Occupational Health Nurses: Cinderellas of the nursing profession

So how much do you really know about occupational health nursing? As there is currently no requirement by the Nursing and Midwifery Council (NMC) to include any occupational health theory or practice in pre-registration nursing programmes, most nurses’ knowledge of the field is limited at best and sketchy at worst. Rather like Cinderella, we do sterling work behind the scenes. 

Occupational health nursing is a small specialism. Identifying our exact number is difficult. Currently, the NMC counts 2,941 Specialist Community Public Health Nursing registered occupational health nurses. But not all hold the NMC-approved qualifications that confer this registration, choosing instead other undergraduate or postgraduate qualifications in occupational health that better meet their needs.

Spend a few minutes jotting down the effects of work on health and vice versa. Your points may include musculoskeletal issues associated with manual handling, uncomfortable working positions or the repetitive nature of working with computers, whether for keyboard or screen tasks. You may have also noted work-related stress associated with workload or the taxing nature of the tasks inherent in healthcare professions, including working with distressed patients or those with challenging behaviour, particularly in emergency and prison services. You may have thought about the high mortality of healthcare workers resulting from the COVID-19 pandemic. 

You’d be right. But there’s also much more. A range of workplace hazards have the potential to impact health:

• Physical: radiation, noise and vibration.
• Biological: organisms and micro-organisms. You may have thought of microbes but did you remember that working with animals, such as mice and rats is associated with allergies? 
• Mechanical: inadequately guarded machinery causing crush injuries and traumatic amputations.
• Ergonomic: poor working postures, repetitive movements and manual handling of heavy or unwieldy loads.
• Psychosocial: long working hours, poorly designed shift patterns, violent and abusive patients.
• Chemical: the Alice in Wonderland phrase “mad as a hatter” refers to the effect of mercury on the central nervous system of hatters used during felting. Mercury exposure is now generally well-controlled in the UK but in less developed nations it still occurs in gold extraction processes. 

Clinicians frequently document their patients’ occupation but rarely think much further than that. A discussion with a respiratory ward staff nurse revealed a patient frequently being admitted with asthma. The nurse had no idea that the patient’s work as a baker may have been the causative factor: flour is associated with occupational asthma. Changing working practices and improving the bakery exhaust ventilation could protect the workforce.

The impact of work on mental health and wellbeing is also high on the agenda for occupational health nurses. Using the biopsychosocial model of care highlights the impact of work on mental health and, conversely, of mental health on worker performance. This is especially important for workers employed in safety-critical roles, particularly as their condition or medication may negatively affect their decision-making, work safety and effectiveness.

The exposing nature of healthcare put practitioners at particular risk during the pandemic with significant effects on both physical and mental health, with some developing post-traumatic stress disorder or long COVID. Occupational health has been important in devising return-to-work strategies but unfortunately some staff were so badly affected that they have made the difficult decision to retire on the grounds of ill-health.  

That (good) work is good for health has long been recognised (Waddell and Burton 2006) and occupational health nurses play a vital role in helping to keep people in employment. We’re always keen to work with other health professionals. When you’re next involved in the admission or discharge of a patient, consider their work and any advice you may offer, including suggesting they contact their occupational health department when planning their return to work. 

For those interested in moving into this specialism, both NHS and non-NHS services offer training positions and sponsorship. See the NMC website for a list of Specialist Community Public Health Nurse registration courses. Other universities, including the University of Cumbria and Robert Gordon University offer excellent alternative occupational health practice courses. 

We’d be delighted to welcome you into our small but vital specialism. 

Reference

Waddell, G. and Burton, A. K. (2006) Is work good for your health and wellbeing? Norwich: The Stationery Office