A survey by the Faculty of Occupational Health Nursing published in September shows OH nurses have an appetite for a representative body setting standards for the profession. But many questions still need to be answered. Nic Paton reports.
It’s now seven years since the Royal College of Nursing (RCN) wound up its Society for Occupational Health Nursing in 2009, and 12 years since the Nursing & Midwifery Council (NMC) consolidated and relaunched its Nursing Register in 2004. The latter process brought occupational health nurses into a new (part 3) register for Specialist Community Public Health Nurses.
During that time, occupational health nurses have, by and large, just quietly got on with their job of looking after the health and wellbeing of the UK’s working-age population. But that doesn’t mean there has not been a niggling, gnawing sense of being ignored, not listened to and misunderstood by the wider nursing and healthcare community, particularly the NMC and the RCN.
To that end, it is perhaps not surprising that a survey of the profession’s views, carried out in the spring and published in October 2016, on the appetite for better professional representation – in particular, the creation of a new professional body, a Faculty of Occupational Health Nursing (FOHN) – struck something of a chord.
Indeed, as one respondent to the survey tellingly put it: “The NMC does not support OH practitioners, the RCN is a toothless lion and there is nothing for me to tap into to support my practice.”
The nationwide survey by the FOHN Development Group OH research and publishing group The At Work Partnership took in the views of 1,429 OH nurses – a large response rate for what is still a relatively small profession. In fact, it is believed to have been the largest study of OH nurses ever carried out in the UK.
The survey headlines certainly made striking and revealing reading. They include the following:
- Just 17% nurses currently feel “represented” by an occupational health body.
- Only 44% say they feel “professionally supported” at work.
- Most do not belong to a dedicated OH body or association, even though the vast majority (93%) are members of the RCN.
- Almost nine out of 10 (87%) feel a “Faculty of Occupational Health Nursing” (or whatever final name is decided upon) will benefit the future of OH nursing.
- Three out of four (74%) say they would join a FOHN; however, one in four are undecided, with the cost of faculty membership an important consideration.
“I felt it showed there is genuine enthusiasm for the notion of a faculty, which was really good news,” says Jo Berriman, leader of the FOHN Development Group.
“The sample size was terrific, although it was of course only part of those on the SCPHN-OH register and part of the overall total of nurses working within occupational health. But what it gave us is a green light to go ahead with our plans to create a faculty, to launch in 2018. However, the survey findings may mean we also need to rethink our original plans.”
They want a voice and they feel that is something they have lost over recent years. They want a degree of self-determination; they want leadership and for the profession to have a clear direction for the future.’
Jo Berriman, leader of the FOHN Development Group
Why is that? Well, because the survey findings also threw up an array of questions to ponder. What should be the role and extent of this new faculty’s “representation”? What should it look like? If set up as a member-based body, what would be a realistic fee?
Then there is the question of how any new faculty will be expected to engage and collaborate with existing (and to some extent, potentially overlapping) OH organisations, notably the Association of Occupational Health Nurse Practitioners (AOHNP) and the National School of Occupational Health.
The first of these questions – what should “representation” actually mean in this context – goes to the heart of what the faculty will, and should, be about, says Berriman. It was clear from the survey that many nurses, even if already members of bodies such as the RCN, AOHNP, the Society of Occupational Medicine (SOM) or others, still do not feel fully represented.
Should “representation” therefore mean FOHN having a regulatory/registration role, in effect replacing the NMC? Or are we just talking more about standard setting (both in education and practice)?
But could this then mean FOHN actively accrediting educational courses (and by implication, having the power to say some courses, even NMC-accredited ones, are not up to scratch from an OH-perspective)? Or should representation mean some form of quasi-trade-union-style organisation that offers a range of member benefits, such as subsidised indemnity insurance and just “fighting our corner” (so potentially treading on the toes of the RCN)?
While the research did look at areas such as an appetite for indemnity insurance, Berriman, for one, is clear this is not a route the new faculty now expects to go down. And the idea of it replacing the NMC as a new regulator specifically for OH is also a non-starter, however appealing that might seem to grass-roots practitioners.
“One thing that was clear from the survey is there is probably no point in us trying to offer insurance. The survey showed there was little support for us doing that and so, no matter what happens, I think that is definitely off the list. I also can’t see us becoming, in effect, a trade union,” she points out.
“From the qualitative comments made to accompany the survey, it was also clear many nurses have different ideas as to what ‘representation’ means. Some thought it could mean us taking on the role of the NMC in the future. But us becoming a regulator? That is never going to happen, not least because it would require parliamentary approval,” Berriman emphasises.
“However, that aside, one of the very strong messages you can take away from this survey is that OH nurses want a voice, and I think that is almost more important than ‘representation’ in the regulatory sense.
“They want a voice and they feel that is something they have lost over recent years. They want a degree of self-determination, leadership and for the profession to have a clear direction for the future. They also want an organisation to represent the speciality and have influence.
“We are not going to be replicating the role of the NMC; it is more about advocacy really. OH nurses feel they have lost some professional standing in recent years. Occupational health is often not a well-understood specialism,” Berriman adds.
What others say about the FOHN survey
Dr Richard Heron, president of the Faculty of Occupational Medicine (FOM)
“What I think we will see coming out from this emerging faculty is a role for setting standards and defining the curricula by which competence is judged.
“It will be about providing authoritative, relevant guidance; about validating the OH competence of nurses coming through, just as FOM does for specialist doctors or GPs.
“I would be delighted to see FOHN becoming successful. It is potentially another key stage in terms of driving up the quality of occupational health services and making them available to the working-age population of this country.”
Diana Kloss, chairman, Council for Work and Health
“There has been dissatisfaction for some time about the combining of training in occupational health with health visitors and school nurses.
“Now that occupational health services have become a multidisciplinary workforce, it is thought preferable to create specialist multidisciplinary training.
“This is an aim that is fully supported by the Council for Work and Health. A FOHN representative attends council meetings, and the plan is that when the organisation is officially created, it will become a full member of the council.
“The council’s report published earlier this year on the occupational health workforce showed that there is already a serious shortage of doctors and nurses trained in occupational health, and that the situation is likely to deteriorate as people retire. In fact, there is something of a crisis that needs to be urgently addressed.
“Many nurses are unhappy with the current situation, as this research shows. The FOHN group should be congratulated on its courage and imagination in trying to create a new structure for the OH nursing profession.”
But all that sounds remarkably close to the AOHNP’s stated role of “developing and promoting the professional leadership and practice” of OH nursing and “to increase representation and raise the profile of occupational health nurses in the UK”. So, could the development of FOHN potentially mean the disappearance of AOHNP, or perhaps the merging of the two organisations?
After all, while 84% of AOHNP members in the survey said they would be willing to join a new faculty, 34% were worried about the possible cost – with £130 a year the proposed fee – suggesting some AOHNP members might have to weigh up whether or not they can afford to be members of both bodies.
Diane Romano-Woodward, president of the AOHNP, concedes this could be an issue, but emphasises that, first and foremost, the association is wholeheartedly behind the establishment of FOHN.
“It has been pretty obvious we have been very supportive of FOHN right from the start; we have a representative sitting on the development board. We are keen to see it go ahead and succeed,” she tells Occupational Health & Wellbeing.
OH nurses will be members of many different organisations, as well as subscribe to a range of journals, all of which adds up. “If a nurse is, say, a member of the Society of Occupational Medicine, as many are, which costs more than £100 a year, then it may well be they would use that money for the faculty instead,” she points out.
“It could be that AOHNP becomes less desirable but, equally, members may still feel having a separate association is important. We are a membership organisation, led by our members, and we will have to see what they want; it could go either way. And it could be a decision based on money. But the key thing is that we very much support the development of FOHN,” Romano-Woodward adds.
Then there is the question of the faculty’s role around education and standards setting. The survey found 98% felt setting standards for professional practice should be either a high or medium priority. There was also strong support for FOHN providing approval for NMC-validated courses relevant to OH nurses, with 85% somewhat or strongly agreed that a future FOHN should provide this.
Certainly, FOHN will expect to work closely with the National School of Occupational Health (NSOH), emphasises Berriman. But she reiterates that nurses should not expect FOHN to somehow supplant the existing role of the NMC in this area.
NSOH head professor John Harrison agrees the two organisations will expect to collaborate closely. “I am very supportive of FOHN. It fits in very well with how I see the school developing. I see us as very much having a role in terms of interpreting curricula and focusing on the quality of training, especially clinical training,” he says.
“We have had various meetings with the representatives developing the faculty. We’ve had some very good conversations about how we can work together in the future.”
“The appetite is there, and there is space, too,” agrees Mandy Murphy, deputy head of the NSOH. “There is a strong feeling that people want to be better represented, in a way they do not get through the RCN, but they feel they have to become, or stay, a member because of the indemnity cover it provides.
“When the merger of SOM and the Faculty of Occupational Medicine did not happen in 2014, it was clear there needed to be somebody to represent quite a large part of the profession. But there is no suggestion it will be setting up an alternative register or anything like that,” she adds.
There will be the potential for FOHN and NSOH to work together to accredit the curriculum, to develop some form of quality framework that would link to clinical placements, suggests Professor Harrison. “I think that would go a long way to giving a ‘kitemark’ to accredited training and clinical placements. There does appear to be a need, a demand, for NSOH-accredited training courses or curricula,” he says.
Anne Harriss, course director, occupational health nursing, at London South Bank University, agrees there could be mileage in FOHN acting as an approving body “to give its stamp to occupational health nursing education”, a bit like the British Standards Institution (BSI).
“Although we do have an approving body in the form of the NMC, its focus is not purely occupational health. What we therefore need are additional bodies, FOHN and the National School of Occupational Health, which can work in partnership with the NMC,” she says.
“I think it would be a really good thing to have, a bit like a BSI kitemark for occupational health. I would like to see FOHN and the National School almost in partnership, not so much formally linked as closely collaborating,” she adds.
Berriman emphasises the survey needs to be seen as a key part of the development process of FOHN.
“We have now got to the point where we have put together the bones of what we are trying to do with the organisation; we have generated quite a lot of publicity and we have a groundswell of support, which we are really encouraged to see. We have got the nearest thing that OH has ever had to having a mandate,” she explains.
“The NMC will stay as the regulator. We will be lobbying them, and they are interested in hearing from the profession. With the RCN, we are in close communication with its public health forum, and that will continue, as will our work with the NSOH. But now that we know much more clearly what people’s priorities are, we will be having those conversations,” Berriman adds.