The government is committed to promoting public health, as shown by the White Paper, Choosing Health. The nursing profession must, therefore, respond to this integrated public health strategy.
The Nursing and Midwifery Council (NMC) is aware that a number of specialist nurses undertake strategic and population-
focused practice, rather than working directly with individuals.
As such, they may make decisions on behalf of one or more populations without having direct contact with individuals within those populations.
Public protection is the remit of the NMC, and it believes that this form of practice has characteristics that require such protection. On 1 August 2004, the NMC launched a nursing and midwifery register, which had three sections: one for nurses, one for midwives, and a register for Specialist Community Public Health Nurses (SCPHNs). Entry on this list was only open to people who already held NMC registration. And there was no direct entry to this part of the register.
The initial intention of the NMC was that only health visitors would get an automatic right of registration as SCPHNs. However, a mapping exercise was undertaken to identify other groups of practitioners, qualified in other areas of nursing, who undertake a public health role. This indicated that occupational health nurses (OHNs) and school nurses who already held a recognised qualification in their field, should also be eligible for direct registration.
As a result, appropriately qualified OHNs have been registered as SCPHNs.
For a limited period, the NMC will also allow a portfolio route to SCPHN registration for nurses who do not hold an NMC-recognised course such as a BSc (Hons) Occupational Health Nursing or its equivalent. Such practitioners must demonstrate that they have acquired a range of competencies in ways other than an NMC-validated award.
Many nurses working in OH settings may be eligible for registration using such an approach.
The NMC can provide further information on how this can be achieved.
As an OHN educator, I am often challenged about the content and mode of delivery of OH courses. Many practitioners seem unaware that the teaching team alone does not decide on course content.
The opinion of employers and service managers plays an important part in the development of the OH curriculum. However, even more significant is compliance with standards set by both the NMC and the validating university.
The recommendations of OHN practitioners who sit on the curriculum development panel sometimes conflict with the requirements of other stakeholders. And at institution level, economies of scale are often significant drivers, so curriculum development can be a challenging process.
The standards relating to the length, content and delivery of courses preparing nurses for registration as SCPHNs, and the proficiency of graduates from such courses, were set by the NMC in 2004. All NMC-validated courses conferring SCPHN registration must comply.
Philosophy and standards
The philosophy underpinning the NMC standards is the recognition that public health initiatives involve a co-ordinated and interdisciplinary approach, addressing the environmental, physical and psychological health concerns of communities and populations.
There are four key principles which are integral to NMC-validated SCPHN courses:
- Preparation: fitness for practice
- Service: fitness for purpose
- Recognition: fitness for award
- Responsibility: fitness for professional standing.
These programmes are about “role-preparation”. Successful graduates will be entering a practice-based profession at a level beyond initial registration as a nurse (or midwife).
The standards of proficiency achieved within these courses are underpinned by 10 key principles of public health practice and are grouped together into the following four domains:
- Searching for health needs
- Stimulation of awareness of health needs
- Influence on policies affecting health
- Facilitating health-enhancing activities.
Ten principles are associated with these domains. These are:
- Promoting and protecting the population’s health
- Developing quality and risk management
- Surveillance and assessment of the population’s health
- Collaborative working
- Working with, and for communities to improve health
- Developing health programmes and services to reduce health inequalities
- Policy and strategy development
- Research and development
- Strategic leadership
- Ethical management of self and resources.
Standards of education
The NMC requires that educational courses prepare people who are fit to practice. To ensure this they have set 11 broad standards relating to course delivery, which encompass:
- Theory – practice balance
- Defined areas of practice
- The academic standard, length, structure and nature of the programme
- Curriculum content
- Student support
- Knowledge underpinning practice
- Supernumerary status of the student.
The requirement for supernumerary status is a thorny issue. Interestingly, health visitor students have always been supernumerary, whereas there are challenges to achieving supernumerary status for those students employed by an OH service and studying on day-release.
Length of programme
Although SCPHN programmes can be studied on a full or part-time basis, there is a limited degree of flexibility in their length.
The NMC stipulates both the time in which a course should be completed and the maximum time in which it can be completed. SCPHN programmes must have an overall length of 52 weeks (full-time equivalent) of which 45 are programmed weeks. They must be completed in not more than 78 weeks of full-time study, or 156 weeks part-time.
The rationale behind this is that it is important that the student has current knowledge. However, nursing is a female-dominated profession and this tight timeframe may pose difficulties for students who wish to take maternity leave. There is little time for anything other than a very short career break.
Programmes must comprise practical and theoretical learning that is transferable to different settings, clients and areas of practice.
Interestingly, the NMC states: “The student has a spread of experience across specialist community public health practice” (NMC 2004), the rationale being that this will enhance public health provision. However, the corollary is that the OH service providers that are sponsoring trainee OH nursing may be reluctant to comply with NMC requirements.
Courses conferring SCPHN registration are to do with role preparation, so it is important that they remain rooted in practice. NMC validation will only be achieved if there is equal emphasis on both the practical and theoretical components of the curriculum.
As practice is such an important element, the NMC stipulates the minimum qualifications and experience of nurses who supervise the practice of students while they study on these programmes, and of the mentors who finally ‘sign off’ competence for registration.
The NMC requires practice facilitators to be registered as SCPHNs and also to hold an appropriate teaching qualification. Compliance with this standard is not easily achievable in the OH setting. The NMC is in discussions with stakeholders representing service, education and government health departments about setting appropriate criteria for those who undertake these roles in all SCPHN practice settings, including OH.
The NMC statement of entry of registered SCPHNs indicates the route that the practitioners have taken to gain that registration. Those who have entered by virtue of being an OHN will see this indicated by the annotation OH. In future, this annotation is likely to disappear. Furthermore, at a recent course validation, the NMC required the removal of reference to ‘specialist units’ on one programme and, in the future, units of study may become totally multi-disciplinary. While this will emphasise the public health nature of the programme, it could lead to a dilution of the specialist nature of OH nurse practice.
However, OH nurses can influence both the NMC and the curriculum of courses that prepare OH nurses. It is important that they keep abreast of future educational developments and make sure they involve themselves in any consultation processes – particularly those that form part of curriculum development – and also become involved in consultations initiated by the NMC.
Anne Harriss is a reader in educational development and course director of the BSc (Hons) Occupational Health Nursing at London South Bank University
- Royal College of Nursing (2005) Competencies: an integrated career and competency framework for occupational health nursing. London: Royal College of Nursing
- Nursing and Midwifery Council (2004) Standards of Proficiency for Specialist Community Public Health Nurses, London: Nursing and Midwifery Council