Occupational health is rarely promoted as a career path among students, but engaging the next generation is necessary to meet the rising demand for OH services. Janet O’Neill highlights why more placements in OH are essential.
Occupational health nursing is not commonly thought of as a career pathway for most registered nurses or allied health professionals (AHPs). This seems strange considering it is a speciality which sits alongside school nursing and health visiting under Specialist Community Public Health Nursing (SCPHN) registration and is often taught by the same universities as other community nursing specialisms such as district and practice nursing.
These professional pathways are well-known by other members of the nursing profession, but sadly this is not the case for OH. Perhaps because occupational health is not funded by the NHS and is therefore seen as a “private service” that needs private funding for education.
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All healthcare students, including those registered in nursing and allied health programmes, will have an OH intervention in the form of immunisations as they commence their studies. This may be the only time that OH is mentioned, unless the student is referred to OH for a fitness to study assessment or because of sickness absence.
Only a very small number of universities have been able to offer OH placements within their pre-registration training programmes.
Consequently, there is a very poor understanding among health professionals of the effect of work on health and vice versa, as well as the essence of OH practice.
Nurses’ appreciation of the reciprocal effects of work on health will not change unless the regulatory bodies, the Nursing and Midwifery Council and Health Care Professions Council, include consideration of health and work within their standards for pre-registration education programmes.
‘Falling’ into OH
So many OH nurses I speak to “fell” into or “stumbled across” OH. I love the story of the midwife who, listening to the less-than-satisfactory experiences of her pregnant or new mum colleagues, went to her OH department and delivered a business case as to why they should employ her. This worked, and she was employed part-time to educate OH on everything relating to maternity and to provide advice to those referred for pregnancy-related reasons. She went on to complete her specialist training in OH and is now a senior OH manager at an NHS trust.
There was nothing about OH in our curriculum 30+ years ago and there still isn’t.”
I too fell into OH when the factory I was working at as a catering manager became aware that I was a nurse and offered me the job of opening an OH clinic. There was nothing about OH in our curriculum 30+ years ago and there still isn’t. The main reason cited by Higher Education Institutions (HEIs) is that there is no space to include it within a curriculum that is already crammed.
Another potential blocker for a career move into OH may be misconceptions around funding to undertake a formal qualification. As OH is not a general service of the NHS, concerns around accessing funding may put people off the speciality. However, it is a myth that OH is not funded; Health Education England (HEE) does fund OH qualifications through the SCPHN – OH route and at least one non-NMC approved BSc (Hons) programme, such as the course offered by the Robert Gordon University. For those working in the NHS, the funding even covers salary costs.
Many OH companies advertise for trainees and then fund their education. The foundation qualification in OH, developed by the Faculty of Occupational Medicine (FOM), Diploma in Occupational Health Practice, has gained funding through the Growing Occupational Health Together programme.
More investment in OH needed
There are growing calls for more OH investment to keep working-age people healthy, including in the landmark reports from Dame Carol Black in 2008 and the Department for Work and Pensions in 2019. Not every employee has access to OH – data suggests access could be anywhere between 37 and 51%.
Those in practice placements talk to their fellow students, providing a wider reach and passing the message on. “
As Waddell and Burton propose, good work is good for health, and the Academy of Medical Royal Colleges, Royal Colege of Nursing and Allied Health Professions Federation produced an action statement for health and work with the intention of “inspiring and supporting” healthcare professionals to have work as a health outcome. Exposure to OH provides the practical tools to reach this outcome.
Increasing access to OH can only happen with more OH clinicians, and providing pre-registration OH clinical placements will raise awareness of OH as a career option. Those in practice placements talk to their fellow students, providing a wider reach and passing the message on.
OH in the NHS
If the NHS is to be effective its workforce must be fit and well, the King’s Fund has said. Boorman’s 2009 report focused on staff health and wellbeing as crucial in the delivery of quality care, and Nicholson followed this up by stating NHS employees must promote their own health and wellbeing to be able to care for patients.
As such, a strong OH workforce is essential to service the NHS. This provision is delivered internally via NHS OH departments and externally via OH providers.
The Covid pandemic highlighted the usefulness of OH in supporting staff. NHS England (NHSE) commissioned the Growing OH and Wellbeing Together programme with one objective: to increase OH capacity.
Not only must the NHS attract motivated and educated professionals, attrition must also be reduced. Attrition among student nurses and nurses within two years of qualifying is often due to workload, stress and personal reasons, according to HEE. Work-life balance is also a factor, the Health Foundation has said. OH is different to other specialities because it has regular working hours, has autonomy within the role, can offer hybrid or home working in some industries, and has plenty of variety.
Practice placements in OH
Practice placements have a big impact on retention amongst the student population. If more students knew about OH as a career and experienced OH as a placement, attrition during or soon after study would reduce.
Pre-registration student placements are one such way of promoting OH as a career. Recruitment into GP surgeries is based on placements – OH can emulate that success.
HEIs not only need more placement opportunities but need quality placements. One of the strong benefits of placements within OH is a high likelihood of exposure to a multidisciplinary team. Many OH teams have nurses, musculoskeletal clinicians such as physiotherapists, OTs, psychotherapists, psychologists, OH physicians, technicians, physiologists, etc. This creates a range of opportunities for nurses and AHPs alike.
Pre-registration student placements are one such way of promoting OH as a career. Recruitment into GP surgeries is based on placements – OH can emulate that success.”
The NMC standards of proficiency for registered nurses fit really well within an OH service and many skill requirements are commonly found within OH (NMC, 2018). Every OH clinician will know that continuous learning comes with the job, great communication skills are essential, and understanding history is second nature. The diversity of the roles and environments people work in, alongside the variety of health issues and the legislation involved, makes this a dynamic field.
Employers benefit from student placements
Having a student placement is not business as usual – it does take some effort – but it does offer both long- and short-term gains.
HEI placement leads undertake a review of the learning environment for all new placements, leading to improvements or validation; useful for retaining and enticing new staff and customers.
Being a mentor, supervisor and assessor requires development. This upskills clinicians, helping with retention, goals and revalidation.
Having students, especially those from differing specialities injects differing perspectives and latest updates and thinking into practice, helping to keep services relevant. Students can assist with service delivery, projects, audits and even research.
Most employers consider their social value strategy, and what better strategy than to support the next generation of healthcare workers?
There is also a financial benefit to offering a student placement. There is a placement tariff of £132, paid for by HEE per 37.5 hour week.
Jasmine Duxbury-Wood, associate director of nursing – north, at Medigold Health, has highlighted the benefits the company has seen after having its first general nursing student join its team in Manchester.
She said: “We developed a timetable so they could experience several areas of the business. However, whilst the student was with us, we learned that they had an interest in drug and alcohol rehabilitation. Thereby, we made sure that the student spent time with our drug and alcohol testing team, they also shadowed one of our occupational health physicians who has a background in drug and alcohol rehabilitation. At the end of the placement, we received some lovely feedback from the student, and they even advised that they are now considering a career in occupational health! We are looking forward to hosting our next student.”
Lyndsey Marchant, business owner at Phoenix OH, has offered placements to two students from Staffordshire University who knew nothing about OH beforehand.
“Both students loved the placement and asked to come back. Our first student is now a registered nurse and employed by us as a trainee undergoing her preceptorship, which has been sanctioned by the head of the school of nursing. They are using an OH technician skills passport that has been updated to reflect the nurse requirements of the role. Overall, a great success,” she said.
As OH practitioners we have a vested interest in attracting highly motivated professionals to the career. We should be encouraging fellow professionals to find out more about what we do and how we do it, and be open to facilitating practice placements.
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