Making the grade

Daniel Richards is a qualified nurse who has just completed a BSc in community nursing and occupational health at Edinburgh University.

I qualified as a nurse in 1993, aged 25, having previously been a music student, life assurance clerk, and care assistant. I worked in acute hospital departments for seven years, in Edinburgh and London. I wanted to continue to use the skills I had developed, but needed a move away from shift work, and also wanted to work to keep people from ending up in hospital rather than looking after them once they became ill.

As I started looking into job prospects in occupational health (OH), I became aware from adverts and from speaking to practising OH nurses that it was necessary to have a degree to get anywhere.

Enquiries to various universities in Scotland and England showed that a degree was pretty much the only option available. I needed to gain ‘top-up’ educational points to add to my RGN qualification before I could get to the entry level for the degree, so I enrolled in modules from a BA in nursing at a university in Edinburgh, and completed them over a year. I also needed a job in OH to get experience.

After a few months, on the strength of being on a degree course, I succeeded in gaining a part-time OH post at one of the Scottish airports. This job later became the springboard to my current post, in the OH unit at Edinburgh University.

I knew the course was called ‘BSc Community Nursing (Occupational Health)’, and that some elements would be shared with community nurses. However, it surprised me that so much of the course – all but one ‘option-specific’ module – was heavily biased towards the more traditional community nurse disciplines. There was always some relevance about the topics we looked at, but some (eg, elder and child abuse, sexual health, school and psychiatric nursing, combined social work/primary care needs assessment) were of much greater use to the other disciplines. We did not share lectures on OH with our non-OH colleagues.

I can see that OH nurses have an important role to play in maintaining and improving public health. It may be worthwhile for OH courses to have some overlap with courses for nurses working in other disciplines, but concentrating on the community and NHS perspective fails to acknowledge that most OHNs work within organisations, and often outside the NHS. Often they operate in a business context which is several degrees removed from NHS community nursing and its agenda, and more allied to health and safety. OHNs are employed to meet the needs of both employers and employees, and that also makes their role different.

As I gained experience in my jobs, it became increasingly surprising that many important topics I was dealing with day-to-day were either not covered in the course, or else dealt with in the briefest way. These topics included risk assessment, absence management, working with line managers and HR departments, dealing with difficult employers or employees, clarifying the role of OH, and how to plan your own continuing standards and education after completing the course.

Whether a degree (or rather, the kind of degree I was doing) was what I needed initially is debatable. In recent years there has been a rush to arm as many nurses as possible with graduate and postgraduate qualifications, and this, no doubt, has helped to raise the status of the nursing profession in general. OH nursing benefits from this, but more time should have been spent looking at educational needs as a continuum, rather than working out how everyone can get a degree.

There are arguments about whether OH nursing should be a graduate-only profession. This is a black-and-white approach and it misses the point – which is that a graded and well-structured system of basic and continuing OH education is needed. It is an over-simplification to divide nurses in OH into those who do and those who do not have a degree. What matters is whether practitioners have the knowledge required for the job they do, and that they can access continuing education.

Having completed my course, I would recommend that anyone thinking about an OH career finds a course and enrols on it. It may seem difficult to find that first job, or to get access to a course, but a qualification is what employers want. And I did learn a lot from my course – it improved my study skills, I was able to share experiences with other practitioners, and I now have more knowledge of research and critical thinking. But the course did waste too much time on ‘community’ topics – time that could have been spent on OH issues.

I also think it is sad that the nursing profession has come to believe (and allowed employers to believe) that a degree is so important. Those who influence nurse education have let OHNs down. They have put current health agendas and the manufacturing of graduates above meeting the basic and continuing learning needs of OHNs.

Cathryn Richardson is a registered general nurse, but has 10 years’ experience in the medical industry. She is now a self-employed OH consultant, and has just started a diploma in occupational health at Warwick University.

I worked first as a Registered General Nurse, then as a business development and contracts manager, gaining 10 years of experience in the medical industry – negotiating and contract managing in the NHS, community trusts and retail (the medical sales industry.) Recent years have involved occupational health, working mainly with independent companies, dealing with directors, human resources, managers and health and safety. I have dealt with a variety of clients including the prison service, the police and the NHS.

I chose to change my career to an area that involved my clinical skills yet still allowed me to utilise my business skills. I then spent the next few months trying to find a company that would take me on and allow me to utilise my skills to the full. I could get a job no problem. However, the comments I got were along the lines of: ‘You have not got a degree/diploma'; or, ‘You are over-qualified – we think you would get bored’.
But I got a job, and clients found I was refreshing as I would handle their objections and was extremely flexible. I very quickly managed the contracts I was working in clinically, and brought in extra business. A process was put in place to mentor me and my competence levels increased. My role was ideal – I worked on both the clinical and the business side.

Once I had decided that OH should be my career, I spoke to many people who had done the degree. Many said they did not feel the degree would benefit me as it didn’t teach the basics of OH. And I found people saying: ‘You will have to decide if you want to work in the business side of OH or the clinical side’.

I was not, and am not, prepared to do this as they both complement each other, and I would like to see a course that supports this. I believe the RCN is looking at competence, which is a welcome step forward. Unfortunately, too late for me.

This lack of business acumen in OH became clear when I lectured on an MSc course last year. Only a handful of candidates could honestly say they had any business awareness let alone business acumen. But, in the current market, a contract can be lost just as quickly as won. Lead times can be long and expectations high and, as a business manager, I rely on the OH advisers to be commercially aware. I rely on them being able to establish what the real issues are, and I feel that this is a competence in its own right.

Current training routes don’t equip OH nurses with this business awareness. I am fortunate that it is second nature to me as I have been in the commercial world for a long time. And I know many advisers who are experienced and have learnt the hard way or have spent time working in the commercial world where targets and statistics are essential parts of the business.

Obstacles I have come up against include being forced to choose between business and clinical skills; a lack of clarity and flexibility when choosing modules; the fact that not all courses are registered with the NMC and that experience is not taken into account.

However, on the positive side, flexible study is possible, allowing mature students to continue working and earning, and course tutors have been very helpful when exploring all avenues.

I have now decided to take the diploma in OH at Warwick University on a distance-learning basis. This fits in with the way I work, as I am now self-employed. I do half business and half clinical, which allows me to utilise my skills and learn on a daily basis and I try to network where I can to learn from others, as I find this is the most effective route.

The course comes highly recommended as relevant to OH, but I am not sure if I will go on to do the degree unless some changes are made to the courses. My ideal would be take modules that would help formalise my business/marketing skills, study international OH and look at ergonomics in the UK and internationally.

I would also like to see a business module added to the course to help advisers be more prepared for the commercial world. With current government initiatives involving OH I feel this is essential. It would also encourage more people to take the degree, as the skills it would teach would lead to a wider career path in OH and help newcomers understand their options.

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