Caring for healthcare staff

ANHONS recently held a conference covering issues such as sickness certification programmes, the Agenda for Change, and H&S in the NHS. Eliza O’Driscoll reports

More than 150 delegates attended the second Association of NHS Occupational Health Nurses (ANHONS) Conference at the National Motorcycle Museum on 21 April.

Dr Ian Blair, a consultant for communicable disease control, and director of the Hampshire and Isle of Wight Health Protection Unit, presented a fascinating and enlightening account of the latest updates in tuberculosis (TB) surveillance.

TB cases have not only plateaued, but started to creep up again and more than 6,000 cases a year are now being reported. London alone has 40,000-100,000 cases a year, approaching the rate used to define a high incidence country.

Blair said TB is very unevenly spread according to ethnic origin and place of birth, with those born abroad, particularly in the Indian subcontinent and Africa, having a much higher rate than people born in the UK. This does not mean that screening on arrival is a good way of picking up cases however, as the majority develop within five years of arriving in Britain.

New typing methods have allowed epidemiologists to compare strains of TB nationally and internationally, and have shown up clusters of cases in various locations. This new typing allows transmission to be identified more precisely, as cases can be linked and also excluded: for example, if you have a healthcare worker with TB, it can now be shown that transmission to another person has definitely not come from that source.

Blair warned OH nurses that there has been a two-fold increase in TB risk among healthcare workers, mainly due to more opportunities for exposure, and he offered some advice on screening. The current guidelines are under review by NICE (National Institute for Clinical Excellence) and draft guidelines are due towards the end of the year.

Sickness certification

Gail Cotton, head of occupational health and safety for Leicestershire Fire & Rescue Service, reported on the Midlands sickness certification pilots. These pilot studies, taking place around the country, have been commissioned by the Department of Health and the Department for Work and Pensions to explore alternative models to the current system of sickness certification. Cotton said that nobody – employees, employers, certifying doctors or OH professionals – is well-served by the current system of self-certification for seven days followed by a visit to the GP for a Med 3 certificate.

One of the biggest reasons for challenging the system is the scale of abuse – of the 22 million requests that doctors get for sicknotes each year, up to 9 million are suspicious, and non-genuine sickness absence is believed to account for 25 million days a year, up to 15% of all absence.

The Midlands pilot involves three different models:

  • Local/in-house occupational health adviser (OHA) delivery
  • Remote OHA based at a call centre
  • External OHA and sickness management provider (peripatetic).

The pilot went live in February and its objectives are five-fold:

  • To determine any changes in sickness absence rates
  • To identify any changes in GP workload
  • To estimate any changes in costs of a nurse-led system
  • To test the acceptability and take up of a nurse-led system to employers, employees and other stakeholders
  • To evaluate the implementation of a nurse-led certification system.

All the nurses involved in the pilots needed to have a consistent approach, so they underwent a two-day training course at Warwick University.1
Cotton was clear that “it would be good for OH if it [sickness certification] does end up coming our way,” although she admitted that it was still unclear “how the financial side is going to impact”.

Career framework

Carol Bannister, OH adviser at the RCN, discussed the recently-published career and competency frameworks from the RCN, which have taken five years to develop. She said common aims within a team help it to be more effective. She says it is time the profession said what we have to do and when to do it.

The search for competencies started with a values clarification exercise: what do OH nursing professionals and stakeholders say their values are? What is the ultimate purpose of OH nursing and how can it be achieved?

A series of questions was put to elicit beliefs about OH nursing. There were more than 800 responses to the values clarification exercise. It was interesting that there were more responses from OH nurses than had been the case with any other area of the nursing profession.

The response led to the formation of competencies and standards for the profession, which, said Bannister, are useful for individuals to identify their skills and knowledge acquisitions and pinpoint any gaps. She sees them as a template for career development that will enable individual career progression and accreditation.

Stress management

Martin Davies, a trained psychiatric nurse who delivers courses on stress management to healthcare staff, gave an interesting and refreshing presentation on the stages of stress, illustrated with his own extremely funny cartoons.

He identified a new and worrying virus spreading through society – the stress virus, otherwise known as ‘joyus strangulatus’, because, as he pointed out, if someone is pushed too far, the sense of humour is the first thing to go. As nurses, he told the audience, we focus on the patient, but what about us?

Davies defined three core attributes necessary for good workplace health:

  • Interest in what you do
  • Pleasure – you have to enjoy at least some of your work
  • Achievement – you need to feel that what you are doing is important.

When you lose these you start to feel helpless and hopeless, leading to stress burnout, which has three stages. Stage one is overload, where you are juggling and plate-spinning to keep going. People at stage two are emotionally and behaviourally out of control, overreacting and indulging in what Davies calls symbolic behaviour. At stage three, the individual is barely functioning and has become rigid and inflexible with rudeness a common symptom, as the person has ceased to care about the feelings of others.

Bloodborne viruses

Dr Elizabeth Boxall, consultant clinical scientist with the Health Protection Agency, and Jane Aston, senior research nurse and surveillance co-ordinator of occupational exposure to bloodborne viruses in healthcare workers at the HPA, gave an update on the topic of hepatitis B and C in healthcare workers.

There is a growing concern, says Boxall, that while the expected risk is of transmission from patients to doctors, there is also now evidence of transmission from doctors to patients.

There were 12 outbreaks of hepatitis B between 1976 and 1990 associated with healthcare staff, and the policy now is to restrict healthcare workers with more than 1,000 copies of HBV DNA per ml from performing exposure prone procedures (EPPs). Those with fewer than 1,000 copies per ml are allowed to continue subject to annual retesting.

For hepatitis C, there have been five transmission events from healthcare workers to patients with transmission occurring to 15 patients. Since 2002, all healthcare workers who test positive for HCV RNA are banned from carrying out exposure prone procedures and those who are intending to do them in their future careers are tested and stopped from further training if positive. They may return following treatment with antiviral agents if they have been clear for six months. No one should be allowed to do EPPs who refuses to be tested.

The conference also heard an update on the Back in Work scheme2 from Julian Topping, of the NHS Employers organisation, a paper on the Ergonomic Aspects of Workstation Assessment from Dr Joanne Crawford of the University of Birmingham, and a vaccination update from Simon Oakley of Sanofi Pasteur MSD.

1. Sicknote Pilots put to the test, Occupational Health Vol: 57 No 1 16-18
2. Raising a glass to OH, Occupational Health Vol 57 No 4 14-16

Calling all OH nurses working in the NHS

Researchers based at the Institute of Psychiatry, King’s College, London, are undertaking a study to investigate service provision to NHS healthcare professionals who have substance misuse problems (Ethics 210/03). This PhD investigation involves the completion of an anonymous postal questionnaire, which takes approximately 20 minutes, supported by the Association of NHS Occupational Health Nurses (ANHONS).

NHS OH nurses play a pivotal role in the management and organisation of care for this group. This study aims to identify the clinical experience, knowledge and attitudes of OH nurses, as well as the policies of the organisations they work for.

The results of this work will enable the development of targeted training programmes for OH professionals. For this goal to be attained, a significant proportion of NHS OH nurses must participate – so we need your help! The results will be presented in 2006 at the ANHONS national conference. If are interested in helping, please contact Samantha Gross at or on 020 7346 8926. You will receive a £5 voucher for your time.

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