There cannot be many people in the OH profession who have not heard about the Royal College of Nursing’s (RCN) Integrated Career and Competency Framework for Occupational Health Nursing.1 The document was launched last autumn following more than two years of consultation and debate – during which it was presented at a number of conferences, including the annual Society of Occupational Health Nursing conference, and the Association of Occupational Health Nurse Practitioners symposium.
The framework was originally conceived as a guide to how OH competencies fit into the Agenda for Change2 and the Knowledge and Skills Framework (KSF),3 which were introduced by the government to help determine pay and conditions within the NHS. Feedback from the profession to the Society of Occupational Health Nursing at the RCN and the Occupational Health Managers Forum, which worked in partnership to develop the framework,4 soon revealed that OH nurses both within and outside the NHS required specific guidance to the competencies and skills required for career progression within occupational health nursing.
The resulting framework took the competencies identified during the consultation period and mapped them against six of the core NHS KSF competencies, and seven of the specific NHS KSF competencies.
It also mapped them against the 10 public health proficiencies required by the Nursing and Midwifery Council (NMC) for entry to part three of its professional register (see below).
In the foreword to the completed document, the Society of Occupational Health Nursing and the Occupational Health Managers Forum state that the framework should provide “signposts to practise at key points in career development and progression, and should be used as a guide to occupational health nurses (OHNs) and their employers for decisions on practice competency; personal and professional development; and career and pay progression”.
So, six months down the line from its introduction, how has it been received so far, and is it being used as was intended – as a guide for OHNs, educators and employers?
“The feedback has been very positive,” says Jan Maw, RCN OH adviser and the RCN’s project lead on the framework alongside OH adviser Carol Banister. “We’ve kept an open weblink on the RCN site and at the last Society of Occupational Health Nursing conference, a lot of organisations told us they have used it.
“I’ve had a lot of enquiries from HR people who’d like to use the document as well and I am happy to send it out to organisations that request a copy.”
This is a key point. One of the problems for OHNs working outside the NHS is that their employers do not come from a healthcare background, so they don’t always understand the requirements for training and development needed for an OHN to develop their career. With the publication of the framework, OHNs are now equipped with a written document to show their employers that outlines the clinical skills required to do their job and, of course, what they might need to increase their learning.
One organisation that is planning to adopt the framework as a guide to its non-healthcare-based line managers is Atos Origin. The company provides OH health services to a number of large organisations including Royal Mail, the Prison Service and the Department of Work and Pensions, and it employs about 60 OHNs in the UK.
“We’re not managed in this business by clinicians, but by operations managers,” says Caroline Cliff, clinical performance and development lead for Atos’ Occupational Health, Counselling and Screening Services. “So we needed to develop something whereby an operations manager could look at a person’s performance, but have some guidance behind them, especially on clinical matters.
“Because operations managers don’t have an OH background, they could be blinded by science. If they don’t understand what an OHN needs, they can’t be expected to know what they’re supposed to achieve.”
Cliff’s department is developing an internal professional portfolio based on the framework, which will serve as internal PREP for all its nurses (Post Registration Education and Practice, a legal requirement for all nurses). A professional lead in each region will complete the professional portfolio with each nurse practitioner, and identify their training needs. This will then be fed back to the operational manager, who will have the necessary information to put those training needs in place.
“It’s still in the development process, but we have used it already in designing the interview process, and I used it very recently in coaching, mentoring and personal development,” adds Cliff.
The relative speed with which the framework has been adopted across a number of organisations is impressive, and reflects the fact that the OH profession had been crying out for a guide to nursing competencies for some time. Bupa Wellness has taken the document and modified it to create a Bupa OH competency framework, which reviews all the job descriptions for the OH staff, and cross references it to the framework. Interestingly, on Bupa’s framework, they’ve added OH technician at the bottom end, because the company uses a lot of staff at this level to carry out basic health assessments, such as audiometry.
“There’s a dearth of nurse practitioners, so we’re looking at a programme of training in-house that goes along with their academic training,” says Sarah Purdy, clinical training consultant for Bupa Wellness.
“Using the framework, all the salaries have been reviewed under the Agenda for Change in the Knowledge and Skills framework to make sure they are consistent. Really, it’s about looking at the whole package, so that staff can see what career development is and how they can progress from one section to the next,” says Purdy.
Of course, the impetus behind the formulation of the framework in the first place was the introduction of the Agenda for Change within the NHS. So has the framework been a useful tool for OHNs working within the NHS, many of whom have had their own challenges in convincing other nurses of the specific skills needed to practise OH nursing, and ensuring that they are banded correctly under the Agenda for Change at the right level for pay and progression?
David Maslen-Jones clinical nurse manager OH, at Plymouth Hospitals Trust and OH visitor to the Nursing and Midwifery Council (NMC), says the framework has been useful. “The competency document relates closely to the Knowledge and Skills Framework as set out in the Agenda for Change. In that way, it’s been very useful in developing job descriptions and Knowledge and Skills Framework for OH staff working within the NHS,” he says.
Each post within the NHS requires you to move through gateways to advance through the health service and the competency document offers a framework to measure staff at three levels:
- Competent: first-level registered nurse, two years’ post-basic experience and post-basic education and training equivalent to university diploma
- Experienced: two years’ experience in an OH setting, post-basic education and training equivalent to a university degree, and holds or is working towards registered OHN qualification with the NMC
- Expert: five years’ experience in an OH setting, post-basic education and training equivalent to university higher degree, and holds a recordable or registered OHN qualification with the NMC.
Maslen-Jones says: “The framework helps to closely define the individual roles of OH practitioners within the NHS setting, working out our levels of competency, pay and progression, and helping us agree terms for attaining different levels of competency.”
As well as addressing the changes within the NHS and concerns that non-healthcare professionals don’t always grasp the complexities of OH learning, the competency document has also been mapped against the 10 public health proficiencies required by the NMC.5
The broadening of the third part of the NMC register has long been a controversial issue. Many within the profession agree that OHNs are working within the public health arena, but are concerned that the inclusion of OHNs with midwives and health visitors does not take into account the fact that the OH role is very specific, and requires clearly defined competencies for staff.
Despite NMC claims that it is working with OH nurse educators to strengthen the competencies for OH working, there are concerns within the profession that some of the content for university courses is too broad, and may be moving away from the specific competencies required by OHNs.
However, one of the NMC-approved degree courses, which has recently revised its curriculum and is highly recommended by students and senior OH practitioners alike, is the OH course offered by the health and social care department at South Bank University. Anne Harriss, course director explains: “When we did our curriculum development, we looked at the core competencies an OH practitioner should have. We used the framework document as a model, so that we could ensure that what OHNs needed was incorporated into our degree programme.”
For example, she explains, one of the important points within the document is that it identifies from the World Health Organisation the 11 key functions of OH services, which include identifying and accessing health risks within the workplace, surveillance of work environment factors, and participation in programmes for the improvement of working practices. All these factors have been incorporated into South Bank’s programme, along with other important aspects, such as leadership and management, and ethical and legal issues.
“The framework has a clear career pathway,” Harriss says. “You start as competent, which is where you enter our course. At the end of our programme, students should be the next level up, an experienced OHN. We argue that they should come out as an experienced OHN, able to do a number of things, such as deciding on priorities, organising a team of others to deliver care; in other words, thinking about their leadership and the management role.
“What I found helpful about the framework was the ability to demonstrate to other members of the curriculum team that this isn’t just my idea, this is what comes from practitioners,” Harriss adds. “The framework makes perfect sense to me; it’s what I would have included.”
The framework has also been utilised below degree level for OHNs working within the NHS. Last year, explains Maslen-Jones, a survey among OH departments throughout the South West of England confirmed a shortage of nurses qualified to deliver OH services to trusts and other external bodies, which require OH services under the auspices of NHS Plus. As a result of these findings, Maslen-Jones has helped to set up a diploma course at the University of Plymouth, run by Plymouth Hospitals Trust, and based on the competencies framework for OHNs working at the competent level.
Maw is understandably pleased that the competency framework has had such a positive impact across the OH spectrum, on educators, employers and, of course, OH practitioners. However, she’s keen to stress that the work is not finished.
“The framework document is now a part of the OH toolkit,” she says. “But we’ve devised it to be a dynamic document, and are relying on our members to keep it contemporary. The OH role is changing, with the recent Choosing Health White Paper and ‘Health, Work and Wellbeing’ strategy by the Department for Work and Pensions. OH is moving more into the spotlight, so the framework document must be dynamic and continue to be used flexibly.”
- Competencies: an integrated career and competency framework for occupational health nursing, www.rcn.org.uk/publications/pdf/occupational_health_competencies.pdf
- RCN (2004) Agenda for Change – a guide to the new pay, terms and conditions in the NHS, London: RCN. Publication code: 002 299
- Department of health (2004) NHS knowledge and skills framework (NHS KSF) and the development and review process www.doh.gov.uk
- RCN (2005) Agenda for Change and nurse employed outside of the NHS, London: RCN. Publication code 002 246
In 2004, the Nursing and Midwifery Council (NMC) established part three of its register for specialist community public health nurses. Part three of the register is open to nurses designated as having a significant role as a public health nurse and OH nurses are one of the disciplines (along with midwives and health visitors) that meet the criteria. OH nurses who already hold an NMC recordable qualification at certificate, diploma or degree level are automatically transferred to part three of the register.
However, nurses training to become qualified OHNs are required in future to complete study at a minimum of first degree level, courses that must be approved by the NMC to meet their standards of proficiency.
Go to www.nmc-uk.org for more information