Nursing or policing?

Whatever the role an OH nurse is expected to take in monitoring employees’
sick leave, it is crucial that she is seen to be independent of management

Last month we published a dilemma from a reader who was worried about the
way her role in monitoring sickness absence might be perceived by employees.
She wrote, "This is my first post since qualifying as an RGN within an
occupational health environment. In controlling their sickness absence my
employer has asked me to become involved in the management of employee absence.
In particular they are intending to request that on their first day of absence
employees contact the OH nurse to advise them of the reason for absence. The
employer has asked me to discuss the symptoms with the employee and offer
advice in regard to the management of their ‘illness’ and to record the
employee’s cause of absence.

"I am anxious to be seen as assisting employees, though am
a little concerned that this may be perceived by the employee as a ‘policing’
role by the OH service. I would welcome any comments from fellow colleagues."

Winning answer

In my experience as an occupational health adviser, the dilemma presented is
very common. Managers do not want to take responsibility for the management of
attendance, and attempt to shift the responsibility on to the occupational
health service.

It is widely acknowledged that the most effective way for an employer to
keep sickness absence levels to a minimum is by adopting a proactive approach
to the issue. To do so, it is important that employers ensure that the steps
they take respect their employees’ employment rights.

If attendance at work is to be managed accurately and effectively it is
important that there is a consistency in approach. A policy should be developed
and effective data collection and analysis carried out.

It is the responsibility of management to monitor sickness and where levels
cause concern they should be investigated promptly and discussed sensitively
with the employee, seeking explanation for such absences. This will assist
managers in determining whether they are dealing with a matter of ill-health,
incapability or misconduct.

Employers will therefore require training in the management of attendance
and it is here that occupational health departments can assist. They can
provide training so that managers develop the skills and knowledge required to
deal effectively with the management of attendance.

Training for managers would typically have the following aims:

– To describe their role and responsibilities within the management of
attendances well as the interface with other members of the multidisciplinary

– To recognise the need to effectively manage attendance and state the
importance of maintaining accurate records.

– To investigate and record accurately incidents of injury and dangerous
occurrences at work

– To identify the support services available to assist their staff

– To conduct a productive return-to-work interview

– To develop effective communication and interpersonal skills, so as
sensitively to address attendance issues with the employee

Monitoring attendance and evaluating reasons for absence is an important
means of contributing to the business. It is not the function of occupational
health nurses to manage attendance but they can be expected to evaluate the
reasons, to identify trends and to consider hazards and risks, which may not
have been identified or adequately controlled.

The occupational health team should therefore work with management teams to
raise the level of awareness on attendance management and give professional advice.
Occupational health personnel can make a significant contribution by assisting
employers to demonstrate that they have acted responsibly and have undertaken
all that is reasonably practicable in terms of promoting the health, safety and
welfare of their staff.

Most employees are absent due to sickness at some time in their working
lives. Clear information should be given to managers identifying that it is
their responsibility, as part of their normal day-to-day work, to review such
absence. Managers should also monitor attendance records to see whether a
pattern develops or if absence becomes more frequent and problematic for
service delivery.

Although it is important to consider the particular circumstances of each
case, setting trigger levels for absence can be useful when deciding whether or
not to take formal action, particularly in the management of short-term
certificated and uncertificated absence. These procedures should be
communicated to each employee and incorporated into individual contracts of

Personnel, line managers and trade unions all have their own interpretation
of what occupational health advice should be. This raises all manner of
professional, ethical and legal problems for OH nurses, who are bound by the
very nature of their work to maintain confidentiality and who strongly believe
that they should be impartial and objective. It is therefore essential that all
organisations employing occupational health services have an agreed policy for
referring employees for health assessment. They need to be aware of and have
respect for the issues of medical confidentiality and the code of professional
conduct that the occupational health team works within.

Although there is no legal requirement to have formal attendance management
policies, it may help an employer in demonstrating to a tribunal that it has
acted reasonably. In the absence of such policies there is a danger of
inconsistencies in the management of similar cases. The policy can give
managers, employees and the occupational staff firm guidelines to work within.

To summarise, the role of the occupational health department is purely
advisory, both to employer and employee and is in no way enforcing or
disciplinary. Its main objective is to ascertain whether or not an employee has
a health problem which is affecting his/her work. It advises employers
accordingly so as to enable them to manage the attendance and performance of

It is also the role of the occupational health nurse to provide health
advice and support to the employee, and in some cases this may be the only
source of support available. It is therefore crucial that the nurse ensures
that she is seen to be independent of the management structure, so that all
parties accept that the advice given is impartial and credible. Good
communication and negotiating skills are vital for the occupational health
nurse to be able to remain professional and impartial in absence-related
issues, which are often difficult cases and represent considerable importance to
the respective interested parties.

Valmai Hughes, BSc (Hons), Dip OHN, RGN, MIOSH
Occupational Health Adviser, Interact Health Management

Information exchange

Do you need information or guidance
on a particular topic? Perhaps you want to research a new area and don’t know
where to start. Other readers may be able to help. Information Exchange is a
new column where readers can contact fellow professionals to ask for advice,
share best practice or set up an informal network. To have your details
included in the column e-mail
or fax them to: 0208 769 7892.

We work as OHAs for a large public
sector employer. We are a team of three OHAs, three secretarial/admin workers
and a counsellor.

We would like to introduce performance indicators and would be
interested in learning how others have done this. In particular, the indicators
used and how they are measured. You can contact us by e-mail at

Nessie Brooks, Rita Fogerty and Kath Griffiths

As part of my BSc (Hons) Managing
health care delivery degree pathway I am exploring clinical supervision as a
tool for support and development. I would like to hear from any readers with
experiences to share, in particular the current models already in use by OHNs.

Linda Lambton
Dupont UK
Fax: 01642 445555

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