CPD Continuing Professional Development: Bridging the gap

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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 It was superseded by the OHNC (Occupational Health Nursing Certificate),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the Diploma in OH Nursing superseded the OHNC, and the responsibility for the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

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