CPD Continuing Professional Development: Bridging the gap

Our learning for life service helps you use the journal for CPD-related private study.  One article in each issue is accompanied by a set of questions and answers. These have been devised by education and healthcare consultant Greta Thornbory and are designed to help you reflect in a structured manner on what you have learnt

Universities have been criticised for not giving newly-qualified occupational health nurses adequate practical experience to carry out the requirements of the job. So how do you bridge the theory/practice gap for the new generation of OHNs?  By Anne Harriss

In occupational health nursing, there is an emphasis on autonomous decision-making, independent functioning, health prevention promotion, analytical and investigative skills and the management of healthcare services.1

The education of occupational health nurses (OHNs) – originally called Industrial Nursing – to perform these functions has a long history, with the first course in OH nursing offered by the Royal College of Nursing (RCN) more than 70 years ago. It was superseded by the OHNC (Occupational Health Nursing Certificate), developed and validated by the RCN. When the OHNC was completed and passed, it was the only qualification that conferred qualified OHN status.

Programmes educating OHNs have undergone a rapid transformation since the late 1980s, when the Diploma in OH Nursing superseded the OHNC, and the responsibility for the validation of education programmes for OHNs transferred from the RCN to the National Boards in many institutions OH training.

Another major influence on the education of all nurses was Project 2000, in the early 1990s, when education moved into universities, rather than being based within schools of nursing in hospitals.

Pre-registration students were now taught on courses offered at diploma or degree level. By the mid-90s, this meant the qualification giving the status of ‘occupational health nurse’ was offered only at first or second degree level. These qualifications were recordable on the nursing register – provided that a statutory body, such as the ENB (English National Board for Nursing Midwifery and Health Visiting, now defunct and has been taken over by the NMC) had validated them.

The RCN now stresses the importance of practitioners holding a specialist qualification, stating in its recommended terms and conditions for nurses who work outside of the NHS, that an OHN is one who holds a recordable qualification in occupational health nursing.2

This specialist status is reflected in the recommended differential in pay scales between those who do or do not hold a recorded qualification. The reason for this differential is that nurses who have completed a specialist course of study in OH nursing should be able to practice at a higher level than a nurse who has not completed such a qualification. However, practitioners should remind themselves that completion of a specialist qualification is not the end of the line, and it is essential that OHNs are committed to becoming life-long learners, continually updating their knowledge and practice skills.

If the OHN is to be a competent, effective and professional practitioner, they require a range of specialist OH nursing competencies. In order to profess competence, these skills must be underpinned by a rich body of knowledge and understanding, achieved by classroom teaching linked to a period of practice in the OH setting. However, some students may graduate with first class honours, while others may be awarded an unclassified degree.

The classification indicates the degree of independent thought and synthesis that the graduate has exhibited in their assessments. A highly academic individual may find day-to-day practice more of a challenge than they found learning in the classroom.

We should also be cognisant of the novice to expert spectrum, proposed by Benner, who says that practitioners can place themselves somewhere in one of the following practice categories: novice, advanced beginner, competent, proficient or expert.3

A new graduate can only become an expert as a result of continuing and reflective practice. It is easy to associate the difficulties inexperienced practitioners face with a theory/practice gap.

Fit for purpose

The teachers of OHNs in the UK have formed the Association of Occupational Health Nurse Educators (AOHNE). This group aims to ensure that all courses are ‘fit for purpose’, and meet the needs of practitioners.

Members of the AOHNE are keen to ensure that graduates from OH programmes are able to practice competently and confidently. Education should not be an esoteric activity, preparing thinkers who are unable to become proficient doers. Rather, the aim is to develop reflective practitioners who are critical thinkers and knowledgeable doers – knowing how to undertake an occupational health skill as well as appreciating why they are doing it.

Students should be taught how to integrate theory with practice in order that they become inseparable,4 enabling the graduate to enmesh these skills within their own professional practice. This allows them to identify gaps in their knowledge or aspects of their professional practice they wish to develop. 

Closing the theory/practice gap

The Nursing and Midwifery Council (NMC) is now calling for all the courses preparing specialist practitioners to be offered at degree level, with equal emphasis on both practice and theory, which should work towards closing the theory/practice gap.

When a new educational programme is being considered, the team that will deliver the programme nominates a curriculum development group (CDG). For example, at London’s South Bank University, the course team recognised the importance of including senior and well-respected members of the OH nursing profession in the CDG. These included OH service managers and representatives from the Association of Occupational Health Nursing Practitioners and the Occupational Health Managers Forum of the RCN. In addition to these practitioners, other members of the group included course lecturers and student representatives.

To start the process, the CDG developed a philosophy to underpin the proposed programme with enthusiastic discussions regarding what constitutes a competent practitioner.

It was confirmed that the degree being developed should promote evidence-based practice and a curriculum was devised, which the group felt confident would meet practice needs. It was decided that they would continue to deliver a degree in OH nursing, with all the units being focused on OH practice, rather than offering a degree in community nursing that included OH nursing specialist units.

Furthermore, as a result of the experience of the number of applicants who had competed diploma level studies, it should be offered at level 3 (the equivalent of third-year degree level work on a degree programme entered by school levers on completion of A-level study).

It was thought that students should be able to complete their degree in one year of full-time study or two years of part-time study. The CDG did not wish to discourage nurses who had not completed diploma-level courses. Applications from these nurses would be welcomed, but applicants would be required to complete a number of units at level 2 (the equivalent of second year/diploma level material) prior to studying the level 3 specialist component. This was considered important to lay a firm educational foundation.

In order to fulfil the practice elements of the programme, all students will be required to obtain a practice placement and nominate a professional supervisor who holds a recordable OH nursing qualification.

The practical side

The practice element of the programme is of equal length to the taught component. Each unit has both theoretical and practice learning outcomes that must be achieved by the student. In addition to the examination or assignment required to complete the unit, students are also required to submit evidence that they have satisfactorily completed the practice competencies associated with that unit of study.

Those who successfully graduate from the programme achieve specialist practitioner status, which shows they have demonstrated a multitude of competencies reflecting the complexity of the role of the OH nurse. Broadly, these competencies include verbal and written communication skills, the ability to undertake evidence-based practice and the ability to undertake a range of risk and health assessments.

Other important aspects of their education is to gain an understanding of how work affects health and vice-versa, and an appreciation of how a return-to-work recovery programme should be organised.

As students progress with their studies, they begin to acquire the skills needed for policy development, as they will increasingly be involved in this aspect of the role of the OH nurse as their career progresses. One of their final units facilitates the development of their leadership and management skills. 

The CDG supported the development of a course that had practice requirements for full and part-time students.

The practice requirements are identical; the way they are achieved differ. Full-time students would attend the university two days a week and achieve learning outcomes associated with professional practice over a minimum of two further days each week. Nurses already working in the OH setting were able to undertake their studies on a part-time basis and achieve the practice outcomes in their own place of work.

Agreeing the curriculum

The agreed curriculum was then developed into the learning outcomes to be presented in the taught units of study. Outcomes to be achieved in the practice setting were also developed from the theory taught in the classroom. Students would be encouraged to reflect on their practice experiences and develop a personal learning plan in order to meet their future learning needs.

This approach supports the humanistic approach of Rogers that education should “facilitate the process of change in an individual in order that he or she may function fully”.5

The learning outcomes and competencies included in the development of our curriculum are congruent with those published by the Department of Health (DOH) in its document that promotes a public health approach in the workplace, and identifies the importance of a framework for practice, working within a multi-disciplinary team, policy development and evidence-based practice.6

The first group of full-time students have just graduated from this programme. Their evaluations were very positive and it appears that their practice needs are being met. These graduates have demonstrated that they have good employment prospects, which suggests the course also meets the needs of OH service managers.

OH educators are all committed to taking OHN practice forward and to ensuring it is promoted. As course deliverers are required to comply with the educational requirements of their university and statutory bodies, this is not without its problems. Curriculum development is an ongoing process. In order to ensure that programmes of study are contemporaneous, they have a life-span of five years, after which re-validation is required by the university. If there is a practice gap, course providers are working towards the same goal of closing it.

- If practitioners think educational programmes are not meeting their practice requirements and they are able to identify how courses could be improved, I would be interested in receiving constructive comments to disseminate to the members of the AOHNE group. Please write to: Anne Harriss, course director, BSc (Hons) Occupational Health Nursing, Faculty of Health, South Bank University, Borough Road, London SE1 OAA. Should readers be interested in becoming professional practice supervisors, contact Nessie Brooks, brooksne@lsbu.ac.uk

References

1. Occupational Health Nursing Concepts and Practice, Rogers, B (1994), London: WB Saunders

2. Nurses Employed Outside the NHS Recommended Pay, Terms and Conditions, Royal College of Nursing (2003), London: RCN

3. From Novice to Expert, Benner, P (1984), California: Addison-Wesley

4. The Theory-Practice Gap in Nursing: From Research-Based Practice to Practitioner-Based Research, Rolfe, G (1998), Journal of Advanced Nursing 28(3) 672-679

5. Freedom to Learn for the 80s, Rogers, C (1983), Ohio:Charles Merrill

6. Taking a Public Health Approach in the Workplace: A Guide for Occupational Health Nurses, Department of Health (2003), London: DoH