Occupational health nurse education: a blueprint for change

A document from Public Health England put sets out a curriculum for occupational health nurse education in the future. Nic Paton talks to leading OH figures about its likely impact on the Nursing and Midwifery Council’s requirements and its implications for individual OH courses.

“Occupational health nursing finds itself at a time of change, therefore it was timely to review priorities for educational programmes to consolidate and develop a new approach going forward,” said Public Health England’s chief nurse Viv Bennett at the launch of its new Educating Occupational Health Nurses guidance in November.

“Occupational health nurses recognise that their educational programmes must continually evolve and adapt in order to meet new workplace challenges as well as to continue the valuable work of the profession,” she added.

Bennett certainly has a point. Occupational health nursing, and OH nurse education specifically, is in a state of considerable flux. Disquiet has been growing for some time among practitioners and educationalists about the Nursing and Midwifery Council’s (NMC) validation structure for courses, particularly the requirement for courses to be delivered under the broad-brush Specialist Community Public Health Nursing (SCPHN) umbrella if they wish to have the NMC stamp.

Key points in PHE’s guidance on occupational health nurse education

The Public Health England document Educating Occupational Health Nurses: an approach to align education with a service vision for occupational health nurses sets out, as it puts it, “the recommended approach for nurse education going forward”.

It includes a range of “prompts” for higher education institutions and lecturers to help them assess and refresh their programmes. Given the backdrop of disquiet about the current NMC-led set-up, this, intriguingly, is one: “Do your current programmes allow for multi-professional education from practitioners employed in workplace health and wellbeing now and in the future?”

The paper articulates four principles that, it argues, should “underpin the OH nursing approach to their working practice”, namely:

the search for health needs
the stimulation of awareness of health needs
the influence on policies affecting health
the facilitation of an awareness of health needs
It then goes on to outline “the requisite ‘theory, knowledge and skills’ that must be included into education programmes to ensure excellent, high quality OH services”.

These it splits into six broad topic areas: public health, the effect of work on health and wellbeing, the effect of health and wellbeing on work, research and evidence-based practice, leadership and management, and professional practice.

There is not room within this article to outline all that is covered within each topic. But, to give a flavour, each topic is broken down into “theory and knowledge” and then “skills”.

For example, under the effect of work on health and wellbeing, there is a section on health surveillance. The theory and knowledge required here, suggests PHE, is to understand the methods, legal requirements, ethical and commercial implications of health surveillance.

The skills you would therefore need as a practitioner would be the ability to:

Advise employers and managers on the legal requirements for health surveillance and the method of health surveillance required for work tasks where a risk and/or a legal requirement has been identified
Carry out risk assessment, identify when health surveillance is required and what method of health surveillance should be used
Recognise what specific health surveillance training is required and access the training as appropriate for their specific job role
Ability to advise employers about suitability for role and fitness for work following health surveillance assessments
Similarly, around stress and mental ill health, the theory and knowledge required would be to understand the health effects of work-related stress and common mental health health issues, such as stress, anxiety and depression.

The skills, in turn, are an ability to:

Advise employers, managers and individual employees on the mental, emotional and physical effects of work-related stress
Advise employers and managers on the employer’s duties in relation to the prevention of work-related stress
Carry out risk assessment in relation to work-related stress
Refer employers and managers to tools for preventing and managing work-related stress
Carry out individual health risk assessment where work-related stress is thought to be a factor in employee ill health.

The reason this document is important, PHE emphasises, is because, while many courses will already cover the areas outlined and more, “they are not currently included in every HEI/university course. Therefore, this guidance has been written to support programme development and change in this respect.”

The full document can be accessed here.

And things may be beginning to come to a head. First, the NMC itself last year announced it was to carry out a review of current pre-registration and then post-registration standards. This has opened the door to discussion about the future shape and direction of education within the profession.

Work by the nascent Faculty of Occupational Health Nursing (FOHN) has also strongly questioned the current educational set-up. A position paper in November 2015 argued that, if the current SCPHN-based approach were to continue, it would need “to be more closely aligned with the needs of future OH strategy and evidence-based provision”.

Last year, the faculty’s survey of the profession also identified a groundswell of support for the idea that it could work with the NMC and the National School of Occupation Health to set standards for OH educational requirements and provide approval for relevant NMC-validated courses.

Then, in March further research by the FOHN argued the current NMC training principles for OH nurses were failing adequately to prepare practitioners for practice or meeting the future needs of the OH nurse workforce.

This was echoed by a report, also published in March, from the National School of Occupational Health (NSOH) and Health Education England, which highlighted “concerns” about the sustainability of NMC-approved courses and worries that the current variety of training courses was leading to a lack of clarity within OH nurse education.

Reaction to PHE guidance on occupational health nurse education

It is therefore with all this in mind that the new guidance from PHE, albeit developed by an occupational health nursing group, should be considered. The document (see panel) sets out a range of prompts for educationalists to consider when reviewing their courses. It then outlines what theory, knowledge and skills need to be taught in six core areas: public health, the effect of work on health and wellbeing, the effect of health and wellbeing on work, research and evidence-based practice, leadership and management, and professional practice.

And the consensus appears to be that, generally, PHE has done a pretty good job.

“The document is valuable and timely,” says Helen Kirk, associate lead nurse, workforce, at PHE. “It addresses concerns that have been expressed by employers and nurses in OH roles by describing key components of learning that fit within the NMC standards.

“It is of course not a mandatory curriculum for providers, but is well placed to guide course content; it is an important refresh to make sure curricula are meeting contemporary practice needs,” she adds.

“Its recommendations, I am pleased to say, mirror the course we have been running at South Bank for several years,” agrees Professor Anne Harriss, course director at London South Bank University. “But from other people’s perspective, it could be a major change. Some centres may find it difficult to include all the material they need.”

“I think this document is a really good outcome, and I am very pleased with it,” says Diane Romano-Woodward, president of the Association of Occupational Health Nurse Practitioners. “It, of course, has a public health nurse slant to it, but it is a really useful document for higher education providers who want to train OH nurses or, indeed, for OH nurses to evaluate their own practice and development requirements.”

“The document is superb. It identifies what the future education requirements will be for occupational health education, and it is completely correct,” agrees Lynda Bruce, lecturer in occupational health at Aberdeen’s Robert Gordon University.

“It is a useful document in that it benchmarks what are good ideas for higher education institutions to be providing in terms of occupational health. There is a big issue around disparity between courses at the moment, although that is a different issue to accreditation. It sets out very clearly what sort of things need to be delivered in terms of training,” adds Professor John Harrison, head of the NSOH.

“One of the things that is valuable about the document is that it goes beyond the knowledge and theory that underpins practice and looks at the skills people actually need; the skills you need to work effectively as an OH nurse rather than just the topics you need to learn,” agrees Christina Butterworth, board member of the FOHN’s development group.

In itself, of course, the PHE document is not suggesting a wholesale transformation of OH nursing education is required. But it clearly feeds into the ongoing debate, as Helen Kirk highlights.

“The standards as they are do apply well to OH, but there is a gap. More detailed interpretation of higher level standards should make course content much more practicable,” she says.

“The NMC is currently reviewing educational standards and how these are applied so I guess we need to watch this space and be keen contributors to any consultations. Also, there is no NMC monopoly for post registration courses only if they wish to meet the SCPHN requirements,” she points out.

Already we’re seeing universities re-evaluate their OH courses, as the PHE document suggests educationalists regularly should. Robert Gordon, for example, has recently launched a non-NMC-validated occupational health nursing BSc.

“With an NMC-validated course, once you have been validated you can only change 20-25% of the material without having to go through the whole process again. On the previous course, because the first two modules were public health-focused, the learning was shared with school nurses and health visitors,” explains Lynda Bruce.

“A lot of students are coming out of business, working full time and often self-funding. They want the course to be relevant, and learning about topics such as poverty and worklessness, while both worthwhile, are just not subjects OH nurses deal with. They had to wait until the third module before they got into the occupational health.

“A lot of students were also frustrated they could not get the practice teachers they needed to achieve Part 3. They wanted to do it, they had the money to do it, the time, and the support of their employer to do it. But they could not find the practice teachers.

“We have put the new course on the website and people are already excited about it; we have had a lot of enquiries. We just felt it was no longer meeting the educational needs required for the OH nurse population,” Bruce adds.

“What I would like to see is the title ‘occupational health nurse’ protected, and only apply to those people who have a recognised qualification in OH nursing, although that would not necessarily have to be an NMC-approved course,” suggests Anne Harriss.

What next for OH nurse education?

“I think the Faculty of Occupational Health Nursing and the National School of Occupational Health will work together much more closely. I think there will need to be some sort of FOHN/NSOH stamp of approval, which the NMC will then register; so we will still have the register,” she adds.

“There has been a rumour for a while that [the SCPHN] Part 3 of the register is going to be abolished and, if that were the case, OH nursing would not have a home. If Part 3 does go, then I do think OH nurses will still want to have their specialist status recognised in some way,” points out Diane Romano-Woodward.

“The Faculty of Occupational Health Nursing, and the people who choose to become active within it, are going to be the people who are best able to determine what occupational health nursing is and what qualifications are appropriate. The NMC has very few nurses working for it now; it has lost credibility among many within the nursing profession,” she adds.

“I would like to get to the position where you have a common stem, which would be multi-disciplinary. There would be clear advantages and economy of scale to doing that, but it would also mean people would be working alongside people from other disciplines, so they know better how they work,” suggests John Harrison.

“You’d have the common stem and then, at the end of that, you would address the more specific competencies related to your profession. I think there does need to be a conversation with the NMC so it understands exactly what OH nursing is about. It needs to be reassured that the curriculum being approved can deliver whatever OHNs have to do in practice. The NMC needs to be sure that training being delivered is properly quality assured,” he adds.

Indeed, Helen Kirk’s “I guess we need to watch this space” comment may well need to be the one OH practitioners take away from all this. No one is suggesting radical change is going to happen overnight. But things do appear to be moving.

For example, John Harrison’s call for a “conversation” with the NMC is taking shape. Butterworth and NSOH deputy head Mandy Murphy met NMC officials in April to press the case for reform of OH nursing education, or trying, as Butterworth puts it, “to develop a plan as to how to move things forward”.

She says: “What we hope to get out of that is a recognition that OH nursing is a speciality that is very different to other nursing specialities; that people often work as autonomous practitioners and therefore do not have that oversight that other nursing professionals have. So, OH nurses have to be very competent at what they do, and we need to have the education to match that.”

Nevertheless, Butterworth emphasises this debate is not about undermining or even scrapping the professional oversight role of the NMC. It is simply about making OH nurse education fit for purpose, fit for the very significant current and future workforce and workplace health challenges the profession faces.

“I firmly believe NMC will carry on its regulatory role,” she explains. “But when it comes to education, I believe the faculty can have more of a role in setting educational standards, delivering courses and setting the curriculum.”

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