In 1859, Florence Nightingale wrote: “I use the word nursing for want of a better”, and “the very elements of nursing are all but unknown”. More than 100 years later, Clark in 1999¹ suggested that nursing is still poorly understood, and as a consequence remains undervalued.
Maybe this is one reason why during the late 1980s so many occupational health nurses presented a more ‘business-like’ appearance, exchanging nurses’ uniforms for civilian suits, and why in the mid-1990s they replaced the word ‘nurse’ with ‘adviser’.
However, does this terminology only serve to undermine the professional identity of nurses who work in occupational health? In some organisations, the scope of practice is already limited, often due to employers’ lack of awareness of the broad range of knowledge and skills that nurses possess.
In addition, government policy acknowledges the workplace as key to improving the health and wellbeing of the population. But why is it that despite the raised profile of public health issues, there is little mention of the contribution of occupational health nurses? As a discreet discipline, if we cannot be proud to call ourselves nurses and define what we do, then how can we influence policy change both locally and nationally, at a time when occupational health is high on the political agenda?
In response to the International Council of Nurses² declaration, the Royal College of Nursing³ published a document in 2003. This described a “core” definition of nursing supported by six “defining characteristics”, and was intended to describe and clarify the role. The Royal College of Nursing has at its core the following statement: “Nursing is the use of clinical judgement in the provision of care to enable people to improve, maintain or recover health, to cope with health problems and to achieve the best possible quality of life, whatever their disease or disability, until death.”
As a generic description, it can be applied to occupational health, but maybe the differences lie in the specific characteristics of the role. Using the above definition as a starting point, 48 occupational health nurses in a workshop were asked to describe the unique features of nursing in this speciality. This raised much debate, but eventually three key areas were identified: having a solid clinical understanding of the effects of work on health/health on work in-depth knowledge of the working environment and an appreciation of operating within a business context.
But if we are having trouble defining the distinctive features of our role, then how do we convey to others the unique qualities and expertise that occupational health nurses have, when we continue to use the term ‘adviser’. This is a title that surely only serves to confuse, as it can be applied to anyone.
When people ask me what I do for a living, I usually get a glazed expression when I tell them that I am an occupational health adviser. I have to explain that I am not a therapist as I don’t make baskets (no offence to my occupational therapy colleagues). I have to defend my status as a ‘proper nurse’, but one who no longer wears a blue dress and tucks patients in at night.
I then have to explain that occupational health advisers are also qualified nurses, who work in a myriad of settings from manufacturing to the NHS, and that the role entails far more than handing out plasters, paracetamol and cough medicine. This leaves them even more perplexed, and at this point, tired of trying to explain what I do, I usually scuttle away and pour myself a long drink.
Why is it that people don’t understand from my job title what I do? Some would argue that it’s only a name, and it’s what we do that really matters. But with a rise in the use of healthcare support workers (OH technicians) and other multi-disciplinary personnel, surely now is the time to re-affirm and promote our unique role within the workplace. Clarifying our job title would be a start – I for one have gone back to calling myself an OH nurse, and I am proud to do so.
Perhaps now is the time to shake off the shackles of the past. In the same way that we moved the name from industrial to OH nurse, maybe the time has come for a complete name makeover, for one which clearly denotes the area of practice in which we work. The title of Workplace Health Nurse springs to mind and may offer a solution, or is that a step too far?
By Caroline Whittaker, senior lecturer, public health (occupational health) University of Glamorgan
Clark, J (1999) A Language for Nursing. Nursing Standard. April 21/Vo13/no3/1999
International Council of Nurses (1998) Scope of nursing practice. Geneva: ICN
Royal College of Nursing Defining Nursing pdf