Getting the balance right

 The publication of the RCN Integrated Career and Competency Framework for Occupational Health Nursing (RCN CCF-OHN) is the culmination of years of hard work and a great deal of consultation across the profession.

The catalyst for the development of the document was Agenda for Change – the government’s massive overhaul of NHS pay and conditions that came into effect on 1 December last year.

There was, says OH adviser Jan Maw – the RCN’s project lead on the competencies framework alongside national OH adviser Carol Bannister – a clear recognition that guidance was needed on OH competencies and where they fitted within Agenda for Change.

“This was particularly the case, too, for nurses working outside the NHS. We had a lot of queries on it, so it was very much a case of the members wanting guidance,” she explains.

The process kicked off two years ago with a wide-ranging consultation process to ask the profession what it felt its core skills and competencies were and should be. From this emerged the eight core activities that make up the framework.

This was then fed into a multi-disciplinary discussion group, including OH professionals, the RCN, health managers, ergonomists, hygienists, the Nursing and Midwifery Council (NMC) and Department of Health and, from there, into a series of workshops.

At each stage, members were surveyed and a draft drawn up, with the latest version launched at last year’s Society of Occupational Health Nursing conference. The two bodies (SOHN and RCN OH Managers Forum), stresses Maw, was one of the key drivers in getting the document off the ground.

But, she adds, the framework is still evolving, as another version is currently being drawn up to bring in the latest RCN Knowledge and Skills Framework, as well as the recent changes to the professional register brought in by the NMC.

This final version, which will be available as a PDF document, hopefully by the end of the year. Any changes are expected to be relatively minor, meaning the framework can be used now by OH nurses as a road map to gauge where they are within the profession, how they can develop their skills and career and, critically, whether they are on the correct pay scale for what they are doing.

“It can give you a broad description of what is likely to be included or required for each level of competence,” says Maw.

“Here is a framework document that tells you exactly what an OH nurse does. Up until now, there has very much been a view among nurses [about OH] of ‘I can do that’, and this protects the OHN’s status,” says Christina Butterworth, chairwoman of the RCN OH Managers Forum. She added: “OH nurses have always battled with trying to explain what they do. By using the competencies, they can let people know what their skills are.”

The framework groups the competencies into a number of different areas (see box opposite). Maw concedes it is more than likely that nurses will find they may be overlapping at different levels or, indeed, that they are working at a different level completely.

“They can map out their own career and professional development as well as their continuing professional development,” she says
The framework will also serve as a useful tool to persuade the reluctant employer of the need to undertake specific career development training.

Nurses have trouble securing opportunities to go on courses and even to find time to develop themselves professionally. This framework will help them show their employers the specific areas in which they need to undertake training. I am always surprised at the number of OH nurses who have to fight to be allowed to go to conferences,” says Butterworth’

The framework is also proving useful for OH educationalists, suggests Maw, in helping them draw up their curricula.

The framework will, in conjunction with the Knowledge and Skills Framework, help with setting and agreeing practice and competence and pay levels. Employers and trusts will be able to use it to gauge whether they are paying practitioners at the right level and at what grade or salary level new posts should be advertised.

For practitioners, the document is a critical tool in the armoury when it comes to ensuring you get the right pay for the work you are doing.
“We have found through feedback that when Agenda for Change is being applied for OH, managers have used the document to fight for the correct grade against the descriptors,” says Maw. “The feedback on it so far has been overwhelmingly positive.”

Butterworth agrees with Maw that the competencies will be helpful to OH nurses going through Agenda for Change. “It gives nurses the evidence to place themselves on the Agenda for Change pay scales,” she says.

Additionally, Butterworth believes the document will help employers choose employees with the right level of qualification for the job. “By looking at the document, an employer can see what level of qualification is appropriate for the job,” she says. “I’d like to see employers understanding who they are employing and why”‘

But the task now is to get the message to a wider audience. “A lot of nurses who work in OH are now using the competencies to educate their employers, but employers who are new to OH are still unaware [of the document]. We haven’t advertised well enough yet to places like the CBI and CIPD,” says Butterworth.

Go to

rcn ohn competency framework: example of career pathway

Competent OHN
First level registered nurse
2 years’ post basic experience
Post basic education and training equivalent to university diploma
Works under guidance of established protocols and procedures at operational level
Maintains safe and competent practice

Experienced OHN
2 years’ experience in OH setting
Post basic education and training equivalent to university degree
Holds or working toward a recordable
OHN qualification with the NMC
Develops and establishes protocols
and procedures at operational level
Develops and leads on safe and competent practice

Expert OHN
5 years’ experience in OH setting
Post basic education and training equivalent to university higher degree
Holds a recordable OHN qualification
with the NMC
Develops, leads and establishes protocols and procedures at operational and strategic levels
Innovates, develops and leads on safe
and competent practice
Leads and develops consultant occupational nursing and consultancy


Uses transferable nursing skills of research, audit, quality assurance, IT, and data collection; works under guidance of established protocols and procedures at operational level; maintains safe and competent practice, and able to apply the principles of the Professional Code of Conduct to occupational health settings.

Through practice, develops understanding of the OHN role in a range of settings both within and outside the NHS.

Adheres to occupational health standards and polices and recognises limitations to own competence and scope of professional practice.
Requires support of more experienced practitioners for non-routine decisions and defers to experienced or expert nurse, and/or OH physician, and/or line manager, and/or human resources for support in more complex occupational health issues.

Communicates effectively within occupational health team and with clients.
Able to undertake a range of routine occupational health screening tasks, and collects, records and stores data accurately.

Maintains and develops competent practice in occupational health nursing with regular personal and professional development activity.
Able to collect, record and interpret occupational health data using an evidence base and with accuracy.

Has developed communication skills with specific groups and individuals in a justified, sensitive and mediating way, and is able to communicate effectively within the occupational health team, with clients, and across operational boundaries.

Ability to work autonomously and, where appropriate, seeks support and guidance from expert nurse, and/or OH, and/or line manager and/or human resources for support in more complex occupational health issues.

Participates in the training and supervision of junior practitioners and engages in continuing professional development and clinical supervision to maintain and develop evidence-based skills and knowledge in occupational health nursing.

Able to work interdependently in a multidisciplinary team and autonomously within a framework of clinical governance and clinical supervision.
Can analyse and evaluate data, and has ability to integrate data and give advice and strategic planning at organisational level.

Demonstrates excellent presentation and analytical skills and to manage conflict with mediating skills.

Can lead on coaching, mentoring and clinical supervision of competent and experienced nurses, and engages in continuing professional development and clinical supervision to maintain and develop evidence-based skills and knowledge.

Where appropriate will have undertaken continued professional development that leads to admission to the register of recognised occupational health and safety professional bodies – for example, ergonomics, hygiene, and occupational psychology.

 framework document also gives detailed competencies for:

Core leadership and management skills
Core quality assurance and
research skills
Legal and ethical issues
Risk assessment
Health promotion, protection and surveillance
Sickness, absence and rehabilitation
Psychological and psychosocial interventions
Occupational hygiene
Maintaining safety and accident control

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