Editorials |
Collaboration—what does this mean?
The Concise Oxford Dictionary defines ‘collaboration’ as ‘to work jointly’, which to me as a nurse is paramount to a successful outcome of caring for people. In occupational health (OH) practice, this means working with others from many specialist professions—medicine being but one. We work with and seek support and advice from many who are outside the mainstream of health care and this includes engineers, toxicologists, ergonomists, hygienists and safety advisers, to name but a few.In December 2007, the Royal College of Nursing (RCN) Society of Occupational Health Nursing and the Society of Occupational Medicine held a joint conference. The focus of this event was on partnership and collaboration between health care professionals working within occupational health and the wider community. The programme consisted of good examples of how the different disciplines involved with occupational health provision work together with successful outcomes. It was well received and something we intend to repeat.
Occupational health has never had a higher profile than now. The government driven Health Work and Well-being (HWWB) Strategy [1] and the Welfare Reform Bill [2], due to be implemented in April this year, provide the ideal platform to raise the profile of occupational health care in the UK and the wider European Union. Chapter 2 of the consultation report on Welfare Reform [3] states that the green paper—‘Health, work and well-being’, proposed the following:
- (i) there should be a national director for health and work,
- (ii) in partnership with employers, employees' GP's and other health professionals develop new initiatives to improve knowledge and understanding and change perceptions and generally improve workplace health and
- (iii) that Statutory Sick Pay would be simplified and resources used in other ways to support employers to manage sickness absence.
- (ii) in partnership with employers, employees' GP's and other health professionals develop new initiatives to improve knowledge and understanding and change perceptions and generally improve workplace health and
The first of these proposals has been implemented; the Director for Workplace Health has been in place for over a year. However, how well are we doing with the other proposals? There appears to be very little interest from health professionals outside mainstream occupational health to consider the impact of work on health. This was demonstrated to me recently when the RCN Society of OH Nursing and OH Managers Forums organized a ‘stakeholders day’ at RCN headquarters in November. While it was well attended by representatives from the OH and safety field, why did the invitations to other nursing and medical groups not encourage their attendance? This was an opportunity to help set the agenda for the implementation of the HWWB strategy and in turn provide better care to the working population of this country.
The term ‘occupational health’ is still not well understood; we are not getting the message out to our non-occupational health colleagues. Every health care professional has a part to play in workplace health, and the aim of hospital and community care must surely be to get the ‘patient’ back to as full an active life as possible, including work. Perhaps, it is time to consider a change of name from ‘occupational health’ to something with a more obvious meaning, such as ‘workplace health’ or ‘employment health’? I am not suggesting we should lose the titles of ‘nurse’ or ‘physician’. We need to be nurses and physicians to undertake the role we do, and what is in a name? I am proud to be a nurse and do not wish to drop that title. I have argued many times that if we consider we are being hampered by the use of our titles, then I do not think we are doing a very good job. It is what we do that matters, not what we are called, we must be more business focused. What we need to be asking ourselves is ‘what contribution are we making to improve the health of the workforce and therefore the profitability of the organization?’
In a recent interview [4], the new president of the Faculty of Occupational Medicine, David Coggon, said that OH professions need to work together and with other stakeholders, with which we would all agree, but the hard bit is getting ‘the others’ interested in workplace health. How do we do this and what do we need to do to make workplace health important to other non-OH health care workers?
One way in which we could all contribute to this is by lobbying for changes in medical and nursing education, with the inclusion of workplace health and the emphasis on health and normal life, including work.
The inclusion of occupational health nurses on the third part of the Nursing and Midwifery Council (NMC) Register (Register of Public Health Nurses) is a great move forward, that at last occupational health is recognized as part of public health. The problem with this is that it has previously been the preserve of health visitors, who focus on the care of babies, children and elderly populations and those between the ages of 16 and 65 have been forgotten, and this is reflected in the educational standards.
The present education for occupational health nurses, which gives access to the third part of the NMC register is lacking. The occupational health content has been diluted, partly due to the very broad standards that have been set by the NMC [5] and there is shared learning with health visitors and school nurses. While this in itself is good, the standards are biased towards the mainstream NHS employed ‘carers’—health visitors and school nurses, and hence OH nurses are graduating as ‘Specialist Community Public Health Nurses’, without the knowledge and skills to undertake occupational health work.
In 2004, the RCN undertook to develop a ‘competency framework for occupational health nurses’ [6]. This framework was developed in partnership with OH nursing groups and there was wide consultation with key stakeholders, including the medical profession. This document sets out the standards of competency expected at different career stages and identifies the levels as ‘competent’, ‘experienced’ and ‘expert’.
It was never intended that this should be linked to education, but for me, this is the starting point. How can we call ourselves ‘specialists’ if we do not have the basic knowledge and skills to be ‘competent’ in contributing to improving the health of working age people and understanding business?
Both occupational health medical and nursing education still need radical change to meet the demands of the modern world of work; therefore, is it time to consider even closer links between the professions and push towards shared learning? We work together in practice, and as workplace health is outside the mainstream of health care and does not fit in with the NHS model of education and practice, is it not time to consider having a ‘Faculty of Occupational Health’? The function of such a faculty would be to set and monitor standards for all the professions working in occupational health practice and be the driver for improving research into the speciality. Medical research is well understood, but nurses still have problems securing funding (or even being allowed) to undertake research, even though in the NMC Code of Conduct [7], nurses are required to provide care based on evidence, but there is little opportunity for this within the present structures.
Perhaps in 2008, occupational health nurses and doctors working together should aim to review the whole area of occupational health practice, what we are called, how we are educated and how we can improve access to research opportunities. In doing this we might just be able to make a difference, where everyone understands what we are, what we do and why, and most importantly, organizations see the benefits of a healthy workforce.
Chair, Royal College of Nursing Society of Occupational Health Nursing
e-mail: cynthiaatwell{at}sky.com
References
- DWP, DH, HSE. Health, Work and Well-being—Caring for our Future (2004) London: HM Government.
- HM Government. Welfare Reform Act (2007) London: HMSO.
- DWP. A New Deal for Welfare: Empowering People to Work, Consultation Report Cm 6859 (2006) Norwich: TSO.
- O'Reilly N. Coggon on: costs and concerns. Occup Health (2008) 60(1):17–18.
- Nursing and Midwifery Council. Standards of Proficiency for Specialist Community Public Health Nurses (2004) London: NMC.
- Royal College of Nursing. Competencies: An Integrated Career Framework for Occupational Health Nursing (2005) London: RCN.
- Nursing and Midwifery Council. The NMC Code of Professional Conduct, Performance and Ethics (2004) London: NMC.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||