The facts behind healthy progress

Helen Kirk’s article (Occupational Health, September 2009) ‘Healthy progress?’ said there is a general consensus that specialist community public health nursing (SCPHN) training programmes are not delivering occupational health nurses (OHN) fully equipped to meet the demands of contemporary practice.

As a lecturer on a popular education programme, I object to this statement. I have offered one of these specialist programmes at the University of the West of Scotland for the past five years, and have fought to keep the content and delivery bespoke to the needs of employers and students in line with contemporary practice.

The feedback from university students and employers is consistently positive, and all the students exiting the programme are more than prepared for the demands facing them in practice.

I would like to respond to some of the inaccuracies and correct the misconceptions that may arise as a result of this article. The main purpose is to reassure students hoping to embark on any future SCPHN programmes and employers that these programmes are orientated to specialism and not generic to health visitors.

Demand for OHNs

The article rightly stated that the demand for OHNs has never been greater, and this has been reflected in the number of SCPHN applicants for the university, when over the past four years the greatest number of students has come from OH. With recent NHS cutbacks, demand for public health nurses has dropped considerably. Kirk’s observation that courses tend to be orientated towards the biggest student numbers is inaccurate, as the largest student numbers are OH nurses.

Curriculum

The article also mentioned there is no detailed curriculum for the discipline. However, the Nursing and Midwifery Council (NMC) has been consulting on specialist skill clusters and members of the Association of Occupational Health Nurse Educators meet regularly. These skill clusters have been discussed and adopted across the curriculum of most of the programmes on offer, again bespoke to the specialist nature of OH.

All NMC-approved nursing programmes are a balance of theory and practice, and in SCPHN programmes this is a 50:50 split. This is where programme leaders rely on the expertise and experience of mentors/practice teachers facilitating the practice experience of students. If Kirk’s observation is that OHNs are not equipped for practice, then surely some of this responsibility lies with the practice experience. Shouldn’t we be questioning the practices of some supervising OHNs who should ensure that students’ placement experiences are varied and in line with good practice?

Specialist registration

It stated that there is no obligation for OHN courses to lead to specialist registration, and an increasing number do not, and this reflects the dissatisfaction with the current system. Not everyone is suited to studying at degree level, and by offering non NMC-validated courses, those doing so are providing OH practitioners with flexibility and choice, while also providing a level of learning suited to their academic ability. Some OH nurses applied to the University of the West of Scotland when they realised their progression was being hampered because of their lack of specialist registration. In addition, when you examine most of the roles advertised in the OH journal and with any of the OH providers, SCPHN registration is often a requirement, and many of the senior/management roles advertised require it.

Teacher-student ratio

The article also stated: “ideally, the NMC indicates that there should be only one practice teacher to one student, and that the rules are very flexible”. This is not the case. Thestandards to support learning and assessment in practice (NMC, 2008) state that only one practice teacher can assess one student at a time – this applies when assessing part-time students. Programme leaders who have been audited by the NMC quality assurance agents, the HLSP, will vouch that this is the standard that must be complied with in practice, and there is no flexibility here.

The article was correct when it highlighted the dearth of practice teachers. But this is the discipline’s failure to plan ahead.

The NMC allowed educational establishments offering SCPHN programmes to map mentors with previous adequate mentor preparation, the former English National Board, or equivalent, to local practice teacher registers.

I presented the paper ‘Practice teacher crisis’ at the 2008 and 2009 RCN Scottish OHN conferences and pleaded with delegates to apply for this mapping process and to write to the NMC informing it of the difficulties that these standards would create for OHNs.

I cannot speak for other Scottish universities, but only five individuals applied for this mapping exercise at the West of Scotland, and only one individual admitted – when asked at the 2009 conference – to writing to the NMC.

To say I was disappointed is an understatement. It seems only now that students are struggling to get practice teachers, and that the crisis is becoming evident and a talking point.

I would also like to highlight that non-OH specialist nurses would not be able to take on an OH student from a private company, as only practice teachers with similar practice experience can sign off the competence of an SCPHN, and this is stated in the Standards (NMC, 2008) mentioned above.

The article was correct in saying that there is no requirement in the Standards (NMC, 2008) for a qualified OH lecturer to teach on an NMC-approved university course. However, the HLSP, the NMC quality assurance agency that is present at any NMC-approved education programme validation, would not approve of this. It would be a recommendation – if not a condition – of validation. In addition, and more importantly, I am not aware of any OH SCPHN programmes running in the UK where there is no OH-qualified teacher on the team.

Student numbers

In response to “the number of OH nurse students is relatively small”, I would like to invite the author to be a guest at the West of Scotland’s 2009 post-graduation event in November, where there will be at least 64 OH nurse students graduating with BSc occupational health nursing. She can discuss with any one of them whether they thought their course work was generic or specialist – I know what their response will be.

I also have 35 students who started, in September, a graduate diploma in specialist community public health nursing programme, compared with half of the number of public health nurses on the same programme. The curriculum is based on the needs of OHNs facing the challenges discussed in the recent government publications (Black, 2008; Boorman, 2009) and the cluster skills required of an SCPHN OHN.

Anyone who feels passionately about NMC-approved programmes and the future of OH nurse education can apply to represent occupational health nursing at the NMC at the next round of elections. That would be one way of influencing the way forward for OHN education and practice.

Marisa Stevenson RGN BSc SCPHN (OHN) PGcert TLHE is programme leader on the graduate diploma specialist community health nursing (OH nursing) at the University of the West of Scotland.

References

  • Black, C. (2008) Working for a Healthier Tomorrow. DoH. London
  • Boorman, S (2009) NHS Health and Wellbeing Review. DoH. London
  • NMC (2008) Standards to support Learning and Assessment in Practice. NMC. London

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