managing an OH service, suchas negotiating service-level agreements. “Many OH services, particularly in the NHS, have to sell their servicesout, as they have to generate income. So if they can negotiate well-planned andmanaged service level agreements, then it puts them ahead of the game. “One of the things we talk about with the students is where they thinktheir interests lie. Some people are going to make fantastic managers andfantastic leaders. Other students do not have the attributes to be able to leada service forward, and it is not where they want to be anyway. What they wantto be is competent, solid practitioners who can deal with clients and managerson a one-to-one basis, they don’t want to be leaders. They don’t want to bebudget holders, they are quite happy doing hands-on occupational health, andthat’s fine – a service needs a mix of leaders and practitioners,” sheargues. Other skills becoming more important as the OH role expands, include notonly being able to do risk assessments, but being able to integrate them withhealth assessments. Similarly, it is important to be able to plan recoveryprogrammes, while at the same time thinking about attendance management. Better attendance management – the bane of so many employers’ lives – is oneof Harriss’ passions. With both GPs and employers becoming increasingly frustrated with thecurrent system of sickness certification, and GPs wanting to make ‘significantprogress’ to abandoning certification altogether by April 2006, there are bothopportunities and dangers ahead for the profession, Harriss believes. “I think GPs still write medical certificates on sufferance, for themost part. They don’t necessarily understand the work environment. Some GPs dohave some occupational health training, but at the end of the day, theirallegiance is to their patient. If their patient says they have back pain andthey can’t do their work and their work involves x, y and z, then the GP islikely to write a sicknote, which I can understand. But the quality of what iswritten on the certificates varies so much. Some are very helpful, others willsay things like ‘unwell’, and what does that tell you?” she asks. “But to some extent, changing sickness certification could be adouble-edge sword. “On the one hand, it could be really good and could mean earlyreferrals – I think the key to good attendance management is earlyintervention. If you see people early it does not necessarily mean you’re goingto get them back early, but you can start planning their return-to-workprogramme and think about a recovery programme, putting the emphasis onrecovery, and bringing in appropriate people to give further advice. “But it could also put OH in a difficult position in that we become apolicing service for management. The OH service has to define how it getsinvolved. But on the plus side, it could be very good. You get to know theclient and their needs early, but I would not want to be part of a team that isa policing service,” she says. At London South Bank University, Harriss carried out a study among herstudents looking at what sort of OH competencies are likely to be commonplacein five years’ time compared with now. Intriguingly, the study threw up thefollowing suggestions: working more within a multi-disciplinary teams,communicating more, having a greater understanding of issues such as health andrisk assessment skills, more legislation, and being able to lead a team. Harriss adds contracting out recovery programmes to this list, somethingthat could rapidly move up the agenda if sickness certification is radicallychanged. Similarly, disabilities are becoming a much more important issue. “OH nurses need to think about developing skills in core areas. Onething in the future that would be really helpful to specialise in is anin-depth understanding of disability issues,” she says. “Under the Disability Discrimination Act (DDA) if someone has adisability – however you define that – the employer has to make suitable andsufficient modifications to the workplace to allow that person to carry onworking,” she adds. So does this mean OH nurses now do not have enough of an understanding ofthis issue, despite all the legislation currently in place? “It depends onthe service,” says Harriss. Stress, of course, has been high on the OH agenda for sometime. But stressamong OH practitioners has, up to now, been something of a taboo issue. In theFebruary issue of Occupational Health, for instance, there was a report of asurvey which concluded that OH practitioners were increasingly stressed out,with some turning to drugs and alcohol to cope. The study of 129 OH practitioners, by recruitment firm OH Recruitment, foundmore than half admitting to feeling stressed, and two-thirds saying their workhad become more stressful over the past 12 months. On this, again, it comes to down to the leadership of the OH nurse in theunit or department, Harriss contends. Generally, there is still too littlerecognition that OH practitioners, despite all their own expertise on stress,are simply human and prone to the same stresses and strains as everyone else. “A good OH manager will identify that their OH staff also need the samebenefits of the OH service that other staff in the organisation do,” shesays. The ideal would be to have a system whereby OH practitioners can be referredto a separate OH service and, so, not be seen by someone with whom they havedirect contact at work. “You know if you have a problem and you want todiscuss it with an OH professional, there is someone there,” she says. There are huge amounts of organisational change going on within theworkplace, and OH is no exception. “So you need to think about how youdeal with that change among your own staff,” says Harriss. The only certainty, it appears, is that the workplace and with it, thedemands on both will alter. The profession, in conjunction with people such asHarriss, needs to work at how it responds. Previous Article Next Article Comments are closed.