New to Occupational Health (OH) and struggling in an isolated role? Need advice but worried you might ask a stupid question? Support and advice is now available through Occupational Health journal.
No question is too simple and no query will be considered invalid. All queries will be reviewed and answered anonymously each month in the new “Ask OH” column that offers an opportunity to share problems and to learn.
The column offers practical advice from a qualified, experienced and reliable senior practitioner. Links to relevant documents and online resources will be provided to help you on your way.
What have you got to lose?
Email your questions to: OH.Editor@rbi.co.uk
I wanted some advice as I perform forklift truck medicals and recently I advised a man who had raised blood pressure of 186/105. I gave him his results and then set a review to repeat his blood pressure two weeks later. It remained at similar levels and so I gave him health advice and then referred him to discuss the issue with his GP. His GP told him “it’s not that bad” and advised that he was fit for work and made no attempt to monitor or follow up.
In my opinion the worker is, at this stage, unfit for his role due to risk. I have advised his employer of this but they are reluctant to follow my advice. What should I do?
I can understand your dilemma as OH advisers have both a professional duty under the Nursing and Midwifery Council (NMC) code of conduct and a duty to the employer to advise on health and safety risks under the Health and Safety Executive (HSE). However you have clearly offered the employee advice, which I would hope has been documented, and you have given formal feedback to the employer.
I suggest you try to educate the employer by offering a clear rationale. This could be achieved by sending the employer a link to the DVLA guidance on which you have based your opinion. You can also alert the employer to the HSE guidance for forklift truck medicals. The guidance identifies the requirement in the HSE’s rider-operated lift trucks Approved Code of Practice (ACOP) for a driver to be reasonably fit. As the employee is likely to be concerned about losing their job, the OH adviser has an opportunity to gain their cooperation to monitor their blood pressure and try to encourage them to adopt lifestyle changes. The extent to which this is possible will depend on the workplace culture, and the longer you are established in a role, the more likely the employee is to trust you. If you follow this advice then you will have fulfilled your moral, professional and legal obligations.
A lady who works in a contact centre tells me that she has low back pain and that the cause is her chair. I have assessed her at work and she has poor posture and is overweight. I have advised her on set-up, micro-breaks and stretches and the importance of good practice. I also discussed the impact of being overweight on her back. The chair is fit for purpose so what else can I do?
Oh dear, this is so common isn’t it? The amount of times that people expect OH advisers to set up a person’s chair because “no-one told me how” is frustrating, especially when many have instructions attached (if only employees would read them). You sound experienced and I expect you have attended training on Display Screen Equipment assessments. I would also suggest using the national Fitback specialised manual handling training available for many common musculoskeletal issues, including backs and work-related upper limb disorders. Knowledge of the flag system used to identify barriers to return to work, for example, will help dispel myths regarding backs and really gives confidence to your practice.
Sadly the reality is that many people would rather blame the equipment than consider their own responsibility, which leads to the purchase of unnecessary specialised chairs and to “chair envy”, which is very infectious. Of course some individuals do have more serious musculoskeletal conditions, but they are generally in the minority and, if the correct advice is adopted, then the symptoms tend to settle. The Back Care charity website has useful information about office workers along with exercise sheets.
It sounds like you have offered all the correct advice but the employee needs to follow your advice and take responsibility for her health. As long as you ensure that the employer supports good practice and gives employees a reasonable workload and adequate breaks, you have managed this situation well and fulfilled your advisory role.
I work in isolation and I am finding myself under pressure from HR to answer questions that are not appropriate when I send feedback on management referrals. At times I also feel pressured by employees to take their side. I don’t want to feel like I don’t know what I am doing but need someone to share and reflect on my practice. What can I do?
First, can I say you are not the only one. I think if we put 100 occupational health advisers (OHAs) in a room and asked them to write down what the biggest challenge is for them, a large proportion would identify isolation and feeling that they can’t please everyone as a regular problem. While many NHS OH nurses work in teams, the majority of OHAs work alone. Some work for providers and some independently. I would start by joining your local OH group. Mine covers the South-West and has a great annual conference. Here is another link to groups that might be in your area: www.ohrecruitment.co.uk/localohgroups. You could also join the OH online forum JISCmail, which is a mine of information. Don’t forget that there are OH groups on Facebook and LinkedIn. Once you are on board you can dip in and out and ask questions and learn just by reading threads. Common problems are shared and advice given freely. If you are recently qualified, then why not keep an email group going with those who were on your course, as many may be needing support. OH is isolating and, at times, not for the faint hearted, but, equally, OHAs are very giving and if you just buddy up with one person it will give you the confidence to reflect on cases and realise you’re doing a good job.