Profession backs shake-up of occupational health nurse education

Nurses leading the development of a Faculty of Occupational Health Nursing (FOHN) have published a radical paper on the future of occupational health nurse education. Nic Paton tests the reactions of leading OH figures and finds strong support for the paper’s recommendations.

“Left unaddressed, there will be a gradual erosion of the professional standing of OH nursing and, therefore, the FDG [Faculty Development Group] urges the regulator to take swift and effective action to remedy matters.”

Are the gloves now off between OH practitioners and the Nursing and Midwifery Council (NMC)? Certainly, the words above and much of the narrative running through the latest position paper from the OH nurses leading the development of a new FOHN, appear to suggest that we are going to be in for an interesting couple of years when it comes to OH nurse education and regulation.

Next steps towards a Faculty of Occupational Health Nursing

The position paper laid out the next steps that the FDG intends to take during 2016 and 2017. These include:

  • During 2016, a survey of OH nurses will be
    carried out to obtain a more accurate picture of the profession, its education requirements, its concerns or views about standard setting, and to consult on the future shape and structure of the faculty.
  • A further position paper will be published on the FOHN website by or before mid-2017. T he aim is for the faculty to be fully operational by the end of 2018.

The 29-page paper, Occupational Health Nurse Education, Funding and Regulation, published in November 2015, not only sets out and updates the timeline and progress towards a future OH nursing faculty, but it can also be read as a highly critical analysis of the current NMC-led education and regulatory landscape.

Occupational Health & Wellbeing approached the NMC for a comment or response to the paper and, while none was forthcoming for publication in this issue, it will almost certainly have led to much discussion and debate at 23 Portland Place.

For one thing, the paper did not pull any punches. It stated: “The FDG believes that the current system of nurse education, funding and regulation is failing employees, employers and nurses alike; and recognises that this may, in part, be due to a lack of knowledge about OH as a specialism.”

Or, equally damning: “In the spirit of ‘partnership and collaboration’, which forms part of the values and principles of the NMC strategy 2015-2020, the FDG is keen to develop a more evolved and consultative way of working with the regulator and professional bodies in future.”

None of this is likely to be comfortable reading for the NMC. However, while the FDG may have been putting tanks on the NMC lawn, the paper avoided directly recommending that the NMC be replaced as the regulator of OH nursing.

For example, it was careful to emphasise that the faculty’s work will “be undertaken in collaboration with the NMC and the National School of Occupational Health.”

It also argued for the closure of the specialist community public health nursing register “but only if there is an alternative recognition of the specialist occupational health qualification at both practitioner and advanced practitioner level status.”

Changes long overdue

What, then, do OH nurses, practitioners and others make of all this? The consensus broadly appears to be that the FDG has got its criticisms spot on, and the need for a faculty and wholesale reform is both needed and long overdue.

Indeed, Dame Carol Black told Occupational Health & Wellbeing that she fully agreed with the concerns set out, saying that “the current system of nurse education, funding and regulation is failing employees, employers and nurses”.

Black added: “I recognise their aim to answer such concerns by seeking establishment of an authoritative professional body, a faculty, either standing alone or under the aegis of an existing body, which sets educational and practice standards, so driving the quality of practice and supporting the professional development of practitioners. This is a considerable task, but I hope it succeeds. I shall watch the outcomes of discussions with the numerous stakeholders with interest.”

Professor Diana Kloss, chair of the Council for Work and Health, also gave her backing. “It has been recognised for some time by senior members of the occupational health professions that the NMC Part 3 qualification is not fit for the purpose of modern OH nursing practice,” she said.

“It is hoped that eventually a new qualification can be created and validated by the National School of Occupational Health, which will eventually assume responsibility for training the multi-disciplinary OH workforce. This is a brave and imaginative step towards that end and the group are to be warmly congratulated,” she added.

Dr Richard Heron, president of the Faculty of Occupational Medicine, said: “We very much welcome the formation of a Faculty of Occupational Health Nursing. The delivery of, and access to, occupational health advice is dependent of a multidisciplinary occupational health workforce, each working together and making the most of their unique yet complementary skills, whether that’s physicians, nurses, ergonomists, industrial hygienists, psychologists, physiotherapists and so on.

“We also welcome it because it is important that each of our specialties is seen to be professional, credible; to have a strong culture and robust governance. We are working with the team developing the faculty to provide whatever support and help we can, and we wish them every success on their journey,” he added.

“The whole idea of a Faculty of Occupational Health Nursing is long overdue,” agreed Professor Sayeed Khan, chief medical adviser to the manufacturers’ organisation EEF. “We have struggled for years to try to have a single voice; and of course the doctors have still not managed to do it, even though the Society and Faculty of Occupational Medicine are now collaborating so closely as to be, for practical purposes, almost speaking with one voice.

“What the NMC has done through Part 3 of the register is create nurses who, really, are not fit for purpose, at least in regards to occupational health. That could be resolved by a Faculty of Occupational Health Nursing, and I think it will be valuable,” he added.

“I believe the FOHN is undertaking a much-needed lead in the review of the OH profession and shaping the future for a better model in educational and professional practice,” argued Janet Patterson, OH practitioner and director of OH nursing services at Black & Banton.

“We can’t sit back and wait for a small team to come up with the answers – I urge all those with a vested interest in OH to contribute and support the FOHN with shaping our future by contributing wherever possible to such developments – the purpose to shape our practice and, of course, for the benefit of our successors,” she added.

And, in fact, that is precisely what is going to happen next. The next stage of the FDG process in 2016 is to carry out a large-scale survey of OH nurses to obtain a more accurate picture of the profession, its education requirements, its concerns or views about standard setting, and to consult on the future shape and structure of the faculty.

Yet more uncomfortable reading to come for the NMC, perhaps?

Failings in occupational health nurse education

The position paper identified what it argued were a number of failings in the system when it comes to education and regulation, including that:

  • Because of the number and variety of higher educational courses, OH nurses are graduating with mixed levels of experience, knowledge and skills.
  • There is also concern about the variation that exists between Specialist Community Public Health Nurse (SCPHN) OH courses, because “some clearly do not include sufficient OH-specific content”.
  • Too many OH nurses are graduating from SCPHN OH courses “having been inadequately prepared to work in the specialism”.
  • Educational sponsorship for SCPHN courses is more readily available from the NHS for health visitors and school nurses than it is for nurses choosing to practice in OH.
  • These deficiencies in education and funding are compounded by problems within regulation, registration and the recording of qualifications, which can lead to those without the SCPHN qualification being “marginalised”.

What is being called for?

The paper made a wide range of recommendations, some of which were that:

  • The NMC and other associated bodies should review the current system through which proficiency for practice is determined, with an emphasis on ensuring “there is increased consultation with senior nurse practitioners and decision-makers in OH”.
  • SCPHN courses must be more closely aligned with the needs of future OH strategy and evidence-based provision.
  • A formal regulatory mechanism should be adopted so that OH nurses can input feedback into NMC standards for OH education.
  • Shared learning with other SCPHNs should no longer be mandatory, and, instead, shared learning with relevant multidisciplinary groups and professionals should be required.
  • An agreed national standard for OH nursing with appropriate alternative levels of qualification should be put in place for those not wishing to attain degree level.
  • OH nurse accreditation should be set at advanced practitioner level, a dedicated career pathway made available for newly qualified OH nurses and a route developed for existing non-SCPHN qualified OH nurses to attain the national accredited qualification in OH.
  • Differences between validated and non-validated SCPHN courses must be addressed, with appropriate consistent standards.
  • A quality assurance process should be incorporated into OH degree courses.
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