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Safeguard OSH Solutions - Thomson Reuters

Safeguard OSH Solutions - Thomson Reuters



Safeguard Magazine

Plotting a new course

Occupational health nurses say it’s important to make their work better understood, both by those looking to enter the profession, and by its end users. JACKIE BROWN-HAYSOM reports.

The HASANZ website describes occupational health nurses (OHNs) as health navigators – people so familiar with the wider health and safety landscape that they can help workers, managers and employers alike find their way through systems and reach their desired destinations.

It’s an apt analogy. With more oneon-one access to frontline workers than any other group of H&S professionals, OHNs are uniquely placed to understand the realities of work-as-done, while their nursing training gives them the analytical skills to identify the need for other H&S specialists to get involved and gauge the need for subsequent interventions.

At the same time, their strong focus on people and ongoing relationships they build with workers mean they’re often regarded as part of the workplace team – trusted health advisers rather than H&S enforcers.

All this should make OHNs the natural connecting point between industry and the wider health and safety profession – but, for reasons unknown, it’s a function neither of these parties uses to full advantage.

“Unfortunately the health navigator role is not always optimised, valued or even recognised, by business or other stakeholders,” says Nikki Edge, president of the Canterbury branch of the NZ Occupational Health Nurses Association.

“OHNs are rarely recognised as subject matter experts, notwithstanding that they work as researchers, teach in universities, advise organisational leadership and are often called on for specialist advice by WorkSafe, ACC and MBIE.”

HASANZ’s 2019 report, Building the Professions, concurs: “[T]here is often limited understanding of the benefits [OHNs] can offer businesses and workers.

“They may be engaged in limited roles, such as compliance-based health monitoring, without an appreciation of the wider range of skills, knowledge and experience they bring to prevent and manage a wide range of health risks, promote wellbeing and support productive work.

“In addition, occupational health nurses have … limited opportunities for management or leadership roles.”

MORE NURSES NEEDED

Naturally this is a big concern for the NZOHNA – but it is not its only problem.

The HASANZ report goes on to say that OHNs are also the oldest group of nurses in clinical practice, with 60% aged over 50. Of course, age is no barrier to good practice, especially as most in the older age group have been in the role for 15 years or more, but the report notes that without a rapid in-flow of well qualified new recruits, the impending retirement of many in this cohort risks leaving the profession seriously short of numbers and experience.

The timing for an impending shortage could hardly be worse. Covid-19 has already pushed occupational health to the forefront; when a vaccine comes on stream, trained workplace vaccinators will be in huge demand.

Add to this the growing threat posed by accelerated silicosis (an aggressive lung disease associated with working with engineered stone), recent moves by WorkSafe to prioritise a number of occupational health issues (including musculoskeletal harm), and the rise of SiteWise, a SiteSafe-backed contractor prequalification programme that gives organisations an improved grading if they undertake annual health monitoring, and it’s clear that the profession is going to have to grow – and quickly.

A WELL EDUCATED GROUP

The Nursing Council puts the current number of OHNs in the country at 548. Just over 300 of them are NZOHNA members, and all but 35 of them female.

All OHNs must hold current Nursing Council practicing certificates, and 55% of them (or 60% of the NZOHNA members) also hold some sort of postgraduate qualification. This makes them one of the best educated sectors within the nursing profession – a fact that is particularly impressive when you consider that there is no role-specific qualification for OHNs in New Zealand. Some have overseas qualifications; others have opted for DIY solutions – usually a post-graduate diploma or degree in health science or business endorsed for occupational health and safety.

While both fields of study are a good fit with the OHN role, the nurses themselves feel the lack of a dedicated education pathway that might serve to attract more people to the profession.

Worse still, with no official qualification, there is no way to prove that someone is a “real” OHN, and nothing to stop any nurse setting up a consultancy, without either training or supervision.

The NZOHNA has done its best to address the problem, developing its own Knowledge and Skills Framework (KSF) – a tiered system, setting out standards for practice aligned to the Nursing Council’s competency framework. This can be used as an assessment tool for occupational health businesses to assess the competence of their OHNs, as a mentoring tool, and as part of the assessment process for the HASANZ register. (Only 16 OHNs are currently on the register, three of them employed by large corporations. Work is under way to lift this number.)

Continuous professional development is compulsory for members of the NZOHNA, which has an established programme, including annual branch CPD days and a biennial conference, both of which are well attended and help foster collegial spirit in an industry where most work independently.

PATHWAY DEVELOPMENT

By far the best thing on the horizon, however – for the association and the profession as a whole – is a new Workforce Development Project, backed by HASANZ and WorkSafe.

A project team of four, headed by Edge, and under the governance of NZOHNA past vice-president Heidi Börner and HASANZ executive director Philip Aldridge, has funding to explore options for a comprehensive, postgraduate education pathway specific to occupational health nursing. Along with a defined skill base, it will include provisions for mentoring new recruits and for working with other stakeholders – in business and the wider H&S industry – to ensure the role is recognized as an advanced specialty practice.

The project team brings together a diverse range of skills, as well as a remarkable 140+ years of OHN experience. Canadian-trained Borner is a Wellington consultant who worked closely with ACC’s musculoskeletal injury prevention programme in the early 2000s; Nicky Curran, project lead for the education and training pathway workstream, is a former Department of Labour inspector, now combining part-time consultancy in the Bay of Plenty with research work at Massey University; NZOHNA president Judy Currie, overseeing improved stakeholder understanding, is a Dunedin-based consultant who’s been an OHN at Otago University, and has provided H&S training and mentoring across Otago and Southland since 1995; Wendy Spence, leading HASANZ register assessor support, has been a consultant in Auckland for more than 30 years; and Canterbury-based Edge worked in multidisciplinary teams and at a newspaper before establishing her own consultancy in 2004.

POTENTIAL GAME-CHANGER

The two-year project, launched in May, is still in the set-up phase, with workstream leaders currently developing milestones for their work, but Edge believes it has the potential to be a game-changer. She points to stakeholder understanding as one area where there is huge potential to make a positive difference.

“OHNs don’t just do hearing and lung function testing. We advise on and manage the effects of work on health and health on work.

“Some larger businesses definitely recognize the value of using OHNs, but smaller organisations don’t understand what is on offer, or how to use it. We are keen to develop tools that will show them, and others, what we can offer to help grow their businesses by managing worker health.”

The project will also examine the range of academic papers currently being used by OHNs, looking for gaps in the system and what additional papers are needed to provide the profession with a qualification tailored to its needs.

“We want to provide clarity for any RN who may be looking at occupational health as a future profession, so they will know what the pathway is and how to get there; and also ensure PCBUs, and those in other H&S disciplines, understand the services we offer, and how we can navigate them through some complex issues.”

EVOLUTION OF THE INDUSTRY

New Zealand’s occupational health nursing history began in the late 1940s when the Department of Health set up industrial health clinics at major ports and industrial sites.

By 1965 there were enough nurses in Auckland for them to form their own professional body, and this local entity morphed into a present nationwide organisation (NZOHNA) in the early 1970s.

For the next 20 years most OHNs worked in publicly funded clinics, although some large employers also had their own in-house occupational health services.

In the 1990s, however, the government withdrew public funding from the clinics, and employers also began to move away from the provision of workplace health services, forcing many OHNs to become self-employed consultants.

This model for service delivery has predominated ever since, with a 2018 NZOHNA survey finding 53% of respondents worked in a consultancy.

JACKIE BROWN-HAYSOM

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