Health and safety is everyone's business. I have been an occupational health nurse (OHN) at Waitemata District Health Board (DHB) for more than 12 years. I am passionate about caring for the staff, the largest group of whom are nurses. For the last four years I have served on the executive of the New Zealand Occupational Health Nurses' Association. This has led me on a journey I would have never dreamed of a few years ago.
Waitemata DHB's occupational health and safety service is nurse-led and is a dedicated and specialised multidisciplinary team delivering a complex and diverse scope of practice. Fostering a culture of health and safety within the DHB has seen many changes, with a growing and greater understanding of responsibilities. Through a system called a 'Safe Way of Working', we holistically manage and drive a culture of occupational health and safety throughout the DHB.
Caring for staff/caring for patients
Staff are an organisation's greatest asset so it is very important to took after them. In difficult times, attracting, retaining and valuing nurses not only makes good business sense; it ultimately provides the best care for patients. Managing the significant hazards threatening the safety of the workforce is essential, eg supporting nurses in using the 'no-lift' programme for moving and handling patients. Violence and bullying at work is increasing as society changes, and we need to continually review and respond to such issues.
OHNs are interested in how work affects people's health and how people's health affects their work. We work in a variety of settings, from large industrial organisations to smatter occupational health services or we are self employed. We champion investment in the health of employee populations. Our primary focus is promoting and restoring health, preventing illness and injury, and protecting staff from occupational hazards. The workplace reflects society's diversity, providing an ideal environment in which to have the greatest impact on individual health. This in turn impacts on societal health.
Part of my journey has led me to challenge thinking and directions for occupational health nursing. The fact occupational health nursing is not included in the primary health care (PHC) strategy, workforce strategy and other associated documents is concerning. The PHC strategy aims to reduce health inequalities, engage communities and improve prevention and management of chronic conditions. OHNs are in an ideal position to improve the health of local populations through a population approach, improved access and exploring new service delivery.
Targeting at-risk populations
The OHN is sometimes the only health professional an individual will see. OHNs offer excellent opportunities to engage the otherwise poorly engaged, eg the male-dominated, multicultural workforces representing a high proportion of target, at-risk populations.
OHNs have sometimes been regarded as being out on a limb, less visible than some nurses, on an island in the health care sector. Overseas, occupational health is recognised as an important component of public health. In the United Kingdom (UK), national director for Health and Work, Dame Carol Black, has reviewed the health of Britain's working age population in a report entitled Working for a Healthier Tomorrow. (1) This measures the economic costs of ill health and its impact on work and looks at what stands in the way of good health. Black recognises that the working environment has a major influence on well-being. For effective delivery of health, attitudes, beliefs, behaviour, practices and services must change. She challenges nurses to embrace a culture of change, to develop networks in communities that will enable new approaches of care.
I had the privilege of meeting Black and hearing her speak at a Royal College of Nursing (REN) occupational health conference in the UK last November. Presentations focused on her review and her belief that wellness is good for businesses. With this mindset, people would be able to see the value of health, work and well-being, Black said. Nurses needed to be evidence-based, to work collaboratively, and increase the scope of their practice.
The UK government supports the belief that work is good for health. A cross-government working party has recognised the huge economic and social cost of worklessness and sickness/ absence that impacts on the individual, families and communities. (2)
The RCN has positioned occupational health under the public health umbrella--it had been detached from mainstream health for too long. Given the government's promotion of the health, work and welt-being programme, OHNs are going to be instrumental in shaping future directions. Professional development with an evidence base is crucial to meeting future needs. Collaboration with mainstream health and all associated disciplines in the occupational health and safety field is essential to achieve unity. Raising the visibility of OHNs will assist in demonstrating their value and worth.
We in New Zealand face many of the same challenges. We are already ahead of some UK OHNs, particularly in rehabilitation and the way our nurses are already extending their roles by combining occupational health and safety. We need to use the evidence already gathered, adapt and took at ways to move forward. Top down, cross-departmental commitment and collaboration are essential. Black has warned that unless the compelling evidence is acted on, Britain's future health cannot be assured. Continuing as they have done is simply not an option. Can New Zealand afford not to be following this path too?
The past few years have been an incredible journey for me, as my scope of practice continues to widen. My ability to think strategically is increasing, as I continue deeply committed to my current role and the future direction of occupational health nursing.
References
(1) Black, C. (2008) Working for a healthier tomorrow: Dame Carol Blacks review of the health of Britain's working-age population. United Kingdom: Crown Copyright. www.workingforhealth.gov.uk. Retrieved 23/04/09.
(2) Government United Kingdom (2008) Improving health and work: changing lives. The Government's response to Dame Carol Black's review of the health of Britain's working-age population. Crown Copyright. www. working for health.gov.uk. Retrieved 23/04/09.
Janice Riegen, RN, BN, PGDipHSc, is a clinical nurse specialist, occupational health and safety, Waitemata District Health Board.
