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WELCOME New Challenges and Opportunities for Occupational Health Nurses DI SHERLOCK Former Chair RCN OHN Group SW What is Occupational Health? Occupational Health aims to promote the conditions at work which promote the highest degree of quality of working life by protecting worker health, enhancing physical, mental and social well being and preventing work related ill-health and accidents. (WHO, 1980) New Challenges and Opportunities for Occupational Health Nurses An Occupational Health Service • Addresses the impact of work on health and health on work. • Seeks to reduce the incidence of illness and injury caused by work. • Seeks to ensure that work fits the worker and all staff are able to achieve their full capacities at work. New Challenges and Opportunities for Occupational Health Nurses What are Occupational Health Nurses? • Occupational Health Nurses are Registered nurses who have done additional specialist training to become autonomous impartial practitioners. • Occupational Health Nurses may be directly employed, subcontracted or selfemployed. • The role encompasses professional, environmental, educational, clinical and managerial responsibilities as well as involvement in research and epidemiology. • The role will vary in relation to the risks of the employment and the needs of the organization. A needs assessment should address people, plant, premises, processes, policies and procedures. • Input will be part of a comprehensive approach to health, well-being and safety. New Challenges and Opportunities for Occupational Health Nurses Role development • Over the past 20 years the role of the Occupational Health Nurse has changed from that of an industrial nurse dealing with accidents and illness at work and providing a treatment and first-aid service in an organisation to a role that encompasses all aspects of preventative health care as a Specialist Community Public Health Nurse. • Occupational Health is preventative rather than curative and proactive rather than reactive. The role of the Occupational Health Nurse must change in line with globalization, the changing economy, changing patterns of employment, changing attitudes and changing health risks (Kenny,1999) New Challenges and Opportunities for Occupational Health Nurses Specialist Community Public Health Nursing • "Specialist Community Public Health Nursing aims to reduce health inequalities by working with individuals, families, and communities promoting health, preventing ill health and in the protection of health. The emphasis is on partnership working that cuts across disciplinary, professional and organisational boundaries that impact on organised social and political policy to influence the determinants of health and promote the health of whole populations". • NMC (2004) New Challenges and Opportunities for Occupational Health Nurses Responsibilities • The Occupational Health nurse has multiple responsibilities to her professional body, the NMC, the employer and employees of the company she works for, her professional colleagues and herself. A nurse must always act in the best interests of her patient. • OHN’s work to a professional code of conduct that includes a strict confidentiality clause. All medical information is held in strictest confidence, and no information will be passed on without prior consent from the client. This can cause conflict. New Challenges and Opportunities for Occupational Health Nurses What are the daily activities of an Occupational Health Nurse in the workplace? • Pre-employment and Pre-placement screening to assess fitness for work • Prevention of ill health through workplace risk assessments • Health Assessment with regard to chemical agents, dust, fumes, noise, vibration, repetitive movement, static and awkward postures, infectious diseases, work-related stress, driving • Statutory Health Surveillance –ie spirometry, audiometry, skin, • Health promotional activities – ie benefits of diet, exercise, etc • Health screening initiatives – ie vision, • Health education and training – which meets the needs of the employees New Challenges and Opportunities for Occupational Health Nurses What are the daily activities of an Occupational Health Nurse in the workplace? • Support, help and advice for employees suffering from illhealth/disability • Management and self-referrals • Sickness Absence Management • Help with rehabilitation and adaptations where necessary • Return to work or resettlement support • Stress Management • Travel Health Advice • Referral to other specialists/agencies as required • Raising awareness and advising on health matters ie: DDA • First-aid supervision and training • Giving advice on health-related issues New Challenges and Opportunities for Occupational Health Nurses 3 strands to the strategy HEALTH, WORK AND WELL-BEING – To stop people from going on to benefits – To decrease the number of Incapacity claimants by 1 million over the next 10 years – To get them back into the workplace and to keep them there • The aim is to achieve ‘a society where the health and well-being of people of working age is given the attention it deserves and where work, remaining in work and returning to work are all recognised as being potentially beneficial to health.’ • Occupational Health Nurses practicing within the work environment are ideally placed to help deliver the new Public Health Agenda as part of Welfare Reform. New Challenges and Opportunities for Occupational Health Nurses Why is the Workplace an important setting for successful prevention strategies? • Employees spend a growing amount of time at work • GP services not easily accessible to all as they are rarely available outside normal working hours. • Men rarely visit their GP and do not talk about health matters in the same way as women do. This leads to late diagnosis →more serious disease → loss of employment and early death. • Employers can influence behaviour by providing a supportive environment and leveraging existing infrastructure to offer low-cost but effective interventions New Challenges and Opportunities for Occupational Health Nurses How can the OHN help in the delivery of the strategy? • By delivering a proactive service that encourages the business to embed health, safety and well-being into it’s culture and business plan and make its employees feel valued. • By delivering Health Promotion interventions that encourage healthy lifestyles and the message that ‘work is good for you’. Introduction of Community Back to Work Health programmes that dispel myths. • By effective assessment of fitness to work and helping the disabled and those with ill-health to optimise their work opportunities through reasonable adjustments. New Challenges and Opportunities for Occupational Health Nurses How can the OHN help in the delivery of the strategy? • Early detection of hazards and recognition of ill-health through workplace visits, health surveillance and self as well as management referrals. • By developing a good working relationship with HR to ensure best practice in absence management policy and procedures. • By developing close liaisons with other health professionals and agencies both inside and outside the workplace to fasttrack employees to appropriate help and support to facilitate early recovery with less interference to work. New Challenges and Opportunities for Occupational Health Nurses Absence from work • Most sickness absence, most long-term incapacity for work, and even premature retirement on medical grounds are caused by the less severe mental health, musculoskeletal and cardio-respiratory conditions. These common health problems should be manageable and allow a normal working life. • With appropriate clinical and occupational intervention, encouragement and support these people could remain in work. Others with more serious health problems should be able to take part in successful rehabilitation programmes. There should be few that would never return to the workplace. New Challenges and Opportunities for Occupational Health Nurses Are other factors involved in sickness absence? • Sickness is not just about health problems. It is a complex interaction between a health problem, health care, the balance between physical and mental capacity v the demands of the job, and the perceptions, attitudes and behaviours of all the players. Work-related factors, employer attitudes, process and practice are all major determinants of job retention or return to work (Marhold et al, 2002) New Challenges and Opportunities for Occupational Health Nurses Waddell and Burton (2006) urges the Occupational Health Services to use the Biopsychosocial Model of Obstacles to work when making interventions to assist recovery and rehabilitation. New Challenges and Opportunities for Occupational Health Nurses What are the Biological factors? What are the Organisational factors? Is there any Injury/Disability? •Lack of clear policies •Lack of understanding from employer •Poor communication •Disciplinary pending •Lack of effective OH •Attitudes of co workers •Future changes of company (downsizing) •Termination of employment •Ill health retirement rules •Lack of modified work •Sick certification prevents return •Poor social support •Litigation What are the Mental Health symptoms? What are the Physical Health symptoms? What are the Psychological factors? What are the perceptions/beliefs about health and work? Is the person happy in their job? Does the person want to return to work? Is the person distressed? Does the person have good coping strategies/self confidence? Anxiety or depression? What are the Social factors? Personal relationships, Carer issues, Housing issues Financial difficulties, Substance dependence, Domestic violence New Challenges and Opportunities for Occupational Health Nurses The Intervention • The OHN must evoke a person-centred tailor made intervention using all appropriate agencies and resources available. These might include GP, Occupational Therapists, Occupational Hygienists, Physiotherapist, Health and Safety Officers, Ergonomists, Psychotherapists, Job Centre plus, Employment advisers, Trade Union Reps, Self-help groups, Social workers, Housing officers, Probation officers – to name but a few - the list is endless. But most essentially it is imperative to have active participation from the employee! • Rehabilitation is not an isolated activity. It should be a seamless process whereby all the physical, psychological and social needs of the injured/ill person are considered. (Joint working group ABI) • A directory detailing all help agencies in a locality that is regularly up-dated would be useful. New Challenges and Opportunities for Occupational Health Nurses work strategies will encourage: Positive health at • Early detection and treatment of mild to moderate symptoms to promote early recovery and prevent the development of persistent symptoms, progressive disability and long-term incapacity. • Accommodation of temporary functional limitations from recurrent or persistent symptoms • Job retention and early return to work interventions to minimise sickness absence and speed up return to sustained work. New Challenges and Opportunities for Occupational Health Nurses If this agenda is to work • All workplaces must have access to occupational health services to enable timely effective interventions. Workplaces will need persuasion and incentives to embrace the new public health centred occupational health services of the 21st century. • More occupational health nurses will be required especially those who come from a mental health nurse background. Others should have greater access to CBT training to better manage employees with mental health problems. • Closer links between GPs, Occupational health nurses and workplaces that will facilitate better healthcare services that meet the needs of working age people to help them remain in work. • Greater investment in ancillary services so that therapies can begin as soon as they are required. • More innovative ways of working within multi-disciplinary/multi-agency working using skill mix. New Challenges and Opportunities for Occupational Health Nurses If this agenda is to work • Occupational Health Nurses will need to find innovative ways of working – perhaps linking in with Pathways to Work programmes, GP surgeries, or working independently to do the job that both they and the government would wish them to do. • More media coverage is needed to raise the profile of OH nurses and the potential of their work. • OHNs will have to engender the same trust as that given to GPs. Too often they are linked with an adversarial role in the workplace – not the autonomous impartial practitioners that they are. OHNs must not allow themselves to be used as tools of management. • Open Communication between all players involved • The workplace and the OHN should develop links within the locality to help build social capacity. New Challenges and Opportunities for Occupational Health Nurses The Following Myths must also be dispelled that – – – – – – – – – – Common health problems are caused by work Mean biological damage or disease Will be cured by treatment Made worse by work Should be treated by rest Necessitate sickness absence and If given a sick note that the employee is not allowed to work Should not return until symptom-free Often lead to permanent impairment Need permanently modified work All these are unhelpful and prevent early return to work New Challenges and Opportunities for Occupational Health Nurses In Summary OH nurses in the 21st Century need to offer: • Value – related to the health and well being of the employee which adds value to the organisation. • Versatility – related to effective multi-disciplinary team-working. • Vision – for an even healthier, safer and more productive workforce. Nurses must have the vision to run with new ideas and to take opportunities as they arise. They must share best practice and help clinicians continuously improve quality and safeguard stands of care through clinical governance. (C Bannister, 1999) • Communication, Collaboration, Networking and Marketing skills are essential to achieve these goals. New Challenges and Opportunities for Occupational Health Nurses Any Questions? New Challenges and Opportunities for Occupational Health Nurses