Including
occupational health as a practice placement for student nurses as part of their
pre-registration diploma is a process that has also been advantageous to OH
teams, by Tammie Daly, Nia Harris & Alison Clarke
Occupational
health nurses (OHNs) are in a unique position to assist student nurses to meet
the public’s ever-changing health needs.
This
article discusses the setting up, implementation, and benefits of including
occupational health as a practice placement for student nurses as part of their
pre-registration diploma programme – a process that has also been advantageous
to the OH staff involved.
According
to an article in Nurse Education Today, ‘collaboration between educational
institutions, clinical practitioners and managers is necessary in order to
reduce ‘reality shock’ and bridge the gap between nursing education and nursing
practice’.1
Nottingham
Occupational Health (NOH) has always maintained close links with Nottingham
University, through lectures, health screening and support.
It
has, in the past, placed Project 2000 students in industry but, due to a
shortage of suitable placements, time constraints and, in some cases, the
attitudes of the students, the project folded.
The
Department of Health’s (DoH) Placements in Focus advocated a more innovative
approach to providing student nurse placements.2
In
2001, Alison Clarke, from Nottingham School of Nursing, suggested NOH consider
including OH as a themed placement for adult branch student nurses as part of
their ‘community experience’.3
The
rationale behind the initiative was for student nurses to understand the
effects of work and the workplace on health, and the effects of ill health on
the individual’s fitness to work.
This
would then enable them to provide better advice to patients on managing their
health in relation to their working environment, managing chronic health at
work, liaising with appropriate support to continue to work with an existing
health problem and returning to work after illness.
Outline
of project
To
try to involve other OHNs, Clarke spoke to the Nottinghamshire OH Group and the
information was distributed via their newsletters. Some OHNs thought the
students would be too inexperienced to work in our speciality, while others felt
unable to commit the time. Six nurses, however, did see the potential, and met
with the programme manager and placement co-ordinator to explore the concept
further.
Two
organisations, Nottingham Trent University and NOH, agreed to pilot the scheme,
while other organisations expressed a willingness to have the students visit
for periods ranging from half a day to two days.
The
placement sites were first audited by the school to help ensure they would meet
the learning needs of the students. The group met to develop a learning package
around professional practice, care delivery, care management and the
development of self and key skills.4
Each
of these domains was explored in relation to OH practice and to ascertain what
possible insight could be expected from the placement, as well as the
development of practice skills.
This
package proved a useful guide for OHNs to facilitate, direct and focus learning
for the students on placement. The placements also benefited the OHNs by making
us critically analyse our own practice, especially when reflecting and
discussing clinical situations with the students.
It
can be difficult for the busy OHN within the daily constraints of clinical
practice to find time to search for, read, appraise and think about using
research. Students ensure we do find the time, especially as they are taught to
look for evidence-based practice, thereby making us initiate, develop and
maintain change.
The
project started in October 2001. NOH, which has three departments and a team of
nurses, was able to place two students, while Nottingham Trent University took
one student, as its nurse worked alone. The placements were structured and a
programme produced before the students started. These included visits to other
OH departments such as Astra Zenica, Boots, The Fire Service and RHMS bakery.
The students also visited other sites and industries with their mentors (see
box, left).
Getting
started
On
the first day, all three students met at the hospital for the induction. This
allowed the nurse from the university to meet the students to help ensure peer
support would be possible during the placement and, hopefully, reduce the
anxiety of the students entering a new environment.
Ground
rules were negotiated to ensure the students realised that the health, safety
and welfare of the OH client group was the main concern. The induction included
an explanation of the role of OH, confidentiality issues (especially as peer
records would be stored in the hospital’s OH department), and the learning
experience that would be available within, and allied to, the placement. It
also covered the expected outcomes from the placement.
Outcome
Throughout
the placements (usually six to eight weeks long), the students met about three
times with the tutor from the school of nursing, to link theory to practice.
The mentors also attended these sessions, providing the opportunity for
communication and consultation between the students, mentors and tutorial
support. It also helped the mentors ensure that the students met their expected
outcomes.
The
OHNs negotiated the learning experiences, acted as role models and promoted
learning through reflection.5 They facilitated the students in self-directed
learning by allowing time within the placements for the students to explore
areas of interest (for example, offshore medicals and drug screening).
This
was especially important because during the placement, the students had to
explore a work/health issue and write a 1,000-word report. Subjects tackled
included reasons for undertaking respiratory surveillance and hepatitis C and
the healthcare worker.
So
far, six groups have had their themed placements in the OH setting, all of
which were evaluated by students, mentors and the school of nursing during a
group discussion at the end of each placement period. Nearly all the students
gave excellent feedback and the placements have proved popular (see box, p20).
The
placements would not have been so successful without the support of other OH
departments. Organisations such as Astra Zenica, Boots, Nottingham Fire
Brigade, and RHMS bakery supported the two main organisations, helping to give
the students a good insight into OH.
Vicky
Wright, OH nurse for Sainsbury’s in the Midlands, is hoping to join the scheme
and take the students for a couple of days next spring. “I am looking forward
to helping student nurses during their training to see how health in the adults
of working age is supported and managed in the workplace,” she says.
Problems
identified
It
wasn’t all smooth sailing; there have been obstacles. One organisation that
joined the scheme later had to withdraw due to time constraints. However, that
nurse still wants to take students for shorter periods.
This
might lead to joint placements in the future (two organisations having a
student for a shorter duration or even half a week each for the six weeks).
There have been rare incidents of problems with time-keeping and absences, but
again these were dealt with on a personal level.
It
must be recognised that it can be emotionally demanding on the part of the OHN,
especially if, like the OHN at the university, you work alone. Also, there can
be conflict between the responsibility to clients and giving the students
enough quality time.
It
can sometimes be difficult to just let go, stand back and allow the students to
undertake procedures, especially if there are time constraints and you would
normally be able to do it quicker yourself. This is one factor you must take
into consideration when supporting students – supervised practice takes time,
and teaching takes even longer. This has, however, been offset, and proved
invaluable when the students were able to provide support in delivering client
care during staff shortages.
Positive
effect
Being
involved in student nurse training can only have a positive effect for all
concerned. It is through education that the quality of care provided to
patients and the general population will be improved.
Students
will be able to link theory to practice, and vice versa. They will be able to
look much more holistically at the patient in relation to work and health, and
hopefully provide them with appropriate health education so they can take
responsibility for their own health at work.
On
future placements, they can raise awareness of good practice, such as promoting
OH services, infection control issues, and action to be taken following
contamination from blood or body fluids. They will understand that ill health
may arise from exposure to hazards at work whether physical, chemical,
biological, psychological or even from an accident.
This
knowledge will stand the students in good stead when they themselves become
ward managers. It will also enable them to look at what the patient will be
doing on discharge from hospital, and think about any special requirements
which will assist them in successfully returning to work. It may even encourage
them to enter the speciality in later years.
Conclusion
The
OHNs learned a lot as well, especially through reflective practice and, for the
most part, have found the students enjoyable and interesting.
It
has made us look at our own evidence-based practice and competencies and has
encouraged other team members to take an active part in student training. It
has also encouraged us to read more literature in relation to our own practice.
It
does take considerable time, commitment and resources on everybody’s part, and
we certainly would not be able to offer such a wide variety of experiences
without the assistance of our colleagues in other industries.
By
working collaboratively with the school of nursing, it has strengthened the
partnership between education institutions and OH. OHNs can benefit from the
expertise of the university and the students have insight into research and
writing for publications. One student working at the university assisted in
writing a latex glove policy and, as a result of his involvement, a joint
article was published in Occupational Health.6
Other
OHNs should be encouraged to either contact their local school of nursing or
have a more positive outlook if approached to take part in a scheme, especially
as the number of pre-registration students is increasing and more placements
will be required. It is beneficial – honestly.
Tammie
Daly, RN, MA(Ed), DPSN(OH), is a nurse consultant at Nottingham Occupational
Health, Queen’s Medical Centre, University Hospital NHS Trust, Nottingham. Nia
Harris, BmedSci (Hons), DipOSH, RGN, is an OH specialist at Nottingham Trent
University. Alison Clarke, MSc, BN, RNT, RN, is a health lecturer at the
University of Nottingham School of Nursing
E-mail: [email protected]
E-mail: [email protected]
References
1.
‘We don’t sing the chorus when the folksinger’s here: the learning society and
healthcare’, Schuller T, 2000, Nurse Education Today, 20,218-226
2.
Placements in Focus: guidance for education in practice for health care
professionals, Department of Health, 2001, ENB, London
3.
Care of Adults in Community and Non Institutional Settings (DN10), Nottingham
School of Nursing 2000a, University of Nottingham (in-house publication)
4.
Diploma in Nursing Assessment of Practice Record: Adult Branch, Nottingham
School of Nursing 2000b, University of Nottingham (in-house publication)
5.
Journal of Advanced Nursing, Volume 21(5), 1006-1015, Atkins, 1995
6.
Stretching the boundaries with new latex-free policy, Harris, N; Roper J, 2003,
Occupational Health, Volume 55, no.1, 19-21
Themed
placements
Nottingham
Occupational Health placements include internal visits/sessions with:
–
Infection control team
–
Health and safety team
–
Lectures on manual handling, DSE, first aid, risk assessment etc
–
Visits to income-generating companies including a bakery and lead factory
–
University site
Nottingham
Trent University placements included internal visits/sessions with:
–
Health and safety department
–
Personnel department
–
Physiotherapy
–
Lectures on risk assessment, DSE, manual handling etc
–
Agricultural college and satellite site, which includes life sciences, sports
science, and labs
Katherine
Hoeglund’s experiences
Before
starting the placement, I did not even know what OH was or how relevant it
would be. I had attended a few times for my hepatitis B vaccinations and that
was about it.
I
was a bit worried I would not enjoy it, mainly because I thought it might be a
bit boring. However, having now completed five weeks on placement, I have
thoroughly enjoyed it. More so than on any other placement, the importance of
policies and procedures has become evident.
My
confidence in undertaking health screenings has soared and I’ve been able to
make links with theory and practice; in other words, my understanding behind
nursing actions.
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The
variety of the placement surprised me, with a lot of visits to external
companies and other OH departments in different fields – vaccinations,
audiology, vitalagraph and vision testing, first aid training, health and
safety risk assessment training, blood-borne virus lectures, back care
lectures, and infection control training to name but a few.
The
skills I have learned on this placement are highly relevant and transferable to
future roles. I would highly recommend this placement to other students.
