Occupational health profile: Helen Kirk, professional lead (nursing and midwifery), Public Health England

Among her many responsibilities, occupational health nurse Helen Kirk is leading a nursing revalidation pilot at Public Health England (PHE). Here, she explains what drives her and what she has learnt in her successful career.

How did you get into occupational health?

After training in nursing and midwifery I served as a captain in Queen Alexandra’s Royal Army Nursing Corps (QARANC). We looked after all the health needs of our “workers” and even their families, particularly overseas.

Helen Kirk

There was complete recognition of the impact of work on health and vice versa. This was an important lesson. In OH we often obsess about workplace stress while losing sight of the biggest stressors, those that arise outside of work, including bereavement, finances, personal relationships and children.

When I returned to civilian practice I applied for a post. I was six months pregnant and, on the phone, the head of midwifery told me the reason I had been rejected was because she wanted someone who could start straightaway.

Initially I was devastated, then appalled that someone would say this, let alone someone in her position. I appealed. And I won the case but it felt like a hollow victory. I needed a change and I now knew what I wanted to do, which was to improve the care and support for workers. The move into OH nursing was very natural. It allowed me to achieve balance in my life, family, community, leisure and, of course, work.

Once I began it was easy to become enthusiastic about OH nursing. I put a lot of energy into my training, getting into lots of workplaces. I tell my own students now that you get out of training programmes what you put in, so invest your energy to maximise your learning.

I worked in food processing, weapons ordnance, and in the NHS I investigated everything from upper-limb disorders in obstetric ultrasonographers to sensory deprivation in oncology pharmacy. I got as actively involved as I could in peer networks because learning from colleagues’ experiences is so important.

Who influenced you intially?

I know it sounds a bit twee to say my mum but it is true. She was the first nurse in Nottingham to qualify with the top grade on the newly introduced district nursing programme, and she did it with four children under 10 at home.

She was thinking about the effectiveness of interventions and efficient delivery of care in public health nursing long before we started talking about evidence-based practice and productivity.

I have worked with some inspiring nurses throughout my career. These include my tutors in nursing and midwifery schools, and inspirational colleagues in my early career who allowed me to develop and even encouraged me to question and change practice as a new staff nurse.

What else influenced you?

I enjoyed my OH nursing course, but the Master’s degree I did at the business schools in Manchester and Cape Town was invaluable. Spending time looking at TB care in South Africa, and studying with senior health leaders there, reminded me of the inter-connectedness between workplace health and wider aspects of public health.

It is important that we see workers in their wider context. TB in South African miners is a big OH challenge, but the solution is not confined to the workplace because miners live within the community.

The Master’s programme was the stimulus to do my first primary research project examining senior nurse leadership. That was tough. Doing research is more of a marathon than a sprint.

Interviewing the directors of nursing was great fun and a welcome relief before the challenge of writing it up. The papers were finally accepted by a prestigious international nursing journal.

The big lesson for me was do not try to do it on your own – you don’t have to and it makes no sense. Identify people who have done it before, from any discipline, get advice and encouragement.

The other key thing for me was being pushed to speak at conferences. I am naturally a talker and at ease in social and work settings, but I dread speaking at conferences. When I spoke at a big event in Dallas last year I felt nauseous for several days beforehand.

Afterwards, the feedback was effusive in a style that only our American peers can get away with. I look for opportunities to speak now, to talk about innovation, to share results, and to promote our specialty. It’s never got easier but you can’t lead by staying in your comfort zone.

What are your priorities and goals in your current role?

I began at PHE as head of OH transition, with the challenge of setting up an OH service for a newly created organisation. More than 70 organisations came together to form PHE, with workers on 120 sites nationally and more transferred each month. My role is to ensure that good OH support is received by all, and to promote the wider public health priorities through the way we look after our staff. Recently we have been supporting staff deployed to Western Africa to tackle the Ebola crisis and other PHE staff who are travelling as volunteers with non-governmental organisations.

In October 2014, the Nursing and Midwifery Council announced that PHE would be a pilot site for professional revalidation. I am the professional lead for nurses and midwives, tasked with setting up the pilot project. A priority is to see how this can be done for nurses who are working in OH and public health.

Under revalidation, nurses must find someone with whom we can have a reflective discussion. That is such an integral part of nursing, talking about cases with colleagues, sharing perspectives and knowledge, and stimulating ideas to improve our practice. Another requirement, multisource feedback, is also commonplace now.

It will be interesting to see how well the proposed model works in PHE, with a widely dispersed workforce and many nurses working alone, and without a nursing management structure. Some of the lessons we will learn in PHE will have high relevance for colleagues in OH.

My first dissertation, 20 years ago, was on competence in midwifery. My proposition that many midwives were not competent in core skills (through lack of practice) was not well received. It has taken time for the need to demonstrate that skills and knowledge are fresh to become accepted wisdom.

In my current role I’m involved in developing a framework for personalised care and population health.

Ultimately, I would like to initiate work on a revised model for OH nursing. My sense is that the often-cited Hanasaari Model is too broad or complicated, and perhaps too idealistic, to be a useful tool in day-to-day practice for nurses in public health settings. We need a more user-friendly model that can, for example, provide a framework for reflective discussion.

I’m interested in looking at how OH nursing might engage better with nursing activities beyond the workplace. Issues include the ageing workforce, stroke or dementia, which are not associated with workplaces, but I wonder if we need to reconsider this. What should the role of OH nurses be in raising awareness of carers’ needs and the impact of family caring on work?

What motivates you today?

Professional standards and improving the evidence base for OH nursing motivate me, which aligns with the revalidation pilot. I’m always driven to look for improvements and put things into action in relation to OH services too.

I have worked with many services and, although at times that can be an isolating role, I’ve also made many long-term friends and colleagues.

I was keen to be involved when the first set of standards was being drawn up for OH services, published in January 2010.

Over the past couple of decades, stress and musculoskeletal disorders have dominated our thinking in OH nursing. A combination of the decline of mining and manufacturing and the advent of better controls have contributed to the shift in the pattern of occupational illness. Looking ahead, we face new challenges, ranging from sedentary behaviour, to nanoparticles, to an older workforce, and to new and drugresistant infections.

With these coming challenges, I find plenty of motivation to consider how we can organise ourselves to meet them.

What advice would you offer to those new to occupational health or early in their careers?

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My advice to someone entering OH now would be to make the most of learning opportunities with colleagues and get involved. I have just been reappointed to the Royal College of Nursing public health steering committee. I’ve learnt a lot from other commitments, such as appointment to UKAP (UK advisory panel for healthcare workers with blood-borne viruses).

My message is: do not be afraid to step outside of your comfort zone. We have all been there even when changing specialty further into our careers.