Occupational health nurses have more first-hand experience of different occupational cultures than any other branch or nursing, but are practitioners being adequately prepared for the challenges of an unhealthy company culture?
The culture of an organisation affects social interaction, levels of trust, risk-taking, fear, anxiety and job security. A bad organisational culture can become endemic, with implications for health at work, individual performance and the economic success of the organisation.
The results of unhealthy management land at the door of occupational health – not just because of its impact on staff, but because the service can come under fire from managers if it is not thought to be complying with management style.
OH practitioners need to be sensitive to cultural mores, adaptable and flexible – especially in commercial organisations where their professional ability is not likely to be understood as well as it is in the NHS, and where OH often isn’t seen as a priority or a profit-making function.
Sometimes the manager purchasing the OH service can feel threatened by the health problems that OH identifies, and those new to OH may be surprised by the negative reaction of some human resources managers, which stems from a bad company culture.
In some cultures, conflict arises because OH is seen to be supporting the employee instead of the business. HR may challenge the reasons behind OH advice, especially if it considers itself to have broader information about the employee, including the gossip that surrounds an individual case.
OH practitioners can be questioned on their ability to deliver, and their advice may be unreasonably questioned if it is not considered useful to supporting managerial decisions.
If OH practitioners are to develop effective relationships with the managers who are their customers, they need to be trained in several key areas.
One OH nurse adviser told me that she had never been taught to write a structured feedback report to management, or to interview clients within the time prescribed by the organisation. Submitting an impartial, meaningful report that captures all the relevant aspects of case management without breaching confidentiality requires real skill. Once it is submitted, the OH practitioner then needs the ability to explain and defend their advice in the face of criticism.
Better skills are needed to meet the ever-increasing, often unspoken demands of HR, and to deal with fraught staff whose health is affected by bullying or harassment. OH practitioners need to be able to gather clear evidence and combine professional and ethical advice.
Bad management can lead to complaints ranging from sexual harassment to bizarre initiation ceremonies, such as the case of a new recruit ordered to eat 50 chicken nuggets within a given time frame. The individual went to OH, was physically sick and wondered what sort of company he had joined. In this instance, the practice was condoned by senior management.
External influences on OH culture are also radically changing practice, including the increasing demand for case management and the demise of health surveillance skills. New, cheaper options for delivering services, such as remote case management, have implications for risk management and create new challenges – for example, in assessing stress levels by phone.
Remote working could be a legal minefield for OH, yet some organisations work without protocols in place. Contacting homeworkers on the telephone has numerous pitfalls, such as the implications of record-keeping, and how clients interpret our advice.
Is sufficient emphasis placed on these practical challenges in the new OH competency framework? Are training establishments anticipating the radical changes facing us?
OH needs to grow its own culture, and it needs government support which endorses core OH practice. It needs to integrate effectively in all types of organisations and develop the authority to influence good practice in the workplace, and bring enlightenment to modern management.
Denise Bainbridge was principal nurse co-ordinator for Royal Mail and a careers adviser for the English National Board. She has headed services in two NHS trusts and spent three years working as a ward sister in Sydney. She is a member of the RCN Managers Forum