With the UK being battered by the disruptive forces of Covid and Brexit, is it time for OH practitioners to be brave and stop worrying about the NMC or even thinking of themselves as nurses? In a very personal perspective, Lindsey Hall sets out the case for why OH needs systemic change.
Having just read, Standards of proficiency for specialist community public health nursing, the Nursing and Midwifery Council’s (NMC) post-registration consultation document for professionals, I can’t help thinking that the profession as we know it is dead.
Future of OH
The whole premise for the NMC’s view of the occupational health nurse in the 21st century continues to be skewed to a belief that we exist in a fantasy world. It is a world of health promotion at the behest of the public purse and not the business, absence management and health surveillance-driven reality of those organisations who choose to employ us – and I include the NHS and other public sector bodies in that.
The language used to describe role of the SCPHN (specialist community public health nurse) OH nurse and their core proficiencies and spheres of influence is undeniably laudable. It just misses the point.
The provision of occupational health advice is no longer a branch of the nursing profession and hasn’t been for years. The recruiting of a physiotherapist and OT to the team providing a service to one of the major banks in 2004 firmly cemented a belief that I had been questioning for years – that you don’t need to be a nurse to do this job. I’ve thought that way ever since.
Irrelevance of NMC
I am well aware that most in OH still have a nursing background, but that is a fact of history. I have been in the profession since the late 1980s when times were very different and there was no other way in.
Today, many still hang on to that notion, but the economic realities of rapidly expanding OH service provision in the last 20 years blows the case out of the water. I have no doubt that being a good OHA requires a set of skills that may be well fed by a nursing background, but those skills are far from exclusive to nurses.
The relationship of OH with the NMC is outdated and pointless. I pay my dues and keep my professional nose clean but have often wondered what would really happen if I stopped paying?”
The relationship of OH with the NMC is outdated and pointless. I pay my dues and keep my professional nose clean but have often wondered what would really happen if I stopped paying?
I am still insured as someone with qualifications, experience and systems within my business and practice. How many of my clients some of whom I have been with Split Dimension for 10 years-plus and who are good well-respected public and private sector organisations would really ditch me for someone else just because I wasn’t paying my NMC annual fee?
Most of them don’t even know the NMC exists. They just expect me to act professionally and give good advice. To them, nothing else matters and they would soon ditch me if I didn’t do that.
I also can’t help thinking that, if we asked the NMC about leaving, it would only be too glad to let us go. We’re insignificant in number and a square peg in a round hole. It would probably tell us that we could no longer call ourselves ‘nurses’ (not even a protected title anyway of course) – but that’s the point, we’re not.
Much of what we do in the UK is done by occupational therapists in the southern hemisphere. I have also met some great HR advisers, managers and safety advisers who understand the health and wellbeing of their workforce better than we do.
Having seen OH services in this country provided by physiologists, non-clinical case managers, physiotherapists, OTs, safety advisers, rehab consultants, technicians and a host of other allied health professionals, to think we are an exclusive group of OH nurses who somehow require some special status is, to be frank, living in a dream.
These other professions do a pretty good job too and are often far more employable and flexible than many OHAs I have come across.
I have seen comments online lamenting that “most (OHAs) seeking work are looking for part-time and ‘ideal’ roles that don’t exist in the real world”. I was also talking to the boss of a large OH business a couple of years ago who would much rather employ physiologists and technicians and thinks most OHAs are a bunch of prima donnas and more trouble than they’re worth.
There are some fantastic exceptions out there, of course, but when thinking of many I have spoken to, interviewed and tried to use as associates in the past 30 years, I find it hard to disagree.
Time to cut the apron strings?
To move forward, we should cut the apron strings of the NMC, embrace the wider world of occupational health provision and find a new governing body that we can all belong to and be trained and governed by. I accept there has to be governance somewhere even though there is currently a rather large void and no one to fill it.
The Faculty of Occupational Health Nursing’s merger with (as was) the Association of Occupational Health Nurse Practitioners (AOHNP) failed to happen, with the AOHNP now rebranding as iOH and continuing to set out its own stall.
Both are well-run organisations but with memberships that struggle to get to a level where they can position themselves as the ‘must join’ organisation for the wider OH community.
Simply put, our profession isn’t big enough to properly support them. With all the other insurances and memberships I have to pay, I am reluctant to stump up for what seems to be a ‘nice to have’. I think they will continue to struggle to get anything like the memberships they need to have a meaningful mandate in the wider business of health and wellbeing at work.
The Council for Work and Health has the multidisciplinary standing but is solely a high-level advisory body to government and not set up for a regulatory or training purpose. Its membership comes from a variety of organisations that are either too small, too specialist or whose interest in health at work is a tiny part of what they do to be able to train and govern a brave new world of multidisciplinary occupational health and wellbeing advisers.
The National School of Occupational Health, in my view, isn’t really a school at all, virtual or otherwise, but a collaboration of overly doctor-orientated training interests far removed from the daily issues that occupational health advisers deal with.
As for FOM and SOM (the Faculty of Occupational Medicine and Society of Occupational Medicine), to my mind it is a shame they still can’t agree to become something greater than the sum of their parts.
Need for academic medical rigour
I recognise we still need an element of academic medical rigour to be part of the wider profession, which SOM and FOM do offer. SOM, in particular, has been keen in recent years to present itself as more OH nurse-friendly and of course currently has Professor Anne Harriss as its immediate past president.
But, even if both organisations do move forward in a more collaborative way, my feeling is they will still be far too small and niche to govern the wider provision of occupational health and wellbeing advice, even if they wanted to.
The one exception may be IOSH (the Institution of Occupational Safety and Health), which has in the past made lots of welcoming noises and expressed an interest in developing health as much as safety.
As OH nurses, we can either cling on to our little world and find that quickly becomes a bleak and lonely place or we can ditch some old values, embrace the change and help drive forward the health agenda for the working people we serve as part of a much wider community.”
I suspect many OH nurses (I can’t talk for the allied health professions) would, however, baulk at the prospect of being run by a bunch safety advisers, but of all the organisations out there, IOSH to my mind has the standing, reputation and structures in place to provide membership, governance and training to a wider field of professionals. More importantly, it also has a richer seam of practicality than the myriad of more clinically orientated groups that currently and ineffectively fill the void.
There is no doubt in my mind that something has to change. Much has changed already and, whatever you think of Brexit, Covid and the other big issues of the world today, the forces of disruption are at play.
As OH nurses, we can either cling on to our little world and find that quickly becomes a bleak and lonely place or we can ditch some old values, embrace the change and help drive forward the health agenda for the working people we serve as part of a much wider community.
Occupational health as many of us know it is dead. Long live occupational health.