Workloads of OH nurses are increasing but the number of nurses is falling, so the employment of more OH technicians could save the day. Nic Paton reports.
It is estimated that there are between 5,000 and 7,000 registered OH nurses practising in the UK and, as has been well documented in Occupational Health, demand from employers for OH advice and support has long been outstripping supply.
This is where OH technicians (OHTs) are, increasingly, coming into the frame. There are no firm statistics as to how many technicians or, as they are sometimes also called, OH support workers, there are in the UK. This is because often an employer directly trains an existing employee to take on various basic OH responsibilities.
Despite the best efforts of the Royal College of Nursing, which in 2011 published guidance on the role and responsibilities of technicians and support workers (see box), there is still no central register of technicians, their role is unregulated, there is no standard entry to employment and there is no defined level of competency or education required.
Nevertheless, for OH practitioners practising in a multidisciplinary environment, the added value that properly supervised technicians can offer in terms of managing demand and easing workload is increasingly being recognised. And demand for people able to step into these sorts of roles is growing, argues Graham Johnson, lead nurse and UK nursing community ambassador at Bupa Health Clinics.
He explains: “I teach on the OH technicians’ course that’s run at Leeds Beckett University, and when I started they had just a handful of people coming on to the course. This year there were 12, some from the NHS, some from the private sector.”
Audrey Dean, of specialist OH recruiter Key People, agrees: “Our team is seeing demand for technicians increasing; there are a lot more clients looking to use them to provide things such as screening services, health surveillance, audiometry and spirometry.
“You do find that often the employer is happy to train an individual themselves with the basic skills they need. It will often be someone who has been working in an admin role in an OH department with general clerical responsibilities, and the employer supports them through basic health surveillance training.”
Role of the OH technician
So, how is the role of the OH technician evolving, what are the common education and training pathways, how will technicians be working alongside practitioners in the future and, given that a technician will normally be a cheaper option than a registered practitioner, how are they being perceived by employers?
Moreover, will this largely unsung member of OH become more visible and better recognised? This is an important question following the failure last year of the Faculty of Occupational Medicine and Society of Occupational Medicine to become a single body – along with moves by the Association of Occupational Health Nurse Practitioners (UK) (AOHNP) (UK) to investigate the feasibility of creating a single body for nurses and technicians.
“I do see a real role of OH technicians; it is just part of having a balanced workforce,” enthuses Caroline Whittaker, academic manager and senior lecturer at the University of South Wales, which offers a Diploma in Higher Education in Occupational Health (Technician).
“Nowadays we take on some roles that used to be done by doctors. For example, OH nurses deal with more sickness absence cases, which frees doctors to focus on more complex, higher-level cases.
“Technicians provide very much the same thing, doing the work we used to do, but which they are better placed to manage.”
The University of South Wales course, she adds, is designed to give would-be technicians a solid grounding in OH practice and health and safety, as well as training in subject areas such as audiometry, spirometry, ECG, blood pressure and urine analysis. “It is about giving them many of the skills nurses will already have from their general nursing training. It is a very practical, hands-on programme,” she says.
Leeds Beckett University’s one-year certificate-level course for technicians is consistently popular, normally attracting between 12 and 15 students, according to associate lecturer Jacqui Livock. She says: “There is definitely demand. You get people from varied backgrounds, both private and NHS. Often they will be funded by their employer as well.
“There is a focus on issues around accountability and responsibility from day one. We look at the boundaries to practice, so a technician knows when to escalate an issue; they can recognise where their level of competency ends.”
Specialist community public health nurse (occupational health) Pauline Proud runs Proud Healthcare Services in Newcastle upon Tyne, and her husband, David, works as a technician. A few years ago she set up an Association of Occupational Health Technicians until her own work commitments meant it fell by the wayside.
“Many companies still do not understand what occupational health is, let alone the difference between an OH adviser and OH technician. They understand the difference between a nurse and a doctor but that is about it. And often they do not really care who they use as long as it gets the Health and Safety Executive off their back,” she concedes.
There is undoubtedly a danger that an employer will perceive a technician to be an “easier” or cheaper option to contracting or employing a registered practitioner. And, to an extent, if all an employer wants is basic OH health surveillance then a properly supervised technician could be one answer.
However, the key is in the words “properly supervised”, Proud emphasises. An employer also needs to recognise that if they go the extra mile and take on a registered OH practitioner it will give them the flexibility to offer more to their employees. In terms of salaries, inevitably the range is going to vary depending on the experience and qualifications the person is bringing to the role, points out Key People’s Dean.
“You get individuals coming into technician roles from very different starting points. For example, if someone is coming to this but also has a nursing qualification that is obviously going to have an effect on the sort of salary they can command.
“For an employer there can be a cost- saving element to taking on a technician, and OH practitioners are thin on the ground. Although demand is growing, I don’t think technician roles will take over.”
A salary range of £17,000 to £20,000 is not uncommon, compared with payment of around £25,000 for a nurse position, points out Steve Roberts, director of recruitment firm Occupational Health Staffing.
“I think the use of technicians simply reflects the general change we’ve seen over the past 10 years from occupational health being a doctor-led service to one that’s more nurse led,” he says, echoing Whittaker. “I think for basic roles – audiometry, spirometry or mobile screening for example – it can probably be quite effective to have a technician helping.
“Having said that, in my experience employers tend not to be that fussed about the qualification; they just want someone who is able to do the job and has the experience they need.”
The future opportunities
Where next for technicians? There have been calls for healthcare assistants to be regulated – perhaps via a centralised professional register – and it will be interesting to see how that debate plays out in the coming months or years, argues Whittaker.
But Johnson is sceptical that the idea of a separate register for technicians is something that the Nursing and Midwifery Council would embrace. Bringing technicians under the umbrella of a single entity could be a valuable solution when it comes to helping technicians achieve greater visibility and representation.
He argues: “Technicians will often be doing things that 20 years ago a nurse would have been doing. It is about them knowing the parameters within which they are competent to work. For an employer or OH provider, it is about offering an alternative option, a better option, for the customer.
“I have not seen any evidence of OHTs encroaching on the work that OH practitioners do. In some respects, it is only echoing the model developed some years ago by the NHS around using healthcare assistants rather than nurses in basic roles. It is a natural progression.
“But I do think it would be good for OHTs to develop their own identity more. A single body for occupational health, one that included and encouraged OHT participation, could in that context help; it could give technicians some identity and develop some traction beneath them,” he adds.
Proud agrees: “I think a single body would be a good idea, to have everyone under a single umbrella. At the moment we do not even know who the OHTs are; they are often under the radar. To have one body would therefore be excellent.”
Lyndsey Marchant, director at Phoenix Occupational Health and a member of the AOHNP (UK), says: “Technicians are a valuable resource. I see technicians gradually working more alongside nurses, although nurses will need to retain the signing off.
“I do not see technicians as a threat to nurses at all – they still need a lot of oversight and regulating, there is a limit to what they can do. So I think it will always be a question of OHTs supporting nurses as much as they can.
“I think a lot of people were disappointed at the single organisation vote. The AOHNP (UK) will be moving forward and has many plans for the future, but there is a risk that technicians get left behind so, yes, I think we would need to make sure their role is promoted and represented too.”
A technician’s point of view
Caroline Whittall has been working as an OH technician at Bupa Health Clinics for four years, having originally come into the organisation in an administrative role.
“The opportunity came up to retrain in a technician role – it was at that time a new thing across Bupa – and I just decided to go for it,” Whittall says.
“I had no medical background apart from being a first-aider. Graham [Johnson] put together a training package, which outlined the sort of skills and competencies they were looking for, the remit of my role and who I would be reporting to,” she adds.
Whittall has also done the technicians’ certificate course at Leeds Beckett University, which she is due to complete in May.
Her role at Bupa includes taking bloodpressure readings, measuring height and weight, spirometry, audiometry and doing tier 1 and Tier 2 hand-arm vibration syndrome (HAVS) assessments. Whittall explains: “I am audited in exactly the same way as the nursing team, and I have an appraisal in the same way as them. I work alongside the nursing team on their daily appointments, but I don’t sign people off.
“I’m now at the point where most of the supervision is indirect – they’re happy for me to relay the decisions and then sign off my work – but I know with other OHTs the supervision can be much more direct.
“I feel lucky in that the team I work with has always been very clear what is expected of me and where the boundaries are. So I feel confident about what I’m doing, and I’m also encouraged to ask questions. But I am still ultimately responsible for my actions; I am still accountable for what I do,” she adds.
The Royal College of Nursing’s guidance
The Royal College of Nursing’s 2011 guidance Roles and responsibilities of occupational health support workers outlines the definition and parameters of the OH technician/support worker role, the need for competency in health and safety, the importance of clinical audit, the education and career pathways of these sorts of roles and the supervision of OH support workers.
The guidance emphasises that technicians and support workers “will work under professional supervision within the guidance of established protocols and procedures”.
In an OH setting, the role is likely to include agreed health screening and surveillance, health education and collection of health data that contributes towards the assessment of health risk arising from any work activity.
The guidance recommends that an employer should ensure a technician/support worker has received training in the following areas:
- introduction to occupational health;
- basic knowledge of anatomy and physiology;
- basic life support;
- principles of infection control; and
- confidentiality, accountability and data protection.
- They should also have been assessed as competent to:
- measure blood pressure, pulse, height and weight, including BMI;
- do urinalysis;
- interpret new starter questionnaires;
- do audiometry;
- measure visual acuity to occupational standard;
- measure colour vision to occupational standard;
- do lung-function testing to include peak flow and spirometry;
- assess mobility;
- do drug and alcohol testing;
- keep records;
- use communication skills;
- use IT skills;
- use health and safety legislation;
- include concepts of health promotion and prevention of ill health; and
- order stock.
For higher level 2 or 3 support workers, they should be competent (where relevant) to do:
- interpretation of food-handler questionnaires;
- Chester step test;
- skin assessment;
- hand-arm vibration syndrome assessment to tiers 1 and 2;
- OH hazards and risk management;
- display screen equipment assessment; and
- interpretation of lung-function and audiometric results.
Supervision by an OH practitioner should be either direct or indirect, the guidance recommends.Direct supervision would be where the OH practitioner observes and directs the activities of the support worker/technician. Under indirect supervision, the practitioner would not be physically working alongside the support worker, but the support worker would need to be “governed by set processes for direction, guidance and support”.
The guidance adds: “Registered practitioners are required to establish that anyone to whom they delegate is able to carry out their instructions, to confirm that the outcome of any delegated task meets required standards and that everyone for whom the registered OH practitioner is responsible is supervised and supported.”