Occupational health nursing skills and role development

Occupational health nurses are registered nurses with a range of different skills and experience.

No specific qualifications are required for a registered nurse to work in occupational health, but some nurses choose to gain a specialist qualification and these are offered by a number of universities around the UK.

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 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 globalisation, the changing economy, changing patterns of employment, changing attitudes and changing health risks (Kenny, 1999).

The role of the specialist occupational health nurse incorporates:

• implementing comprehensive pro-active occupational health and safety strategy to prevent occupational injury and disease
• promotion of health and work ability, by focusing on non-occupational, workplace preventable conditions that, whilst not caused directly by work, may affect the employees ability to maintain attendance or performance at work, through a comprehensive workplace health promotion strategy
• improving environmental health management, by reducing risk to the working population and the wider community
• contributing to the wider public health agenda.

National oversight and coordination of training for occupational health nurses is provided by the Nursing and Midwifery Council (NMC), which maintains a register of specialist community and public health nurses. Nurses with a qualification in occupational health are distinguished as specialists in ‘Community and Public Health - OH’. See: RCN nursing careers resource.

See also further information from the Faculty Of Occupational Health Nursing who work with occupational health nurses and physicians as well as industry to set standards and recognise the skills and qualifications needed to become an OH professional.

For anyone interested in a career in this area of nursing, any of the following would be considered beneficial:

• experience of working in accident and emergency and/or practice nursing
• public health, infection control
• counselling, psychological health
• learning about relevant legislation
• management of sickness absence
• development of manual handling policies and rehabilitation of staff with chronic conditions
• undertaking a role as an RCN safety representative.

Knowledge of health promotion and education is desirable as well as an understanding of health and safety issues, health screening, stress management and basic first aid.

Membership of the RCN public health forum can provide a useful means of keeping up to date with current developments. Attending occupational health conferences also provides the opportunity to network with nurses working within this field.

Specialist occupational health nurses

Specialist occupational health nurses undertake an additional period of formal study in occupational health, leading to a recognised specialist degree in occupational health nursing. For more information, see: Specialist community public health nursing (SCPHN).

The role of the specialist occupational health nurse incorporates:

• implementing comprehensive pro-active occupational health and safety strategy to prevent occupational injury and disease
• promotion of health and work ability, by focusing on non-occupational, workplace preventable conditions that, whilst not caused directly by work, may affect the employees ability to maintain attendance or performance at work, through a comprehensive workplace health promotion strategy
• improving environmental health management, by reducing risk to the working population and the wider community
• contributing to the wider public health agenda.

Occupational health nursing: clinical issues

Assessment on fitness to drive

The DVLA has developed guidance which is aimed at all health care professionals and designed to help support enquiries from the general public about driving with various medical conditions. It regularly updated and includes condition specific and general guidance, see: Assessing fitness to drive: guide for medical professionals.

The assessment of fitness to practice guidance advises:

If you think the patient may be engaging in an activity where they pose a very real risk of danger to the public or themselves, such as the patient driving when they are not fit to drive, but you are not sure whether you should act, ask yourself: 

• what might the outcome be in the short or longer term if I do not raise my concern? 
• how could I justify why I did not raise the concern? 

If you decide to proceed, you should: 

• first advise the patient that they are unfit to engage in the activity in question and give the reasons 
• advise the patient to tell the appropriate authority 
• put your advice in writing to the patient, if appropriate
• keep a copy of any correspondence to the patient on the patient record. 
  (GOV.UK. General information: assessing fitness to drive)

The guidance from the General Medical Council (GMC) on Confidentiality: patients' fitness to drive and reporting concerns to the DVLA or DVA may also be of use.

Immunisation

Occupational health nurses provide a variety of vaccines including staff flu vaccinations. The RCN has further information on vaccination and immunisation.

Medicines management

Occupational Health Schemes (OHS) are exempt from the restrictions that apply to; general sales list medicines, pharmacy medicines and prescription only medicines. (An OHS is a scheme in which a person, in the course of a business carried on by him, provides facilities for employees for the treatment or prevention of disease.)

NICE guidance Patient Group Directions (PGDs) 2013 recommends that PGDs are not used when exemptions in legislation allow medicine supply and/or administration without the need for a PGD. The scope of this exemption in legislation is much broader than the use of PGDs. There is further information on the NHS Specialist Pharmacy Services website; see: Using PGDs in Occupational Health Services and When not to use a PGD.

In the case of prescription only medicines, the person supplying or administering the medicines, if not a doctor, must be a registered nurse. They must act in accordance with the written instructions of a doctor setting out the circumstances in which the medicine is to be used under the OHS.

See the BMA's The occupational physician (PDF). This guidance has useful information on prescribing in occupational health settings and an example template for a ‘Specimen operating policy/written instruction’ in appendix 6.

Statutory medical examinations

The Faculty of Occupational Medicine (FOM) and the Health and Safety Executive (HSE) have further advice on statutory medical examinations. Essentially, nurses are not able to carry out statutory medical examinations where it is specified that these must be done by a medical practitioner, for example for asbestos and ionising radiation medicals.

Work and health

It is recognised that being in work has a positive impact on health and wellbeing. It is important to appropriately manage sickness and absence and to support people to return to work as soon as possible.