Evidence-based occupational health is an absent speciality

Finding evidence-based occupational health (OH) nursing is like the quest for the Holy Grail. You want to believe it exists, but suspect that the quest will be more like Monty Python than Indiana Jones.


Lack of evidence


I see very little to suggest that occupational health nurses base their practice on evidence. I see next to no primary research published by OH nurses (OHNs) in the UK (even those in academic appointments). I see lots of OHNs doing postgraduate degrees, but rarely find they’ve published their dissertation research in peer-reviewed journals. As much time at OH nursing conferences seems to be devoted to commercial providers promoting their latest ‘cure all’ under a thin veil, as is devoted to nursing research. I can’t think of many examples where OHNs have systematically reviewed an important OH nursing issue.


Although many OHNs will have trained before the concept of evidence-based practice became established, I’ve never seen a ‘study day’ addressing evidence-based OH nursing practice or research methods. I suspect that event organisers know that a case study of a wellness programme is more likely to put bums on seats than one on primary research. The unhappy conclusion is that OH nurses are neither interested in evidence-based practice, nor equipped to deliver this.


Lack of engagement


OH nurses don’t have to rely on producing and analysing the evidence for themselves. They can do it in collaboration with others, but there’s little indication that they are doing this. Very few OH nurses comment on emerging evidence-based guidelines from the NHS Plus OH Clinical Effectiveness Unit EU (OHCEU) and the National Institute for Health and Clinical Effectiveness (NICE). Many will argue that they didn’t know that consultation was under way, but that’s not an excuse. Trying to base practice on evidence is an active process. It is nonsense for professional nurses in specialist roles to expect to be spoon-fed.


A number of the major projects from NICE and OHCEU have begun to deliver. How many OH nurses have read the consultation drafts? How many have commented? How many have engaged with nursing representatives on guideline development and steering groups? The answers to these questions do not put OH nursing in a good light. They don’t portray an image of leadership of the important issues OHNs tackle every day.


Lack of input


The biggest NICE guideline development group has just concluded its work. This group didn’t tackle an expensive cancer drug or a new miracle cure for heart disease – it tackled an issue at the heart of occupational health: long-term sickness absence and incapacity. Launched on 24 March, the conclusions may not be earth-shattering, but they are based on the best available evidence. The new guideline will become the single most important measure of appropriate practice in every legal test. It will be the bedrock for the future research that will improve the evidence base for a revision in the next three to five years.


Nursing input into its production has been limited. OH nurses have commented on consultation drafts, but the nursing representative on the group resigned due to work demands. However, that shouldn’t matter now. What matters is that all nurses who consider themselves OH specialists read it, digest it, and practise it. This, of all guidelines, needs to be the one that gets all OH nurses who haven’t yet embraced evidence-based practice out of the starting blocks. After this, the other guidelines from NICE and OHCEU deserve time and action too.


OH nurses must step up a gear and begin to practise with the specialism and professionalism that their title suggests.


Dr Richard Preece is a consultant OH physician.

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