the sick and injured and counselling were the two functions most often mentioned by OH nurses in describing their work. How times have changed! Occupational health nurses are now at the forefront of risk assessment, health surveillance, advice on health and safety, vocational rehabilitation and health promotion. The Royal College published Competencies – an integrated career and competency framework for occupational health nursing (2005). A comprehensive and up‐to‐date examination of the competencies needed was published by Public Health England in 2016: Educating occupational health nurses: an approach to align education with a service vision for occupational health nurses.
Because nurses command lower salaries than doctors, employers in times of prosperity were often willing to provide a nurse in the factory for the welfare of their workers. In more straitened times, they have been asking what the nurses can contribute that cannot be done equally well by first‐aiders and welfare officers. Treatment is available free from the NHS; why should the employer duplicate it? The occupational health nursing profession is, therefore, having to justify itself by demonstrating that nurses too have an important role to play in a system based on prevention rather than treatment. They find this much easier to do when they can show specialist training and qualifications and when they are able to work independently of the doctor, though under overall medical supervision. In practice, many OH services are managed by nurses, who tend these days to be termed Occupational Health Advisers, with physicians being employed part‐time.
The Royal College of Nursing was at one time responsible for training occupational health nurses. From August 1988, validation of courses and standards became the responsibility of the National Boards for Nursing, Midwifery and Health Visiting, since abolished and replaced by the Nursing and Midwifery Council. There were three recognised qualifications. The first was the Occupational Health Practice Nurse Award which was obtained after a practical course open to enrolled and registered nurses which demonstrated how nursing skills are adapted for use in an industrial setting. The Occupational Health Nursing Certificate could be obtained after a period of training, either one academic year full‐time or two years (six terms) on day release and covered all aspects of OH. Only registered nurses could become fully qualified OH nurses. The third qualification was the Occupational Health Nursing Diploma. In the 1990s transitional arrangements were created to enable nurses with at least five years’ experience in OH to undertake further training in order to obtain a post‐registration graduate qualification in OH nursing. From 31 October 1998 only the qualification of Specialist Nurse Practitioner in Occupational Health (SCPHN) (at first degree level) has been recorded in the NMC Professional Register, Part 3 (under review). The Council has issued the Standards of Proficiency for Specialist Community Public Health Nurses (2004). None of these qualifications has statutory recognition, so that any nurse can work in an OH department without having completed specialist training, though they may not be regarded as competent persons under the health and safety legislation without it, unless working under the supervision of a qualified OH nurse or physician. In 2016 the NMC introduced a mandatory revalidation procedure for nurses. Nurses must revalidate every three years to renew their registration.
The revolutionary changes in nurse education brought about by Project 2000 have had significant effects on the training of occupational health nurses. Courses are validated jointly by the NMC and the universities and have been upgraded to degree level. The syllabus has been planned using the framework of the Hanasaari model, developed at a conference in Finland. This stresses the need to regard the total environment in which the workplace is set, but has been criticised for not giving sufficient emphasis to topics specific to OH. The Faculty of Occupational Health Nursing (FOHN), already discussed, has set out to review training and the curriculum, and to negotiate with the NMC and the FOM, with the eventual aim of the creation of an OH nursing qualification which is fit for purpose in the changed health and work climate.
Occupational Health Review conducted an up‐to‐date survey of the work of OH nurses in 1996 with the assistance of the RCN Society of Occupational Health Nursing. The number of OH nurses then employed in the UK was estimated to be about 5000–8000. The majority were women, about 80 per cent full‐time; 95 per cent of respondents to the questionnaire had a formal OH qualification, including 10 per cent with a degree. The ratio of OH nurses to employees was three times higher in the private sector than the public sector; 95 per cent of OH nurses worked with a physician in the team. About one in six organisations employed only GPs with no formal OH qualification. Health promotion was a part of more nurses’ jobs than any other activity. Most time was taken up with routine health screening. Six out of ten nurses experienced conflict with the physician at least some of the time, and more than eight out of ten had problems with human resources departments and departmental managers. Nine out of ten nurses received at least some encouragement from their employer to undertake continuing professional development.
In 1993 the HSE published Anna Dorward’s study Managers’ perceptions of the role and continuing education needs of occupational health nurses. Predictably, lay managers had a far more limited perception of the role of the occupational health nurse than did doctor managers or nurse managers: they saw them only as providing treatment for illness and injury at work. Only 50 per cent of lay managers supported nurses taking time off to attend courses. It would seem that the occupational health nursing profession still had a need to sell itself to employers as a vital component in health and safety provision. Training initiatives have to take into account that the acquisition of more extensive qualifications involves significant sacrifice of time and money for most OH nurses. At the time of writing there is a significant shortage of qualified OH nurses, which is reflected in a rise in salaries.
More recently, research undertaken by John Ballard, the editor of Occupational Health at Work, published in 2006, showed that the OH services rated by nurses as most important were the confidential handling of health data, assessing fitness for work, health surveillance, disability management and assessing risks to mental health: Performance indicators and benchmarking in occupational health nursing (RCN).
The Employment Nursing Advisers are full‐time employees of the Health and Safety Executive and part of the Employment Medical Advisory Service. They are key figures in occupational health because many nurses are working on their own and have only EMAS to turn to for advice and information. In recent years, much of their time has been spent in advising employers about the provision and training of first‐aiders, who, as has been seen, do not have to be qualified nurses. They were given a new title in 1998: HM Inspectors of Health and Safety (Occupational Health) to stress that they work alongside other inspectors in investigating complaints and possible breaches of the law, and have all the powers of the HSE inspectorate.
Dame Carol Black in her review published in 2008 stated that there is need to improve recruitment of OH professionals and to make the specialty more appealing to medical and nursing students. Making the specialty broader based and more mainstream would make it more attractive as a career. The workforce must be supported by a strengthened academic community. Her suggestion that the professions should speak with a more united voice has led to the creation of a Council for Work and Health.
1.7 The inter‐disciplinary nature of occupational health
The law is on the whole very unspecific about demarcation between doctors and nurses. There are a number of detailed regulations about the supply and administration of medicines. Prescription‐only medicines (POMs) may only be supplied through a registered pharmacy on the written prescription of a doctor, dentist, or very exceptionally a specially registered nurse; and no person may administer medicines parenterally (administration by breach of the skin or mucous membrane) unless he is either a doctor or a dentist or acting in accordance with the directions of such a person. However, there are exceptions for OH nurses, now to be found in the Human Medicines Regulations 2012. These exempt from the above requirements the supply or administration of medicines in the course of an occupational health scheme by a registered nurse where the nurse is acting in accordance with the written general instructions of a doctor.
When a doctor signs a general
