The AOHNP thanks Dr Richard Preece for a thought-provoking and challenging article on evidence-based guidelines (Occupational Health, April 2009, page 10). As a profession, we do need to be challenged, and these articles do encourage debate which is always welcome.
Lack of evidence
We agree that both evidence in peer-reviewed journals and at conferences may be lacking in the UK, and that we should be learning from our colleagues in Europe and the US. This is not in any small part due to that most valuable of resources – time. Most OH nurses (OHNs) have a workload that far exceeds their available time and also have limited personal time. The caring nature of nurses means they take on lots of responsibilities in and outside of work that their medical counterparts are able to delegate more easily to nurses and the like.
Also, traditionally doctors/the medical profession as a whole earn three times the salary of any nurse. Therefore they can afford more professional childcare, clerical support and modern technology which in turn frees them up to pursue professional interests, such as research, in their personal time.
Investing financially in nurses and recognising them as equal professionals to doctors will boost confidence in nurses and will make a dramatic difference to both the opportunity (time) and ability to engage outside the workplace.
The AOHNP is more than happy to offer a peer review of any research that OH nurses conduct during their degree and diploma studies. Once OH nurses (OHNs) start to share their research, the AOHNP may be able to hold a scientific meeting or conference.
We must refute the claim that OHNs are not trained in evidence-based practice – it is part of our clinical governance requirements. Many universities will provide evidence-based practice modules for OHNs who need to brush up their skills. Some of our members’ OHN training was all evidence-based, and from this they create their own evidence from daily nursing practice. However, this is easier when working with small numbers in a unique setting and as practice can be changed accordingly, but to convert this to a large study with wider research parameters is not possible without a clear need. Some OHNs do their own research to support any hypothesis they want to challenge, but have not published this and made it more widely available.
Many OH advisers are actively involved in evidence-based OH research, although their names do not appear on any of the papers published in journals. How many of us collect and collate the information that is sent to either paid researchers from academic or a medical body doing research?
In OH, there is a wealth of data just waiting to be analysed and adapted into evidence-based research. However, in the real world, analysing 20-plus years of collected data on a subject, comparing it with peer-reviewed international data, and then recommending screening criteria based on the evidence, does not prove to be a ‘hot’ enough topic.
We would also have to question some of the analysis of biological data being published. Sadly, many pure statisticians do not understand that biological data needs to be handled differently to numerical data (as we are sure our peers will already be aware, biological data has a different ‘normal distribution curve’ to pure numerical data).
Lack of engagement
There have been very few research projects coming out of the Occupational Health Clinical Effectiveness Unit or the National Institute for Health and Clinical Excellence (Nice) that are directly relevant to OH practice, and any consultation input we have provided is usually ignored or watered down as it does not fit the NHS or Department of Health (DoH) models. The value of OHNs is rarely recognised and primary care providers would rather bury the evidence than admit they should leave workplace issues to OH practitioners. We must also comment that occupational physicians are also not visibly engaged, and a review of the occupational medicine journals will show that most of the research comes from academic sources and the other royal colleges of medicine.
The AOHNP as a member organisation responds to all Nice and OHCEU consultation documents and members also personally respond to the various DoH and Nursing and Midwifery Council consultations. We would of course encourage all OHNs to bombard these consultations with responses and to use the AOHNP as a medium by which to do so, as providing this ‘one voice’ for our members is part of our mandate.
Lack of input
Representation is an issue. As with many initiatives that claim to be representative, they still request OH representation from physicians with a token single place for an OH nurse. If Preece recognises the value of OHN input, we seek his future support, and request that his occupational medicine colleagues do likewise.
While we accept there is work to do with regard to the national engagement of OHNs, this is already happening at quite a few levels by professional motivated representatives. Our board in general is offering feedback and we have representation on various committees. As a representative body, we are also looking at how we do get people engaged and motivated rather than offering reasons as to why we are not.
The AOHNP will continue to engage with these various research and academic institutes and other organisations to make sure the voice of OH nursing is strong. We hope that all OHNs now actively become engaged and share local good practice in the development of national best practice.
By Jeremy Smith, president, Association of Occupational Health Nurse Practitioners (AOHNP)