The Specialist Community Public Health Nurse in Occupational Health.

Queen’s Nurse and University of Bradford Nurse Lecturer, Catherine Kelsey and Senior Occupational Health Manager at Mars UK, Lucy Lefley discuss the role of the specialist community public health nurse (SCPHN) working in occupational health.

SCPHNs who work in occupational health can be found on part 3 of the nursing register along with school nurses, health visitors and family nurses – their area of practice is indicated on the register.

Occupational health is considered a distinct role of public health nursing. A variety of role titles exist which aim to capture the essence of occupational health nursing. These include occupational health advisor (OHA) – for ease we will reference the OHA in the rest of this article. Ultimately the role of the OHA is concerned with ensuring people keep well at work; both mentally and physically.

The earliest account of a nurse caring for the workforce is that of Philippa Flowerday who was employed in the UK by J & J Colman’s mustard factory and is considered to be the first ‘industrial nurse.’ Her role meant her time was split between working in the factory and visiting the sick and needy at home.

Although occupational health nursing is a relatively new concept, having its origins in the late 19^th Century, occupational medicine can be dated back to Bernardino Ramazzini, widely considered the “father of industrial medicine.” His published work entitled, De Morbis Artificum Diatriba (The Diseases of Workmen) was the first comprehensive book on occupational disease.

From Rammazini’s investigations into miners’ illnesses, to the suffering of the 19th century matchmakers whose exposure to white phosphorous led to the most horrible of diseases ‘Phossy jaw’, workers have been, and continue to be, exposed to the most hideous of risks both nationally and internationally.

Those working in occupational health cannot reduce risks or promote positive health and wellbeing without support: a multi-disciplinary team approach is required.

A Collaborative Role

Occupational health is considered a multidisciplinary service, bringing together a myriad of professionals including, physicians, nurses, ergonomists, occupational hygienists, counsellors, cognitive behavioural therapists, physiotherapists and health and safety practitioners.

The primary role of the OHA is to be actively involved in the prevention of work-related ill health and promote positive health and wellbeing. OHAs provide advice on legal compliance, support and rehabilitation of employees who have become ill as well as providing support to enable employees to remain in work where appropriate. They also plan, implement and evaluate health surveillance and wellbeing programmes.

Education Opportunities  

 There are many educational opportunities available to those working in occupational health. The most well recognised qualification is that of the Specialist Community Public Health Nurse (SCPHN) programme of study, which encapsulates the 2004 standards, and leads to either a degree or post-graduate qualification. Only SCPHN courses approved by the NMC allow entry onto part 3 of the register.

Many OHAs also develop interests and choose to gain advanced knowledge in particular areas such as ergonomics, health and safety and occupational hygiene. All of these skills being highly valued within organisations. In reality, it depends very much upon the requirements of the role, the needs of the organisation and the area of clinical practice, as well as the aspirations of the OHA.

One of the key roles of OHAs in particular, is to provide support to employers and employees on attendance management. A process which can cause considerable angst to an employee who has been referred.

Attendance Management

Many of us will have a period of absence in our working lives, some of which may be prolonged. A referral to occupational health usually occurs when an employee has been absent from work due to a health condition or they have a health issue that is impacting on their work performance.

This process should not be deemed as being ‘cloak and dagger’ but should be a transparent process and take place after a discussion with the employee’s line manager, HR and off course the employee themselves. The role of the OHA is to provide impartial, professional advice that enables managers to proactively support the health of their employees.

Consent is of vital importance in occupational health. Consent should be obtained to undertake the consultation and an explanation of the process offered. All consultations should be treated as confidential and prior to any report being released to the employer, consent should once more be obtained.

Following the consultation the employer will receive a report (provided consent has been provided by the employee) that should provide answers to any questions asked on the referral form and should also cover the following areas:-

• Current health issues
• Prognosis
• Fitness to work
• Current or planned treatment
• Advice on workplace adjustments
• Advice on return to work programmes
• Applicability of the Equality Act
• Whether a further occupational health consultation is necessary

To help the OHA give a complete account of the situation they may need to obtain third party information from a GP, Specialist or counsellor and again, written consent from the employee is required.

A variety of legislation exists that protects the rights of employees and their data. All those working in occupational health who undertake such roles are required to be conversant with these acts. The Access to Medical Reports Act (1988) is of particular relevance in occupational health consultations.

Job satisfaction

Primarily OHAs support well people, who for a multitude of reasons find themselves in need of care, which in the main is short-lived – although there are many who may never be able to return to full and productive employment.

Occupational health nursing is a career that can bring its own professional rewards, including opportunities to climb the career ladder and demonstrate autonomy and accountability. Job satisfaction can develop as a result of being involved in the planning of a rehabilitation programme that enables an employee to return to full and productive employment, and the recognition of poor health, whether this is work-related or not.

Catherine and Lucy have both worked in occupational health for several years – it is a career that they have both enjoyed and Lucy continues to enjoy.

Their ethos is that work should do the employee no harm.