The more things change…

Recently, I was fortunate enough to obtain some 16-year-old articles printed in this journal. They were written by some of the occupational health (OH) leaders of the day, people whoI looked up to in awe. But do the OH nurses of today even know their names?

Ruth Alston was the education officer for OH at the English National Board for Nursing, Midwifery and Health Visiting, and Peter O’Malley was the OH and medical services manager at J Sainsbury, and I was fortunate enough to have him as my mentor.

I was keen to see if things had changed over time, or if we are still struggling with the same issues 16 years on.

We would hope, of course, that the profession has progressed and we have been guided by the wisdom and knowledge of these professionally respected individuals. However, on reviewing Ruth Alston’s series of three articles on ‘A Future for Occupational Health nursing’, I quickly realised that the same issues were of concern then as now.

Back to the future

Her first article drew on a UKCC report on the future of community education and practice from 1991 and the clear ‘steer’ for nurse practitioners to function effectively in the community, thus paving the way for our public health role by identifying the needs of populations and planning, implementing and evaluating effective care interventions as advanced post-graduate practitioners.

Our role as client and community advocates acknowledges the need for health promotion and the educational role as clearly defined developments for this ‘advanced’ practice – although ‘health promotion’ is derided by OH practitioners today in spite of the ‘wellbeing’ rebranding by the government in its Welfare to Work reforms.

It’s interesting to note how this lack of interest among OH nurses has contributed to the growth of the ‘wellness’ industry, with many such companies operating in this arena with no nursing or medical personnel involvement. This de-medicalisation of health promotion/wellness shows initiative and business focus as it is easier to show a return on investment (ROI) with these initiatives – an area that was of concern to O’Malley in his article ‘Keeping up Standards’ in 1992, in which he talked about”the impossible task of evaluating the perceived cost of absence”.

Quality control

Alston too, in her third article, emphasised the importance of quality measurement as the challenge of articulating the contribution of OH nursing to the organisational business plan. At the time, she felt the profession had failed to ensure acceptance of the added value of OH nursing to an organisation in the promotion of health, safety and environmental standards and in human resources management.

Alston believed that the US led the way in this work and subsequent years saw much greater collaboration with our transatlantic counterparts as we shared their knowledge and skills at communicating quality to an organisation and converting the principles into a format that was robust and acceptable to the UK legal and business infrastructure.

It’s heartening to see an improvement at least in the ability to calculate ROI though the Business Healthcheck tool, produced by management consultancy Pricewaterhouse­Coopers and corporate responsibility group Business in the Community, whereby employers are now able to assess the cost of ill health to the business and the impact of wellness programmes on these costs. As an important part of the government’s Health, Work and Wellbeing strategy it seems the issue finally has the attention of government and is, therefore, pitched at the right level – although it is a shame that it’s taken so long to get to this point.

In her second article, Alston discussedthe role of continuing education in producing confident and adaptable practitioners whoare fit for the inevitable political, social, economic and organisational influences that ultimately affect role viability and job satisfaction – did she have a crystal ball do you think? Again, the importance of health promotion was emphasised, particularly in relation to lifestyle and occupational risk.

This article, published in 1993, gives a clear indication of what was planned for nurse education, with the creation of ‘opportunities for inter-disciplinary learning leading to a greater awareness of other professional roles’ – the specialist community public health nurse (OH) was obviously a twinkle in the eye of the ENB, the forerunner of today’s Nursing and Midwifery Council.

Get involved

The final article hauntingly imploredOH nurses to ‘get political’. Things haven’t changed much in this regard and she accused OH nurses of taking an ‘isolationist stance’ with regard to professional issues that affect nursing in general and OH nursing in particular, and stated that being part of a profession demands that nurses ‘opt in’. Alston wenton to acknowledge the effectiveness of small group activities and this is borne out by the success of the many proactive regional OH nursing groups around the country.

At the time, Alston felt OH nurses rarely joined interest or pressure groups or put themselves forward as leaders of their profession. This too is a situation that we still struggle with today – many OH nurses lack confidence in their abilities to lead the profession or have little desire to do so. This is a real concern, however, a co-ordinated effort on the part of current leaders and OH course tutors could turn this situation around.

The identification of OH nurses with leadership ability and a willingness to progress the profession, a formal/informal support/mentoring arrangement and appropriate educational input all facilitated by senior, practising OH nurses would ensure and secure the future of our specialism. Failure to do this may see OH fade into obscurity, monopolised by ‘interested others’ without the fine detail of experience and specialist education – a watered down ‘workplace health & wellbeing’ practitioner from all sorts of dubious backgrounds.

If, in 1993, Alston felt that OH nursing faced an identity crisis, what would she make of our current situation? While I acknowledge that we’ve come a long way and there are some truly exemplary practitioners out there, the apathy in OH that Alston spoke of 16 years ago still exists in many quarters and I add my plea to her final sentence: ‘Is anyone out there interested enough to join the debate?’

by Sharon Horan, occupational health consultant


  • Alston,R. A Future for Occupational Health Nursing. Occupational Health; January 1993

  • Alston, R. A Future for Occupational Health Nursing. Occupational Health; February 1993

  • Alston, R. A Future for Occupational Health Nursing. Occupational Health; March 1993

  • O’Malley,P. Keeping Up Standards. Occupational Health; November 1992

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