OHA’s can contribute by helping managers to manage sickness absence more effectively. The nurse may be involved in training line managers and supervisors in how to best use the OH service, 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 ensure that employees referred for assessment due to sickness absence are comfortable with the process.
With their close relationship with workers, knowledge of the working environment, and trends in ill-health in the company, nurses are often in a good position to advise management on preventing sickness absence. In my experience, referral to General Practitioners has limited use for work-related issues, gain best results, and keep the GP aware, referring to a specialist occupational physician.
Planned rehabilitation strategies can ensure a 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 program who will, with the manager and individual employee, complete a risk assessment, devise the rehabilitation program, 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 health changes before such conditions result in an 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 client’s advocate to ensure that managers fully appreciate the value of improving the workforce’s health. OH, nurses have the skills necessary to undertake this work and may develop areas of special interest.
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The occupational health nurse may develop pro-active strategies to help the workforce maintain or restore their workability. New workers, older workers, women returning to work following pregnancy, or workers who have been unemployed for a prolonged period of time may benefit from health advice or a planned program of work hardening exercises to help maintain or restore their workability even before any health problems arise. Increasingly the problems faced by the 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 advise management on strategies that can be adopted to improve workers’ psycho-social health and well-being.
Health and safety
The OHA can have a role to play in developing health and safety strategies. 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 nurse’s health, risk assessment, health surveillance, and environmental health management are fully utilized in the health and safety strategy. Occupational health nurses are trained in health and safety legislation, risk management, and the control of workplace health hazards. Therefore, they can make a useful contribution to the overall management of health and safety at work, with particular emphasis on ‘health’ risk assessment.
The nurse often has close contact with the workers and is aware of changes to the working environment. Because of the nurse’s 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 from informal changes to existing processes and working practices that the nurse can readily identify and assess the likely risk. This activity requires and pre-supposed regular and frequent workplace visits by the occupational health nurse to maintain up-to-date knowledge and awareness of working processes and practices.
A risk management approach is increasingly driving legislation in Europe. OHA’s are trained in risk assessment and risk management strategies. 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 by 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 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 occupational health nurses 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 an 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 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 are important aspects of the role.
OHA’s, along with other health, environmental, and safety professionals in the workplace health team, are privileged 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 from practicing. Nurses have a long and well-respected tradition in 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. Personal information protection 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 occupational health professionals’ ethics. 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 workers’ privacy 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.”