Education by degrees

is the most appropriate qualification for an occupational  health nurse and does it match what
employers, public or private, really want? 
By Nic Paton

In recent years, the pressure on occupational health nurses to be qualified
to degree level has intensified.

But according to Dr Alan Feest, course director and senior lecturer in
occupational health nursing at the University of Bristol, there remains a
discrepancy between what the profession feels should be the yardstick for
excellence and what some employers actually want from their OH team.

"I have heard employers say they do not interview people who have
specialist practitioner status because they are not prepared to pay specialist
practitioner wages to someone who they will then have to train," he says.

What do employers want?

It is this sort of attitude that goes to the heart of the education debate
in occupational health – what is the most appropriate qualification for OH
nurses and does it match what employers – public or private – really want?

May Ryan, lecturer in occupational health and leader of the pathway for
occupational health nursing at Brunel University, argues that, while the degree
or postgraduate-level specialist practitioner qualification remains the
professional benchmark, the reality is that, for some people, a diploma or
lesser qualification is adequate.

"A number of people will want nursing specialist practitioner’s
qualifications but there will be others who will want to go for a course that
offers a more discrete qualification," she says.

"Employers will make decisions in terms of who they are going to want
to take on. A specialist practitioner qualification is not a mandatory

Ryan, who is also a member of the Association of Occupational Health Nurse Educators,
adds that a diploma-level qualification may, for instance, be favoured by
employers who already have a comprehensive health team in place. "They may
also suit people who feel they do not want to sit at degree level," she

Dorothy Ferguson, MSC coordinator at Glasgow Caledonian University, concurs.
"If you want a professional qualification in occupational health nursing,
then you have to look at the specialist practitioner qualification. And you
have to make sure the course you are doing is recognised by the UKCC," she

Specialist practitioner courses

A specialist practitioner course has to be 50 per cent theory and 50 per
cent practice, Ferguson adds. In Scotland students do not have the option of a
diploma course because no-one offers occupational health at that level. An
increasing number of students are graduates anyway.

While, according to Bristol’s Feest, scepticism remains among employers
about the relevance of a professional qualification within the workplace, this
should in no way put OH practitioners off striving to attain professional

"Everybody should try to go for the degree. We have had people who have
been suppressed all their working lives. One of my best students came to us at
the age of 52 after spending 25 years working as an OH nurse," he says.

"When she came to us she was a nervous, shaking chain smoker. In the
first week she was angry, in the second week she was quiet and by the third
week she was asking questions. She has now worked through a whole range of
senior positions."

The university offers a BSc Honours degree in occupational health nursing,
based in the engineering faculty because "it is run by people who
understand the technology", although the course is registered with the
medical faculty.

The two-year residential course is taught entirely by practising
practitioners, and includes an assessment of the student’s workplace and has a
Nebosh component.

Says Feest: "We have a facility here that allows us to give people a
pass degree or a diploma, but they enter into the degree course."

"Some people are not interested in getting specialist practitioner
status. It is really only relevant to those in the NHS. The English National
Board [the statutory body in England that ensures programmes meet UKCC standards]
is very hospital orientated, but most OH nurses do not work in the NHS,"
he contends.

"Most of the large institutions offer extensive and large nursing
courses and they have to fit OH nurses into that. We just do OH nursing. It
covers the core syllabus but entirely from the OH point of view.

"Occupational health has a special client base, problems of
confidentiality and other things. It is really inappropriate to lob it in with
a school of nurses," says Feest.

In the past, practitioners have often turned to the ENB for careers advice
or information on the best choice of course. Technically, according to Tom
Langlands, director of primary health care nursing education at the ENB, the
board has now passed its careers advisory role to the NHS Careers Advisory
Service in Bristol.

But he adds, "Because of the network the board has, and its links with
higher education, very often we are able to respond to individual

Course information

The ENB publishes a circular outlining where courses are located, including
a brief outline of what each individual programme is about. While it is mostly
aimed at university departments, it is available to the public. The board also
has a publications department, where information on specialist practitioner standards
can be obtained.

Whether students are in Scotland or the rest of the country, geography is
likely to play an important part in helping to decide where to study, says
Caledonian’s Ferguson. Speaking to former students who have already done a
course should also be a crucial part of the decision-making process.

"From the basic education point of view, the course you choose will
probably be dictated by where you live and what is available locally. For most
people, gaining access to a programme is a question of whether they can
physically get there," she says.

This is particularly relevant when it comes to day release courses, although
it is less of an issue on residential courses. Yet, if the course is right,
students will invariably find a way of getting there, adds Brunel’s Ryan.

"People need to enquire of the colleges and to discuss the times and
the ways in which they can access the courses available.

Distance learning

The option of studying through distance learning has so far been limited – with
only Aberdeen University offering such a course. But this may be about to
change. Graham Johnson, occupational health nurse at Interact Health
Management, formerly MTL Medical Services, is in the final stages of linking up
with a university in the north-west of England to offer a BA Honours distance
learning course in Occupational Health and Safety Management – which will lead
to a specialist practitioner qualification in OH nursing including a Nebosh

"We feel that that there is a market ready for tapping into. It is
often difficult for individuals to get the day release they need," he

He hopes to have the course up and running from October. "Government
strategy appears to have put occupational health nursing on the map at last.
Now our education needs to catch up. The more courses there are and the more
modes available the better," he says.

Financial benefits

OH practitioners also need to think carefully what they may be giving up if
they discount the option of a specialist practitioner qualification, Johnson
argues. Salary levels can differ markedly between pre- and post-specialist
practitioner qualified nurses, with the latter expecting to make about £30,000
or more compared with about £10,000 less for the former.

The cost of the course itself is unlikely to be an issue, as most employers
can be expected to foot the bill, recognising the benefit that will come their
way from having a professionally qualified occupational health nurse on board.

Would-be students should turn to the ENB, speak to universities and
colleagues and read journals such as Occupational Health or Nursing Times,
Johnson advises.

And, according to Sue Lamb, recruitment and development manager at OH Recruitment,
employers looking to recruit OH professionals do still generally want nurses
with a specialist practitioner qualification.

Some are unsure of the layers of qualifications and all the different
degrees, but in the end what the employer really wants is a course that has
been recognised by the UKCC and ENB, adds Lamb.

A pure occupational health qualification is a luxury few organisations can
afford these days, and OH nurses would be well advised to obtain a parallel
health and safety qualification, asserts Lily Lim, project leader for the BSc
and MSc occupational health and safety degree course at Middlesex University.

"If you are studying for a qualification in safety, then it seems very
logical that both health and safety and occupational health should be part of
it," she says.

Pure OH courses are able to provide greater clinical depth and knowledge,
she concedes, but that can now often be provided through practice nurses in GP
surgeries and OH nurses with specialist clinical knowledge.

The Association of Occupational Health Nurse Educators, of which Lim is
chairwoman, has been collating a database of all the courses available. This is
due to be published on the internet but, until then, Lim has said he is happy
to field individual queries by e-mail.

The old-fashioned route of learning your OH skills on the job can still
apply, albeit now in a much more limited form, argues Ryan.

"People often gain access to occupational health by simply going into
departments, where they are usually given a lot of supervision and training, so
learning on the job is still an option."

But, according to the ENB’s Langlands, where the specialist practitioner
qualification comes into its own is that it gives nurses greater clinical
knowledge and the ability to attain a higher level of responsibility.

"The specialist practitioner qualification is a leadership preparation
for the occupational health nurse," he says. "It is not a requirement
for anyone to be a specialist practitioner. What you want depends on what your
employer wants you to do or what you are seeking from your career. Your
qualification is about what competencies you need for that role," he

Bristol University OH course:

English National Board publications department: 020-7391 6314

Lily Lim: l.lim@mdx

Case study: Bristol University

Carol Standish, an occupational
health nursing officer at Akcros Chemicals in Manchester, is due to finish a
BSC Honours degree at Bristol University in occupational health nursing under
Dr Alan Feest in a matter of weeks. But getting to this point was an uphill

Standish originally enrolled on a diploma course in community
health nursing at the University of Manchester – the nearest college to her
home – with the intention of then going on to a degree course and obtaining
specialist practitioner status.

On the Manchester course, she found herself sitting in lectures
attended by 80 other students, mostly midwives, community psychiatric nurses
and district nurses. "Particular parts of it I found relevant, but I found
it difficult to apply it to my work," she says.

Also, as the day release course was based on a modular
structure and not all her modules fell on the same day, she was forced to take
more time off from her employer than she had anticipated. Then, to cap it all,
just before she completed the course, the ENB removed its training

"I had signed up for four years and now my plans were
scuppered. My options seemed to be Leeds, Sheffield or Wolverhampton,"
says Standish.

But she saw the residential course in Bristol advertised in
Occupational Health. "It was much more relevant in terms of my
organisation than any of the others that I had seen," she says.

"If you go into an OH department, you have got to know the
law and health and safety law in particular. It is not like nursing on a ward.
Sometimes in occupational health you are on your own."

Case study: Caledonian University

Proximity to home and work was the
biggest selling point for occupational health nurse Tracy McFall when it came
to choosing a course in 1998. But McFall, an OH nurse with IBM in Greenock,
also chose Caledonian University’s occupational health nursing degree course
"because I rather liked its approach to OH, which takes in quite a public
health agenda", she says.

McFall found studying alongside community nurses, district
nurses and community psychiatric nurses a very positive experience, particularly
in helping her understand how the different health professionals meshed in the
community, and could be used in the workforce. It also helped in building up

"I am particularly interested in how public health can
link into occupational health strategy. What can OH nurses do to link in with
Government strategy, for instance?"

McFall, who has just had a baby, is now working on a PhD
looking at the role of occupational health nursing in the prevention and
detection of coronary heart disease in the workplace.

She says, "I found the course really beneficial. I used
the community psychiatric team in my workplace. If I had not studied with the
team I may not have known that resource was there.

"I think the difficulty with occupational health is that
it sometimes operates in isolation. We are not very good at telling other
health professionals what we do, it is about working in collaboration."

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