Occupational Health Nursing – Looking after our Working Community in Covid-19

QN Tracie Mckelvie writes about the unique challenges of delivering Occupational Health services to a police force during Covid-19.

I have been nursing for over 30 years, having achieved State Enrolled Nurse (SEN) status, Registered General Nurse (RGN), Occupational Health Specialist Practitioner, and more recently, the title of Queen’s Nurse. I am as passionate about my work now as I was ‘back in the day’.

I have specialised in Occupational Health Community Nursing for the last 18 years, and the current challenges that we are being presented with today are arguably the greatest I have seen throughout my Nursing career.

Our Biggest Asset

Within Occupational Health, we ‘the people’ are our nation’s biggest asset. In order to do a great job, to be happy in our jobs, and to be the best that we can be, our physical and psychological wellbeing is paramount. We’re a non-perishable and non-disposable commodity, yet in today’s current climate, we’re not only faced with the uncertainty of an invisible presence that has disrupted life as we know it, but we are also trying to ensure the health and wellbeing of our working communities, whilst striving to keep ourselves and each other safe in the process.

As an Occupational Health and Wellbeing lead for a Police Service, I am responsible for a multi-disciplinary team. I am responsible for ensuring that we have the right skill mix in the unit at any one time, to ensure we are effective as a team. My role as manager includes a strategic function, which is not only about having a voice around the table and about influencing change, it’s also about ensuring that appropriate Occupational Health response and resources are deployed in these unprecedented times.

Occupational Health Nurses witness first-hand the impact that occupational exposure can have, and it comes in several forms. It is our job to ensure that the physical, psychological, biological, chemical, and environmental hazards are considered for our working communities in order to eliminate or to reduce, as far as reasonably practicable, any potential or predicted detriments to health. We have to be skilled in being versatile and adaptable to both people and business need. The current Public Health crisis has presented many of us with the challenge of implementing safe and effective measures in order to attempt to deliver ‘business as usual’.

The Occupational Health Specialism

Although Occupational Health is a highly skilled specialist area of Community Nursing, the role of the Occupational Health Nurse has historically been misunderstood, even among our own Nursing colleagues. Typically, unless you’ve been unwell or you’ve been faced with work related issues that have impacted upon your health, your contact with Occupational Health will probably have been minimal.

Occupational Health has however evolved significantly over recent years, highlighting that Occupational Health Nurses are rather unique; it takes many years of experience and structured formal postgraduate training to become a confident and competent and established practitioner and although Occupational Health Nursing is still seen as a relatively small cog in a big wheel, this specialist area of Community Nursing is becoming more and more widely recognised.

There are however challenges. Nationally, there is a shortage of qualified and skilled Occupational Health practitioners, to include both nurses and doctors. There are fewer training courses available and many practitioners who are retiring are not being replaced, simply due to the shortage of specialist trained staff. The NMC is reviewing their current standards for Occupational Health, as the existing ones are outdated, and this is a positive step forward to ensuring that standards are indeed relevant in today’s climate. Due to the shortage of practitioners, this has placed Occupational Health high on the government’s agenda, having been cited in papers such as “Our healthier nation” and “Improving lives: the future of work, health and disability”, with the latter setting out a clear strategy for the future reform of the Occupational Health market. This is certainly something to look out for in future months.

While some may perceive Occupational Health Nursing as not being as clinically hands on as more traditional nursing roles, there is no doubt that Occupational Health Nurses are highly skilled in their speciality. We work autonomously, and we utilise a wide range of clinical and analytical skills in order to undertake our roles and make effective decisions. Duties can range from undertaking pre-employment medicals, health surveillance and health screening, administering vaccinations, phlebotomy, overseas travel clinics, assessing fitness for work, health promotion and health education, delivering training, client consultations, case conferences and complex case management. Occupational Health Nurses are incredibly robust and we pride ourselves on seeking to provide a service, no matter what. We are about looking at what you can do, rather than what you cannot.

Adapting in a Complex Workforce

I work in an organisation with a varied workforce that operates highly stressful and complex specialist functions under ordinary circumstances, so to be faced with an unknown new hazard brings a new layer of complication. Several of our specialist functions, such as response and custody policing, firearms, crime scene investigations, control room operatives, and disaster victim identification and recovery teams are at the core of policing work. It is therefore essential that we have the opportunity to engage with and observe our colleagues to gain a better understanding of what their roles entail. This enables us to respond proactively, as well as tailoring our services to meet specific needs.

In ‘ordinary’ times, our Occupational Health department is busy and vibrant with a high volume of traffic visiting us on a daily basis. In addition to our clinical function, our service also provides a safe, confidential space for our Officers and Staff to come and talk about their symptoms, their feelings, their struggles and coping strategies, and importantly how this may be impacting upon their health. Occupational Health is probably the only place in the organisation where a holistic assessment of health can take place using a biopsychosocial model.

In our current climate, and what is fast becoming the ‘new norm’, I am extremely proud to say that we are still able to continue to provide our services, but with a difference. Since the Coronavirus outbreak, we have had to respond in quick time in order to ensure as best as possible that our Officers and Staff are protected in their line of duty; protected from a biological hazard that is not yet fully understood.

In order to keep our employees and ourselves as safe as possible, and due to the social distancing measures, we ceased all non-essential face-to-face appointments a little prior to the Government’s lockdown instruction, and with the exception of not undertaking the physical elements of clinical tasks such as lung function assessments, hearing assessments, and vaccination and phlebotomy clinics, by being versatile, we are still able to continue to offer our full suite of services by adapting the way in which we work.

Essentially, aside from some necessary, but very carefully managed clinics, we are offering our services remotely, while continuing to liaise with other clinicians and specialists to ensure a connected and continued care pathway. Technology allows for visual interaction, and with the ongoing dedication and commitment from my team, we have also been able to extend our support network outside core hours, to cover evenings and weekends.

The Aftermath

For our Officers and Staff, while we are already making a difference, there will inevitably be lessons learnt. We not only have to consider that we are being faced with the potential loss of life, but also the aftermath of what’s to come. With this in mind, we will continue to dedicate ourselves, our compassion and our skills to ensure the best possible care. We will continue to adopt a collaborative approach, to ensure a consistent pathway in supporting our employees, and we will seek out specialists who can work alongside our existing welfare provision.

For myself and my team, we are already seeing the detrimental effects of the pandemic. We are communicating on a daily basis with our staff to provide support to them, their families and to their managers. We support each other and we have access to specialist and peer support, which is vital as we are working tirelessly to try to reach out to as many people as possible. We listen intently to the challenges that they and their loved ones face. We absorb wholeheartedly our people’s descriptions of events – descriptions of the real threat to life in their line of duty, descriptions of the real fear and anxiety they are feeling, descriptions of when they or their loved ones are unwell, and to the news on their personal loss.

We are scared. Scared for our NHS and for our health care workers. We are scared for ourselves and for our own families. We scrutinise and we listen out for scientific developments and government updates in the hope that we as a nation can be assured that this pandemic will be beaten, soon. We are however also determined. We won’t stop caring, and we won’t stop supporting. It’s just the way we are.

While there is much understandable uncertainty regarding the UK economy and its recovery from the current crisis, I can honestly say that despite the challenges and uncertainty, I love what I do. My job is never boring, and aside from the current Public Health crisis, my role presents with new challenges almost on a daily basis! I believe that there are exciting times ahead for the future of Occupational Health Nursing. At the end of the day, with us, the people being our nation’s biggest commodity, we have to look after ourselves, and each other.

We are ALL in this together.

Tracie Mckelvie QN

Tracie was a participant in the QNI’s Executive Nurse Leaders Programme 2018-19, funded by the National Garden Scheme.