At the age of 45 Dipti feels her life is starting to fall apart. She is finding her job as a secretary increasingly difficult because her eyesight is deteriorating. She has type 2 diabetes, high blood pressure and is overweight.
John (25) is having trouble coping with his work in a call centre. He is under pressure to meet performance targets, works long hours and gets stressed. He suffers from obsessive-compulsive disorder, and is worried that he is going to have to take sick leave while he waits for an appointment for therapy.
Tracy (32) is worried that her job is disabling her. She has worked in a small bakery for five years and has become allergic to flour dust, which has turned her into an asthmatic, wheezing and short of breath. She is trying to live with her symptoms.
Three workers who face debilitating occupational health problems: three workers who - given the right experience, expertise, and resources - can be helped. In different ways, they all illustrate the vital role that can be played by a UK profession that seems unmatched in most other European countries: occupational heath nursing.
Dipti’s kind of diabetes, for example, is suffered by nearly three million people in the UK and is often linked to being overweight. Occupational health (OH) nurses can help companies provide incentives for staff to walk or cycle to work, and to make sure there are healthy, attractive options for lunch in the works canteen. At the same time, Dipti can be given access to regular eye tests.
Like John, as many as one in six workers are reckoned at any one time to be suffering from anxiety, depression or stress. But OH nurses can help employers learn how to reduce mental health problems by improving work practices. They can also help John to better understand his needs and, if necessary, help him to find another job.
Tracy, as one of 450,000 new cases of occupational ill health in the UK every year, can be given access to expert advice on her condition. OH nurses can help her managers understand how to reduce exposure to dust in the workplace and try to ensure that no more bakers are made sick like Tracy.
Dipti, John and Tracy are just three of the typical cases highlighted in a 2014 report by the UK Council for Work and Health, which brings together OH nurses with a wide range of other medical professionals. The council is working on a project to envision how occupational health in the UK might develop the next 20 years.
The project’s leader, Professor John Harrison from Imperial College Healthcare NHS Trust in London, has summarised what OH nurses do. “Occupational health professionals improve the health of the UK’s working population, increase the productivity of UK businesses and enable our public services to become more efﬁcient and cost effective,” he said.
“It is a unique multidisciplinary approach that prevents work-related illnesses, provides early interventions for those who develop a health condition, reduces sickness absence and uses the workplace to promote health and wellbeing. We are distinctive because we offer a holistic approach that focuses on the person, their work and the business rather than just the disease.”
For Susanna Everton, vice-president of the UK Association of Occupational Health Nurses, the primary role of OH nurses was to identify hazards at work, assess the risks and prevent ill health. This can involve dealing with senior management at a strategic level, as well as with individual workers at a personal level.
The most important tasks that OH nurses do are “assessing the health needs of the employee and trying to match those to the resources available,” she said. “The OH nurse should be in a position to influence the decision-makers, and increase their awareness of their responsibilities toward the health and wellbeing of their employees. The OH nurse should also offer appropriate support to the individual to enable them to perform to their optimum level.”
Barbara Wilson, a manager with the occupational health company Clarity Healthcare, argued that OH nurses have to understand the needs of employer and employee, and the specifics of the jobs they do. “In short, we know the difference between a multispindle centrifugal lathe operator and a sagger maker’s bottom knocker,” she said. (One operates a high-tech lathe, and the other makes the bottom of pottery boxes.)
The first occupational health nurse
The first OH nurse in the UK was Phillipa Flowerday, who was 32 when she was appointed on 28 October 1878 to work at the Coleman’s Mustard factory in Norwich. To help better the heath of workers, she worked as an “industrial nurse” alongside the company doctor every morning, and visited people in their homes in the afternoons.
Her historic role was recounted in a new textbook, Contemporary Occupational Health Nursing, published by Routledge in 2014. It said that OH nursing was first formally identified as a special field within the UK nursing profession in 1934, when the Royal College of Nursing launched an industrial nursing course. Since then it has mushroomed.
By May 2014, according to the Nursing and Midwifery Council, there were 3,461 registered OH nurses in the UK, slightly more than in 2011 when there were 3,447. There is no detailed breakdown of where they all work, but they are roughly divided between the public sector, including the National Health Service, private companies and commercial occupational health providers.
That means that OH nurses work for many different employers in many different environments: for multinational corporations, small businesses, local authorities and other public agencies; at offices, factories, power stations, oil rigs, construction sites, railways, shipyards, airports and numerous other places. Their tasks can include medical screening; hearing and skin testing; pollution surveys: vaccinations; virus analysis; first aid; rehabilitation and managing those off work because of sickness.
There is no doubt that they are addressing a serious problem. According to the Council for Work and Health report, about 12,000 people are killed annually in the UK by diseases caused by their jobs. Every year 400,000 people report that stress at work is making them ill, and a massive 175 million working days are lost to ill health (see box below).
These problems are replicated in other countries, with the United Nations’ World Health Organisation estimating that there were 300,000 work-related deaths across Europe every year. Yet less than one in ten of the working population had access to occupational health services in many European countries, it said.
Occupational health nursing in the UK
The UK’s historic commitment to occupational health was highlighted by Kira Duckworth, a lecturer in OH nursing at Robert Gordon University in Aberdeen. “OH practitioners are seen as a specialised workforce who should be highly trained not just in medical knowledge but also health, safety, management and also have a good understanding of how business works,” she said.
“The government has focused on OH services and recognised the role they can play to help ensure a healthy workforce, with the emphasis on getting people back into the workplace. OH professionals recognise that many people with disabilities can lead long and productive working lives, but often just require a few adjustments to do so.”
Duckworth pointed out, though, that OH nurses still faced important challenges. Many worked remotely and felt isolated from others in their profession. Some employers failed to understand the importance of hiring properly educated and trained professionals. Sometimes employees saw OH nurses as part of management, and being referred to them as a reprimand.
But there were great opportunities too. “I think we are on the cusp of a big explosion of OH services,” she said. “With government focus we hopefully will see the role develop further with more recognition on how an OH service can help keep the working population healthy and safe whilst at work.”
Susanna Everton, who has been an OH nurse in London for nearly thirty years with the BBC, the police and the engineering services company, Lloyd’s Register, stressed how important it was to have good interactions with other professionals. “There needs to be trust between the OH nurse and the patient but also a clear understanding of what the OH nurse can do to support the employer in their business strategy,” she said.
“This cannot be done in isolation and often requires good communications with human resources, safety professionals other health professionals – physical and psychological and the employee’s primary health care support. The OH nurse needs to promote, protect and prevent.”
Everton is worried that some employers are cutting backing resources for occupational health, and that there is sometimes not enough support from senior management. “There is always a big debate about the cost of in-house provision or contracted services,” she said. “Many organisations look at the short term and do not always see occupational health as the investment in their people and their business that those of us in the profession do.”
Nevertheless, she was upbeat about the job. “I think it can be a really rewarding branch of nursing, because there is so much variety and opportunity to extend the role of care of a person who in most cases is not ill,” she said. “Often the OH nurse is the only one doing that job in an organisation.”
There was great job satisfaction when things worked well, Everton concluded. “There is quite a buzz to be felt when you know that some programme you have introduced, or some intervention you have organised, or some examination you have performed, has made a real difference to an organisation or an individual, particularly in difficult environments.”
Four occupational nurses: in their own words
Janet Patterson (43) is occupational health coordinator for the baking company, Greggs, in Newcastle-upon-Tyne. The company employs over 20,000 people in making food and selling it in High Street shops across Britain.
“Occupational health (OH) nurses need to gain trust of all dimensions by demonstrating credibility, honesty and no personal self-interest - it’s all about the people,” she said. The job had evolved from being mostly reactive in dealing with sickness and accidents to being 80 per cent preventative.
“OH nurses empower individuals to take care of themselves in both mental and physical wellbeing,” she said. Employers often brought in occupational health expertise to meet legal requirements for health surveillance of workers, but it could add a great deal more.
Patterson was concerned that in times of austerity, occupational health could be chosen for cutbacks. “Businesses are wanting more for less,” she maintained. “More are opting for a tick-box service where they just get what is legally required.”
She also feared there were problems ahead. “The future of OH nursing is in a state of uncertainty due to questions about the qualifications and changing direction of OH nursing,” she said. “Some OH nurses don’t feel like nurses and some don’t want to lose their nursing identity.”
Sue Plant (55) has worked most of her professional life as an OH nurse for the government of the Isle of Man, situated in the Irish Sea between northern England and Northern Ireland. “I dealt with guys who dig holes in the roads, bus and tram drivers, teachers, and airport firemen among others,” she said.
“The most important thing an OH nurse does is to prevent ill health. This can be achieved by education of the workforce through presentations and health advice and education, but also via vaccinations, health surveillance where a risk assessment has identified this, and being accessible.”
Plant stressed the importance of not being tied to a desk. “I was more interested in getting out there, meeting the workforce, solving problems and listening to what was going on. That was far more satisfying than being stuck in an office pouring over policies and paperwork.”
Like colleagues, she was worried about the impact of the economic downturn. “I think that the most difficult challenge OH nurses face is that they constantly feel that they have to justify their usefulness at a time when the recession has led to cutbacks, especially in the private sector,” she said.
“In the harsh world of the private sector you have to convince clients of how using OH services can benefit their business. There was a campaign some years ago with the slogan 'good health means good business' and this still holds true. But when finances are tight, occupational health can often be the icing on the cake that never gets applied.”
Karen Coomer (47) is director of KC Business Health in Yorkshire, a company that provides occupational health services to small and medium-sized firms. “I could be work for as many as five different organisations in one week providing services such as case management, health surveillance and training,” she said.
She thought the most vital things that OH nurses do are “to understand the culture, risks and nature of the work environment in order to provide evidence-based fitness to work advice and prevent ill health.” This not only included knowledge of traditional occupational health diseases and the causes, but also psychosocial aspects of work.
According to Coomer, one of the main challenges was the lack of understanding of the role of OH nurses by other health professions, including doctors. There were also problems “persuading organisations to invest in strategic long term prevention of ill-health at work, not just trendy fashionable quick fixes such as some wellness initiatives,” she said.
OH nursing would need to adapt as more people carried on working in old age, she warned. “It is crucial that we look towards the changes necessary to sustain ageing workforces. New health issues such as dementia are now being managed in the workplace and musculoskeletal problems are still an issue with older manual workers.”
Jeremy Smith (47) is a self-employed occupational health consultant in Kent. “I have worked in the National Health Service, the ports industry, the gas industry, local government, manufacturing and retail - to name a few,” he said.
“Occupational health is not about finding a cure it is about advising both the employee and the employer on what they should consider in helping the employee return or to remain in work.” He reckoned that at the moment about 40 per cent of his work was prevention and 60 per cent reactive. In previous jobs, though, he had been more preventative and worked strategically with management to improve worker health.
“In my opinion the most important thing any OH nurse can do is make sure any advice they provide is evidence-based and as current as possible,” he said. There could be problems, though, when employees didn’t want to hear that they were fit for work, or when employers refused to act on advice and failed to manage their workforce.
Occupational health in the UK – the facts
– 175 million working days are lost due to ill health every year
– After six weeks off ill, nearly one in five people will eventually leave paid employment
– Every year about 400,000 people report work-related stress at a level they believe is making them ill
– 80 per cent of the adult population will suffer with back pain at some time in their working lives
– 12,000 people die every year from occupational diseases – brought down by lung diseases, poisoned by asbestos or eaten away by cancers