OHA’s can contribute by helping managers to manage sickness
absence more effectively. The nurse may be involved in helping to train
line managers and supervisors in how to best use the OH service, in how
to refer staff, what type of information will be required, what to
expect from occupational health. By developing transparent referral
procedures, ensuring that medical confidentiality is maintained and that
the workers’ rights are respected the OHA can do much to ensure that
employees referred for assessment due to sickness absence are
comfortable with the process.

OH nurses, with their close
relationship with workers, knowledge of the working environment and
trends in ill-health in the company are often in a good position to
advise management on preventing sickness absence. In my experience
referral to General Practitioners have a limited use for work related
issues, and gain best results by as well as keeping the GP aware,
referring to a specialist occupational physician.

Planned
rehabilitation strategies, can help to ensure safe return to work for
employees who have been absent from work due to ill-health or injury.
The nurse is often the key person in the rehabilitation programme who
will, with the manager and individual employee, complete a risk
assessment, devise the rehabilitation programme, monitor progress and
communicate with the individual, the OH physician and the line manager.
Nurses have also become involved in introducing proactive rehabilitation
strategies that aim to detect early changes in health before such
conditions result in absence from work. Improving and sustaining working
ability benefits many groups, the individual, the organization and
society, as costly absence and other health care costs are avoided.

In
many cases the OH nurse has to work within the organization as the
clients advocate in order ensuring that managers appreciate fully the
value of improving the health of the workforce. OH nurses have the
skills necessary to undertake this work and may develop areas of special
interest.

The occupational health nurse may develop pro-active
strategies to help the workforce maintain or restore their work ability.
New workers, older workers, women returning to work following pregnancy
or workers who have been unemployed for a prolonged period of time may
all benefit from health advice or a planned programme of work hardening
exercises to help maintain or restore their work ability even before any
health problems arise. Increasingly the problems faced by industry are
of a psychosocial nature and these can be even more complex and costly
to deal with. OH nurses, working at the company level, are in a good
position to give advice to management on strategies that can be adopted
to improve the psycho-social health and wellbeing of workers.

Health and safety

The
OHA can have a role to play in developing health and safety strategies.
Where large, or high risk, organizations have their own in-house health
and safety specialists the OHA can work closely with these specialists
to ensure that the nurses expertise in health, risk assessment, health
surveillance and environmental health management is fully utilized into
the health and safety strategy. Occupational health nurses are trained
in health and safety legislation, risk management and the control of
workplace health hazards and can therefore make a useful contribution to
the overall management of health and safety at work, with particular
emphasis on ‘health’ risk assessment.

Hazard identification

The
nurse often has close contact with the workers and is aware of changes
to the working environment. Because of the nurses expertise in the
effects of work on health they are in a good position to be involved in
hazard identification. Hazards may arise due to new processes or working
practices or may arise out of informal changes to existing processes
and working practices that the nurse can readily identify and assess the
likely risk from. This activity requires and pre-supposed regular and
frequent work place visits by the occupational health nurse to maintain
an up to date knowledge and awareness of working processes and
practices.

Risk assessment

Legislation in
Europe is increasingly being driven by a risk management approach. OHA’s
are trained in risk assessment and risk management strategies and,
depending upon their level of expertise and the level of complexity
involved in the risk assessment, the nurse can undertake risk
assessments or contribute towards the risk assessment working closely
with other specialists.

Advice on control strategies

Having
been involved in the hazard identification and risk assessment the
occupational health nurse can, within the limits of their education and
training, provide advice and information on appropriate control
strategies, including health surveillance, risk communication,
monitoring and on the evaluation of control strategies.

Research and the use of evidence based practice

Specialist
OHA’s utilize research findings from a wide range of disciplines,
including nursing, toxicology, psychology, environmental health and
public health in their daily practice. The principal requirement for an
occupational health nurse in practice is that they have the skills to
read and critically assess research findings from these different
disciplines and to be able to incorporate the findings into evidence
based approach to their practice. Research in nursing is already well
established and there is a small, but growing, body of evidence being
created by occupational health nursing researchers who investigate
occupational health nursing practices. OHA’s should ensure that they
have access to and the skills necessary to base their practice on the
best available evidence. At the company level occupational health nurses
may be involved in producing management reports on for example sickness
absence trends, accident statistics, assessment of health promotion
needs and in evaluating the delivery of services, the effectiveness of
occupational health interventions. Research skills and the ability to
transfer knowledge and information from published research to practice
is an important aspect of the role.

Ethics

OHA’s,
along with other health, environment and safety professionals in the
workplace health team, are in a privileged position in society. They
have access to personal and medical information relating to employees in
the company that would not be available to any other group. Society has
imposed, by law, additional responsibilities on clinical professionals
to protect and safeguard the interest of patients. The ethical standards
for each discipline are set and enforced by each of the professional
bodies. Breaches of these codes of conduct can result in the
professional being removed from the register and prevented for
practicing. Nurses have a long and well-respected tradition in society
of upholding the trust placed in them by patients. This level of trust
in the occupational health nurse’s professional integrity means that
employees feel that they can be open, honest and share information with
the nurse in the confidence that the information will not be used for
other purposes. This allows the nurse to practice much more effectively
than would ever be possible if that trust was not there. The protection
of personal information enables a trusted relationship between employees
and the nurse to be developed and facilitates optimum working
relationships and partnership. The International Commission on
Occupational Health (ICOH) has published useful guidance on ethics for
occupational health professionals’. This guidance is summarized below
“Occupational Health Practice must be performed according to the highest
professional standards and ethical principles. Occupational health
professionals must serve the health and social wellbeing of the workers,
individually and collectively. They also contribute to environmental
and community health the obligations of occupational health
professionals include protecting the life and the health of the worker,
respecting human dignity and promoting the highest ethical principles in
occupational health policies and programs. Integrity in professional
conduct, impartiality and the protection of confidentiality of health
data and the privacy of workers are part of these obligations.
Occupational health professionals are experts who must enjoy full
professional independence in the execution of their functions. They must
acquire and maintain the competence necessary for their duties and
require conditions which allow them to carry out their tasks according
to good practice and professional ethics.”

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