What now for OH training?

Don’t you just hate it when someone with nothing better to talk about asks you what you do, and when you tell them you are an OH nurse (OHN), they either look blank or assume you mean that you’re an occupational therapist and start cracking jokes about basket weaving?

With the transfer of OHNs to part three of the Nursing and Midwifery Council (NMC) register, you now have the opportunity to make these idiots look even blanker. Just reply ‘I’m a specialist community public health nurse’, and watch their eyes glaze over.

But from now on, this is how anyone with a recordable qualification in OH will be listed on the NMC’s register (although they will also keep their original registration on the nursing part of the register).

In last month’s issue of Occupational Health,1 members of the Association of OH Nurse Educators (AOHNE) offered readers advice on the likely impact of changes to the NMC register, but what does the NMC itself predict will be the long-term implications of this momentous change to OH practice?

“The specialist community public health nurse part of the register was intended to accommodate future demands for a wider and more flexible public health nursing workforce,” says the NMC.

“Public health nursing is recognised as a growing area of specialist practice as recently indicated by government moves to expand the role and the number of school nurses. The three areas of specialised nursing practice to move to this part of the NMC register share similar characteristics that define the general focus of specialist community public health nursing. This includes working with both individuals and wider communities in clinical and general settings in predominantly public health work.”

Liz Plaistow, NMC professional adviser for public health nurses, says: “Society’s increased focus on public health is very much reflected in our new register. Now that health visitors, school nurses, occupational health nurses and family health nurses (Scotland) are on the specialist community public health nurses part of the register, we will be developing ways to enable others on our register with appropriate qualifications to be included as well.”

What are the implications?

So, does the new location of OHNs within the umbrella of community public health nursing have any fundamental implications for how the profession is perceived?

“We are, and always have been, public health nurses because we work with populations,’ says Anne Harriss, OH course director at London South Bank University. “Being on the third part of the register just confirms this. My feeling is that some OH nurses have a misunderstanding about what public health nursing is. We need a common philosophy of what public health is – it is about protecting the health of communities and our community is the workplace.”

OH consultant Cynthia Atwell, who is a visiting teaching fellow at the University of Warwick agrees. “In theory, I don’t have a problem with part three registration. What we are called is not important.”

The crucial issue for Atwell is the question of what the NMC will take into account when deciding who is entitled to part three registration. “I’m hoping they will take account of people’s experience and not just their paper qualifications,” she says. “If you have a degree, you can be called a specialist practitioner, but in reality, it is just the beginning.”

Caroline Whittaker, who is the OH diploma programme leader at the University of Warwick, believes that focusing on degrees to the exclusion of other qualifications would be a mistake.

“It is important to have a high academic standard, but I think the doctors have got it right with their different levels of qualification in occupational medicine.”

She adds: “We still have a lot of nurses that don’t have the full qualifications, but while I firmly believe that the degree is important, I would like to see a career progression within the registration process, starting with the diploma. At the moment, a newly-registered nurse could do a degree and become a registered OHN without ever having practiced. We should be encouraging people to achieve – for instance, if they do well at the diploma, they can then go on and do a degree.”

At the moment, there does appear to be some confusion about exactly which qualifications will entitle an OH practitioner to part three registration, partly owing to the fact the NMC has yet to finalise all the details. What is clear is that anyone who currently holds an OH degree from a recognised institution will be entitled to register as a SCPHN.

A period of transition

However, there will be a transition period to allow these institutions to incorporate the new standards of proficiency in public health into their curricula, and graduates of those institutions that have not got approval from the NMC by the end of the transition period will not be able to gain part three registration.

Harriss is not concerned by this, as within South Bank, they are already developing the curriculum to meet the new requirements.

“We have to comply with the document Standards of Proficiency for entry to the SCPHN register.2 And within that there are a number of broad principles and associated domains – for example, working with communities,” says Harriss.

“We are currently developing our programme so that will be some core modules with other public health nurses – for instance, those working in health protection and OH nurse and other specialists like school nurses.”

Harriss continues: “We have a number of core units, and the others are fairly specialist. For instance, it doesn’t matter if you’re a school nurse or an OH nurse, topics such as leadership go across the board and so does the ability to read and analyse evidence.”

“However,” she adds, “While the core units will be broad, we are mindful to produce OHNs who have appropriate skills, such as risk assessment. Our progress is a natural evolution but it won’t be completely different because we are already public health nurses.”

“Learning outcomes are going to be broadly similar but the way we put it will change. We don’t want to lose the flavour of what occupational health is: we want to be as good as we’ve ever been and take things forward,” says Harriss.

“We need to ensure that any degree we develop meets the needs of practitioners, and that we resist the pressure to be an all-singing, all-dancing public health nurse who can be an OHN in the morning and a health visitor in the afternoon.”

Harriss concludes: “We don’t think we should be producing someone at the end of the degree who can work in any of these disciplines. We are committed to developing a high-quality programme that meets the needs of the occupational health profession.”

But what about those in the profession that do not currently hold a relevant degree? As far as the NMC’s Plaistow is concerned, the crucial point for aspirants to part three status is to remember the need to fulfil all of the 10 criteria laid down in the standards of proficiency for entry to the SCPHN register. These are:

  • Surveillance and assessment of the population’s health and well-being
  • Collaborative working for health and well-being
  • Working with, and for, communities to improve health and well-being
  • Developing health programmes and services and reducing inequalities
  • Policy and strategy development and implementation to improve health and well-being
  • Research and development to improve health and well-being
  • Promoting and protecting the population’s health and well-being
  • Developing quality and risk management within an evaluative culture
  • Srategic leadership for health and well-being
  • Ethically managing self, people and resources to improve health and well-being.

“Applicants will be expected to meet the standards for SCPHN when they register,” says Plaistow. This means that they need to be mindful of the fact that when they come up for renewal, they need to meet the competencies of part three.

For those without a registerable qualification, Plaistow outlines three possible options:

  • They can either continue to practice occupational health without being on part three of the register
  • They can look at the qualifications that they already have, and map that against the requirements and then undertake any additional training that might be necessary.
  • They can undertake the whole SCPHN training from scratch by enrolling on a recognised degree course.

Of these options, the second looks likely to prove by far the trickiest route to gaining part three status. “OH nurses who don’t have a degree-level qualification need to put together a portfolio that demonstrates they have the knowledge and skills to meet the standards,” Plaistow says.

“Perhaps a health promotion module would meet the public health requirement, for instance. It is up to them to produce a portfolio that says: I am functioning in a public health capacity.”

Atwell believes the NMC should be taking a broad view of what qualifications are acceptable. “There are a lot of us around who do not have the OH degree, and a number of people who have master’s degrees in, say, ergonomics or management, and they don’t take any account of that,” she says.

Atwell also believes that a degree on its own is not an automatic passport to a successful career in OH. “People come out with these degrees and have unrealistic expectations of what is available to them,” she says.

However, Atwell is optimistic that the profession will thrive among its new public health bedfellows. “Having looked at the proposals from the NMC, I think we cover all of that anyway. We apply the community principles in the workplace. The group of people we look after may be workers but it is still public health.”

And she warns that there is no room for nostalgia in a forward-looking profession. “We have to move with the times or we will be totally left behind. There have never been more opportunities for occupational health nurses than there are at the moment.

“When I first came into OH, it was all about diseases, which we now have pretty much under control. But we don’t know what the next challenges will be. OH nurses with the right education and enquiring minds can do an awful lot,” she adds.


1. A time of change, Occupational Health, February 2005, volume 57 no. 2, p12
2. www.nmc-uk.org/nmc/main/publications/StandardforSCPHpageA4.pdf

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