What’s in a name? If you are an occupational health nurse (OHN) faced with a rapidly changing profession, not to mention a patient and client base that bears little resemblance to that of five years ago, let alone a decade, quite a lot, in fact.
The key theme of December’s Royal College of Nursing Society of Occupational Health Nursing’s (SOHN) annual conference was collaborative working. Speakers at the event in Cardiff, which was held jointly with the Society of Occupational Medicine, made the case for, among other innovations, a network of regional occupational health centres, a Faculty of Occupational Health, and more closely linked training pathways for OH physicians and nurses.
Time for a change?
Whatever the detail, what does seem increasingly clear is that OH nurses and physicians, OH technicians, GPs, physiotherapists, psychologists, health and safety professionals and even occupational therapists, are all going to be working much more closely together in the future. And this in turn raises the question: if OH is becoming a much broader church, and a much more high-profile, front-line specialty, is it time to think the unthinkable and consider a change of name?
This is not as facetious a suggestion as it first appears. OH practitioners have long complained of being misunderstood, by employers, staff, government ministers, the Nursing and Midwifery Council, doctors and other healthcare professionals, to name but a few.
The role of the OHN has changed immeasurably over the years and, while there may be a lot of affection, heritage and history associated with it, does it now accurately reflect what the profession is all about? Just as importantly, are the words ‘occupational health nurse’ self-explanatory to employers and employees, or are they confusing and inadequate when it comes to explaining what the profession actually does and can offer?
One of the difficulties with the title ‘occupational health’ is its history – in particular, its association with heavy, factory-based industries that, while they are still a part of today’s working landscape, are not nearly as significant a fixture as they once were, argues professor Michael O’Donnell, chief medical officer at health insurer Unum.
“One of the problems is that we have moved past the industrial age. So things such as health screening, while there is still obviously a call for them, are not seen as important within a modern working environment,” he points out.
OH also has an association with fitness to work – or the management of people who are off sick back into work – whereas in fact in the future, there may need to be much more of an emphasis on helping people to stay in work in the first place, says O’Donnell.
“Occupational health is often asked: ‘Is this person fit to work?’, or ‘Are they covered by the Disability Discrimination Act?’, rather than: ‘Can you help to identify a solution to the problem?’,” he says.
“There is nothing necessarily wrong with the title. The biggest problem is that we have gone down the route of there being all sorts of expectations around it. It is all stuck with tradition,” he adds. “If you were looking for something that would have more influence and would be as useful as possible, I would say it could be called ‘occupational rehabilitation’, which is more about looking at whether and how people are able to work. I think it could help employers.”
People simply do not understand the term ‘occupational health’, agrees Dr Sayeed Khan, chief medical adviser to the engineering and manufacturers’ organisation the EEF (Engineering Employers Federation).
“My preference [for a name for the profession] is ‘workplace health’,” he says. “Anyone can call themselves an adviser, specialist, practitioner or professional, but only doctors and nurses can call themselves doctors and nurses, hence that’s why I like ‘nurse’ in the title.”
The issue of whether the profession should retain the title ‘nurse’ is one charged with emotion. The word ‘nurse’ signifies membership of a respected, high-end profession with a long and cherished history. It emphasises to the employee – and this again is a hugely important issue – that the person before them is independent, even if they are nominally working for their employer. It also emphasises that this is a person bound by the confidentiality strictures of the patient/nurse, patient/doctor relationship.
At a practical level, as many delegates at the SOHN conference pointed out, it is also what most OH nurses see themselves as, first and foremost. They started out their careers as nurses, trained as nurses and are proud of that fact. Losing the term would therefore be akin to losing a central part of their identity.
Yet a debate during the conference’s ‘Question Time’-style question and answer session also highlighted one of the ongoing problems with the nurse title. Asked whether the Royal College of Nursing could make the case for trying to get an OH-based storyline into one of the popular TV medical-based soaps, such as Casualty or Holby City, professional nursing department team leader Carol Bannister pointed out that, even in this day and age, for most TV producers, the term ‘nurse’ means female, uniformed “angels”.
It is arguable much the same problem exists with employers and staff. For many, what they want (and sometimes think they are getting) when they call in an OH nurse is a ‘works’ nurse’ who can dole out sticking plasters and bandages, tea and sympathy. There is also the question of whether having the title ‘nurse’ or ‘doctor’ makes workplace health issues more likely to become medicalised.
As Unum’s O’Donnell points out: “If you have a broken leg and cannot drive to work, for instance, it may be treated solely in medical terms, and no-one will think, well, maybe he can come to work in a taxi? You do not need to be an OH nurse or doctor to realise that.”
In this context, the word ‘nurse’ (or doctor or physician) can become problematic. As it is a medical title, when an employee is sent to ‘the nurse’, the situation immediately becomes a medical issue.
“We cannot afford to let the traditions go but, on the other hand, we have a vocational rehabilitation department that includes OH nurses, therapists, physiotherapists and psychiatrists,” says O’Donnell.
Yet, even having argued for the title of ‘occupational rehabilitation’, O’Donnell concedes that this is somehow quite a strong, hard-edged name. Perhaps, he muses, ‘workplace nurses’ might be more appropriate? But then that, again, is loaded with connotations of tea, sympathy and sticking plasters. So there’s no easy answer.
SOHN chair Cynthia Atwell, for one, believes the profession needs to retain the nurse title, but agrees there may be a case for changing the occupational health element.
“I feel we need to keep the title ‘nurse’ there because that is our background, the base upon which we specialise. And also I am proud to be a nurse. But we do not seem to be able to make people understand what occupational health is all about. So maybe we do need to change our name,” she says.
While she suggests ‘wellbeing nurse’ or ‘health at work nurse or physician’ could be an option, she stresses the profession needs to be raising awareness as much through its actions as by tinkering with its title.
“If you are doing a good job, you do not need to have a fancy title,” she says. “We need to be raising the profile of the profession generally, what we do and what we can achieve.”
Caroline Whittaker, senior OH lecturer at the University of Glamorgan, argues that perhaps the lack of understanding of what OH is and does comes down to the fact that the profession doesn’t do a very good job of selling itself.
OH nurses rarely win, or even put themselves forward for, awards – something the recent Occupational Health Awards are doing their best to counter. “There is some wonderful OH being done out there, but we do not celebrate ourselves [enough]”, Atwell says. “We also need to try to encourage young doctors and nurses, to make them recognise that OH is an attractive option for them. We need to sell the message that it is not boring and that it is an interesting job.
“We have a lot of OH physicians that are retiring and not many are coming up behind. We need to show that OH is an attractive pathway. Too often, nurses just want to go to accident and emergency, to theatres and then to ITU [intensive therapy unit],” she adds.
Another arguing for a change is Bashyr Aziz, senior lecturer at Wolverhampton University and a member of the SOHN steering committee. “It is time for OHNs to reconsider their title,” he agrees. “The reference to occupational health was appropriate two decades ago, when there were occupations clearly identified as being hazardous. Heavy industry was hazardous mining was hazardous.
“Nowadays, however, in a post-industrial Britain, there are few occupations that are in themselves hazardous, although construction and agriculture still have unacceptably high rates of fatal accidents,” he says.
“Overall, most of the time lost from work is due to conditions such as stress and musculoskeletal disorders, which are associated not with particular occupations, but with unhealthy workplaces. Some workplaces are healthy, other workplaces with comparable jobs and workforces are unhealthy,” Aziz says.
Therefore it might be more appropriate to talk about “workplace health and wellbeing”, rather than “occupational health”, he argues.
“Another fact is that occupational health continues to be mistaken for occupational therapy. This is understandable. A person with psychological disease receives psychological therapy to promote psychological health a person with skin disease receives skin therapy to improve skin health. It seems only right that a person with an occupational disease should receive occupational therapy to promote occupational health,” Aziz adds.
He also believes the use of the title nurse needs to be examined. “In our public health roles as health promoters and educators, we perhaps create wrong expectations as nurses. A nurse or a doctor, by most people’s definitions, is a person who provides treatment and helps the sick get better.
“OHNs, first and foremost, help ensure that the worker does not require treatment. I propose that for occupational health in the 21st century, a more appropriate title is ‘workplace health and wellbeing adviser’,” he says.
The sheer range of the sort of work OH now does means that it may well be high time for it to consider changing its name, agrees Dudley Lusted, head of corporate healthcare development at Axa PPP.
“OH now does prevention, early intervention, health promotion, management of stress and musculoskeletal disorders, rehabilitation and more. That says to me something like ‘organisational wellbeing’ or ‘organisational health’, rather than simply ‘occupational health’,” he says. “The focus on the word ‘occupational’ suggests it is a problem caused by work. But in the knowledge economy, most of these types of things come in from outside work.”
As to the idea that OH nurses are psychologically attached to being called nurses, he laughs out loud.
“Whenever I meet an OHN and call them an OHN, they say they are not – they are advisers, or whatever it might be. So I’d always got the impression they hated it,” he says.
But before everyone rushes in and changes the name, it is important to think long and hard. OH may be misunderstood at times, but would anything else be any better? It is also important to recognise that, with any change of this sort, you often have to go back to square one when it comes to building up name recognition and brand value.
Word of caution
One urging caution is Geny Foster, director of the Commercial Occupational Health Providers Association, and managing director of OH consultancy Medigold.
“I am a great believer in simplicity,” she says. “It is also an issue of authority. A teacher is a teacher because they have a certain qualification. When we are sick, we are at our most vulnerable, and people take a certain amount of comfort from these titles that they are being seen by a doctor or a nurse.”
What she believes OH could do better, and much as HR has had to do over the past few years, is to become less protective and territorial, and do more to lift the veil and mystique that it sometimes wraps around its activities.
“There is sometimes a tendency for us to be slightly patronising to employers, as if we are doing something that is a black art,” she argues. “But employers are not stupid. They may have different angles that they are coming from, but they do understand what we do. I get asked a lot of questions that are outside pre-employment or sickness absence, but it is still all the commonality of the workplace.
“I would keep it as occupational health, because one of the problems we have as an industry is that there is all too often a blurring between us and first-line care,” she says. “‘Occupational health’ is a bit like Ronseal: it does what it says on the tin.”