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Occupational health nursing practice in Australia: What occupational health nurses say they do and what they actually do
Occupational health nursing practice in Australia: What occupational health nurses say they do and what they actually do Gary Mellor, RN, MN, MRCNA, MACOHN, School of Nursing & Midwifery, Griffith University, Queensland Winsome St John, RN, PhD, FRCNA, School of Nursing & Midwifery, Griffith University, Queensland Carol McVeigh, RN, PhD, FRCNA, School of Health Sciences, Massey University, New Zealand
Introduction This study investigated current activities of occupational health nurses (OHN) in Australia related to the applicability of and their involvement in emergent role, wellness-based practices and traditional role and illness-based practices. A questionnaire encompassing the eight Areas of Practice as articulated by the Australian College of Occupational Health Nursing (ACOHN) competency standards was used to obtain data from 93 OHNs affiliated with ACOHN. More traditional role Areas of Practice such as treatment services, health assessment and rehabilitation services were seen as more applicable to their practice and a substantial amount of time was spent on them. Managing occupational health and safety (OH&S) service’ was the only emergent area that was a substantial part of the OHN’s role. Less time was devoted to other emergent and pro-active areas of OHN practice, such as illness and injury prevention, health promotion, health education and research into OH&S. While less time was allocated to emergent Areas of Practice, and they were ranked more lowly they were considered to be applicable to practice. The findings of this study suggest that OHNs in Australia may not be engaging fully in all Areas of Practice that have been articulated by the ACOHN, particularly emergent role activities.Although Australian OHNs perform all the activities articulated in the ACOHN Areas of Practice, their focus is still primarily illness and injury based, and also management. While the profession is supportive of emergent role activities, there is a need to debate possibilities, undertake research into barriers and supports for emergent role activities, more clearly articulate future directions for the OHN role, and develop strategies to support OHNs as they develop their professional role.
Workplace injury and illness in Australia creates great hardship and costs the Australian community billions of dollars every year (National Occupational Health and Safety Commission (NOHSC) 1999). According to NOHSC, 205 workers were killed as a result of workplace injuries, and an estimated 2000 people died from occupational disease in the years 1999 to 2000 (NOHSC 2002). It is within this scenario that the occupational health nurse (OHN) can make an important contribution to the health and safety of workers. In contrast to their counterpart in hospitals, OHNs work with greater autonomy and isolation. Rogers (1991) revealed that 91% of OHNs in the United States of America (USA) are sole practitioners and, according to Barlow (1992), they remain isolated from professional support. Haag and Glazner (1992) argue that the result is that the role of OHNs remains unclear and bound by a primary focus on traditional role activities related to first aid and treatment. However, in addition to providing treatment and first aid, OHNs can undertake emergent role activities and contribute to improving the work environment, preventing health problems and promoting wellness. The Australian College of Occupational Health Nursing (ACOHN) has developed competency standards with Areas of Practice that reflect both traditional role and emergent role activities. This paper presents an exploratory-descriptive study into the current role of the Australian OHN. The aim of the study was to gain a greater understanding of the traditional role and emergent role activities that OHNs perform in their daily practice, and to analyse their activities in relation to the scope of practice as articulated by the ACOHN Areas of Practice.
Literature Review Keywords: occupational health nurse, activities, scope of practice Correspondence to: Mr Gary Mellor, School of Nursing & Midwifery, Griffith University, Queensland Email: [email protected] Acknowledgement: This study was supported by a Queensland Nursing Council research grant RAN 0143. The authors acknowledge and thank the ACOHN for its support.
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Alston (1994) has described the scope of occupational health nursing as a mix of traditional and emergent functions. A traditional perspective encompasses those elements of nursing that relate to providing treatments and health assessments, whereas emergent functions are those that involve preventative, educational and managerial practices. Research into the performance of the traditional illness-based activities in occupational health nursing has shown that they remain a central focus of OHN practice
Occupational health nursing practice in Australia: What occupational health nurses say they do and what they actually do
(Silverstone & Williams 1982, Cooney & Cooney 1988, Kocks & Ross 1991, Eckberg et al 1997, Olsen et al 1997, Rogers & Livsey 2000). However, other studies have revealed a push for expanding the OHN’s role into wellness–based practices that include: occupational health management (Scalzi et al 1991, Ballard 1996, Burgel et al 1997); workplace assessment (Simons 1980, Cooney & Cooney 1988, Hublebank et al 1988); health education (Rossi 1987, Cooney & Cooney 1988, Hublebank et al 1988); health promotion (Hublebank et al 1988, Allred & Parrish 1994); and research (Rogers et al 2000). For nearly 100 years OHNs have developed an important role in managing the health and safety of employees in Australia. Sorely (1923) allowed a glimpse of the Australian industry nurse’s functions during the early part of the last century, describing them as providing direct nursing care, health surveillance and referral of cases to doctors. A review of the sparse research currently available suggests that little has changed in the Australian OHN’s role since then. Cooney and Cooney (1988) undertook the only contemporary study able to be located that examined the activities of Australian OHNs. Their survey of 50 Western Australian establishments employing OHNs found that the most common activities performed were first aid treatments, dispensing medications, and follow-up treatments. The only emergent function they identified was a health education role. However, this research is dated and since this time OHNs have worked to professionalise their role. The Australian College of OHNs (ACOHN) has articulated a commitment to an emergent role, defining the role of the OHN as being to ‘conserve, promote, and restore the health of persons at their workplace’ (ACOHN 1991 p3). The ACOHN provided greater clarification of the OHN role in 1994 when they identified nine major areas of professional practice (ACOHN 1994), which were: practising in accordance with legislative standards, codes of practice and guidelines; managing an occupational health service; assessing the work environment; assessing, monitoring and evaluating worker’s health; providing information, education, training and advice; enhancing the health of workers; managing an illness and injury treatment service; managing the rehabilitation of ill and injured workers; and applying research methodologies to the investigation of occupational health and safety (OH&S) issues. Moreover, ACOHN argued that the scope of practice in occupational health nursing is context specific, with workplace requirements playing an influential role in shaping the practice of OHNs. The ACOHN argued that an individual OHN’s scope of practice would vary from workplace to workplace, influenced by factors such as: the number of OH&S personnel, the corporate philosophy, and the type of workplace environment (ACOHN 1994). The need for OHNs to flexibly respond to the need of employers and economic changes has interested many authors. Miller (1989) and Davey (1995) identified that established approaches to addressing OH&S issues are being challenged by the changing nature of worker populations and workplaces that include a higher proportion of women and more diverse ethnicity among workers. O’Brien (1995) noted that changes in corporate
culture, which is moving towards participatory management styles, are resulting in a need for OHNs to take a greater consulting and leadership role. Employers are now expecting OHNs to contribute to greater cost containment and to undertake research into cost-effective health care (Lusk et al 1988, Martin et al 1993, Nelson 2001), while employees continue to expect OHNs to provide treatment and prevention services (Yoo et al 1993). The pressure on Australian OHNs to remain contemporary and relevant in current workplaces is highlighted in the work of Farr et al (1994), who describe a variety of professionals and para-professionals who present themselves as OH&S practitioners (physiotherapists, occupational therapists, and others). As the need for OH&S expertise increases in Australia, Davey (1992) warns that nurses will experience competition from these professions. To retain their role as the primary health practitioner at the workplace, OHNs must maintain versatility, demonstrate the relevance and importance of their skills, and articulate their role to employers, employees, government and the community. Before the outcomes of practice can be studied, it must be clear what OHNs actually do every day. Currently, there is no research into what OHNs do in Australia. Although the ACOHN have developed a description of the OHN’s Competencies and Areas of Practice, they have never been validated. The degree to which the actual practice of OHNs in Australia reflects a mix of traditional and emergent functions is, at present, unknown. Lack of information about the actual practice of the OHN in Australia limits the profession’s ability to make valid claims to a professional scope of OHN practice and to plan future development of the OHN role. In view of the changing economic and corporate climate, there is a need to describe, clarify and discuss the future directions of the OHN’s scope of practice, particularly in relation to traditional and emergent functions.
Method This survey study was part of a larger investigation into the scope of OHN practice in Australia. Data were collected through a self-administered, researcher-developed questionnaire that was mailed to 416 participants who were members of ACOHN. The members of ACOHN were chosen because they represent a significant proportion of OHNs in Australia and it was considered that by belonging to a professional organization they have a demonstrated commitment to occupational health nursing.
Instrument The questionnaire contained 44 items that elicited demographic data and asked the participant to describe the OHN’s activities and Areas of Practice in which they engaged, and the time they devoted to them. The demographic data were used to describe the sample and to examine factors that could potentially impact on the OHN’s role activities. Specifically, 22 items reflected role activities of occupational health nursing practice in Australia (see Table 1). 20 of these items were based on the activity statements described in a study by Lusk et al (1988) into the role of the OHN in the USA. Lusk’s activity statements have been used in other studies in the USA (Lusk 1990, Martin et al 1993, Nelson Collegian Vol 13 No 3 2006
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Table 1: Applicability and Ranking of Activities performed by OHNs, and Time Dedicated to ACOHN Areas of Practice
Area of practice
Applicable to practice (%)
Rank
Time Allocated (%)
Counsel employees regarding health risks
93
1
19
Supervise the provision of care for job related emergency and minor illness episodes
88
2
Assist in the rehabilitation and relocation of disabled workers
84
8
Provide follow up of employees with workers compensation claims
83
9
Evaluate the ability of absentees to safely return to work
79
13
Performing periodic health assessments
74
16
Meet regularly with members of other health disciplines to identify problems and propose solutions
88
3
Develop and implement OH&S policies and procedures based on professional guidelines in occupational health
87
4
Develop analysis for management, noting statistics relating to employee injury and exposure to hazardous substances
86
5
Develop and implement OH&S policies and procedures for the workplace which comply with legislation
85
6
of the health care department
79
11
Serve as a member of the OH&S committee
79
12
Develops budgets for the occupational health area
47
22
Plan and develop educational programs related to worker safety, health promotion and risk prevention
85
7
Participate in employee safety orientated classes and programs for high-risk areas
78
14
Conduct plant rounds regularly to identify hazards and potential violations
76
15
Participate in environmental monitoring
65
19
Conduct pre-placement physicals
63
20
Develop health programs to address the particular needs of the corporation
80
10
Extend health programs to workers dependants
57
21
Generate analysis on trends in health promotion, risk reduction and health care expenditure
71
17
Conduct research to determine cost effective alternatives for health care programs and services
67
18
Activity statement
TRADITIONAL ROLE ACTIVITIES Managing an illness and injury treatment service
Managing the rehabilitation of ill and injured workers
Assessing, monitoring and evaluating workers health
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19
EMERGENT ROLE ACTIVITIES Managing an occupational health service
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Makes recommendations for more efficient and cost effective operation
Providing information, education, training and advice
Assessing the work environment
Enhancing the health of workers
Applying research methodology to the investigation of occupational health and safety issues
2001) to identify occupational health nursing activities. To ensure the activity statements were appropriate in the Australian context, they were reviewed in relation to descriptors in the ACOHN competency standards (1994) and distributed to three experienced OHNs for comment. A further two items were added based on this consultation and the ACOHN competency standards Areas of Practice (1994). Consent to use the activity statements were given by Lusk and ACOHN. The resulting activity statements were grouped into eight of the nine Areas of Practice outlined in the ACOHN competency standards (see Table 1). The first Area of Practice: practising in accordance with legislation, standards, codes of practice and guidelines were excluded as it described a required level of competency rather than the nature of activities. Lusk’s instrument had asked 20
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10
10
7
5
nurses to rank the importance of occupational health nurse activity statements; however, this approach did not consider each activity independently. In this study, in order to consider each activity separately, participants were asked whether each activity was applicable or not applicable to their practice. Activity statements were grouped into the eight ACOHN areas of practice and participants were asked, as a percentage, how much they devoted to each Area of Practice. Identifying the applicability of each activity as well as the time dedicated to each ACOHN Area of Practice enabled the OHNs’ perspectives about what they actually do in everyday practice to be explored in the light of professional expectations. A panel of Australian experts consisting of three expert OHNs and two nursing academics reviewed the questionnaire. Feedback
Occupational health nursing practice in Australia: What occupational health nurses say they do and what they actually do
Table 2: Demographic Profile of OHN Participants
Mean (sd)
Range
Age
44.4/91 (8.9)
27-61
Years of nursing experience
21.7/91 (9.4)
1-39
Years of service at the organization
6.5/92 (5.4)
1-21
Number of safety personnel at the workplace
3.3/91 (3.4)
0-19
Group
n(%)
Manufacturing
51(55%)
Health
11(12%)
Other
9(10%)
Government
7(8%)
Mining
6(6%)
Education
5(5%)
Recreation/Hospitality
2(2%)
Construction
2(2%)
Type of Industry
Sole Practitioner
Highest Nursing Qualifications
Highest Non-Nursing Qualification
Short Courses
was sought regarding the length of the questionnaire, the clarity of the instructions and the overall presentation. No significant modifications were needed.
Data collection and analysis Following approval from the researchers’ university Human Ethics Committee, a questionnaire package was mailed to all current members of ACOHN. Each package contained an information sheet, the questionnaire, and a reply paid envelope for returning the questionnaire anonymously to the researcher. A reminder was distributed four weeks later and via an advertisement placed in the Occupational Health Nurse Forum Newsletter published by ACOHN.
Other OH&S Personnel
84(90%)
Sole OH&S Practitioner
9(10%)
Masters
1(1%)
Graduate Cert/Diploma
22(24%)
Degree
14(15%)
Certificate of Nursing
48(52%)
Associate Diploma
6(7%)
Master
6(7%)
Graduate Cert/Diploma
41(45%)
Degree
6(7%)
Associate Diploma
2(2%)
Diploma
4(4%)
None
32(35%)
Multiple
75(81%)
Workers Compensation
5(6%)
Health Assessment
4(4%)
Safety
1(1%)
Other
4(4%)
None
4(4%)
Data were analysed using the Statistical Package for Social Sciences (SPSS Version 10). Frequencies were identified for type of industry, sole practitioner, education and the applicability of each activity statement to their workplace. The activity statements were then ranked according to the number of OHNs who identified them as appropriate to their workplace. Means, standard deviations and range were calculated for age, experience, years of service, and the number of other safety personal at the workplace. Mean scores were calculated for the percentage of time allocated to each Area of Practice. The relationship between the time dedicated to each Area of Practice was analysed using inferential statistics. Independent t-test tested for differences between sole practitioners and OHNs who worked with other OH&S personnel. A co relational analysis (Pearson’s r) was utilised to Collegian Vol 13 No 3 2006
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Table 3: Chronbach’s Alpha Coefficient: Areas of Nursing Practice
Area of Practice
n
n of Items
Alpha
Managing an occupational health service
130
7
0.81
Assessing the work environment
131
2
0.70
Assessing, monitoring and evaluating worker’s health
133
3
0.77
Providing information, education, training and advice
131
2
0.81
Enhancing the Health of Workers
130
2
0.75
Managing an illness and injury treatment service
132
2
0.84
Managing the rehabilitation of ill or injured worker
132
2
0.95
Applying research methodology to the investigation of occupational health and safety
131
2
0.87
investigate the relationships between the OHNs’ years of experience, years of service at the organisation and the percentage of time dedicated to Areas of Practice. A post-hoc ANOVA analysis was used to identify the differences between the type of industry, the level of tertiary qualifications of OHNs and the time dedicated to Areas of Practice. Lastly, Chronbach’s alpha co-efficient was used to determine the internal consistency of activity statement items within each Area of Practice.
Results Of the 416 questionnaires distributed to all ACOHN members, 160 were returned to the researcher. 60 respondents indicated that they were no longer working as OHNs, and a further seven questionnaires were returned substantially incomplete and deemed unusable. Several questionnaires were returned with some missing data, but were accepted for use in the study. Consequently, a final sample of 93 questionnaires (22%) was used in analysis.
Sample profile The demographic details of the participants are outlined in Table 2. The majority of the OHN respondents were of mature age (M=44, SD=9) and 91 % were women. Of the 93 OHNs surveyed, 9 were sole practitioners and the remaining 84 nurses worked with other safety personnel at their workplace (M=3, SD=3). The OHNs were experienced (M=2, SD=9), with substantial experience at their current organisation (M=6, SD=5). A certificate of nursing qualification was held by 52% of the sample and the remainder (48%) had undertaken undergraduate and/or post-graduate nursing education. Regardless of their nursing qualification, 65% of the OHNs sampled had obtained nonnursing tertiary qualifications, and nearly all (96%) had engaged in additional and numerous short courses in occupational health and safety. Occupational health nurse engagement in activities A Chronbach’s alpha coefficient was used to examine the reliability of the activity statements scaled within each Area of Practice (Table 3). In all Areas of Practice, the Chronbach Alpha was 0.70 or above. Additionally, one interesting result from the data was that 43% (35/93) of the participants estimated their aggregated time to Areas of Practice as greater than 100%, which could arguably be an expression of role overload in area performance. 22
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The applicability of activity statements, ranking of activity statements’ applicability to practice and the percentage of time allocated to each Area of Practice are outlined in Table 1. These data suggests a degree of coherence between the rank order of Areas of Practice and the time spent in them. The results highlight the substantial attention given to traditional role OHN activities and Areas of Practice. Treatment and rehabilitation activities were ranked in the top ten activities. Moreover, OHNs dedicated a substantial amount of their work time to the three areas of traditional role practice. Emergent role Areas of Practice revealed mixed results. Management of OH&S services was the most substantial emergent role Area of Practice for OHNs. Four out of the seven activities in this Area of Practice were ranked in the top ten activities and OHNs devoted substantial amounts of their time to this area. All other emergent role Areas of Practice were less prominent with only two other activities statements ranked in the top ten, and the time dedicated to these areas was much less than traditional role Areas of Practice. Examination of whether demographic and workplace factors had any effect on the time OHNs dedicated to Areas of Practice identified that there were no statistically significant differences (p<0.05 level) in time spent on Areas of Practice for the different groups in relation to education, type of industry, sole practice and numbers of other OH&S staff. There were also no statistically significant correlations (p<0.05 level) between years of nursing experience and experience at the particular organisation and time spent on Areas of Practice.
Discussion This Australian study investigated occupational health nursing practice with participants who were mature, well-educated and experienced OHN practitioners. As they were affiliated with a professional organization, they were appropriate subjects for a study of traditional and emergent dimensions of the occupational health nurse role. The OHNs in this study identified activities from all eight Areas of Practice as applicable to their work, and allocated time to them. However, they highlighted a consistent focus on traditional role activities. As OHNs are the primary contact for employees with health concerns, it could be expected that they will perform these services. This expectation appears to be accepted by most
Occupational health nursing practice in Australia: What occupational health nurses say they do and what they actually do
OHNs as applicable to their role. Furthermore, the ability to provide treatment, care and rehabilitation may provide OHNs with a way of distinguishing themselves from other OH&S practitioners in the workplace who cannot provide these services. These results support Yoo et al (1993) who concluded that treatment and rehabilitation based activities may be important because employees expect that OHNs will care for them in times of illness or injury at the workplace. However, if these illnessfocused activities are the only focus of occupational health nursing practice, then OHNs’ role in the workplace will be limited, and they will not realize the advantages and opportunities that emergent role activities may bring both themselves and the profession. Some interesting patterns became apparent in relation to emergent role activities. The most applicable emergent Area of Practice, which also consumed the most time, was managing an occupational health service. These activities relate to data analysis and policy development, OH&S incidents (such as incident reporting, and injury and illness treatment), and constitute a response to occupational injuries and illness rehabilitation; and indicate activities required for compliance with standards. Although decision-making, management and administrative activities indicate some measure of control over practice, they may also represent an unnecessary impost that could intrude on OHNs’ ability to engage in core therapeutic practices. Furthermore, these activities are linked to a traditional role focus on illness, rather than focusing on health and wellness. The only management activity seen as applicable by fewer OHNs, and thus ranked more lowly, was development of budgets. A lack of activity related to budget development is consistent with previous overseas studies (Nelson 2001). Why a major portion of the OHNs did not develop budgets is unclear, particularly as they are taking up the role of managing their health services. Lack of involvement in budgeting may hamper the ability to assume full control and accountability for professional practice. Apart from managing an occupational health service, OHNs devoted less time to the performance of the other emergent role practices of: research (5% of time); assessing the work environment (10% of time); and health education/promotion areas (7% of time). With the exception of the health education/promotion area (ranked 7th), the applicability of the role activities in these three emergent role Areas of Practice was ranked below traditional role activities. However, despite them being ranked more lowly, a substantial proportion of respondents still identified these activities as applicable to their role. This discrepancy between the applicability of these activity statements and the time spent on them indicates that there may be a tension between the desire to engage in emergent role activities, particularly health promotion, and the immediacy and pressing nature of providing treatment and illness-based services. This study revealed a lack of involvement in research by OHNs. Why nurses do not perceive research to be applicable to their practice is unclear. Davey (1992) pointed out that OHNs may lack the skills and knowledge to conduct and review research. However, in light of the tertiary qualifications held by many of the OHNs in this study, the current lack of engagement in research
is surprising. Developing research-mindedness is particularly important in light of the evidence-based practice movement in Australia and internationally. Failing to engage in research activities will limit OHNs’ opportunities to access and generate evidence that could develop OHN practice and demonstrate their value to employers and the community. These findings suggest that there may be a need for greater emphasis on the development of research skills in occupational health nursing education. Results in this study were surprising in that they indicated that demographic and work characteristics such as industry type, sole practice, educational qualifications, years of experience, and experience at the workplace did not affect OHNs’ engagement in role activities, particularly emergent role activities. In particular, these findings contradict the common assumption that postgraduate education promotes a broader practice role. Lusk et al (1988), Martin et al (1993) and Nelson (2001) have identified that the expectations of the employers about the OHNs’ role was a determining factor in the activities OHNs perform. Thus, reasons why OHNs may not be engaging in emergent role activities may relate to restrictions on OHNs’ roles, lack of support and/or conflicting professional and corporate loyalties. ACOHN has asserted that practice differs as a result of workplace contexts. Research is needed to identify whether the most important contextual issue affecting Australian OHN roles is employer expectations. The researcher-developed tool used in this study may be of value for ongoing research into OHN activities in Australia. The high Chronbach Alpha Coefficient generated within the study scales demonstrate the validity of Lusk’s activity statements within Australia, and also demonstrates their consistency within the framework of the ACOHN Areas of Practice. While this study has contributed to a better understanding of the role and activities of the Australian OHN, limitations of the research must be acknowledged. The results of this study should be generalized to the entire OHN population in Australia cautiously, due to a low response rate, and the impact of professional affiliation with ACOHN. Regardless of the limitations, this study is one of only a few national and international studies that has examined the contemporary view of the OHN role and activities in the workplace in relation to traditional and emergent roles.
Conclusion In establishing OHNs’ engagement and estimated time allocated to role activities, this study adds to the body of knowledge regarding a unique and important specialty within nursing and provides a baseline for further research about OHNs and their role in the workplace. The findings suggest that OHNs in Australia may not be engaging fully in all Areas of Practice that have been articulated by the ACOHN, particularly emergent role activities. Although Australian OHNs perform all the activities articulated in the ACOHN Areas of Practice, their focus is still primarily illness and injury based, and also management. Although emergent role activities were identified as relevant, they did not receive the same prominence in their work. The inability to provide a more contemporary approach to OH&S practice suggests that OHNs may not be fulfilling their full professional potential, as articulated by ACOHN. Collegian Vol 13 No 3 2006
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The reasons why some Australian OHNs engage more fully in emergent role activities than others is not clear, because none of the demographic and workplace factors examined had an impact on the results. What is clear is that while the profession is supportive of emergent role activities, there is a need to develop and support OHN practice in emergent role areas of practice. The ACOHN, as the peak professional body for OHNs, has an important role to play in the development of the OHN role in Australia. There is a need to debate possibilities; undertake research into barriers and supports for emergent role activities; more clearly articulate future directions for the OHN role; and develop strategies to support OHNs as they develop their professional role. REFERENCES Allred R, Parrish R 1994 Preventative measures applied by RNs in health occupational health settings. American Association of Occupational Nursing Journal 42(1):23-28 Alston R 1994 Occupational health nurses’ changing roles: an international perspective. University of New England Press, Armidale Australian College of Occupational Health Nurses 1991 Occupational health nursing in Australia: a guide to employment. Australian College of Occupational Health Nurses Inc, Rozelle Australian College of Occupational Health Nurses 1994 Competency standards of occupational health nurses. Australian College of Occupational Health Nurses Inc, Rozelle Ballard J 1996 Occupational health nurses: an OHR survey. Part one: work and workload, managers and priorities. Occupational Health Review January/February:9-16 Barlow R 1992 Role of the occupational health nurse in the Year 2000: perspective View. American Association Occupational Health Nurses Journal 40(10):463-467 Burgel B, Wallace E, Kemerer S, Garbin M 1997 Certified occupational health nursing: job analysis in the United States. American Association Occupational Health Nurses Journal 45(11):61-69 Cooney J, Cooney C 1988 Education for occupational health nurses: knee-jerk reactions or good forward planning. The Journal of Occupational Health and Safety – Australia and New Zealand 4 (6):533-537 Davey G, 1992 Education for effective occupational health and safety practice: a necessity rather than choice. The Journal of Occupational Health and Safety – Australia and New Zealand 8(5):413-420 Davey G 1995 Developing competency standards for occupational health nurses in Australia: a research process. American Association Occupational Health Nurses Journal 43(3):138-143 Ekeberg C, Lagerstrom M, Lutzen K 1997 Empowerment and occupational health nursing: a conceptual framework for reducing role ambiguity and facilitating client empowerment. American Association Occupational Health Nurses Journal 45 (7):342-348 Farr T, Patterson C, Witheriff J, Wilks J 1994 An occupational analysis of Queensland workplace health and safety practitioners Part 1: Background responsibilities,
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duties and tasks. The Journal of Occupational Health and Safety – Australia and New Zealand 10(1):17-26 Haag A, Glazner L 1992 A remembrance of the past, an investment for the future. American Association Occupational Health Nurses Journal 40(2):56-60 Hubelbank J, Glynn P, Love C 1988 Occupational health nurse practitioners: employment activities one year after graduation. American Association Occupational Health Nurses Journal 36(10):420-424 Kocks D, Ross M 1991 The role of health professionals at worksite services in South Africa. American Association Occupational Health Nurses Journal 39(7):343-347 Lusk S 1990 Corporate expectations for occupational health nurses’ activities. American Association of Occupational Health Nurses Journal 38(8):368-374 Lusk S, Disch M, Barkauskas V 1988 Interest of major corporations in expanded practice of occupational health nurses. Research in Nursing Health 11:141-151 Martin K, Shortridge L, Dyehouse J, Nan Magliozzi A 1993 Corporate perspective of the role of the occupational health nurse. Research in Nursing and Health 16:305-311 Miller M 1989 Social, economic, and political forces affecting the future of occupational health nursing. American Association Occupational Health Nurses Journal 37(9):361-366 National Occupational Health and Safety Commission 2002 National OHS strategy 2002 - 2012. Aus Info, Canberra National Occupational Health and Safety Commission 1999 National OHS improvement framework. Aus Info, Canberra Nelson G 2001 Roles and value added contributions of the occupational health nurse: corporate perceptions. American Association Occupational Health Nurses Journal 49(3):121-129 O’Brien S 1995 Occupational health nursing roles: future challenges and opportunities. American Association Occupational Health Nurses Journal 43(3):148-152 Olsen D, Kockevar L, McGovern P 1997 Form follows function: occupational health nursing as a member of the management team. American Association Occupational Health Nurses Journal 45(4):161-169 Rogers B 1991 Occupational health nursing education: curricular content in baccalaureate programs. American Association Occupational Health Nurses Journal 39(3):101–107 Rogers B, Agnew J, Pompeii L 2000 Occupational health nursing research priorities: a changing focus. American Association Occupational Health Nurses Journal 48(1):9-16 Rogers B, Livsey K 2000 Occupational health surveillance, screening, and prevention activities in occupational health nursing practice. American Association Occupational Health Nurses Journal 48(2):92-99 Rossi K 1987 Occupational health nursing worldwide. American Association Occupational Health Nurses Journal 35(11):505-509 Scalzi C, Wilson D, Ebert R 1991 Future preparation of occupational health nurse managers. American Association Occupational Health Nurses Journal 39(3):114-117 Silverston R, Williams A 1982 The role and educational needs of occupational health nurses. The Royal College of Nursing of the United Kingdom, London Simons R 1980 The occupational health nurse: safety’s overlooked resource. Occupational Health Nursing 28(5):7-12 Sorley J 1923 The nurse in industry. Health 1(6):162-165 Yoo K, Ashworth P, Boore J 1993 Expectation and evaluation of occupational health nursing services, as perceived by occupational health nurses, employees, and employers in the United Kingdom. Journal of Advanced Nursing 18:826-837
Introduction This study investigated current activities of occupational health nurses (OHN) in Australia related to the applicability of and their involvement in emergent role, wellness-based practices and traditional role and illness-based practices. A questionnaire encompassing the eight Areas of Practice as articulated by the Australian College of Occupational Health Nursing (ACOHN) competency standards was used to obtain data from 93 OHNs affiliated with ACOHN. More traditional role Areas of Practice such as treatment services, health assessment and rehabilitation services were seen as more applicable to their practice and a substantial amount of time was spent on them. Managing occupational health and safety (OH&S) service’ was the only emergent area that was a substantial part of the OHN’s role. Less time was devoted to other emergent and pro-active areas of OHN practice, such as illness and injury prevention, health promotion, health education and research into OH&S. While less time was allocated to emergent Areas of Practice, and they were ranked more lowly they were considered to be applicable to practice. The findings of this study suggest that OHNs in Australia may not be engaging fully in all Areas of Practice that have been articulated by the ACOHN, particularly emergent role activities.Although Australian OHNs perform all the activities articulated in the ACOHN Areas of Practice, their focus is still primarily illness and injury based, and also management. While the profession is supportive of emergent role activities, there is a need to debate possibilities, undertake research into barriers and supports for emergent role activities, more clearly articulate future directions for the OHN role, and develop strategies to support OHNs as they develop their professional role.
Workplace injury and illness in Australia creates great hardship and costs the Australian community billions of dollars every year (National Occupational Health and Safety Commission (NOHSC) 1999). According to NOHSC, 205 workers were killed as a result of workplace injuries, and an estimated 2000 people died from occupational disease in the years 1999 to 2000 (NOHSC 2002). It is within this scenario that the occupational health nurse (OHN) can make an important contribution to the health and safety of workers. In contrast to their counterpart in hospitals, OHNs work with greater autonomy and isolation. Rogers (1991) revealed that 91% of OHNs in the United States of America (USA) are sole practitioners and, according to Barlow (1992), they remain isolated from professional support. Haag and Glazner (1992) argue that the result is that the role of OHNs remains unclear and bound by a primary focus on traditional role activities related to first aid and treatment. However, in addition to providing treatment and first aid, OHNs can undertake emergent role activities and contribute to improving the work environment, preventing health problems and promoting wellness. The Australian College of Occupational Health Nursing (ACOHN) has developed competency standards with Areas of Practice that reflect both traditional role and emergent role activities. This paper presents an exploratory-descriptive study into the current role of the Australian OHN. The aim of the study was to gain a greater understanding of the traditional role and emergent role activities that OHNs perform in their daily practice, and to analyse their activities in relation to the scope of practice as articulated by the ACOHN Areas of Practice.
Literature Review Keywords: occupational health nurse, activities, scope of practice Correspondence to: Mr Gary Mellor, School of Nursing & Midwifery, Griffith University, Queensland Email: [email protected] Acknowledgement: This study was supported by a Queensland Nursing Council research grant RAN 0143. The authors acknowledge and thank the ACOHN for its support.
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Alston (1994) has described the scope of occupational health nursing as a mix of traditional and emergent functions. A traditional perspective encompasses those elements of nursing that relate to providing treatments and health assessments, whereas emergent functions are those that involve preventative, educational and managerial practices. Research into the performance of the traditional illness-based activities in occupational health nursing has shown that they remain a central focus of OHN practice
Occupational health nursing practice in Australia: What occupational health nurses say they do and what they actually do
(Silverstone & Williams 1982, Cooney & Cooney 1988, Kocks & Ross 1991, Eckberg et al 1997, Olsen et al 1997, Rogers & Livsey 2000). However, other studies have revealed a push for expanding the OHN’s role into wellness–based practices that include: occupational health management (Scalzi et al 1991, Ballard 1996, Burgel et al 1997); workplace assessment (Simons 1980, Cooney & Cooney 1988, Hublebank et al 1988); health education (Rossi 1987, Cooney & Cooney 1988, Hublebank et al 1988); health promotion (Hublebank et al 1988, Allred & Parrish 1994); and research (Rogers et al 2000). For nearly 100 years OHNs have developed an important role in managing the health and safety of employees in Australia. Sorely (1923) allowed a glimpse of the Australian industry nurse’s functions during the early part of the last century, describing them as providing direct nursing care, health surveillance and referral of cases to doctors. A review of the sparse research currently available suggests that little has changed in the Australian OHN’s role since then. Cooney and Cooney (1988) undertook the only contemporary study able to be located that examined the activities of Australian OHNs. Their survey of 50 Western Australian establishments employing OHNs found that the most common activities performed were first aid treatments, dispensing medications, and follow-up treatments. The only emergent function they identified was a health education role. However, this research is dated and since this time OHNs have worked to professionalise their role. The Australian College of OHNs (ACOHN) has articulated a commitment to an emergent role, defining the role of the OHN as being to ‘conserve, promote, and restore the health of persons at their workplace’ (ACOHN 1991 p3). The ACOHN provided greater clarification of the OHN role in 1994 when they identified nine major areas of professional practice (ACOHN 1994), which were: practising in accordance with legislative standards, codes of practice and guidelines; managing an occupational health service; assessing the work environment; assessing, monitoring and evaluating worker’s health; providing information, education, training and advice; enhancing the health of workers; managing an illness and injury treatment service; managing the rehabilitation of ill and injured workers; and applying research methodologies to the investigation of occupational health and safety (OH&S) issues. Moreover, ACOHN argued that the scope of practice in occupational health nursing is context specific, with workplace requirements playing an influential role in shaping the practice of OHNs. The ACOHN argued that an individual OHN’s scope of practice would vary from workplace to workplace, influenced by factors such as: the number of OH&S personnel, the corporate philosophy, and the type of workplace environment (ACOHN 1994). The need for OHNs to flexibly respond to the need of employers and economic changes has interested many authors. Miller (1989) and Davey (1995) identified that established approaches to addressing OH&S issues are being challenged by the changing nature of worker populations and workplaces that include a higher proportion of women and more diverse ethnicity among workers. O’Brien (1995) noted that changes in corporate
culture, which is moving towards participatory management styles, are resulting in a need for OHNs to take a greater consulting and leadership role. Employers are now expecting OHNs to contribute to greater cost containment and to undertake research into cost-effective health care (Lusk et al 1988, Martin et al 1993, Nelson 2001), while employees continue to expect OHNs to provide treatment and prevention services (Yoo et al 1993). The pressure on Australian OHNs to remain contemporary and relevant in current workplaces is highlighted in the work of Farr et al (1994), who describe a variety of professionals and para-professionals who present themselves as OH&S practitioners (physiotherapists, occupational therapists, and others). As the need for OH&S expertise increases in Australia, Davey (1992) warns that nurses will experience competition from these professions. To retain their role as the primary health practitioner at the workplace, OHNs must maintain versatility, demonstrate the relevance and importance of their skills, and articulate their role to employers, employees, government and the community. Before the outcomes of practice can be studied, it must be clear what OHNs actually do every day. Currently, there is no research into what OHNs do in Australia. Although the ACOHN have developed a description of the OHN’s Competencies and Areas of Practice, they have never been validated. The degree to which the actual practice of OHNs in Australia reflects a mix of traditional and emergent functions is, at present, unknown. Lack of information about the actual practice of the OHN in Australia limits the profession’s ability to make valid claims to a professional scope of OHN practice and to plan future development of the OHN role. In view of the changing economic and corporate climate, there is a need to describe, clarify and discuss the future directions of the OHN’s scope of practice, particularly in relation to traditional and emergent functions.
Method This survey study was part of a larger investigation into the scope of OHN practice in Australia. Data were collected through a self-administered, researcher-developed questionnaire that was mailed to 416 participants who were members of ACOHN. The members of ACOHN were chosen because they represent a significant proportion of OHNs in Australia and it was considered that by belonging to a professional organization they have a demonstrated commitment to occupational health nursing.
Instrument The questionnaire contained 44 items that elicited demographic data and asked the participant to describe the OHN’s activities and Areas of Practice in which they engaged, and the time they devoted to them. The demographic data were used to describe the sample and to examine factors that could potentially impact on the OHN’s role activities. Specifically, 22 items reflected role activities of occupational health nursing practice in Australia (see Table 1). 20 of these items were based on the activity statements described in a study by Lusk et al (1988) into the role of the OHN in the USA. Lusk’s activity statements have been used in other studies in the USA (Lusk 1990, Martin et al 1993, Nelson Collegian Vol 13 No 3 2006
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Table 1: Applicability and Ranking of Activities performed by OHNs, and Time Dedicated to ACOHN Areas of Practice
Area of practice
Applicable to practice (%)
Rank
Time Allocated (%)
Counsel employees regarding health risks
93
1
19
Supervise the provision of care for job related emergency and minor illness episodes
88
2
Assist in the rehabilitation and relocation of disabled workers
84
8
Provide follow up of employees with workers compensation claims
83
9
Evaluate the ability of absentees to safely return to work
79
13
Performing periodic health assessments
74
16
Meet regularly with members of other health disciplines to identify problems and propose solutions
88
3
Develop and implement OH&S policies and procedures based on professional guidelines in occupational health
87
4
Develop analysis for management, noting statistics relating to employee injury and exposure to hazardous substances
86
5
Develop and implement OH&S policies and procedures for the workplace which comply with legislation
85
6
of the health care department
79
11
Serve as a member of the OH&S committee
79
12
Develops budgets for the occupational health area
47
22
Plan and develop educational programs related to worker safety, health promotion and risk prevention
85
7
Participate in employee safety orientated classes and programs for high-risk areas
78
14
Conduct plant rounds regularly to identify hazards and potential violations
76
15
Participate in environmental monitoring
65
19
Conduct pre-placement physicals
63
20
Develop health programs to address the particular needs of the corporation
80
10
Extend health programs to workers dependants
57
21
Generate analysis on trends in health promotion, risk reduction and health care expenditure
71
17
Conduct research to determine cost effective alternatives for health care programs and services
67
18
Activity statement
TRADITIONAL ROLE ACTIVITIES Managing an illness and injury treatment service
Managing the rehabilitation of ill and injured workers
Assessing, monitoring and evaluating workers health
24
19
EMERGENT ROLE ACTIVITIES Managing an occupational health service
26
Makes recommendations for more efficient and cost effective operation
Providing information, education, training and advice
Assessing the work environment
Enhancing the health of workers
Applying research methodology to the investigation of occupational health and safety issues
2001) to identify occupational health nursing activities. To ensure the activity statements were appropriate in the Australian context, they were reviewed in relation to descriptors in the ACOHN competency standards (1994) and distributed to three experienced OHNs for comment. A further two items were added based on this consultation and the ACOHN competency standards Areas of Practice (1994). Consent to use the activity statements were given by Lusk and ACOHN. The resulting activity statements were grouped into eight of the nine Areas of Practice outlined in the ACOHN competency standards (see Table 1). The first Area of Practice: practising in accordance with legislation, standards, codes of practice and guidelines were excluded as it described a required level of competency rather than the nature of activities. Lusk’s instrument had asked 20
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10
10
7
5
nurses to rank the importance of occupational health nurse activity statements; however, this approach did not consider each activity independently. In this study, in order to consider each activity separately, participants were asked whether each activity was applicable or not applicable to their practice. Activity statements were grouped into the eight ACOHN areas of practice and participants were asked, as a percentage, how much they devoted to each Area of Practice. Identifying the applicability of each activity as well as the time dedicated to each ACOHN Area of Practice enabled the OHNs’ perspectives about what they actually do in everyday practice to be explored in the light of professional expectations. A panel of Australian experts consisting of three expert OHNs and two nursing academics reviewed the questionnaire. Feedback
Occupational health nursing practice in Australia: What occupational health nurses say they do and what they actually do
Table 2: Demographic Profile of OHN Participants
Mean (sd)
Range
Age
44.4/91 (8.9)
27-61
Years of nursing experience
21.7/91 (9.4)
1-39
Years of service at the organization
6.5/92 (5.4)
1-21
Number of safety personnel at the workplace
3.3/91 (3.4)
0-19
Group
n(%)
Manufacturing
51(55%)
Health
11(12%)
Other
9(10%)
Government
7(8%)
Mining
6(6%)
Education
5(5%)
Recreation/Hospitality
2(2%)
Construction
2(2%)
Type of Industry
Sole Practitioner
Highest Nursing Qualifications
Highest Non-Nursing Qualification
Short Courses
was sought regarding the length of the questionnaire, the clarity of the instructions and the overall presentation. No significant modifications were needed.
Data collection and analysis Following approval from the researchers’ university Human Ethics Committee, a questionnaire package was mailed to all current members of ACOHN. Each package contained an information sheet, the questionnaire, and a reply paid envelope for returning the questionnaire anonymously to the researcher. A reminder was distributed four weeks later and via an advertisement placed in the Occupational Health Nurse Forum Newsletter published by ACOHN.
Other OH&S Personnel
84(90%)
Sole OH&S Practitioner
9(10%)
Masters
1(1%)
Graduate Cert/Diploma
22(24%)
Degree
14(15%)
Certificate of Nursing
48(52%)
Associate Diploma
6(7%)
Master
6(7%)
Graduate Cert/Diploma
41(45%)
Degree
6(7%)
Associate Diploma
2(2%)
Diploma
4(4%)
None
32(35%)
Multiple
75(81%)
Workers Compensation
5(6%)
Health Assessment
4(4%)
Safety
1(1%)
Other
4(4%)
None
4(4%)
Data were analysed using the Statistical Package for Social Sciences (SPSS Version 10). Frequencies were identified for type of industry, sole practitioner, education and the applicability of each activity statement to their workplace. The activity statements were then ranked according to the number of OHNs who identified them as appropriate to their workplace. Means, standard deviations and range were calculated for age, experience, years of service, and the number of other safety personal at the workplace. Mean scores were calculated for the percentage of time allocated to each Area of Practice. The relationship between the time dedicated to each Area of Practice was analysed using inferential statistics. Independent t-test tested for differences between sole practitioners and OHNs who worked with other OH&S personnel. A co relational analysis (Pearson’s r) was utilised to Collegian Vol 13 No 3 2006
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Table 3: Chronbach’s Alpha Coefficient: Areas of Nursing Practice
Area of Practice
n
n of Items
Alpha
Managing an occupational health service
130
7
0.81
Assessing the work environment
131
2
0.70
Assessing, monitoring and evaluating worker’s health
133
3
0.77
Providing information, education, training and advice
131
2
0.81
Enhancing the Health of Workers
130
2
0.75
Managing an illness and injury treatment service
132
2
0.84
Managing the rehabilitation of ill or injured worker
132
2
0.95
Applying research methodology to the investigation of occupational health and safety
131
2
0.87
investigate the relationships between the OHNs’ years of experience, years of service at the organisation and the percentage of time dedicated to Areas of Practice. A post-hoc ANOVA analysis was used to identify the differences between the type of industry, the level of tertiary qualifications of OHNs and the time dedicated to Areas of Practice. Lastly, Chronbach’s alpha co-efficient was used to determine the internal consistency of activity statement items within each Area of Practice.
Results Of the 416 questionnaires distributed to all ACOHN members, 160 were returned to the researcher. 60 respondents indicated that they were no longer working as OHNs, and a further seven questionnaires were returned substantially incomplete and deemed unusable. Several questionnaires were returned with some missing data, but were accepted for use in the study. Consequently, a final sample of 93 questionnaires (22%) was used in analysis.
Sample profile The demographic details of the participants are outlined in Table 2. The majority of the OHN respondents were of mature age (M=44, SD=9) and 91 % were women. Of the 93 OHNs surveyed, 9 were sole practitioners and the remaining 84 nurses worked with other safety personnel at their workplace (M=3, SD=3). The OHNs were experienced (M=2, SD=9), with substantial experience at their current organisation (M=6, SD=5). A certificate of nursing qualification was held by 52% of the sample and the remainder (48%) had undertaken undergraduate and/or post-graduate nursing education. Regardless of their nursing qualification, 65% of the OHNs sampled had obtained nonnursing tertiary qualifications, and nearly all (96%) had engaged in additional and numerous short courses in occupational health and safety. Occupational health nurse engagement in activities A Chronbach’s alpha coefficient was used to examine the reliability of the activity statements scaled within each Area of Practice (Table 3). In all Areas of Practice, the Chronbach Alpha was 0.70 or above. Additionally, one interesting result from the data was that 43% (35/93) of the participants estimated their aggregated time to Areas of Practice as greater than 100%, which could arguably be an expression of role overload in area performance. 22
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The applicability of activity statements, ranking of activity statements’ applicability to practice and the percentage of time allocated to each Area of Practice are outlined in Table 1. These data suggests a degree of coherence between the rank order of Areas of Practice and the time spent in them. The results highlight the substantial attention given to traditional role OHN activities and Areas of Practice. Treatment and rehabilitation activities were ranked in the top ten activities. Moreover, OHNs dedicated a substantial amount of their work time to the three areas of traditional role practice. Emergent role Areas of Practice revealed mixed results. Management of OH&S services was the most substantial emergent role Area of Practice for OHNs. Four out of the seven activities in this Area of Practice were ranked in the top ten activities and OHNs devoted substantial amounts of their time to this area. All other emergent role Areas of Practice were less prominent with only two other activities statements ranked in the top ten, and the time dedicated to these areas was much less than traditional role Areas of Practice. Examination of whether demographic and workplace factors had any effect on the time OHNs dedicated to Areas of Practice identified that there were no statistically significant differences (p<0.05 level) in time spent on Areas of Practice for the different groups in relation to education, type of industry, sole practice and numbers of other OH&S staff. There were also no statistically significant correlations (p<0.05 level) between years of nursing experience and experience at the particular organisation and time spent on Areas of Practice.
Discussion This Australian study investigated occupational health nursing practice with participants who were mature, well-educated and experienced OHN practitioners. As they were affiliated with a professional organization, they were appropriate subjects for a study of traditional and emergent dimensions of the occupational health nurse role. The OHNs in this study identified activities from all eight Areas of Practice as applicable to their work, and allocated time to them. However, they highlighted a consistent focus on traditional role activities. As OHNs are the primary contact for employees with health concerns, it could be expected that they will perform these services. This expectation appears to be accepted by most
Occupational health nursing practice in Australia: What occupational health nurses say they do and what they actually do
OHNs as applicable to their role. Furthermore, the ability to provide treatment, care and rehabilitation may provide OHNs with a way of distinguishing themselves from other OH&S practitioners in the workplace who cannot provide these services. These results support Yoo et al (1993) who concluded that treatment and rehabilitation based activities may be important because employees expect that OHNs will care for them in times of illness or injury at the workplace. However, if these illnessfocused activities are the only focus of occupational health nursing practice, then OHNs’ role in the workplace will be limited, and they will not realize the advantages and opportunities that emergent role activities may bring both themselves and the profession. Some interesting patterns became apparent in relation to emergent role activities. The most applicable emergent Area of Practice, which also consumed the most time, was managing an occupational health service. These activities relate to data analysis and policy development, OH&S incidents (such as incident reporting, and injury and illness treatment), and constitute a response to occupational injuries and illness rehabilitation; and indicate activities required for compliance with standards. Although decision-making, management and administrative activities indicate some measure of control over practice, they may also represent an unnecessary impost that could intrude on OHNs’ ability to engage in core therapeutic practices. Furthermore, these activities are linked to a traditional role focus on illness, rather than focusing on health and wellness. The only management activity seen as applicable by fewer OHNs, and thus ranked more lowly, was development of budgets. A lack of activity related to budget development is consistent with previous overseas studies (Nelson 2001). Why a major portion of the OHNs did not develop budgets is unclear, particularly as they are taking up the role of managing their health services. Lack of involvement in budgeting may hamper the ability to assume full control and accountability for professional practice. Apart from managing an occupational health service, OHNs devoted less time to the performance of the other emergent role practices of: research (5% of time); assessing the work environment (10% of time); and health education/promotion areas (7% of time). With the exception of the health education/promotion area (ranked 7th), the applicability of the role activities in these three emergent role Areas of Practice was ranked below traditional role activities. However, despite them being ranked more lowly, a substantial proportion of respondents still identified these activities as applicable to their role. This discrepancy between the applicability of these activity statements and the time spent on them indicates that there may be a tension between the desire to engage in emergent role activities, particularly health promotion, and the immediacy and pressing nature of providing treatment and illness-based services. This study revealed a lack of involvement in research by OHNs. Why nurses do not perceive research to be applicable to their practice is unclear. Davey (1992) pointed out that OHNs may lack the skills and knowledge to conduct and review research. However, in light of the tertiary qualifications held by many of the OHNs in this study, the current lack of engagement in research
is surprising. Developing research-mindedness is particularly important in light of the evidence-based practice movement in Australia and internationally. Failing to engage in research activities will limit OHNs’ opportunities to access and generate evidence that could develop OHN practice and demonstrate their value to employers and the community. These findings suggest that there may be a need for greater emphasis on the development of research skills in occupational health nursing education. Results in this study were surprising in that they indicated that demographic and work characteristics such as industry type, sole practice, educational qualifications, years of experience, and experience at the workplace did not affect OHNs’ engagement in role activities, particularly emergent role activities. In particular, these findings contradict the common assumption that postgraduate education promotes a broader practice role. Lusk et al (1988), Martin et al (1993) and Nelson (2001) have identified that the expectations of the employers about the OHNs’ role was a determining factor in the activities OHNs perform. Thus, reasons why OHNs may not be engaging in emergent role activities may relate to restrictions on OHNs’ roles, lack of support and/or conflicting professional and corporate loyalties. ACOHN has asserted that practice differs as a result of workplace contexts. Research is needed to identify whether the most important contextual issue affecting Australian OHN roles is employer expectations. The researcher-developed tool used in this study may be of value for ongoing research into OHN activities in Australia. The high Chronbach Alpha Coefficient generated within the study scales demonstrate the validity of Lusk’s activity statements within Australia, and also demonstrates their consistency within the framework of the ACOHN Areas of Practice. While this study has contributed to a better understanding of the role and activities of the Australian OHN, limitations of the research must be acknowledged. The results of this study should be generalized to the entire OHN population in Australia cautiously, due to a low response rate, and the impact of professional affiliation with ACOHN. Regardless of the limitations, this study is one of only a few national and international studies that has examined the contemporary view of the OHN role and activities in the workplace in relation to traditional and emergent roles.
Conclusion In establishing OHNs’ engagement and estimated time allocated to role activities, this study adds to the body of knowledge regarding a unique and important specialty within nursing and provides a baseline for further research about OHNs and their role in the workplace. The findings suggest that OHNs in Australia may not be engaging fully in all Areas of Practice that have been articulated by the ACOHN, particularly emergent role activities. Although Australian OHNs perform all the activities articulated in the ACOHN Areas of Practice, their focus is still primarily illness and injury based, and also management. Although emergent role activities were identified as relevant, they did not receive the same prominence in their work. The inability to provide a more contemporary approach to OH&S practice suggests that OHNs may not be fulfilling their full professional potential, as articulated by ACOHN. Collegian Vol 13 No 3 2006
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The reasons why some Australian OHNs engage more fully in emergent role activities than others is not clear, because none of the demographic and workplace factors examined had an impact on the results. What is clear is that while the profession is supportive of emergent role activities, there is a need to develop and support OHN practice in emergent role areas of practice. The ACOHN, as the peak professional body for OHNs, has an important role to play in the development of the OHN role in Australia. There is a need to debate possibilities; undertake research into barriers and supports for emergent role activities; more clearly articulate future directions for the OHN role; and develop strategies to support OHNs as they develop their professional role. REFERENCES Allred R, Parrish R 1994 Preventative measures applied by RNs in health occupational health settings. American Association of Occupational Nursing Journal 42(1):23-28 Alston R 1994 Occupational health nurses’ changing roles: an international perspective. University of New England Press, Armidale Australian College of Occupational Health Nurses 1991 Occupational health nursing in Australia: a guide to employment. Australian College of Occupational Health Nurses Inc, Rozelle Australian College of Occupational Health Nurses 1994 Competency standards of occupational health nurses. Australian College of Occupational Health Nurses Inc, Rozelle Ballard J 1996 Occupational health nurses: an OHR survey. Part one: work and workload, managers and priorities. Occupational Health Review January/February:9-16 Barlow R 1992 Role of the occupational health nurse in the Year 2000: perspective View. American Association Occupational Health Nurses Journal 40(10):463-467 Burgel B, Wallace E, Kemerer S, Garbin M 1997 Certified occupational health nursing: job analysis in the United States. American Association Occupational Health Nurses Journal 45(11):61-69 Cooney J, Cooney C 1988 Education for occupational health nurses: knee-jerk reactions or good forward planning. The Journal of Occupational Health and Safety – Australia and New Zealand 4 (6):533-537 Davey G, 1992 Education for effective occupational health and safety practice: a necessity rather than choice. The Journal of Occupational Health and Safety – Australia and New Zealand 8(5):413-420 Davey G 1995 Developing competency standards for occupational health nurses in Australia: a research process. American Association Occupational Health Nurses Journal 43(3):138-143 Ekeberg C, Lagerstrom M, Lutzen K 1997 Empowerment and occupational health nursing: a conceptual framework for reducing role ambiguity and facilitating client empowerment. American Association Occupational Health Nurses Journal 45 (7):342-348 Farr T, Patterson C, Witheriff J, Wilks J 1994 An occupational analysis of Queensland workplace health and safety practitioners Part 1: Background responsibilities,
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duties and tasks. The Journal of Occupational Health and Safety – Australia and New Zealand 10(1):17-26 Haag A, Glazner L 1992 A remembrance of the past, an investment for the future. American Association Occupational Health Nurses Journal 40(2):56-60 Hubelbank J, Glynn P, Love C 1988 Occupational health nurse practitioners: employment activities one year after graduation. American Association Occupational Health Nurses Journal 36(10):420-424 Kocks D, Ross M 1991 The role of health professionals at worksite services in South Africa. American Association Occupational Health Nurses Journal 39(7):343-347 Lusk S 1990 Corporate expectations for occupational health nurses’ activities. American Association of Occupational Health Nurses Journal 38(8):368-374 Lusk S, Disch M, Barkauskas V 1988 Interest of major corporations in expanded practice of occupational health nurses. Research in Nursing Health 11:141-151 Martin K, Shortridge L, Dyehouse J, Nan Magliozzi A 1993 Corporate perspective of the role of the occupational health nurse. Research in Nursing and Health 16:305-311 Miller M 1989 Social, economic, and political forces affecting the future of occupational health nursing. American Association Occupational Health Nurses Journal 37(9):361-366 National Occupational Health and Safety Commission 2002 National OHS strategy 2002 - 2012. Aus Info, Canberra National Occupational Health and Safety Commission 1999 National OHS improvement framework. Aus Info, Canberra Nelson G 2001 Roles and value added contributions of the occupational health nurse: corporate perceptions. American Association Occupational Health Nurses Journal 49(3):121-129 O’Brien S 1995 Occupational health nursing roles: future challenges and opportunities. American Association Occupational Health Nurses Journal 43(3):148-152 Olsen D, Kockevar L, McGovern P 1997 Form follows function: occupational health nursing as a member of the management team. American Association Occupational Health Nurses Journal 45(4):161-169 Rogers B 1991 Occupational health nursing education: curricular content in baccalaureate programs. American Association Occupational Health Nurses Journal 39(3):101–107 Rogers B, Agnew J, Pompeii L 2000 Occupational health nursing research priorities: a changing focus. American Association Occupational Health Nurses Journal 48(1):9-16 Rogers B, Livsey K 2000 Occupational health surveillance, screening, and prevention activities in occupational health nursing practice. American Association Occupational Health Nurses Journal 48(2):92-99 Rossi K 1987 Occupational health nursing worldwide. American Association Occupational Health Nurses Journal 35(11):505-509 Scalzi C, Wilson D, Ebert R 1991 Future preparation of occupational health nurse managers. American Association Occupational Health Nurses Journal 39(3):114-117 Silverston R, Williams A 1982 The role and educational needs of occupational health nurses. The Royal College of Nursing of the United Kingdom, London Simons R 1980 The occupational health nurse: safety’s overlooked resource. Occupational Health Nursing 28(5):7-12 Sorley J 1923 The nurse in industry. Health 1(6):162-165 Yoo K, Ashworth P, Boore J 1993 Expectation and evaluation of occupational health nursing services, as perceived by occupational health nurses, employees, and employers in the United Kingdom. Journal of Advanced Nursing 18:826-837