One of a kind

Last
year, Tammie Daly became the country’s first occupational health nurse
consultant and, to date, remains the only OHN in such a post. She explains her
experiences over the last year, what she has achieved in her job and her plans
for the future.  By  Nic Paton

When
Tammie Daly became the country’s first occupational health nurse consultant
last year, she expressed the hope that her appointment would open the door for
other OH professionals to become nurse consultants. But one year on, she is
still alone.

“It
is very sad. I believe there are two or three areas that are looking to draw up
the papers to make a submission, but, yes, I am still the only one,” she
admits.

Daly
took up her new post in June last year, moving over from managing the
Nottingham City Hospital OH department – primarily a management role – to
having a position that encompasses the Queen’s Medical Centre (where she is now
based), City Hospital and Nottingham University.

“A
lot of what has happened over the past year has not been mega change, but that
is just the way things go. It is a gradual process, bringing about change,
rather than a sudden blast,” she explains.

The
Nottingham OH team is a large one, including a clinical director, another
consultant, two specialist registrars, a nurse manager, four specialist OH
nurses, two trainee OH nurses, and a team of OH nurse advisers, as well as
clerical and administrative staff.

It
serves about 18,000 NHS workers and provides a range of services to commercial
organisations and small- and medium-sized enterprises, something it has been
doing since well before the Government launched NHS Plus.

“We
give OH access to industries such as bakeries and foundries, and have been
doing so since the 1980s. We have some small garages that we go to just once a
year. It is getting quite difficult for small firms to get OH advice because a
number of the bigger organisations have stopped doing outside work, so we think
it is important,” says Daly.

“But
we have to look after the NHS first, as that is our core service,” she adds.

In
the past year, Daly has seen the team take on yet more referrals and give out
an ever-widening range of advice. The nurses now undertake BCG vaccination
clinics and she has helped to organise a back pain clinic with the Nottingham
specialist back pain team.

“We
have one of them come into the department and run a clinic every Friday, so
that if someone is coming to us with any type of back pain, they can get expert
advice or we can refer them back into the correct system,” she says.

The
OH team is also looking to work closely with the trust’s dermatology nurse
consultant. “We now have much closer links with the dermatology nurses, and we
are able to share and update knowledge much better. We’re hoping to develop a
formalised referral system, and there is going to be a meeting in September to
this end,” she adds.

Becoming
a nurse consultant, she believes, has not substantially changed her
relationship with her trust management – which was always good – or her
reputation within the trust, which, again, was always good. “They recognise OH
is there to help the managers, so they are usually appreciative that we are
there to help,” she says.

Perhaps
the biggest change for Daly has been moving from a role where the core function
of the job was the management of a single site to a combined clinical role
across a number of sites.

“This
has probably been my biggest hurdle. When I was just running one department, I
knew exactly what was going on because I was looking after it. Now I am giving
out expertise to, and working with, three different departments,” she explains.

“It
is much easier to work in a single department where you know everyone
intimately. I know of nurse consultants who have simply been drawn back into
the management structures,” she says.

She
has a clinical commitment – it is one of the requirements of being a nurse
consultant – but Daly is also keen to try to step back and look at the service
as a whole, with fresh eyes.

“I
need at least one day a week where I do clinical work, so I try to have a set
day, as it is very easy to slip back into just doing management things, and
find you have lost the focus of being a nurse consultant,” she says.

“You
need to question why you are doing certain parts of your practice. You may be
doing basic health screening, but is that right for the individual? Could we be
spending our time in a better way? Why are things being done this way?”

This
nurse consultant role brings with it extended responsibilities, too, both
within the trust and in the profession as a whole. Daly has found herself
working much more closely with the Royal College of Nursing (RCN), offering
advice and support on a wide range of areas.

“I
am able to give advice to other people in different areas. I hope people will
start to get to know me and will know they can come to me. I think it is
especially important for nurses who are working alone, as it is nice to know
there is someone you can call. It is an important part of my role as an
advocate for OH. Nottingham OH has always tried to do that to an extent, but
you have to do it while ensuring you do not let your own organisation suffer,”
she explains.

Good
examples of Daly and the team providing support include the SARS outbreak and
the debate over smallpox immunisation, when she worked closely with both her
trust and the relevant authorities to provide OH-based advice.

Another
issue has been forging ever-closer ties with local GPs. The relationship
between GPs and OH professionals when it comes to sickness absence is moving
inexorably closer, with many GPs even keen to pass sickness certification over
to OH nurses.

“If
GPs do not fully understand our role, and why should they, they cannot always
give the best advice and that is what we are trying to do,” Daly argues.

She
would like to see more clarity emerging about the role of OH, particularly in
relation to GPs. “From the doctor’s point of view, there has to be clarity
about what the role is and how it is going to evolve.”

But
her primary role has to be to her own team at Nottingham, acting as an OH guide
and mentor. Among her qualifications, Daly has a masters degree in education,
and passing on experience is, she considers, a primary function of any
effective nurse consultant.

“My
role is to ensure the team is happy and working to the best of its ability,”
she explains.

“Part
of that is helping other team members progress. I am trying to formalise the
training needs much more, so that when staff attend conferences and training,
they can provide me with feedback, so we can decide whether the organisation
should be changing practice. The feedback will also be passed on to the rest of
the team if appropriate. I organise monthly training sessions for all nurses,
and clerical staff can attend if content is suitable.

“It
is about getting the staff away and giving them time to study, but still making
sure it is done in an appropriate way and with an appropriate member of the
team.”

For
the year ahead, Daly says she would like to see some more OH nurse consultants
come into the frame. “The OH speciality is very different from some of the
other hospital-based nurse consultant roles, who have to deal with issues such
as bed allocation and waiting lists. So, it would be great to have someone else
to talk to in the OH field to bounce ideas off,” she says.

While
it may be lonely being the country’s only OH nurse consultant, it may not be
wholly surprising either. The fact an OH nurse consultant position was created
was in itself a message that, for the first time, clinical skills in OH were of
as much value as management skills when it came to career progression. It was
also a recognition of the increasing importance NHS managers are putting on the
health of the workforce, both that of the NHS and the people who come through the
door as patients.

Within
this, inevitably, there are issues of funding. Because OH nurse consultants
will, most likely, like Daly, have been nurse managers, appointing a nurse
consultant effectively means finding the funding for two new roles, because the
trust will still need a nurse manager. Maybe this is why the pay is nowhere
near the £45,000 often quoted.

Perhaps,
more importantly, though, there are issues of perception and education. What
sort of OH nurse do NHS trusts want? What sort of qualifications should they
have? What should be the extent of their role?

While
Daly may be blazing a trail, others are inevitably being more circumspect. “The
idea of an OH nurse consultant is still in its early days,” says Daly. “People
may be waiting to see what happens.”

What
is the role of a nurse consultant?


Nurse consultant posts, first announced in 1999, are designed to offer nurses
an alternative career track that does not mean they are forced to go into
management


They were created largely as a means of keeping experienced nurses in clinical
positions, but by and large have gone to nurses in ‘frontline’ and acute care
positions


Those filling such posts, which command a salary of up to £45,000, are expected
to be experienced practitioners with advanced educational qualifications


They are expected to combine expert practice with professional leadership
skills, consultancy, education, service development, research and evaluation


Posts must include a firm commitment to keeping 50 per cent of the time available
to work directly with patients


To get a nurse consultant, a local organisation has to make the case for the
post; a request that then goes up through the regional office to the Department
of Health, after which, if agreed, the post is advertised


The NHS Plan set a target of creating 1,000 nurse consultants by 2004

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