OH: the view from out there

The WHO report on the role of the OH nurse in its European
member states gives an interesting insight into the different ways occupational
health is delivered. There is much we can learn from understanding how others

The World Health Organisation report, The role of the occupational health
nurse in workplace health management, was published in 2001. It describes the
role of the OHN in Europe and reflects the current rapid development of
occupational health services within the WHO member states.

The main drives for these changes are

– The acknowledgement by employers that there are economic, social and
health benefits to having access to occupational health services

– The developing programme of EU legislation in health, safety and
environmental legislation

– The recognition that OH should be an important part of the public health

Linda Maynard interviews one of the co-editors, Dr Stuart Whitaker about
this report.

Can you tell us about the background to this report and how it came to be
published by the WHO?

Several years ago there was a meeting of occupational health nurses in
Europe, funded by the WHO. The delegates agreed to produce a document on the development
of OH nursing, but for a variety of reasons this did not happen.

The WHO approached me to help edit a document that took account of these
discussions and more recent publications from the WHO and other relevant

After the text was drafted, it was circulated to the WHO collaborating
centres in OH and various nursing bodies in Europe for comments. Further
comments arising from a meeting of leading figures in OH were also taken into
account in preparing the final text.

As you can appreciate this was not a simple task, but I have to thank all
involved in the process for giving their time and effort and for bringing their
expertise from their own countries. It has proved to be a very productive
exercise, with a report that we believe fulfils a useful purpose for OH nurses.

How does this fit into the current literature from the WHO on
occupational health?

This report is published as part of the European Series of reports on
workplace health and follows the report, Occupational medicine in Europe: scope
and competencies, edited by Ewan MacDonald and Professor Baranski, who is
Regional Adviser, Healthy Workplaces at the WHO. Professor Baranski
alsoco-authored this report.

Who is this report aimed at?

At the beginning of the report there is a section that identifies the target
audience. This starts with the policy-makers in the Ministries of Health,
Education, Labour, Employment, etc. These individuals in positions of influence
may not be aware of OH nurses in their own countries, so we wanted to give them
a document that put OH nurses at the top of the OH agenda. It is also helpful
to any members of the multi-professional OH team to give them some useful
information on how the role of OH nurses has been developed in different

Can you give us any examples?

OH nurses in the UK have adopted a positive pro-active agenda that is driven
by risk assessment and risk management, whereas in France the expectation and
practice is that they will be more involved in delivering primary health care.
We can all benefit by thinking about the various roles that OH nurses fulfil.

Workplace health management is billed as a "new and exciting
concept" – how does this differ from what we know as occupational health
in the UK?

The term "workplace health management" was adopted for two
reasons. First, the WHO is increasingly using this term to refer to all the
activities that might help contribute to healthy workplaces and to encourage
employers and employees to consider how they can contribute towards managing
health issues at work.

Secondly, this term is also used in the report instead of occupational
health, as in many countries occupational health is automatically translated to
"occupational medicine". This suggests a largely reactive,
medically-oriented activity that has sometimes failed to engage with the
management strategies in some organisations.

The report promotes the concept of OH being expanded to include
non-occupational workplace preventable conditions. Has health promotion not
always been a central part of good OH practice?

OH has always been concerned with protecting and promoting the health of
workers, but due to limited resources in many countries, occupational health
professionals needed to prioritise their time and activities. Protection from
workplace exposures took priority. But increasingly, employers are recognising
that any health complaint that interferes with attendance or performance at
work, whether it is caused by work or not, is of concern to them. If there is a
better way of managing those problems, such as some health education activity,
they are willing to support this.

How can OH nurses deliver this expansion of the role to employees,
particularly in poorer countries with competing costs, without reducing the
attention paid to preventing occupational accidents and disease?

Inherent in the role of the OH nurse is the skill to assess the real and
perceived needs of working populations and therefore, the ability to prioritise
actions to address the key problems. OH nurses tend to be resourceful people
and this applies whether they are in rich or poor countries or in rich or poor

When you talk about competing costs in poor countries, it is important to
recognise that OH can probably do more in those poorer and developing countries
to help reduce costs than they can sometimes do in highly mechanised and
well-developed countries.

Although outside the scope of this WHO report, if you placed most OH nurses
in the working conditions found in some factories, mines or manufacturing sites
in poorer countries who are undergoing rapid industrialisation they would
quickly save those organisations money by helping to prevent occupational
accidents and disease. They could also help those societies having to pay for
lifelong disabilities caused by unsafe working conditions, often by simple
interventions such as machine guarding or by providing healthcare at the
workplace where it does not exist in the community.

Why are OH nurses identified in the report as being ‘essential’ to the
success of workplace health management?

OH nurses form the single largest group of health care professionals
involved in delivering occupational health. They are the professionals who can
actually deliver services and with their high degree of expertise and skill are
able to take forward a health agenda with management that closely matches the
needs of the organisation in which they work.

Occupational health nurses do not just deliver a programme designed by
others, they are the professionals who can take a concept and make it a reality
at the workplace. That’s why to be successful any workplace health strategy
needs them.

The report seems to reflect what is happening in OH in countries where OH
nursing practice is at its most advanced. Is there also an implication that
other countries should develop their services along the same lines?

I think the document does try to reflect what occupational health nurses in
some countries have achieved and this provides a useful landmark against which
OH nurses can consider their own practice. Occupational health nurses have
raised the standards of their professional education and training and, in many
organisations, have emerged as the key figure involved in the delivery of
quality OH services.

The report also provides European policy-makers in decision-making positions
with some information on the broad range of skills and roles that their OH
nurses could become involved in. But I do not think that the report could, or
should be used to set standards for different countries, as this is a complex
and difficult area to work in. The preparation of OH nurses throughout Europe
varies tremendously for example; the health care culture, legislation and
social expectations are very different.

We in occupational health need to understand more about the variations and
why they exist before we can start to advise others about what to do.

Have you any general aspirations that you hope this report will achieve?

I hope this document will be useful to help raise the profile of OH nurses,
and to create more of an ongoing discussion about occupational health

In fact, discussions have already started between OH nurses in Europe
concerning the next document that we want to write about OH nursing. We intend
to keep OH nursing firmly at the top of the agenda.

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