The OH profession’s remit is expanding, but many employers are unsure what it is all about. It is time to define that OH brand, says Karen Coomer.
Branding is a concept that is used to differentiate a service or product from that of a competitor. At one level, branding is about promoting products but it is also about a range of other things that include the image presented to the world; everyone from countries to political parties and organisations are encouraged to think of themselves as a brand.
Barwise (2009) describes this as “at its best caring, measuring and understanding how others see you and adapting what you do to take into account changes, without abandoning what you stand for. At its worst, it means putting a cynical gloss or spin on your product or actions to mislead or manipulate those you seek to exploit.”
It appears that brand equity is about trust, reputation and consistent performance to deliver to promised requirements – when this fails the value of the brand can fall. The difficulty with the value of branding is that it is intangible, therefore the decision on what to believe and the meaning of the brand is dependent on the brand values. An example of this can be seen in the car industry: Volvo = safety, Jaguar = classy, Ferrari = sport.
Brand behaviour becomes important in relation to how the organisation communicates and relates to stakeholders. However, unless a brand has a clear idea of the value it brings, and to whom, it will have difficulty making it stand for anything distinctive.
Occupational health nursing has gone through changes over the years and, alongside this, the brand values have changed. No longer is OH nursing confined to uniformed treatment-based nursing. The education, practice and focus of OH are now very different, but is the role clear to customers, other health professionals and even ourselves? Is there now confusion as to what OH stands for and where we should be heading – what is our brand value and, ultimately, our brand behaviours?
The iceberg model
The iceberg model has been applied to many ideas, from understanding Sigmund Freud, the founder of psychoanalysis, to organisational behaviour and marketing. The challenge is to seek understanding of the unseen drivers, which in turn influence the visible behaviour seen by all.
In the context of this article, the analytical iceberg model will be used to discuss the drivers that influence brand behaviours that are visible to OH stakeholders and the wider health community.
Beneath the surface
Self-image of OH
In the 1920s, a nurse was described as the following (Ashdown, 1927): “A good nurse must be punctual, good tempered, obedient and loyal to all rules as the foundation of her work. She must also be active, yet quiet and deft; methodical, reliable, careful, clean and neat; observant, intelligent, possessed of self-control, gentleness, tact, sympathy and common sense. She must be careful to respect professional etiquette, remembering what is due to those in authority; courteous in manner and guarded in her behaviour towards doctors.”
By contrast, in the 21st century, the Nursing & Midwifery Council Code (2008) under the standards of conduct, performance and ethics for nurses and midwives states: “As a registered nurse, midwife or specialist community public health nurse, you are personally accountable for your practice. In caring for patients and clients, you must:
- make the care of people your first concern, treating them as individuals and respecting their dignity;
- work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider communities;
- provide a high standard of practice and care at all times; and
- be open and honest, act with integrity and uphold the reputation of your profession.”
Social and cultural changes over the years have altered the way nurses are perceived. The female virtues of nursing have been replaced by the development of a profession with the attributes and behaviours that characterise a professional membership. In modern terms that is often balancing the tricky job of combining care and compassion with evidence-based practice, which is not always easy to do in performance-led cultures of many organisations.
So, in the broad arena of nursing, what is different about occupational health nursing? The stock answer has been to protect and promote the health of the working population (WHO, 2001).
However, in the past few years OH nursing has changed because of the social, political and economic value it now represents. It can be suggested that this has had an impact on the allocation of resources, role definition and sense of identity in OH nursing. It is a fundamental basis of the iceberg because without a strong consistent self-image it can appear that OH nursing lacks the confidence to explain clearly what we are, what we do and, more importantly, where we want to go in terms of contributing to the wider debate on workplace health. It influences the way we behave and the way in which others respond towards us. If we don’t have clarity of our worth then there is the risk that our customers, stakeholders and employers will simply go elsewhere.
So, who is our voice now? The Royal College of Nursing (RCN) was always one of the windows in which our sense of identification and coherent voice was represented. Since the demise of the RCN, OH forums and the RCN OH specialist adviser, is this the case anymore? Maybe there is great work going on in the newly formed Public Health Forum, but where is the evidence – how many of us now feel truly engaged and informed about how the RCN represents the OH nurse profession?
The Association of Occupational Health Nurse Practitioners (AOHNP) was formed in 1992 to promote and represent occupational health nursing – but does this have the political clout of the RCN and consequent public profile? It is primarily a networking/support group managed by volunteers and a part-time administrator. Therefore, its success will be evident only if all OH nurses (not just the volunteers) actively engage in raising the profile so stakeholders know where to go when the need to work collaboratively with OH nursing becomes apparent.
A new approach to OH
Or is it time for a new approach? An Academy of Occupational Health has been mooted (Atwell et al, 2010) and there seems to be some sense in a body that represents the standards and coordinates the work of occupational health for the good of all – this could be a good opportunity to define all the key players in the speciality of occupational health and rebrand for the future.
One website plus one source of information equals a consistent message. However, there would need to be commitment from all parties involved that the image and skills of each profession are valued and, controversially, historical barriers between doctors and nurses addressed to go forward as a coalition on equal terms.
OH values and beliefs
Anyone can call themselves a wellbeing or occupational health adviser but the word nurse is protected by regulation – it is a protected title. Our regulatory body determines our professional ethics and values in a code of professional conduct (NMC, 2008). These guide our clinical practice and provide us with a shared sense of common values, beliefs and boundaries in the body of nursing. However, in OH nursing the psychological contract with our profession can, at times, be at odds with the expectations of the organisations in which we work. Working in this way requires a confidence in our ability not to be influenced, coerced or manipulated into working unprofessionally.
It is our shared professional values and beliefs that make us unique – and there is evidence that values and beliefs will be an important aspect of long-term sustainable growth in organisations.
In 2009, the Chartered Institute for Personnel and Development (CIPD) embarked on research – Time for change – towards a next generation for HR. This stimulated debate on how HR will develop in the next five to 10 years. One of the outcomes identified was the way in which HR is becoming an insight-driven discipline. This is going beyond employee engagement to building truly authentic organisations that operate with trust and transparency in relation to an adult culture. If HR is to become the guardian of ethical practice in organisations – as a brand concept we can, and should, be able to contribute by not only focusing on the economic value of our brand but also social and ethical outcomes.
Skills, competency, knowledge
Our OH skills, competency and knowledge are key factors to our brand. Unless we can deliver high-quality standards to identify and prevent ill health, and promote health in the workplace we demonstrate little value to our customers. It is therefore imperative that the foundation of occupational health education is fit for purpose in the workplace.
The NMC (2004) Standards of proficiency for specialist community public health nurses have barriers that seem at odds with the real world in which OH students, practice teachers and educators work. The reality in many organisations is that a business case has to be made for nurses to complete these courses and this is difficult when return on investment is a consideration – particularly in these difficult economic times.
The sponsorship of these degrees, the availability of practice teachers and, in particular, the requirement of supernumerary status are all difficulties that may not be as apparent in other NHS public health roles. In the private sector, comparisons are not made with health visitors, sexual health advisers and infection control nurses, they are compared to professional courses such as accountancy, HR and engineering that do not have the operational barriers the NMC insists are essential for standards of proficiency.
Contemporary OH practice
In addition, the essential business skills occupational health nurses need to meet contemporary occupational health practice are sometimes not reflected in the courses offered. Presumably it is simply not cost-effective for universities to offer skills that are not a generic requirement for all public-health nurses. This leads to a lost opportunity to educate occupational health nurses to standards where they are fit for future market needs unless they do a specific OH course that is not accredited to the third (SCPHN) part of the NMC register.
It could, therefore, be argued that gaining knowledge in disciplines aligned to ours – such as occupational hygiene, safety, organisational psychology, HR and management practice – may, in the longer term, be much more useful than a generic course with other nursing disciplines.
What are occupational health nursing’s motivational drivers? Why are we attracted to the discipline of occupational health? Does the social and political landscape change what we deliver and affect our motivation?
The fundamentals of occupational health nursing are outlined in the WHO document The role of the occupational health nurse in workplace health management (WHO, 2001). It states that
“occupational health nurses can make a major contribution to the sustainable development, improved competitiveness, job security and increased profit in enterprises and communities by addressing those factors that are related to the health of the working population”.
Times, however, have changed and the rules of engagement in occupational health have therefore become different. This is partly because of:
- the increased focus on wellness;
- delegation of health surveillance and other technical duties to non-nurses;
- the increase in remote case management;
- the demise of the generic occupational health nursing role to measurable occupational health activities – outsourcing has become the dominant business model;
- the introduction of fit notes; and
- competition from other non-nurse disciplines such as health and safety advisers, rehabilitation case managers and disability advisers.
All the above can be perceived as a positive step as different opportunities will inevitably arise to develop the field of occupational health. However, our initial motivating factors for entering OH nursing may therefore also have to change. Work motivation and job performance are not the same thing. For example, remote case management may achieve performance targets, and working from an OH call centre may be more cost-efficient, but if the motivating factor is a varied and meaningful job then working in such a defined way could lead to low job satisfaction.
The writer John le Carre once said: “A desk is a dangerous place from which to view the world.” In occupational health having a presence in the workplace is often perceived by employees and managers as understanding the issues related to the workplace, and our job is to interpret the identified issues into the language and practice that influences organisational and behavioural health change.
The principles of workplace risk assessment, hazard identification and control strategies are necessary to understand the relationship between health and work and prevent occupational ill health. It is crucial that occupational health practice does not become eclipsed by a wellness agenda that focuses solely on health promotion and wellbeing programmes. If this happens, OH nurses could run the risk of feeling and becoming increasingly deskilled and lose the unique identifier.
Tip of the iceberg
Back to the question – how do other people see OH nursing? From a behavioural perspective this is going to be largely dependent on the environment and culture in which we work. It will also depend on how we value our contribution and are able to market this effectively. For each of us, the unseen drivers of self-image, skills, competency and knowledge and our values and beliefs will be different depending where we are on the professional journey of OH.
This will affect and change our overall motivation to practise OH. It is therefore important that we have the self awareness and confidence to be ambassadors for our discipline in a clear way, understood by all, and with the knowledge of where we can, and do, make a difference.
What’s in store for the OH brand?
The future of the OH brand depends on the environmental, political and economic factors of the times. This means that OH will always be changing and in any market-driven economy there will be winners and losers. We have choices to make. We can observe the changes, stand back and let them happen. We can adapt as best we can on an individual level. Or we can collectively understand the changes and position our brand to innovate and progress occupational health nursing together as a profession.
That choice is ours.
Karen Coomer is an occupational health nurse practitioner and director at KC Business Health.
Ashdown A, (1927). A Complete System of Nursing. Waverley Book Company.
Atwell, C & R Preece, Do we need a Faculty of Occupational Health? Occupational Health (at work). February/March 10. Vol.06/5.
Barwise P, (2009). Brands and Branding. In Clifton, R (Eds). The Economist. Profile Books.
Nursing & Midwifery Council (2008). The Code: Standards of conduct, performance and ethics for nurses and midwives.
Nursing & Midwifery Council (2004). Standards of Proficiency for Specialist Community Public Health Nurses.
Sears L. (2009). Time for a change – Towards a next generation for HR, CIPD.
WHO (2001). The Role of the Occupational Health Nurse in Workplace Health Management. WHO Regional Office for Europe.