PERFORMANCE INDICATORS AND BENCHMARKING IN OH NURSING

A report conducted by the At Work Partnership for the Royal College of Nursing Society of Occupational Health Nursing

November 2005

Performance indicators and benchmarking in occupational health nursing

A report by the At Work Partnership for the Royal College of Nursing Society of Occupational Health Nursing

John Ballard Sarah Silcox Paul Suff

© The At Work Partnership Ltd 2005 The At Work Partnership Ltd 19 Bishops Avenue Elstree Hertfordshire WD6 3LZ info@atworkpartnership.co.uk

The At Work Partnership
The At Work Partnership (AWP) is an independent publisher, research and conferences organisation that focuses on occupational health and disability at work issues. It is committed to researching, evaluating and disseminating high quality, reliable and evidence-based information for the improvement of working lives. It publishes the bi-monthly professional journal Occupational Health [at Work] and organises seminars on all aspects of occupational health and disability at work. The At Work Partnership has worked jointly with the Institute for Employment Studies on a research project funded by the Health and Safety Executive (HSE) to examine the impact of the HSE’s guidance on risk assessment, and on a second project on accident reporting for the Learning and Skills Council. It has also been commissioned by the Department for Transport, the Home Office and the Metropolitan Police. Private sector joint initiatives have included research sponsored by the healthcare group AXA PPP. For further information, email info@atworkpartnership.co.uk

Acknowledgements
The At Work Partnership would like to thank all the OH nurses who dedicated time to completing the questionnaire and to attending the focus group, and Mike Duffy for his analysis of the data.

injury and illness data Cost–benefit analysis of OH interventions Display screen equipment assessments Sharps/needlestick prevention and management Immunisation Travel health advice Provision of training and education (eg manual handling) – excluding first aid Organisation of first aid and first-aid training Provision of confidential counselling General health and wellness screening Interpreting and advising on OH law Confidential handling of health and personal data Results 3: Role and competence Essential services and level of provision Essential services and OH nursing competence i Performance indicators and benchmarking in OH nursing Contents .PERFORMANCE INDICATORS AND BENCHMARKING IN OH NURSING CONTENTS Executive summary Objectives Methods Survey findings General information OH functions Essential services? Role and competence Generic skills OH performance indicators OH policies and policy development iii iii iii iii v vii viii xi xii xiii xv Conclusions Introduction and background Methods Questionnaire Survey analysis SOHN conference and performance indicators workshop 1 3 4 4 Results and analysis Results 1: General information Physicians in the workplace OH facilities Out-of-hours cover OH support for off-site and home workers 5 11 13 14 15 16 16 18 21 23 25 27 30 32 34 38 40 42 45 47 49 51 53 55 57 60 62 64 66 68 70 70 75 83 Results 2: OH functions and competences Attendance monitoring Return-to-work interviews Home/off-site visits to workers on sick leave Disability assessments and adjustments Vocational rehabilitation Analysis of pre-employment/pre-placement questionnaires Assessment of fitness for work Developing fitness-for-work standards Health surveillance provision and interpretation of health surveillance Health and safety risk assessment Assessment of risks to mental health (including stress) Advising on work organisation and design Provision of personal protective equipment Monitoring work-related accident.

PERFORMANCE INDICATORS AND BENCHMARKING IN OH NURSING Results 4: Generic OH nursing skills Research skills and awareness Team working Budget management Resource management Leadership skills Interpreting developments in OH practice Communication with clients and OH colleagues Conflict management Presentation skills Coaching/mentoring Clinical supervision Importance rating and competence 85 85 85 86 87 87 88 89 90 90 91 91 92 95 95 95 97 100 103 103 103 104 105 105 106 106 107 108 109 119 121 123 125 125 126 127 Results 5: OH performance indicators Management–OH referral times Fitness-for-work reports Time taken to be seen by external specialist Provision of post-exposure prophylaxis Results 6: Role in OH policies and policy development Medical confidentiality Attendance Disability Bullying and harassment Stress Manual handling Health and safety and the reporting of injury and illness data Bloodborne viruses Substance misuse Results 7: Clinical governance Occupational health support for the OH team Competence of occupational medicine Results 8: Core competences Results 9: Focus group OH education and qualifications Manpower: is there an ideal ratio between the number of OH nurses and the number of employees in an organisation? The balance between what ‘customers’ expect from the OH service and what OH practitioners perceive as essential Discussion Literature review Aims and objectives The role and required competences of OH nurses Role of the OHN Competences of the OHN 128 129 129 130 134 136 136 138 141 142 144 144 144 146 147 150 Provision and delivery of occupational health UK-wide provision OH provision in the NHS Small and medium-sized employers Multi-national organisations Accepted standards and performance measures for OH Definitions of OH activities Employer and employee OH priorities Benchmarking OH performance Developing competences in OH Summary of sources References Appendix The performance indicators questionnaire ii 156 157 Performance indicators and benchmarking in OH nursing Contents .

The term OH sister is very rare (just over 1%). NHS. Methods A 29-item survey was mailed to OH nurses in October 2004. and self-employed. in total. It also aimed to provide a broad understanding of the facilities and opportunities available to OH nurses and establish target areas for professional development. All participants were chosen at random from membership of the RCN Society of Occupational Health Nursing. OH nurse (26%) and OH manager (23%). and the competences of OH nurses to deliver those services. with one-third managing at least one member of staff. within broad employment sectors: commercial OH providers. Around one-third of respondents report that at least one full-time nurse without a formal OH qualification works in their place of work in an OH nursing capacity. Qualifications Eighty-five per cent of OH nurses responding to the survey have a formal OH qualification (the OH nursing degree and diploma are the most common qualifications). Three-quarters of OH nurses work as part of an OH team. Questionnaire data were analysed across the whole sample and. There was no universal . 2% self-employed (some respondents worked across more than one sector). The median size of employer in the survey is 1. other public sector.2 million people. other private sector.800 employees. Employment sectors Responses came from all employment sectors: 20% commercial OH provider. Survey findings General information Survey and response A total of 473 OH nurses responded to the survey (24% response). Two-thirds of OH nurses work full-time. nearly 2. a third also report that at least one part-time non-OH qualified nurse works in an OH capacity. for example whether the OH nurse worked alone or as part of a team. where appropriate.EXECUTIVE SUMMARY Objectives The research aimed to establish the current scope and standards of performance in delivering occupational health nursing services throughout the UK. Job titles and contracts The most common job titles are OH adviser/OH nurse adviser (44%). 16% other public sector. The survey covers organisations that employ. Survey data was supplemented by information from a focus group held at the RCN Society of Occupational Health Nursing annual conference in November 2004. 28% NHS. A limited number of cross-analyses were made. More than two-thirds of respondents (69%) have responsibility for more than one workplace. 38% other private sector.

agreement in the focus-group discussion on whether those working in occupational health should be required to have a specific qualification in the discipline. Nursing provision There is large variation in the numbers of OH nurses working in different organisations, although the mean across all sectors is 3.7 full-time equivalent (FTE) nurses per place of work (includes fully qualified, non-OH qualified and OH nurses in training). There are around 4.5 nurses in total per workplace (full- and part-time combined). Numbers are highest in the NHS (just under five FTE nurses per place of work) and commercial OH providers. Nursing levels are lowest in the other public sector (just over two FTE nurses per place of work). The data gives crude estimates of roughly one nurse working in OH for every 1,140 employees, or one FTE for every 1,420 employees. However, taking only those nurses who are either fully OHqualified or who are in training, the ratios are much higher: one qualified or in-training OH nurse per 1,760 employees, or one FTE per 2,092 employees. Overall, there is around one fully qualified OH nurse for every 2,050 employees, or one FTE per 2,450 employees. The NHS employs the highest ratio of OH nurses per employee (1.28 nurses per 1,000 staff), with the other public sector the lowest ratio (0.52 per 1,000). Focus-group participants felt that it would be impracticable to prescribe a ratio for the number of OH nurses required for a particular size of workforce, since this would depend not just on the number of workers, but the nature of their work and the type of OH provision required. Access to occupational medicine Around 83% of OH nurses have access to a FOM-qualified OH physician at their place of work – with access highest in the NHS and commercial OH providers. A fifth of respondents say that a full-time FOM-qualified OH physician practices at their place of work; just over two-thirds have access to a part-time FOM physician. Across all sectors, there are around 0.32 FOM-qualified OH physicians per 1,000 employees – highest in the commercial OH providers (0.51 per 1,000 employees) and lowest in the other private sector (0.25 per 1,000). There are around 0.2 FTE qualified OH physicians per 1,000 employees across all sectors. OH facilities The vast majority (95%) of OH nurses have a dedicated OH facility or clinic at their workplace; almost a quarter describe the facility as excellent, while a similar proportion say the facility is unsatisfactory. Respondents from the NHS are most likely to describe the facility as unsatisfactory (31% of NHS respondents). Out-of-hours cover A fifth (21%) of OH nurses say their organisation provides OH cover outside standard daytime hours – including just 11% of NHS respondents. Just over half of organisations say OH cover is provided for home and/or off-site workers, with one-fifth saying that such cover is not required.

OH functions
Absence Two-thirds of OH departments offer some form of attendance monitoring service, though only 38% say they offer a comprehensive service. Private sector OH departments are much more likely than those in the public sector to offer a comprehensive attendance monitoring service. However, private sector respondents are also much more likely to rate such a service as essential than are their public sector counterparts. Disability and return to work Three-quarters of OH services offer return-to-work interviews, with around half saying the service is comprehensive. Sixty-one per cent of OH services are able to provide home or off-site visits for employees on sick leave (higher in the private sector). The vast majority (94%) of OH services offer some form of disability assessments and advice on adjustments; two thirds say the service is comprehensive and four-fifths describe the function as essential. Most services (82%) offer vocational rehabilitation, but less than half of respondents describe the service as comprehensive – public sector OH services outside the NHS are the worst performers in this respect. The majority of respondents (88%) describe vocational rehabilitation as essential. Pre-employment and fitness for work Nearly all OH services (95%) have some role in the analysis of pre-employment or pre-placement health questionnaires; 80% of respondents say the service is comprehensive. More than three-quarters of respondents describe the function as essential. Eighty-four per cent of OH services provide comprehensive analysis of fitness to work – only four respondents across the whole sample say such a service is not offered. Most agree that the function is essential. Eighty-five per cent of respondents say that their OH service plays a part in developing fitness-for-work standards. Around half of all respondents describe the service as comprehensive, though respondents from the other public sector are less likely to report a comprehensive service. Health surveillance Nearly all services across all sectors provide health surveillance and interpret the results. Three quarters describe provision as comprehensive and around 85% say it is an essential function. Risk assessment Although most respondents (86%) report that the OH department provides health and safety risk assessments, only half of those offering the service describe the provision as basic rather than comprehensive. Two-thirds of respondents say the service is essential. Around 90% of respondents say their OH service offers some level of assessment of risks to mental health; however just half say this is comprehensive. Only one-third of other private sector respondents describe the service as comprehensive. By contrast, 91% of respondents say that provision of mental health risk assessments is essential.

Health and safety Most organisations offer some provision in advising on work organisation and design – a third of respondents say their service is comprehensive. Nearly all respondents agree that this function is either essential or desirable. Less than two-thirds of services provide personal protective equipment and a majority of these describe such provision as basic. Nearly all OH services offer display-screen equipment assessments, with two-thirds describing the service as comprehensive. Just under two-thirds say the function is essential, and one-third desirable; very few say the service is not required. Three-quarters of OH services monitor work-related accident, injury and illness data. Eighty-three per cent of other private sector OH services monitor such data – more than in the other sectors – and 70% of respondents in that sector say that this function is essential. Cost–benefit analysis Just over half (57%) of respondents say that their service carries out cost–benefit analyses of OH interventions, with most of those that do offering only basic provision. By contrast, 90% of respondents rate this function as either essential or desirable. Infectious diseases Ninety-seven per cent of all NHS respondents report that their OH departments provide services to prevent and manage sharps and needlestick injuries – four-fifths say the service is comprehensive. Most other public sector services offer at least some level of provision, while no service is offered in 43% of commercial OH providers and 36% of other private sector employers. Provision of immunisation is virtually universal among NHS respondents (85% comprehensive, 9% basic). More than half (53%) of other public sector respondents say that immunisation provision is an essential function in their organisations, and 23% say it is desirable; yet just 35% provide a comprehensive service and 35% no service at all. In contrast to the provision of immunisation and sharps/needlestick management, travel health advice is more commonly available in the private than public sector. Nearly two-thirds of commercial OH providers (63%) and other private sector respondents (61%) say that they provide some level of travel health advice and service, compared with just over half in the NHS (52%) and other public sector (53%). Private sector respondents are also more likely to rate this function as important than their public sector counterparts. Training Although two-thirds of respondents say their OH services offer some level of training and education in occupational health and safety (eg manual handling), less than half of those that do say the service is comprehensive. The majority of respondents consider the provision of training to be either essential (53%) or desirable (32%). Sixty per cent of OH services provide some level of first-aid organisation and first-aid training – with such services more likely to be offered in the private than public sectors. Counselling Most OH departments (89%) offer confidential counselling – though the provision of a comprehensive service is more likely in the NHS (66%) and other public sector (69%) than in either the commercial OH providers (46%) and other private sector (52%). More than two-thirds

occupational health law. with commercial OH providers more likely than those in other sectors to offer a comprehensive service. Confidential handling of health and personal data. fewer than half of all respondents say they provide a comprehensive service. 51% of whom see the service as essential and 38% desirable. Provision of personal protective equipment. Unsurprisingly. 95% of OH nurses rate confidential handling of personal data as essential. However.of respondents rate confidential counselling as an essential function – just 3% of all respondents consider it to be of nil or negligible value. By contrast. This is followed by assessment of fitness for work and delivering and interpreting health surveillance. assessing fitness for work. In many cases there is a good match between services considered as essential and where provision is viewed as comprehensive. Confidential handling of health and personal data and the assessment of fitness for work are ranked highest across all the employment sectors. home/off-site visits to workers on sick leave. Wellness Four-fifths of organisations offer some level of health and wellness screening. travel health advice/provision and home/offsite visits to workers on sick leave are the least likely to be rated as essential functions. general health and wellness screening. For example. travel health advice/provision and cost–benefit analysis of OH interventions are the least comprehensively provided. Only 21% of organisations assess the cost–benefit of OH interventions. An even bigger percentage of respondents (98%) say that their OH service provides confidential handling of health and personal data and 88% describe the provision as comprehensive. yet 50% of respondents consider this as essential. 81% of respondents view assessing risks to mental health as essential. OH law Ninety-one per cent of all respondents’ OH services provide advice on. and delivering health surveillance are the four functions where provision is most likely to be comprehensive. with three-quarters of respondents describing this function as essential. both in terms of provision and perceived . Respondents from the NHS are more likely to perceive such services as desirable (57%) rather than essential (28%) – a trend reversed among commercial OH provider respondents. 95% of respondents describe the function as essential. Provision of personal protective equipment. Essential services? All of the OH service areas are ranked according to whether OH nurses perceive them as essential (box 1) and whether provision is considered comprehensive (box 2). The most important function according to OH nurses is confidential handling of health personal data. and interpretation of. analysis of preemployment/pre-placement questionnaires. and 88% rate their service provision in this context as excellent. but just 42% of OH services provide comprehensive cover.

satisfactory or unsatisfactory. Self-rated competence varies considerably: just 15% of OH nurses rate their skills in cost–benefit analysis of OH interventions as excellent. They were also asked to describe their role in the delivery of each service: lead. The full list of assessed skills is grouped below: I at least 70% excellent – confidential handling of health and personal data. whereas 75% consider that they excel in the confidential handling of health and personal data. Box 1: Essential OH nursing functions (all sectors) 1 Confidential handling of health and personal data (95%) 5 Disability assessments and adjustments (81%) 9 Developing fitness-for-work standards (71%) 13 Display screen equipment assessments (62%) 17 Monitoring work-related accident. support or nil/negligible. injury and illness data (37%) 24 Home/off-site visits to workers on sick leave (25%) Note: the figures show the percentages of OH nurses who rate each service as comprehensive Role and competence Respondents were asked to rate their level of competence in each service area as excellent. sharps and needlestick prevention and management is ranked as the fourth most important service in the NHS. There are some difference between sectors. Notably. but 20th by respondents from commercial OH providers. injury and illness data (58%) 21 Cost–benefit analysis of OH interventions (50%) 25 Travel health advice/provision (25%) 2 Assessment of fitness for work (88%) 6 Assessing risks to mental health (81%) 10 Confidential counselling (68%) 14 Vocational rehabilitation (61%) 18 Attendance monitoring (53%) 22 Organisation of first aid and first-aid training (44%) 26 Home/off-site visits to workers on sick leave (23%) 3 Delivering health surveillance (84%) 7 Analysing of pre-employment/preplacement questionnaires (77%) 11 Health and safety risk assessment (66%) 15 Advising on work organisation and design (59%) 19 Provision of training and education (53%) 23 Provision of personal protective equipment (44%) 4 Interpretation of health surveillance (84%) 8 Interpreting and advising on OH law (76%) 12 Sharps/needlestick prevention and management (63%) 16 Delivering return-to-work interviews (58%) 20 Immunisation (50%) 24 General health and wellness screening (39%) Note: the figures show the percentages of OH nurses who rate each function as essential Box 2: Comprehensive provision of OH services (all sectors) 1 Confidential handling of health and personal data (88%) 5 Interpretation of health surveillance (73%) 9 Interpreting and advising on OH law (49%) 13 Immunisation (46%) 17 General health and wellness screening (41%) 21 Advising on work organisation and design (33%) 25 Travel health advice/provision (24%) 2 Assessment of fitness for work (84%) 6 Disability assessments and adjustments (64%) 10 Developing fitness-forwork standards (47%) 14 Health and safety risk assessment (43%) 18 Organisation of first aid and first-aid training (39%) 22 Provision of training and education (31%) 26 Cost–benefit analysis of OH interventions (21%) 3 Analysing of pre-employment/preplacement questionnaires (80%) 7 Display screen equipment assessments (62%) 11 Vocational rehabilitation (47%) 15 Sharps/needlestick prevention and management (43%) 19 Attendance monitoring (38%) 23 Provision of personal protective equipment (26%) 4 Delivering health surveillance (74%) 8 Confidential counselling (57%) 12 Delivering return-to-work interviews (47%) 16 Assessing risks to mental health (42%) 20 Monitoring work-related accident. analysis of preemployment/pre-placement questionnaires .importance.

I 50%–69% excellent – assessment of fitness for work. immunisation. sharps/needlestick prevention management. delivering health surveillance. as the percentage of nurses in lead roles in a particular job function increases. developing fitness-for-work standards. attendance monitoring I less than 29% excellent – assessing risks to mental health. cost–benefit analysis of OH interventions. vocational rehabilitation. provision of training and education. For example. OH nurses are more likely to be in a lead role in the confidential handling of health and personal data (77% in lead role) than any other function. interpreting and advising on OH law. developing fitness-for-work standards. and 75% describe their competence as excellent. 21% of respondents have a lead role in advising on work organisation and design. return-to-work organisation of first aid and first-aid training. and . Generally. sharps/needlestick prevention and management. travel health advice/provision. monitoring work-related accident. interpretation of health surveillance. injury and illness data. display screen equipment assessments. monitoring work-related accident. confidential counselling. assessing risks to mental health. health and safety risk assessment. vocational rehabilitation I less than 30% in lead role – delivering return-to-work interviews. health and safety risk assessment. Similarly. home/off-site visits to workers on sick leave. They are least likely to have a lead role in the provision of personal protective equipment (just 8% in a lead role). assessment of fitness for work I 50%–69% lead role – delivering health surveillance. organisation of first aid and first-aid training. provision of personal protective equipment. so does the respondents’ overall level of self-rated competence. The full list of functions can be ranked as follows: I at least 70% lead role – confidential handling of health and personal data. cost–benefit analysis of OH interventions. home/off-site visits to workers on sick leave. general health and wellness screening I 30%–49% lead role – disability assessments and adjustments. injury and illness data. immunisation. provision of personal protective equipment. 77% of nurses have a lead role in the confidential handling of data. advising on work organisation and design. analysis of preemployment/pre-placement questionnaires. display screen equipment assessments. confidential counselling. interpretation of health surveillance I 30%–49% excellent – general and health and wellness delivering screening. provision of training and education. interviews. attendance monitoring. advising on work organisation and design. travel health advice/provision. interpreting and advising on OH law. disability assessments and adjustments.

21% describe their competence in this area as excellent. However, there are some exceptions. Most notably, 46% of OH nurses have a lead role in disability assessments, yet just 32% describe their competence in this area as excellent. Across all job functions, OH nurses are more likely to rate their competence as excellent if they are personally in a lead role in delivering that service. Conversely, where nurses rank their competence as unsatisfactory it is generally (though not exclusively) in cases where they have only a negligible or no role. As an example, of those with a lead role in sharps/needlestick prevention and management, 69% describe their competence as excellent, 29% as satisfactory and none as unsatisfactory. For those in a support role, 36% believe their competence to be excellent, 60% satisfactory and 1% unsatisfactory. However, of those with no or negligible role, 13% describe their competence as excellent, 49% satisfactory and 26% unsatisfactory. The match between respondents’ rating of what functions they consider essential and their overall self-ratings of competence in delivering those services is less good. Although self-rated competence is relatively high in data handling, assessing fitness for work, health surveillance, analysis of pre-employment/pre-placement questionnaires and DSE assessments – all of which are perceived as important functions of the OH service – the proportion of nurses describing their competences as excellent is relatively low in some other functions rated as essential. For example, only 15% of OH nurses rate their competence in cost–benefit analysis of OH interventions as excellent, yet 50% rate this as an essential service (a third of OH nurses describe their competence in this area as unsatisfactory). Significantly, while 81% of OH nurses say that disability assessments and adjustments are essential components of the OH service, just 32% rate their competence as excellent (and one in nine practitioners rate their competence as unsatisfactory). The situation is similar for mental health assessments (81% essential v 29% excellent), counselling (68% v 34%) and vocational rehabilitation (61% v 28%). By contrast, general health and wellness screening is ranked seventh out of the 26 OH functions in terms of competence, but 24th in perceived importance. Satisfactory competence does not imply that services are not being delivered. However, the fact that OH nurses tend to rate their competence lower in some areas compared with others supports the notion that there is room for improvement. For example, while, the majority of OH nurses rate their competence as excellent in handling confidential information, assessing fitness for work, DSE assessments, health surveillance and analysing employment health questionnaires, the majority of nurses describe their performance simply as satisfactory in disability assessment, assessing risks to mental health, advising on work organisation and design, interpreting and advising on OH law and the provision of confidential counselling. Assuming perceived competence relates to actual competence, these are clear areas for targeting training and professional development.

Generic skills
Nurses were asked to rate their competence in, and importance of, 12 generic skill areas. Excellent skills The most highly rated generic skills are, in descending order: communicating with clients and OH colleagues (81% of respondents rate their skills as excellent); team working (71%); presentation skills (45%); leadership skills – operational level (44%); interpreting developments in OH practice (33%); coaching/mentoring (33%); clinical supervision (31%); resource management (27%); leaderships skills – strategic level (25%); conflict management (23%); research skills (23%); and budget management (17%). Room for improvement Some skill areas are notable for the relatively large minority of nurses rating their competence as unsatisfactory, and these are cause for concern. More than a quarter (26%) of OH nurses say that their skills in budget management are unsatisfactory; 19% say they have unsatisfactory competence in strategic-level leadership skills; 15% in clinical supervision; 13% in research skills and awareness; 13% in conflict management; and 11% in coaching and mentoring. Essential functions Generic skills most likely to be viewed as essential are, in descending order: communicating with clients and OH colleagues (94% of respondents rate their skills as excellent); team working (87%); interpreting developments in OH practice (71%); leadership skills at the operational level (66%); presentation skills (65%); conflict management (58%); coaching/mentoring (55%); clinical supervision (55%); resource management (54%); leadership skills at the strategic level (52%); research skills (51%); and budget management (44%). Generally, as the level of importance increases, so does the overall level of self-perceived competence. Most OH nurses (94%) rate communication with clients and OH colleagues as essential, and 81% rate their competence as excellent (less than 0.5% say their competence is unsatisfactory). However, while 71% of OH nurses rate the interpretation of developments in OH practice as essential (the third highest-ranked skill), only 33% feel their competence is excellent. And while 58% rate conflict management as an essential skill, just 23% rate their competence in this area as excellent. OH nursing qualities An open question in the survey asked respondents to state what they consider to be the most important competency of the OH nurse. Of the 394 responses, by far the most common theme is that of ‘communication and listening’, mentioned by one-third of the respondents. The 10 qualities mentioned most often in the unprompted responses are, in descending order: communication and listening; interpersonal skills; knowledge and education; confidentiality; awareness of legislation; leadership; self-motivation and proactive working; knowing one’s own limitations; teamwork; and evidence-based practice.

OH performance indicators
Respondents were asked to provide estimates of various performance measures, such as referral times and time taken to deliver OH reports. Referral times The average (mean) time taken between a management referral and a worker being seen by an OH professional is 6.05 days – slowest in the NHS (8.2 days) and quickest in the other private sector (4.51 days). (Self-employed respondents reported mean referral times of 4.15 days, but with just 11 self-employed respondents, this figure is not reliable.) There is considerable variation in the data and the spread of reported referral times is even more revealing. Threequarters (73%) of private sector OH services report that mean referral times are no more than five days. This contrasts with the NHS where just 29% are seen within five days. Nearly one-quarter (22%) of commercial OH providers say that referral times are no more than two days (the equivalent figure for the NHS is 6%). Among commercial OH providers, other private sector and other public sector organisations, between 37% and 41% of all cases are seen by the OH professional between three and five days after referral. Forty per cent of referrals in the NHS take six to 10 days. Reports and external consultations Fitness-for-work reports take on average 3.0 days to be delivered from the time the worker has seen the OH professional (mean across all sectors). There is relatively little variation between sectors. The mean average time between a referral from OH to a person being seen by an external specialist is 13.4 days (slightly longer in the NHS and other public sector). Respondents were asked to select the factors most likely to delay referral to an external specialist. These are, in descending order: NHS waiting list (cited by 70% of respondents); time taken by employee’s GP (69%); time taken by private health consultant (35%); lack of cooperation by employee (16%); signing off by line manager (11%) and signing off by the occupational physician (10%). Post-exposure prophylaxis Respondents who work within either the healthcare sector or emergency services were asked to provide information on the provision of post-exposure prophylaxis (PEP) following a needlestick injury. All NHS respondents report that PEP is available, either through the OH department (46% provide this service) or through an accident and emergency (A&E) or other department (75%). PEP is provided both by the OH department and by A&E in some organisations. The vast majority (94%) of NHS respondents say that PEP is available outside normal working hours (8 am to 5.30 pm). Respondents were also asked how swiftly an OH professional sees a worker after a needlestick injury (this is not the same as the time taken to receive PEP). Within the NHS, two-thirds of cases (63%) are seen by the OH professional within two hours.

19% nil/negligible).25 – evidence-based practice . Bullying and harassment Nearly all (96%) of organisations have a policy on bullying and harassment.48 – access to occupational physicians +0. less than zero suggests that improvements are needed. 18% no role). Half of OH nurses have a support role in its development and/or delivery. However. that the performance is satisfactory. on average. -1 = unsatisfactory. Clinical governance Performance ratings Respondents were asked to rate 10 areas of OH nursing practice within their organisation as excellent. 0 = satisfactory. RIDDOR (58% support. satisfactory or unsatisfactory. 19% lead. These were then scored according to an arbitrary rating +1 = excellent. Two-thirds of nurses have a support role. 17% lead. with 36% having a support role. Other policy areas Nurses are more likely to have a support role than a lead role in developing and/or delivering policies on manual handling (54% support role.OH policies and policy development Medical confidentiality Nearly all respondents (94%) report that their OH service has a policy on medical confidentiality and health data security. Attendance and disability Ninety-eight per cent of respondents’ organisations have a sckness absence policy. The OH nurse is most likely to play a support role in its development and/or delivery. 15% lead. A score of zero suggests. +0. 5% have a lead role and 28% no or negligible role. OH nurses are more likely to have a support role than a lead role in developing and/or delivering these policies: sickness absence – 64% support. Stress Most respondents’ organisations have a stress policy (93%). 29% have a lead role and 14% have no or negligible role (7% of respondents either have no policy or did not answer the question). and substance misuse (50% support. 12% lead. 27% nil/negligible). disability – 63% support. health and safety (67% support. 11% lead. Bloodborne viruses Slightly more nurses (37%) have a lead rather than a support role (30% support) in developing and/or delivering policies on bloodborne viruses. 26% nil/negligible – 5% unstated/no policy). and 97% a disability policy. 22% lead. Seventeen per cent report no or negligible role (16% either had no policy or did not state it). The 10 performance areas are ranked in descending order.34 – ethics +0. 43% of OH nurses have a lead role in developing and/or delivering the policy.

A large majority of respondents (87%) rate the occupational medicine competence as either excellent (46%) or satisfactory (41%). Using the arbitrary scoring system above.38 (ranging from +0.08 – legal support -0.23). for example between the provision of healthcare and line-management issues. There is little variation between sectors. Nearly half (46%) of lone practitioners have no access to OH support for themselves. however.33 to +0.17 – strategic planning -0.17.56). occupational medicine competence is given an average score of +0. Arguably provision through an independent provider – either by buying in an external service or entering partnership arrangements with other organisations – is the best way of avoiding conflicts.01).42 between sectors). non-OH-qualified doctors may still have a role in undertaking certain functions where OH expertise is not required (undertaking driver medicals. Opportunities for professional development are similar for both lone and team workers. However. for those working alone it is -0. OH support for the OH professional Nearly one-third (31%) of OH nurses report that they have no provision of OH support for themselves. Nurses working as part of a team are more likely to rate opportunities for trainee nurses as good (score = +0.02 – peer support and mentoring -0. compared with the all-sector score (score = -0.14 – clinical supervision -0.07. for example).18 – opportunities for professional development -0.23 – opportunities for trainee OH nurses Working as part of a team does improve the score for peer support and mentoring. .08) than are OH nurses working alone (score = -0.+0. The average score for respondents working as part of a team is +0. Forty-two per cent of OH nurses report having access through in-house provision and just 27% can access OH services through an independent provider. The difference is not statistically significant. Competence of OH physician The vast majority (96%) of respondents report that they have access to occupational medicine. The focus group generally agreed that all occupational physicians should be OH-qualified.18 – service delivery auditing -0. There are few meaningful differences between sectors though there appear to be more opportunities for trainee OH nurses within the NHS (score = +0. compared with just 21% of those working as part of a team.

and evidence that OH providers. The focus group raised issues concerning the need for OH nurses – and physicians – to be appropriately qualified and how best to deliver OH nurse education. Conclusions OH nurses practice in a wide range of situations. the study provides a detailed picture of the work of OH nurses in the UK. It also provides a comprehensive insight. the different roles OH nurses have in delivering those services and nurses’ own perception of their competence in performing the functions required of them. Overall. of the levels of OH services provided by organisations across all employment sectors. such as the inconsistent level of OH provision for OH nurses themselves and the perceived lack of training opportunities for nurses new to the field. for the first time. and areas where the general level of OH nurse competences might be improved. educators and policymakers can consider when deciding how to address gaps in OH nursing provision. Although many of the findings represent the subjective views of respondents. to members of large multidisciplinary teams in the NHS. . from single practitioners working in isolation for medium-sized private sector businesses. There was concern that OH nurse education was moving inflexibly towards degree-only qualifications. Vocational or core-competency approaches should continue to be encouraged. taken en masse the data provide a strong body of evidence on possible gaps in service provision. major companies and commercial OH providers. The experiences of OH nurses are diverse and this research sheds light on the different situations and challenges faced by nurses. Others are self-employed and contract their services to several client organisations. how their practice differs between sectors. Some participants called for more flexible approaches that would suit nurses who either did not want to take a degree or who were selffunding and resource-limited. the value placed on those services by the OH nurses themselves. The research identifies other wider issues. variable referralresponse times.Education Participants in the focus group were divided on whether OH nurses should be required to have a formal OH qualification.

INTRODUCTION AND BACKGROUND
This report presents the findings of research carried out by The At Work Partnership for the Royal College of Nursing (RCN). The research aimed to establish the current scope and standards of performance in delivering occupational health nursing services throughout the United Kingdom, and the competences of OH nurses to deliver those services. There are three elements to the research: I a literature search to set the findings in context I a questionnaire-based survey of 2,000 practising occupational health nurses, stratified by sector, region and size of service, to establish service delivery benchmarks and draft performance indicators I a workshop at the RCN Society of Occupational Health Nursing annual conference in November 2004, to refine the draft performance indicators. The RCN is developing national competency standards for all nursing disciplines. The standards will form part of an integrated career and competency framework across the nursing profession. The current research will help inform the development of core and specialist competences for OH nurses. Occupational health within organisations is being delivered increasingly by OH nurses. However, there have been no comprehensive studies to date on the extent and range of performance delivery in occupational health nursing in the UK. According to the National Audit Office’s (NAO) 2003 report on the management of health and safety risks to NHS staff: ‘Occupational health services fulfil a number of important roles, from health surveillance and screening, health education and counselling, assessments of individual employees’ fitness for work, and the rehabilitation of staff into work following an injury or illness, to planning and implementing health improvement measures in the workplace’ (National Audit Office, 2003). However, the NAO also concluded that, even in the NHS – which markets its own OH services to other employers – ‘All NHS trusts provide some occupational health services but this is largely reactive and the quality and accessibility varies’. The NAO report found variable access to OH services, particularly to out-of-hours provision, and that a lack of resources to invest in OH is frequently cited as a constraint on the level of services provided. A study by the Institute of Occupational Medicine (IOM) found that very few employers (3% of UK companies) provided access to wide-ranging occupational health support, though a higher
1
Performance indicator and benchmarking in OH nursing Introduction and background

percentage of employers (15%) provide access to some kind of OH support (Pilkington and Graham, 2002). OH support ‘often takes second place within health and safety, and has no distinct identity’, the report says. The IOM identified the following ‘key measures of OH support which could be used for benchmarking purposes’: formal risk management; provision of information and training on health-related issues; rehabilitation or other programmes which modify work activities based on health needs; health surveillance initiatives; and associated monitoring in trends in health over time or across employee groups. A full literature review is given on pages 129–155 of this report.

2
Performance indicator and benchmarking in OH nursing Introduction and background

METHODS
Questionnaire
A 29-item questionnaire was sent to 2,000 OH nurses taken from the RCN Society of Occupational Health Nursing (SOHN) membership database – with freepost return envelopes. They were mailed in October 2004. The questionnaire is reproduced in appendix 1 on p.157. The sample was randomised by practitioners’ names. The surveys were completed anonymously enabling the respondents to provide objective information without fear of compromising their organisations. Respondents were required to tick appropriate multiple-choice boxes or provide numerical answers. There was only one open question requiring a descriptive answer. The questions were of the following types: I general information about the respondent (job title, formal qualifications, years’ OH experience, employer’s business) I extent of OH provision in general (number of employees covered, number of OH nurses, OH physicians, OH facility, out-of-hours provision, support for off-site workers) I availability of OH nursing services and competences for various generic OH services (eg basic/comprehensive/non-existent) I rating of the importance of the generic services (essential/desirable/nil or negligible) I respondent’s role in delivery of the generic services (lead/support/negligible or none) I respondent’s level of competence in delivering the generic service

(excellent/satisfactory/ unsatisfactory) I respondent’s self-assessment of competence in core OH nursing skills (excellent/ satisfactory/unsatisfactory) and rating of their importance for their work (essential/ desirable/negligible) I performance indicators as a function of the time taken to deliver the service (days/ weeks/months) and factors that limit the service delivery I role of OH nurse in policy development and delivery (lead/support/negligible or no policy) I clinical governance – quality of OH nursing practice at respondent’s organisation (excellent/satisfactory/unsatisfactory)
3
Performance indicators and benchmarking in OH nursing Methods

by broad industrial sector. Most of the data are broken down into percentage responses. Survey analysis The survey responses were analysed across the entire survey response. means and standard deviations are given. The headline findings were then discussed at a specially convened workshop where practising OH nurses were able to comment on the relevance of the results for their work. SOHN conference and performance indicators workshop The main survey findings were presented at the RCN/SOHN conference in November 2004. Skill areas. 4 Performance indicators and benchmarking in OH nursing Methods . and by team or single-practitioner services. in-house and contracted services. Where appropriate. according to whether the respondent was the lead or support practitioner. OH nursing services and selfrated competences were ranked across all sectors and within each sector. medians.I provision of OH services for the OH professional (in-house/independent provider/none) I rating of occupational medicine competence that respondent has access to (excellent/ satisfactory/unsatisfactory/non-existent).

Figure 1: Employer’s business 40% 35% 30% 25% 20% 15% 10% 5% 0% Commercial OH provider Other private sector NHS Other public sector Self-employed 20% 38% 28% 16% 2% Note: some respondents work in more than one sector Forty-four per cent of OH nurses report that their job title is either OH adviser or OH nurse adviser. 44% from the public sector (28% NHS). Fifty-eight per cent of respondents are from the private sector. 26% OH nurse and 1% (just seven nurses in total) describe themselves as OH sister (figure 2). 33% of NHS OH nurses are OH managers and 35% are OH nurses – both job titles are more common in the NHS than in any other sector. 473 were returned (24% response). A small minority (4%) work in more than one sector. By contrast.RESULTS AND ANALYSIS Results 1: General information Of the 2. A further 23% are OH managers. The terms OH adviser or OH nurse adviser is less common in the NHS than in other sectors (27% of NHS OH nurses have this job title). around one-third (34%) are from commercial OH providers. Twenty-one respondents say they work in more than one sector (the totals thus add up to more than 100%).000 questionnaires mailed in October 2004. 5 Performance indicators and benchmarking in OH nursing Results and analysis . with 2% describing themselves as self-employed (figure 1). Of the private sector respondents.

13% manage one member of OH staff. 6 Performance indicators and benchmarking in OH nursing Results and analysis . The mean number of staff managed is 2. Of those who gave their total contracted hours. 20% 21 to 30 hours. Onethird (32%) of respondents say that they manage at least one member of staff.Figure 2: Job title 45 40 35 30 25 Per cent 20 15 10 5 0 OH adviser/nurse adviser OH manager OH nurse OH sister Other/unstated Around three-quarters (74%) of respondents report being part of an OH team. one quarter (26%) are the lone OH practitioner in their workplace (figure 3). 11% of respondents are contracted to work 20 hours or fewer per week. Of those with management responsibilities. with the majority having no OH staff to manage. 27% six to 10 and 13% more than 10. but there is huge variation. and 69% 31 hours or more (figure 5). 23% manage two members of staff. 25% three to five. Almost half (48%) describe themselves as being the lead nurse in the team (which includes those who are the lone OH practitioner). Figure 3: Working alone or part of an OH team 80 70 60 50 Per cent 40 30 20 10 0 Sole OH practitioner Part of OH team Note: figures based on 412 respondents answering the question Two-thirds of respondents (64%) work full-time hours and 33% part-time (3% did not respond to the question) (figure 4).1.

7 Performance indicators and benchmarking in OH nursing Results and analysis . 19% for 15 years or more and 7% for more than 20 years.Figure 4: Full time or part time 70 60 50 40 Per cent 30 20 10 0 Full-time Part-time Not stated Figure 5: Contracted working hours 80 70 60 50 Per cent 40 30 20 10 0 less than 20 hours 21 to 30 hours more than 31 hours The vast majority of respondents (85%) have at least one formal OH qualification.89 years. The median length of time since being OH-qualified was 7. with the OH degree and OH nursing diploma the two most common qualifications (figure 6). Nine per cent of the respondents had been OHqualified for one year or less.

and NHS (78%) and self-employed (82%) the most likely (figure 7). Slightly more than one-third (34%) report that at least one part-time non-OH qualified nurse works in an OH capacity at their place of work. 31% work at just one workplace.Figure 6: Respondents’ OH qualifications 35 30 25 20 Per cent 15 10 5 0 OHN cert OHN Dip OHN deg PGDip MSc/PhD No formal qualification Almost a third (29%) of respondents report that at least one full-time non-OH qualified nurse works in an OH capacity at their place of work. Figure 7: Responsibility for more than one place of work 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed* All sectors Yes n = 473 * There were just 11 self-employed respondents No Don't know/not stated 8 Performance indicators and benchmarking in OH nursing Results and analysis . More than two-thirds (69%) of nurses have responsibility for more than one workplace. Public sector respondents (58%) are least likely to have responsibility for more than one place of work. More than one-quarter (27%) of commercial OH provider respondents have responsibility for a single place of work.

12 n = number of survey organisations in sector that provided information * Excludes one commercial OH provider that employs 500 non-OH nurses (with this included.66* 1.45 0.48 1.10 0.9) are OH-qualified. on average 3.64 1.06 0.06 0.90 1.24 1.94 4.51 0.09 2.09 0. NHS employers employ 6.36 0.53 n = number of survey organisations in sector * Excludes one commercial OH provider that employs 500 non-OH nurses (with this included.13 0.08 non-OH nurses per employer) 9 Performance indicators and benchmarking in OH nursing Results and analysis .14 2.1 (1.13 0.11 0.9) are OH-qualified.16 0.10 3.37 0.42 0.10 3. Other private sector organisations employ.01 1.51 0.65 0.96 4.13 127 68 416 6.12 FTE) are OH-qualified (excluding OH nurses in training).58 1.66 full-time equivalents (FTE)).41 0. inevitably. Other public sector organisations employ 2.83 FTE).41 0.08 0.06 0. Commercial OH providers employ on average 5. However.40 2.6 nurses (3.4) are OH-qualified.39 0. with 8.4 (2.10 0.40 2.and part-time nurses worked at their place of work as well as their level of qualification.84 1.4.22 0.49 0.68 1.19 0.04 0. nurses (all levels) Non-OH qualified Currently training Certificate Diploma Degree PGDip MSc or PhD Total OHqualified nurses Commercial OH provider Other private sector NHS Other public sector All sectors 75 146 5.05 0. of which 3.5 0.86 2.4. nurses per organisation (all levels) Non-OH qualified Currently training Certificate Diploma Degree PGDip MSc or PhD Total OHqualified nurses Commercial OH provider Other private sector NHS Other public sector All sectors 75 146 127 68 416 4.76 0.79 FTE) of which 3.10 0.43* 0.20 0. with 8. of which 2.22 0.42 1.26 3.58 1.68 2.88 0.16 0.41 0.55 (or 3.19 0.56 non-OH nurses per employer) Table 2: OH provision by sector: full-time equivalents Sector n Mean no.3 FTE) of which 1.55* 2.05 0.60* 0.9 nurses (2.17 (2.98 0.73 0.83 2.7 (1.61 0.17 1.0 FTE) of which 2.16 0.18* 0.92 0. this hides enormous variation and is skewed by the larger number of nurses employed.63 0.82 nurses (4.56 0.61 1.43 0. the mean number of nurses working in an OH capacity in respondents’ organisations is 4.22 0.53 (2.79 1.82* 3. Table 1: OH provision by sector: full-time and part-time nurses Sector n Mean no. As shown in tables 1 and 2.02 0.14 nurses (4.91* 1.61) are OH-qualified.53 0.92 1.Respondents were asked to report how many full.24 0.63 1.79* 2. the average number of non-OH nurses in the commercial OH provider sector would have risen to 12.25 0. by the commercial OH providers and the NHS.42 0.00 0.13 0. the average number of FTE non-OH nurses in the commercial OH provider sector would have risen to 11.

The median size is 1.25 FTE fully qualified OH nurses per 1.800 employees (figure based on the 431 respondents who answered this question).760 employees (or one FTE for every 2. non-OH qualified and in training) is one nurse for every 1.155. or one FTE OH-qualified nurse for every 2. These ratios are almost twice as high as for the least-provided sector.01 FTE per 1. and given this constraint. or one full-time equivalent nurse for every 1.Taking the entire sample.125) commented that they felt unable to complete this question given that they work for OH providers and provide OH services for a number of client companies. The NHS employs the highest ratio of both total OH nurses working in OH (1.40 FTE nurses (all levels) and 0. 10 Performance indicators and benchmarking in OH nursing Results and analysis .34 FTE fully qualified OH nurses per 1. By contrast. The crude estimate for OHqualified nurses plus OH nurses in training is one nurse for every 1.450 employees. the other public sector. Nevertheless. however. and half in larger employers.000 employees.54 per 1. our crude estimate for the number of nurses working in OH (qualified. our respondents provide OH cover for 2. The other private sector organisations are better served than the other public sector with 0.55 FTE nurses (all levels) and 0. it must be borne in mind that the majority of private sector organisations have no OH support at all and the figures represent only those firms that have OH provision.050 employees. It is worth noting that some focus group participants (p.000 employees) and fully qualified OH nurses (0. the mean tends to be skewed by a few very large employers.140 employees. however. with a mean size (where given) of 5.000 employees.420 employees. The median gives a more accurate picture than the mean since half the sample work in organisations smaller than the median. There is an estimated one fully qualified OH nurse for every 2. Table 3 gives the ratio of nurses (qualified and non-qualified) working in occupational health per 1. which has around 0.000 employees. The figures for respondents who work for commercial OH providers may give a reasonable picture of the organisations to which their services are contracted.092 employees).000 employees across the UK.000).000 employees per organisation. the focus-group feedback noted that some respondents from this sector were unsure how to answer this question if they were contracted to more than one employer.

41 374.54 381.40 0.000 employees Total OH-qualified** nurses per 1.000 employees (full.70 0.155.and part-time) Total nurses per 1.34 607. with 134 (28%) reporting that a parttime non-FOM qualified physician operates there. with 327 (69%) saying that a part-time FOM-qualified OH physician operates at their place of work (figure 8).58 791.66 0.68 0.996 1.Table 3: Ratio of nurses working in OH capacity per 1.000 0.55 0.52 0. organisations † All sectors Commercial OH provider* Other private sector NHS Other public sector 2. Assumes that two part-time OH nurses = 1 FTE * Excludes one commercial OH provider that employs 500 non-OH nurses † Based on respondents who provided information for this question ** Excludes OH nurses in training Physicians in the workplace A total of 104 respondents (22%) report that a full-time FOM-qualified OH physician operates at their place or places at work.419 0.344 68 5.01 0. Figure 8: Physicians in the workplace – FOM-qualified and non-qualified (% where physicians operate – all sectors) 70 60 50 40 Per cent 30 20 10 0 Full-time FOM Part-time FOM Full-time non-FOM Part-time non-FOM 11 Performance indicators and benchmarking in OH nursing Results and analysis .236 146 5.222 431 5.608 0.95 0.000 employees (FTE) FTE = full-time equivalent.28 1.49 0.15 0.39 0.000 employees Sector Total employees No.30 0.88 0.772 127 4.66 0.000 employees (FTE) Total OH-qualified** nurses per 1.786 1.25 Mean employee size Total nurses per 1. Thirty-two respondents (7%) say a full-time non-FOM qualified physician operates at their place or places of work.689 75 4.

we have no information on the average hours worked by the part-time physician.56 FTE = full-time equivalent. Across all sectors.85 0.57 physicians per employer (1.29 0.03 1.53 0.34 0. Assumes that two part-time physicians = 1 FTE (likely to be an overestimate) Table 5 gives crude estimates for the number of physicians – both FOM-qualified and non-OH qualified – per 1.0 FTE).45 0.54 0. but this is likely to be an overestimate with some physicians working much less than half time for their client companies.000). there are around 0. with more than this mean in the commercial OH provider sector (0.000) and NHS (0.66 1. The table assumes two part-time doctors for one FTE. Respondents’ rating of the occupational medicine competence to which they have access to is reported on p.82 0.121.000 employees. FOMqualified OH physicians (fulland part-time) Mean number FOM-qualified OH physicians (FTE) % of organisations with no access to FOM-qualified OH physicians Mean number nonOH qualified physicians/GP (fulland part-time) Mean number nonOH qualified physicians/GP (FTE) Commercial OH provider Other private sector NHS Other public sector Self-employed All sectors 94 178 131 74 11 473 2. Access is lower in the private and other public sectors.32 FOM-qualified physicians per 1. Commercial OH providers have 2.92 FTE).45 qualified OH physicians per employer (0.0 0. 12 Performance indicators and benchmarking in OH nursing Results and analysis .02 1.51 per 1. with 17% of respondents reporting having no access to an OH-qualified physician in their workplace.03 qualified OH physicians per employer (1. and lowest of all among self-employed OH providers.Table 4 shows the mean number of OH physicians qualified by the Faculty of Occupational Medicine (FOM) and non-OH qualified physicians/GPs per employer by sector and the proportion of employers without access to an OH physician. However.34 per 1.11 1.000 employees by sector. unlike the OH nurse data.18 0.52 0.48 FTE). there are 1.14 0. The table also shows estimated figures for the number of full-time equivalent physicians.92 12% 22% 12% 16% 45% 17. Across all organisations in the survey.48 0.90 0.38 0.3% 2.45 1. Coverage is lower for both the other public and other private sectors.27 1. Table 4: Physicians in the workplace (OH and non-OH qualified) Sector n Mean no.57 1. with just 12% of respondents in both of these sectors reporting having no access in their workplaces. Access to an FOM-qualified OH physician is highest in the commercial OH provider and NHS sectors. These figures are higher than in the NHS – 1.82 1.

20 374.772 0.000 employees Total FOM-qualified physicians per 1. Assumes that two part-time physicians = 1 FTE (likely to be an overestimate) OH facilities The vast majority (95%) of respondents report having a dedicated OH facility or clinic at their workplace.51 0.27 0.76 0.155.Table 5: Ratio of physicians working in OH capacity per 1.37 0.52 0. Figure 9: Dedicated OH facility or clinic (all sectors) 60 50 40 Per cent 30 20 10 0 Excellent Satisfactory Unsatisfactory None 13 Performance indicators and benchmarking in OH nursing Results and analysis . Nearly one-third (31%) of NHS respondents and one-quarter (25%) of other public sector respondents say that their OH facility is unsatisfactory.37 791.32 0. A majority (56%) describe this as being satisfactory. compared with just 16% of commercial OH providers and 20% of private sector respondents (figure 10).22 381.and part-time) Total physicians per 1.222 0.33 0.15 607.000 employees (FTEs) Total FOM-qualified physicians per 1.22 0.000 employees Sector Total employees Total physicians per 1.19 0.54 0.32 0.236 0. A smaller proportion of NHS respondents (17%) and other public sector respondents (13%) describe their facility as excellent.344 0.16 FTE = full-time equivalent.24 0.32 0. 22% excellent and 22% unsatisfactory (figure 9).689 1.34 0. compared with commercial OH providers (26%) and other private sector (28%).000 employees (full.000 employees (FTEs) All sectors Commercial OH provider Other private sector NHS Other public sector 2.25 0.

while 16% say it is not required (1% did not answer the question).30 pm) 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed* All sectors Yes No Not required n = 473 * There were just 11 self-employed respondents 14 Performance indicators and benchmarking in OH nursing Results and analysis . Figure 11 shows how this compares across the sectors.Figure 10: Dedicated OH facility or clinic (by sector) 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed* Excellent Satisfactory Unsatisfactory None * There were just 11 self-employed respondents Out-of-hours cover Across all sectors. 21% of organisations provide OH cover to employees outside standard working hours (8. 62% say that cover is not provided. Three self-employed practitioners provide out-of-hours cover. while only 8% of respondents say this is not necessary.00 am to 5. Figure 11: Provision of OH cover outside standard daytime hours (8. Surprisingly.30 pm).00 am to 5. only 11% of NHS employers provide OH cover outside standard hours. Onefifth of respondents (18%) say they have a lead role in providing out-of-hours cover. Out-of-hours cover was much higher in the private sector (29%) and commercial OH providers (27%).

around onequarter (26%) say they do not provide cover (1% did not respond). This pattern of responses is broadly similar across all sectors. though fewer self-employed respondents provide off-site cover (just 11 self-employed practitioners responded to the survey. so care should be taken in drawing conclusions from this finding). Figure 12: Provision of OH cover for off-site and/or home workers 60 50 40 Per cent 3 0 20 10 0 Commercial Other private OH provider sector NHS Other public sector Self employed* All sectors Yes * There were just 11 self-employed respondents No Not required 15 Performance indicators and benchmarking in OH nursing Results and analysis . The role of OH nurses in delivering off-site support is discussed below. One-fifth (20%) of respondents say off-site cover is not necessary in their workplace.OH support for off-site and home workers More than half (53%) of organisations provide OH cover for off-site and home workers (figure 12).

Figure 13: Attendance monitoring – level of provision (all sectors) 60 50 40 Per cent 3 0 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Respondents are much more likely to rate this as an essential function in the private sector and in commercial OH providers than they are in the NHS or other public sector (figure 14).Results 2: OH functions and competences Attendance monitoring Almost two-thirds (64%) of all respondents report that the OH department offers an attendance monitoring services (figure 13). 16 Performance indicators and benchmarking in OH nursing Results and analysis . Eight of the 11 self-employed practitioners describe this function as essential. The private sector (49% of commercial OH providers and 46% in the rest of the private sector) is much more likely to offer a comprehensive attendance monitoring service than the public sector (22% of NHS and 31% in the rest of the public sector) (figure 13). suggesting that this is an important part of their business. Across all sectors. 38% say that they offer a comprehensive attendance monitoring service. This compares with 32% of commercial OH providers and 23% of other private sector employers. Thirty-seven per cent of NHS employers and 39% of other public sector organisations do not offer attendance monitoring at all within their OH function. with 26% describing it as basic and 29% non-existent.

OHN role and competence in attendance monitoring Figure 15a: Role in delivery 50 40 30 Per cent 20 10 0 Lead Support Negligible Figure 15b: Level of competence 50 40 30 Per cent 20 10 0 Excellent Satisfactory Unsatisfactory 17 Performance indicators and benchmarking in OH nursing Results and analysis . 45% satisfactory and 12% unsatisfactory (12% not stated).Figure 14: Rating of importance 80 70 60 50 Per cent 4 0 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Respondents were asked to rate their role in delivering attendance monitoring (lead. satisfactory or unsatisfactory) (figure 15b). Two-thirds of the respondents have either a lead (23%) or support (41%) role with one-third (33%) no or negligible role (3% did not answer). support or negligible) (figure 15a) and to rate their level of competence (excellent. Nearly one-third (30%) describe their competence as excellent.

of the 59 respondents who describe their skills as unsatisfactory. a lead role have. Of the 156 respondents who described their role as none or negligible. 93% of them have no or negligible role in attendance monitoring (table 7). 16 did not answer the question Table 7: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 143 214 59 48 17 3 48 54 3 4 29 93 0 0 0 n = number of respondents in each category Return-to-work interviews The majority (73%) of respondents in all sectors offer return-to-work interviews as part of their OH function. Conversely. for example. of those in a support role. Fifty-eight per cent of all respondents described such a service as essential. Only four per cent of those with no or negligible role believe that they have excellent skills in this area. Slightly fewer (38%) respondents from the public sector (excluding NHS) than in other sectors described their service in this area as comprehensive. with one-third (34%) describing it as satisfactory. and 60% satisfactory. with around half of them describing the service as comprehensive (figure 16). there is an almost equal split between those stating that they have satisfactory (39%) and unsatisfactory (35%) competence (table 6). The cross-analysis yields interesting findings. with nine of the 11 of self-employed respondents holding this view (figure 16). one-third (35%) say they have excellent competence. in their own opinion.By cross-referencing the two factors we were able to estimate whether or not those in. Table 6: Competence against role in delivering attendance monitoring Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 109 192 156 62 35 4 34 60 39 2 1 35 2 4 22 100 100 100 n = number of respondents in each category. 18 Performance indicators and benchmarking in OH nursing Results and analysis . the necessary competence. conversely. Nearly two-thirds (62%) of those with a lead role in attendance monitoring describe their competence as excellent.

Of the 138 respondents describing their role as a lead one. Six of the 11 self-employed respondents considered the service essential. 46% satisfactory and 6% unsatisfactory (11% not stated) (figure 18b).Figure 16: Return-to-work interviews – level of provision 60 50 40 Per cent 3 0 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated More respondents in commercial OH providers (73%) and the private sector (71%) describe the provision of return-to-work interview as either essential or desirable. compared with those in the NHS (67%) or other public sector (64%) (figure 17). More than one-third (37%) describe their competence as excellent. 58% believe they have excellent competence – no one described their competence as 19 Performance indicators and benchmarking in OH nursing Results and analysis . Figure 17: Rating of importance 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed* All sectors Essential Desirable Nil/negligible Not stated Nearly three-quarters of the respondents have either a lead (29%) or support (42%) role in returnto-work interviews. with one-quarter (26%) no or negligible role (3% did not answer) (figure 18a).

OHN role and competence in return-to-work interviews Figure 18a: Role in delivery 50 40 30 Per cent 20 10 0 Lead Support Negligible Figure 18b: Level of competence 50 40 30 Per cent 20 10 0 Excellent Satisfactory Unsatisfactory Table 8: Competence against role in delivering return-to-work interviews Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 138 201 122 58 41 10 39 55 43 0 2 18 3 2 29 100 100 100 n = number of respondents in each category. Of those in a support role. 12 did not answer the question Table 9: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 175 218 27 46 25 0 47 51 15 7 24 81 0 0 4 n = number of respondents in each category 20 Performance indicators and benchmarking in OH nursing Results and analysis . the vast majority (81%) have no or negligible role. more feel their competence is satisfactory (55%) than excellent (41%). only 15% have a support role and none has a lead role (4% did not answer the question on competence) (table 9).unsatisfactory (table 8). Of the 27 respondents describing their competence as unsatisfactory.

Nine of the 11 self-employed respondents say they offer this service. The provision of off-site/home visits is slightly lower in the NHS and other public sector respondents (54% in both sectors) compared with commercial OH providers (60%) and other private sector respondents (68%). Home/off-site visits to workers on sick leave Figure 19a: Level of provision 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 19b: Rating of importance 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 21 Performance indicators and benchmarking in OH nursing Results and analysis . with six of them describing the provision as comprehensive.Home/off-site visits to workers on sick leave Three-fifths (61%) of all respondents say that their OH service offers some level of provision for home or off-site visits to workers on sick leave.

Of 62 respondents who describe their competence in this area as unsatisfactory. 36% of those in a support role have excellent competence and 59% satisfactory (table 10). OHN role and competence in home/off-site visits to workers on sick leave Figure 20a: Role in delivery 50 40 30 Per cent 20 10 0 Lead Support Negligible Figure 20b: Level of competence 40 30 Per cent 20 10 0 Excellent Satisfactory Unsatisfactory Cross-analysis finds that virtually all those in a lead role have either excellent (60%) or satisfactory (36%) competence. 93% have no or negligible role (though one individual has a lead role in this function). Two-thirds (68%) describe their competence as either excellent or satisfactory (figure 20b).Only half (50%) of respondents have either a lead (27%) or support role in this area (figure 20a). Table 10: Competence against role in delivering home/off-site visits to workers on sick leave Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 126 111 215 60 36 12 36 59 33 1 3 27 3 2 28 100 100 100 n = number of respondents in each category. 21 did not answer the question 22 Performance indicators and benchmarking in OH nursing Results and analysis .

Four-fifths (81%) of respondents describe the service as essential. with very little variation across the sectors (figure 21a). 14% desirable. Disability assessments Figure 21a: Level of provision 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated 23 Performance indicators and benchmarking in OH nursing Results and analysis .Table 11: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 144 181 62 53 25 2 28 36 5 17 39 94 2 1 0 n = number of respondents in each category Disability assessments and adjustments Nearly all OH services (94%) offer some form of disability assessment and advice on adjustments. and no respondents said the service was of nil or negligible importance (6% of respondents did not answer the question) (figure 21b). Around two-thirds (64%) describe this service as comprehensive.

One-third (32%) of respondents describe their competence as excellent. half (51%) satisfactory and 11% unsatisfactory (figure 22b).Figure 21b: Rating of importance 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Just under half (46%) of nurses have a lead role and 42% a support role in delivering disability assessments and adjustments (figure 22a). OHN role and competence in disability assessment Figure 22a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 22b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory 24 Performance indicators and benchmarking in OH nursing Results and analysis .

11% express concern about their level of competence in disability assessment and adjustment. just under half (47%) of respondents across all sectors describe the service as comprehensive – other public sector employers (34% comprehensive) are the worst performers in this context. However. Table 12: Competence against role in delivering disability assessments and adjustments Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 216 199 46 52 17 9 45 67 13 1 11 54 2 5 24 100 100 100 n = number of respondents in each category. with only minor variation between sectors (figure 23b).Of those in a lead role. 12 did not answer the question Table 13: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 150 239 50 75 41 6 23 56 44 3 3 50 0 1 0 n = number of respondents in each category Vocational rehabilitation The majority (82%) of OH departments across all sectors offer vocational rehabilitation (figure 23a). with just three individuals with a lead role (1%) describing their competence as unsatisfactory (table 12). The vast majority of respondents (88% describe vocational rehabilitation as either essential or desirable. Of those in support roles. Vocational rehabilitation Figure 23a: Level of provision 60 50 40 Per cent 30 20 10 0 Commercial Other private OH provider sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated 25 Performance indicators and benchmarking in OH nursing Results and analysis . there is an almost equal split between those who describe their competence as excellent (52%) and as satisfactory (45%).

Figure 23b: Rating of importance 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated More OH nurses describe their role in vocational rehabilitation as one of support (42%) than lead (34%) (figure 24a). More nurses describe their competence in this area as satisfactory (45%) than excellent (28%) or unsatisfactory (15%) (figure 24b – 12% did not answer the question). OHN role and competence in vocational rehabilitation Figure 24a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 24b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory 26 Performance indicators and benchmarking in OH nursing Results and analysis . Around one-fifth (19%) have no or negligible role.

with 80% describing the provision as comprehensive. 23 did not answer the question Table 15: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 133 213 69 74 26 6 21 66 29 3 8 65 2 0 0 n = number of respondents in each category Analysis of pre-employment/pre-placement questionnaires Virtually all respondents (95%) say their organisation offers some level of analysis of preemployment or pre-placement health questionnaires. Around three-quarters (77%) describe this service as essential. 71% satisfactory and 10% in need of improvement. 27 Performance indicators and benchmarking in OH nursing Results and analysis . There was little variation between sectors (figure 25a). Just 2% of those is a lead role describe their competence as unsatisfactory. 29% are in a support role and 6% in a lead role. Table 14: Competence against role in delivering vocational rehabilitation Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 162 198 90 61 14 4 35 71 18 2 10 50 2 5 28 100 100 100 n = number of respondents in each category.Of those in a lead role. the majority (61%) describe their competence as excellent (table 14). Of the 69 respondents who believe their competence in this area is unsatisfactory. with most others saying it is a desirable function of the OH department (figure 25b). just 14% say they have excellent competence. Of those in a support role.

Analysis of pre-employment/pre-placement questionnaires Figure 25a: Level of provision 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 25b: Rating of importance 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Three-quarters (73%) of OH nurses have a lead role in analysing pre-employment/pre-placement questionnaires. 28 Performance indicators and benchmarking in OH nursing Results and analysis . with just 5% having no or negligible role (figure 26a). with no respondents describing their competence as unsatisfactory (figure 26b). Nearly three-quarters (72%) describe their competence in this area as excellent.

10 did not answer the question Table 17: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 341 113 0 79 62 - 17 32 - 4 5 - 0 1 - n = number of respondents in each category 29 Performance indicators and benchmarking in OH nursing Results and analysis . Table 16: Competence against role in analysis of pre-employment/pre-placement questionnaires Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 345 95 23 78 61 61 20 38 26 0 0 0 2 1 13 100 100 100 n = number of respondents in each category.OHN role and competence in analysis of pre-employment/ pre-placement questionnaires Figure 26a: Role in delivery 100 Per cent 50 0 Lead Support Negligible Figure 26b: Level of competence 80 60 Per cent 40 20 0 Excellent Satisfactory Unsatisfactory More respondents with a lead role described their competence as excellent (78%) compared with those in a support role (61%) (table 16).

with 24% in a support role (figure 28a). The vast majority (95%) of respondents describe their competence as excellent (61%) or satisfactory (34%). Between 88% and 92% of respondents across the various sectors describe this function as essential (figure 27b). 30 Performance indicators and benchmarking in OH nursing Results and analysis . Assessment of fitness for work Figure 27a: Level of provision 100 90 80 70 60 Per cent 5 0 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 27b: Rating of importance 100 90 80 70 60 Per cent 5 0 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Seventy-one per cent of respondents have a lead role in assessing fitness for work.Assessment of fitness for work The vast majority (84%) of respondents report that their OH department provides a comprehensive service in the assessment of fitness to work. only four respondents (1%) from the whole sample say that this service was not provided (figure 27a). with just 1% describing their competence in this area as unsatisfactory (figure 28b – 4% did not answer the question).

Figures round up to more than 100%. this compares with just over half (53%) of those with satisfactory self-rated competence. Table 19: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 287 163 5 84 53 40 14 44 40 1 2 20 1 1 0 n = number of respondents in each category 31 Performance indicators and benchmarking in OH nursing Results and analysis .Those in a lead role were twice as likely to rate their performance as excellent (72%) as do those in a support role (35%) (table 18). OHN role and competence in assessment of fitness for work Figure 28a: Role in delivery 100 Per cent 50 0 Lead Support Negligible Figure 28b: Level of competence 80 60 Per cent 40 20 0 Excellent Satisfactory Unsatisfactory The vast majority (84%) of those who rate their competence as excellent are in lead roles in the assessment of fitness for work. 9 did not answer the question. Table 18: Competence against role in assessing fitness for work Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 337 114 13 72 35 31 26 62 31 1 2 8 2 1 31 101 100 101 n = number of respondents in each category.

Developing fitness-for-work standards Most OH departments (85%) have a role in developing fitness-for-work standards. Other public sector respondents were the poorest performers in this context. 29% excellent and 15% unsatisfactory (figure 30b – 8% did not answer the question on competence). with only one-third (34%) describing their service as comprehensive and 22% describing it as non-existent (compared with 13% across the whole sample). Nearly half (48%) of respondents describe their competence as satisfactory. with around half (47%) describing the service as comprehensive (figure 29a). 32 Performance indicators and benchmarking in OH nursing Results and analysis . Virtually all respondents across all sectors described the service as either desirable (23% of all respondents) or essential (71%) (figure 29b). Developing fitness-for-work standards Figure 29a: Level of provision 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 29b: Rating of importance 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Three-quarters (75%) of respondents have a role in developing fitness-for-work standards (figure 30a).

Of the 71 respondents who believe their competence is unsatisfactory. 77% satisfactory and 7% unsatisfactory.OHN role and competence in developing fitness-for-work standards Figure 30a: Role in delivery 40 Per cent 20 0 Lead Support Negligible Figure 30b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory More of those in a lead role describe their competence as excellent (57%) rather than satisfactory (38%) – two per cent describe their competence as unsatisfactory (table 20). only 21% have a role in developing fitness-for-work standards (table 21). 13% describe their competence as excellent. 19 did not answer the question Table 21: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 135 225 71 79 31 4 17 59 17 4 9 75 1 1 4 n = number of respondents in each category 33 Performance indicators and benchmarking in OH nursing Results and analysis . Table 20: Competence against role in developing fitness-for-work standards Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 185 172 97 57 13 5 38 77 21 2 7 55 3 3 19 100 100 100 n = number of respondents in each category. Of those in a support role.

spirometry and urinalysis) and the interpretation of health surveillance. three-quarters (73%–74%) of which are described as comprehensive (figures 31a and 32a). Around 85% of respondents across all sectors view these services as essential (figures 31b and 32b).Health surveillance provision and interpretation of health surveillance The vast majority (93%–94%) of OH departments offer health surveillance (such as audiometry. Health surveillance provision Figure 31a: Level of provision 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 31b: Rating of importance 100 90 80 70 60 Per cent 50 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 34 Performance indicators and benchmarking in OH nursing Results and analysis .

35 Performance indicators and benchmarking in OH nursing Results and analysis . 34% satisfactory and just 2% as unsatisfactory (figure 33b).Interpretation of health surveillance Figure 32a: Level of provision 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 32b: Rating of importance 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Most OH nurses have a role in delivering health surveillance (just 8% have a negligible or no role). with more (67%) having a lead than support role (23%) (figure 33a). Three-fifths (59%) rate their competence as excellent.

Those rating themselves as excellent are more likely to be in a lead role (78% in lead role) compared with those rating their competence as satisfactory (53% in lead role) (table 23). 11 did not answer the question Table 23: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 281 160 10 78 53 10 17 34 40 4 12 50 1 1 0 n = number of respondents in each category 36 Performance indicators and benchmarking in OH nursing Results and analysis . Table 22: Competence against role in delivering health surveillance Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 316 109 37 70 44 30 27 50 51 0 4 14 3 2 5 100 100 100 n = number of respondents in each category. and just 4% of those in a support role rate their competence in this area as unsatisfactory (table 22).OHN role and competence in health surveillance provision Figure 33a: Role in delivery 80 60 Per cent 4 0 20 0 Lead Support Negligible Figure 33b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory No practitioners in a lead role.

50% rating their competence as excellent. Table 24: Competence against role in interpreting health surveillance Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 294 135 34 63 30 29 34 65 38 0 4 24 3 1 9 100 100 100 n = number of respondents in each category.The picture is slightly different for the role of OH nurses in the interpretation of health surveillance: 62% have a lead role and 29% a support role (figure 34a). 10 did not answer the question 37 Performance indicators and benchmarking in OH nursing Results and analysis . none of the practitioners in a lead role. those rating themselves as excellent are more likely to be in a lead role (78% in lead role) compared with those rating their competence as satisfactory (50% in lead role) (table 25). Similarly. OHN role and competence in interpretation of health surveillance Figure 34a: Role in delivery 100 Per cent 50 0 Lead Support Negligible Figure 34b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory As with the provision of health surveillance. and just 4% of those in a support role rate their competence in this area as unsatisfactory (table 24). 43% satisfactory and 3% unsatisfactory (figure 34b).

Health and safety risk assessment Figure 35a: Level of provision 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated 38 Performance indicators and benchmarking in OH nursing Results and analysis .Table 25: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated 236 202 14 78 50 0 17 44 43 4 6 57 1 0 0 n = number of respondents in each category Health and safety risk assessment Although most respondents (86%) report that the OH department provides health and safety risk assessment about half of these say that the service is basic rather than comprehensive (figure 35a). most of the others describe it as desirable (figure 35b). Seven out of 11 self-employed respondents claim to offer a comprehensive service. Around twothirds of respondents across all sectors describe the service as essential.

OHN role and competence in health and safety risk assessment Figure 36a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 36b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory 39 Performance indicators and benchmarking in OH nursing Results and analysis . and a similar proportion (59%) describe their competence as satisfactory (figure 36b).Figure 35b: Rating of importance 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Three-fifths (60%) of respondents have a support role in health and safety risk assessment (figure 36a).

13 did not answer the question. with virtually all other respondents describing it as desirable (figure 37b). Most respondents (81%) describe such provision as essential. 40 Performance indicators and benchmarking in OH nursing Results and analysis . However. only around half of these offer a comprehensive service (figure 37a) – other private sector employers were the worst performers in this respect with 33% describing their provision as comprehensive. Table 26: Competence against role in health and safety risk assessment Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 105 284 71 61 22 11 33 72 55 1 4 25 5 2 8 100 100 99 n = number of respondents in each category. one practitioner in a lead role and 12 in a support role describe their competence as unsatisfactory. however. this contrasts with the 284 respondents in a support role of whom 22% describe their competence as excellent (table 26). 61% describe their competence as excellent.Of 105 respondents in a lead role. The majority of those who describe their competence in this area as unsatisfactory (58%) have either no or a negligible role in this area. figures round down to 99% Table 27: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 135 279 31 47 13 3 46 73 39 6 14 58 1 0 0 n = number of respondents in each category Assessment of risks to mental health (including stress) Around 90% of all respondents say they offer some level of assessment of risks to mental health and stress.

with just 2% saying it is unsatisfactory (table 28). 82% describe their competence as either excellent (29%) or satisfactory (53%) (figure 38b).Assessing risks to mental health Figure 37a: Level of provision 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 37b: Rating of importance 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated The majority of respondents (84%) have either a lead (38%) or support (46%) role in assessing mental health risks (figure 38a). with 70% satisfactory and 12% unsatisfactory (table 29). 41 Performance indicators and benchmarking in OH nursing Results and analysis . Similarly. of those in a support role. just 16% say their competence is excellent. More than half (53%) of those in a lead role describe their competence as excellent. However.

12 did not answer the question Table 29: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 138 252 60 68 30 7 25 60 43 5 9 50 1 1 0 n = number of respondents in each category Advising on work organisation and design Around half (53%) of all respondents say their OH department offers a basic level of service in advising on work organisation and design. a further third (33%) offer a comprehensive service. 42 Performance indicators and benchmarking in OH nursing Results and analysis .OHN role and competence in assessing risks to mental health Figure 38a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 38b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 28: Competence against role in assessing risks to mental health Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 179 216 66 53 16 11 42 70 35 2 12 45 3 2 9 100 100 100 n = number of respondents in each category.

while one third (34%) said it was a desirable function.while 12% have no service provision in this area (2% did not respond) (figure 39a). There was little variation between sectors. Three-fifths (59%) said this service was essential. though slightly more public sector respondents (66%) said the service was essential (figure 39b). Advising on work organisation and design Figure 39a: Level of provision 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 39b: Rating of importance 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 43 Performance indicators and benchmarking in OH nursing Results and analysis .

Those in a lead role are much more likely to describe their competence as excellent compared with those in a support role (table 30).Just 21% of OH nurses have a lead role in advising on work organisation and design. A similar percentage (21%) describe their competence as excellent and 57% satisfactory (figure 40b). 19 did not answer the question. with 55% having a support role (figure 40a). total figures round down to below 100 Table 31: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 97 269 74 60 12 5 35 72 32 5 13 62 0 2 0 n = number of respondents in each category 44 Performance indicators and benchmarking in OH nursing Results and analysis . OHN role and competence in advising on work organisation and design Figure 40a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 40b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 30: Competence against role in advising on work organisation and design Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 100 260 94 58 13 5 33 75 38 4 9 49 5 3 7 100 100 99 n = number of respondents in each category.

though more than half of these describe the provision as basic (figure 41a). Across all sectors. Provision of personal protective equipment Figure 41a: Level of provision 45 40 35 30 25 Per cent 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 41b: Rating of importance 50 45 40 35 30 Per cent 25 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 45 Performance indicators and benchmarking in OH nursing Results and analysis .Provision of personal protective equipment Just under two-thirds (62%) of OH departments provide personal protective equipment (PPE). even though 47% of respondents from that sector describe such provision as essential (figure 41b). Just 18% of other public sector employers offer a comprehensive service in the provision of PPE. the proportion of respondents describing the provision of PPE as an essential function of the OH department is greater than the proportion who say that a comprehensive service is provided (figures 41a and 41b).

Those in a lead role are far more likely to rate their competence as excellent compared with those in a support role or with no role (table 32).Just 8% of OH nurses say they have a lead role in the provision of PPE – the lowest ranked of any of the job functions (figure 42a). The majority of respondents (77%) describe their competence in this area as satisfactory or better. some numbers round up to more than 100 Table 33: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 81 284 66 32 4 2 42 63 17 26 33 82 0 1 0 n = number of respondents in each category 46 Performance indicators and benchmarking in OH nursing Results and analysis . Half (49%) have a support role and 40% have a negligible or no role. OHN role and competence in provision of personal protective equipment Figure 42a: Role in delivery 40 Per cent 20 0 Lead Support Negligible Figure 42b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 32: Competence against role in the provision of personal protective equipment Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 39 233 187 67 15 11 26 77 50 3 5 29 5 4 10 101 101 100 n = number of respondents in each category. 14 did not answer the question.

Perhaps unsurprisingly. compared with 83% of other private sector organisations (figure 43a). 70% of other private sector respondents say that such a service is essential – compared with 45% of respondents from OH providers. injury and illness data Three-quarters of OH departments monitor work-related accident. injury and illness data.Monitoring work-related accident. Private sector OH departments are also more likely than those from other sectors to offer a comprehensive service. 54% of NHS respondents and 57% of other public sector respondents (figure 43b). There is some variation between sectors. with 66% of commercial OH providers offering such a service. with 23% not offering this service. Monitoring work-related accident. injury and illness data Figure 43a: Level of provision 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 43b: Rating of importance 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 47 Performance indicators and benchmarking in OH nursing Results and analysis .

injury and illness data Figure 44a: Role in delivery 50 40 30 Per cent 20 10 0 Lead Support Negligible Figure 44b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 34: Competence against role in monitoring work-related accident. Sixty respondents describe their competence in this area as unsatisfactory. with most (80%) describing their competence as satisfactory or excellent (figure 44b). 15 did not answer the question Table 35: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 123 257 60 49 17 0 38 62 17 11 20 83 2 1 0 n = number of respondents in each category 48 Performance indicators and benchmarking in OH nursing Results and analysis . injury and illness data Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 110 220 128 55 21 11 39 72 41 0 5 39 6 2 9 100 100 100 n = number of respondents in each category. but 83% of these said that they have either no role or only a negligible role in this area (table 35).Just 23% of respondents have a lead role in monitoring work-related accident. OHN role and competence in monitoring work-related accident. injury and illness data (figure 44a).

Only 50% of other public sector OH departments offer some provision in this area.Cost–benefit analysis of OH interventions Just 57% of respondents’ OH departments carry out cost–benefit analysis of OH interventions (figure 45a). with non-provision between 36% and 40% in the other sectors. In keeping with the overall finding. despite the fact that around half of respondents across all sectors rate this function as essential and 40% desirable (figure 45b). with just 15% describing their competence as excellent – the lowest-ranked of all the competences. Of the 71 respondents describing their competence as excellent two-thirds (65%) have a lead role in this function (table 46b). 45% of respondents have no or negligible role in cost–benefit analysis (figure 46a). Cost–benefit analysis of OH interventions Figure 45a: Level of provision 50 45 40 35 30 Per cent 25 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 45b: Rating of importance 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 49 Performance indicators and benchmarking in OH nursing Results and analysis .

OHN role and competence in cost–benefit analysis of OH interventions Figure 46a: Role in delivery 50 40 30 Per cent 20 10 0 Lead Support Negligible Figure 46b: Level of competence 50 40 30 Per cent 20 10 0 Excellent Satisfactory Unsatisfactory 3 Table 36: Competence against role in analysis of cost–benefit of OH interventions Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 102 141 213 45 10 5 50 68 23 4 18 62 1 4 10 100 100 100 n = number of respondents in each category. 17 did not answer the question Table 37: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 71 196 163 65 26 2 20 49 15 14 24 82 1 1 1 n = number of respondents in each category 50 Performance indicators and benchmarking in OH nursing Results and analysis .

with just under two-thirds describing this provision as comprehensive (figure 47a). according to respondents from this sector). with just under one-third saying it is desirable – very few feel it is of nil or negligible value (figure 47b).Display screen equipment assessments The vast majority of respondents report that their OH departments offer assessments in compliance with the Health and Safety (Display Screen Equipment) Regulations 1992. Commercial OH providers are most likely to offer a comprehensive service (76%. Display screen equipment assessments Figure 47a: Level of provision 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 47b: Rating of importance 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 51 Performance indicators and benchmarking in OH nursing Results and analysis . Just under two-thirds agree that this function is essential.

The majority of respondents have either a lead (44%) or support (39%) role in delivering DSE assessments (figure 48a). 16 did not answer the question. some figures round up to more than 100 Table 39: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 263 155 24 62 27 4 31 59 13 6 14 79 2 0 4 n = number of respondents in each category 52 Performance indicators and benchmarking in OH nursing Results and analysis . OHN role and competence in display screen equipment assessments Figure 48a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 48b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 38: Competence against role in carrying out display-screen equipment assessments Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 210 185 62 78 44 24 20 50 34 0 2 31 2 5 11 100 101 100 n = number of respondents in each category. with most rating their competence as either satisfactory (33%) or excellent (56%) (figure 48b). Those rating their competence as excellent are more likely to be in a lead role than those with satisfactory self-rated competence (table 38).

Four-fifths (79%) of all NHS OH departments provide comprehensive services. Sharps/needlestick prevention and management Figure 49a: Level of provision 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated 53 Performance indicators and benchmarking in OH nursing Results and analysis . is that around half of both commercial OH providers (49%) and other private sector (52%). Only a minority consider the service of nil or negligible importance. Most other public sector respondents provide some level of service (31% comprehensive. Of interest. with 15% providing basic services and just 3% saying that the service is not available.Sharps/needlestick prevention and management As expected. figures that far outweigh the level of comprehensive service provision in these sectors (figure 49b). 49% basic). The vast majority (88%) of NHS respondents consider that such services are essential. A large minority (43%) of commercial OH providers and 36% of other private sector employers offer no facilities to prevent or manage sharps and needlestick injuries. and more than two-thirds (68%) of other public sector respondents also view this service as essential. the provision of OH services to prevent and manage sharps and needlestick injuries is much higher in the NHS than in any other sector (figure 49a).

Two-fifths (41%) of respondents describe their competence in this area as excellent. this clearly reflects the lower level of service outside the NHS. and 43% satisfactory (figure 50b). 68% of respondents have some role in sharps/needlestick prevention and management (figure 50a).Figure 49b: Rating of importance 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Overall. however. OHN role and competence in sharps/needlestick prevention and management Figure 50a: Role in delivery 40 Per cent 20 0 Lead Support Negligible Figure 50b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory 54 Performance indicators and benchmarking in OH nursing Results and analysis .

Table 40: Role in sharps/needlestick prevention and management Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 185 135 140 69 36 13 29 60 49 0 1 26 3 2 13 101 99 101 n = number of respondents in each category. more respondents tend to view the service as essential than are actually providing a comprehensive service (figure 51b). Provision is higher in other public sectors than both other private sector and commercial OH providers. For example. totals did not equal 100 as numbers rounded to nearest integer Table 41: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 194 203 39 65 26 0 25 40 5 9 33 92 0 1 3 n = number of respondents in each category Immunisation A similar picture emerges with the provision of immunisation by OH departments (figure 51a). 55 Performance indicators and benchmarking in OH nursing Results and analysis . 13 did not answer the question. more than half (53%) of public sector respondents consider the service as essential and 23% desirable. 36 of them (92%) have no or negligible role (table 41). with the exception of the NHS. As with sharps/needlestick prevention and management. 9% basic). Provision is almost universal among NHS respondents (85% comprehensive. And of the 39 respondents describing their competence in this area as unsatisfactory.The majority (69%) of those in a lead role in this function describe their competence as excellent (table 40). yet only 35% provide a comprehensive service and 35% no service at all.

Those with self-rated unsatisfactory competence are most likely (91%) to have no or negligible role in its delivery (table 43).Immunisation Figure 51a: Level of provision 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public Self employed sector All sectors Basic Comprehensive Non-existent Not stated Figure 51b: Rating of importance 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Two-thirds (64%) of respondents have either a lead (42%) or support role (22%) in delivering immunisation services (figure 52a). in most cases. Three-quarters (73%) of respondents in a lead role believe their competence to be excellent (table 42). with competence described. 56 Performance indicators and benchmarking in OH nursing Results and analysis . as satisfactory (33%) or excellent (44%) (figure 52b).

OHN role and competence in immunisation Figure 52a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 52b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 42: Competence against role in delivering immunisation services Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 199 105 153 73 37 13 24 55 31 1 4 44 2 4 12 100 100 100 n = number of respondents in each category. These trends are largely followed in terms of respondents’ rating of importance of such services (figure 54b). 57 Performance indicators and benchmarking in OH nursing Results and analysis . with 29% in both providing comprehensive services in this area (figure 54a). 16 did not answer the question Table 43: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 206 154 75 71 31 3 19 38 5 10 31 91 0 1 1 n = number of respondents in each category Travel health advice Around two-thirds of commercial OH providers and other private sector respondents (63% and 61% respectively) provide either basic or comprehensive travel health advice and services. The level of provision is lower in the NHS (52% basic or comprehensive) and other public sector (53%).

58 Performance indicators and benchmarking in OH nursing Results and analysis . two-thirds (68%) rate their competence as at least satisfactory (figure 55b).Travel health advice Figure 54a: Level of provision 50 45 40 35 30 Per cent 25 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors 7 Basic Comprehensive Non-existent Not stated Figure 54b: Rating of importance 50 45 40 35 30 Per cent 25 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated Although only half of the OH nurses (52%) have either a support or lead role on this area (figure 55a). The majority (85%) of those describing their competence as unsatisfactory have no or negligible role in travel health provision and advice (table 45).

OHN role and competence in travel health advice Figure 55a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 55b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 44: Competence against role in delivering travel health advice/provision Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 130 117 209 52 19 8 44 70 35 2 9 44 2 2 12 100 100 99 n = number of respondents in each category. 17 did not answer the question. some numbers round down to less than 100 Table 45: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 107 214 109 63 27 3 21 38 10 16 34 85 1 1 2 n = number of respondents in each category 59 Performance indicators and benchmarking in OH nursing Results and analysis .

Provision of training and education (eg manual handling) – excluding first aid Figure 56a: Level of provision 45 40 35 30 25 Per cent 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 56b: Rating of importance 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 60 Performance indicators and benchmarking in OH nursing Results and analysis . This is in stark contrast to the 85% describing the service as either essential (53%) or desirable (32%) – similar across all sectors (figure 56b).Provision of training and education (eg manual handling) – excluding first aid Just over two-thirds (68%) of all respondents’ organisations provide some level of occupational health training and education (such as manual handling). but only a minority (28% commercial OH provider. 30% NHS and 22% other private sector) offer a comprehensive service (figure 56a). 37% other private sector.

14 did not answer the question. with three-quarters describing their competence as excellent (29%) or satisfactory (46%) (figure 56b). OHN role and competence in provision of training and education (eg manual handling) – excluding first aid Figure 56a: Role in delivery 40 Per cent 20 0 Lead Support Negligible Figure 56b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 45: Competence against role in delivering training and education (excluding first aid) Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 114 187 158 68 22 11 31 70 34 1 6 39 1 3 15 101 101 99 n = number of respondents in each category.Two-thirds (64%) have either a lead (24%) or support (40%) role in training (figure 56a). numbers round up/down to above/below 100 Table 46: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 137 219 74 56 16 1 31 60 15 13 24 82 0 0 1 n = number of respondents in each category 61 Performance indicators and benchmarking in OH nursing Results and analysis . Those with a greater role are more likely to rate their competence as excellent (table 45).

By contrast. These trends are reflected in respondents’ views on the importance of such services (figure 57b).Organisation of first aid and first-aid training Sixty per cent of OH services offer some kind of training and organisation of first aid at work. Organisation of first aid and first-aid training Figure 57a: Level of provision 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 57b: Rating of importance 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 62 Performance indicators and benchmarking in OH nursing Results and analysis . Around half (52%) of other private sector respondents report that their organisations provide comprehensive first-aid and first-aid training services (59%) (figure 57a). 59% of NHS departments provide no such services.

Nearly half of the respondents (48%) have no or negligible role in delivering first-aid training (figure 58a). with 93% of those reporting unsatisfactory competence having no or negligible role in its delivery (table 48). though two-thirds describe their competence as either excellent (35%) or satisfactory (33%) (figure 58b). 18 did not answer the question Table 48: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 166 156 96 65 11 1 15 43 5 20 46 93 0 1 1 n = number of respondents in each category 63 Performance indicators and benchmarking in OH nursing Results and analysis . OHN role and competence in organisation of first aid and first-aid training Figure 58a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 58b: Level of competence 40 30 Per cent 20 10 0 Excellent Satisfactory Unsatisfactory Table 47: Competence against role in organisation of first aid and first aid-training Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 128 101 226 84 25 15 13 66 31 1 5 39 2 4 15 100 100 100 n = number of respondents in each category. The vast majority (84%) of respondents in a lead role describe their competence as excellent (table 47).

Only a very small minority (3%) consider the services of negligible or no value. Provision of confidential counselling Figure 59a: Level of provision 70 60 50 40 Per cent 30 20 10 0 Commercial Other private OH provider sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 59b: Rating of importance 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 64 Performance indicators and benchmarking in OH nursing Results and analysis . provision of a comprehensive service is much higher in the NHS (66%) and other public sector (69%) than either the commercial OH providers (46%) and other private sector (52%). More than two-thirds (68%) consider that such provision is essential.Provision of confidential counselling The majority of employers (89%) provide some level of confidential counselling services (figure 59a). However. with more NHS (79%) and other public sector (77%) respondents than commercial OH provider and other private sector respondents (both 62%) taking this view (figure 59b).

Similarly. Twothirds of respondents with excellent self-rated competence in this area are in a lead role in its delivery (table 49).Most OH nurses have some role in confidential counselling: 38% lead. and 2% not stated (figure 60a). most rate their competence as either excellent (34%) or satisfactory (52%) – just 8% were unsatisfactory (6% not stated) (figure 60b). 8 did not answer the question Table 50: Job function against competence Competence/Role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 160 246 39 68 27 3 29 63 31 3 10 67 1 0 0 n = number of respondents in each category 65 Performance indicators and benchmarking in OH nursing Results and analysis . 46% support. 14% none/negligible. OHN role and competence in the provision of confidential counselling Figure 60a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 60b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 49: Competence against role in provision of confidential counselling Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 181 217 67 60 21 6 37 71 36 1 6 39 2 2 19 100 100 100 n = number of respondents in each category.

Although more than half (51%) of both commercial OH provider and other public sector respondents describe the service as essential. respondents in the NHS and other private sector are more likely to see the service as desirable rather than essential (figure 61b). General health and wellness screening Figure 61a: Level of provision 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 61b: Rating of importance 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 66 Performance indicators and benchmarking in OH nursing Results and analysis . Six of the 11 self-employed practitioners also offer comprehensive health and wellness screening services. However. comprehensive services are much more likely to be provided by commercial OH providers (55%) than the other sectors.General health and wellness screening Most organisations (79%) provide some form of health and wellness screening (figure 61a).

Most describe their competence as excellent (48%) or satisfactory (41%) (figure 62b). with 27% in a support role and 21% having no or negligible role (2% not stated) (figure 62a). OHN role and competence in general health and wellness screening Figure 62a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 62b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Table 51: Competence against role in delivering general health and wellness screening Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 238 126 100 71 29 19 26 67 49 0 2 18 3 2 14 100 100 100 n = number of respondents in each category. 9 did not answer the question Table 52: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 226 195 21 75 31 5 16 44 10 8 25 86 1 0 0 n = number of respondents in each category 67 Performance indicators and benchmarking in OH nursing Results and analysis . Nearly threequarters (71%) of those in a lead role describe their competence as excellent (table 51).Half of all respondents (50%) have a lead role in general health and wellness screening.

Interpreting and advising on OH law Figure 63a: Level of provision 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 63b: Rating of importance 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 68 Performance indicators and benchmarking in OH nursing Results and analysis . a figure not matched by the percentage of firms providing comprehensive services.Interpreting and advising on OH law The vast majority of OH departments in all sectors (91%) provide advice and interpretation on OH law. with 49% describing the service as comprehensive (figure 63a). Three-quarters of all respondents describe the service as essential (figure 63b). There was little variation between sectors.

with just 2% rating their competence as unsatisfactory (table 53). fewer describe their competence as excellent (30%) than satisfactory (53%) (figure 64b). A minority (11%) describe their competence as unsatisfactory (6% did not respond to this question). 11 did not answer the question. 56% describe their competence as excellent. some numbers round down to less than 100 Table 54: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 144 252 52 80 33 10 19 62 31 1 4 60 1 1 0 n = number of respondents in each category 69 Performance indicators and benchmarking in OH nursing Results and analysis . However. OHN role and competence in interpreting and advising on OH law Figure 64a: Role in delivery 60 40 Per cent 20 0 Lead Support Negligible Figure 64b: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Of those in a lead role. Table 53: Competence against role in interpreting and advising on OH law Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 206 203 53 56 13 2 40 77 21 2 8 58 1 2 19 99 100 100 n = number of respondents in each category.An almost equal percentage of respondents have either a support (43%) or lead (44%) role in advising on OH law (figure 64a).

Ninety-five per cent of all respondents said that such provision was essential – again with little variation between sectors (figure 64b). Most respondents (88%) said that a comprehensive service was provided. Just two out of 473 respondents said that such a service was not provided. Confidential handling of health and personal data Figure 64a: Level of provision 100 90 80 70 60 Per cent 50 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Basic Comprehensive Non-existent Not stated Figure 64b: Rating of importance 100 90 80 70 60 Per cent 50 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed All sectors Essential Desirable Nil/negligible Not stated 70 Performance indicators and benchmarking in OH nursing Results and analysis .Confidential handling of health and personal data The vast majority (98%) of survey respondents said that their organisation provided confidential handing of health and personal data (figure 64a). with little variation between sectors.

Three-quarters (75%) describe their competence as excellent and 21% satisfactory (4% did not respond) (figure 65b). The vast majority in a lead role describe their competence as excellent (table 55). OHN role and competence in confidential handling of health and personal data Figure 65a: Role in delivery 80 60 Per cent 4 0 20 0 Lead Support Negligible Figure 65b: Level of competence 80 60 Per cent 40 20 0 Excellent Satisfactory Unsatisfactory Table 55: Competence against role in confidential handling of health and personal data Role/competence Lead Support None/negligible n Excellent % Satisfactory % Unsatisfactory % Not stated % Total % 362 99 1 83 53 0 15 43 100 0 2 0 2 2 0 100 100 100 n = number of respondents in each category. 11 did not answer the question Table 56: Job function against competence Competence/role Excellent Satisfactory Unsatisfactory n Lead % Support % None/negligible % Not stated % 354 99 2 85 56 0 15 43 100 0 1 0 1 0 0 n = number of respondents in each category 71 Performance indicators and benchmarking in OH nursing Results and analysis . with 21% in a support role and none with just one respondent describing their role as nil or negligible (2% not stated) (figure 65a).More than three-quarters (77%) describe their role as a lead one.

as the percentage having a lead role increases (circles). where nearly half (46%) of nurses have a lead role and a much smaller percentage (32%) of respondents describe their competence as excellent. The x-axis refers to the 26 skill areas. arranged in order of increasing numbers in lead roles. Figure 66: Do nurses in a lead role tend to have high levels of self-rated competence? 90 80 26 25 26 70 23 22 23 18 24 25 60 24 50 Per cent 40 11 10 17 21 22 21 18 19 20 13 14 12 14 13 15 16 16 17 30 3 5 6 7 9 11 10 8 7 8 9 12 15 19 20 20 1 2 3 4 4 5 6 10 1 0 0 5 10 15 20 25 30 Lead role Excellent competence Note: the x axis refers to the 26 skill areas. Where the paired points are closest there is a closer match between the percentage of nurses in lead roles and the percentage with excellent levels of competence. Some are very close – such as data handling (77% lead role. Generally.Results 3: Role and competence All 26 skill areas have been plotted in terms of respondents’ self-rated competence against the percentage in a lead role (figure 66). arranged in order of increasing percentages in lead roles. such as disability assessments. the percentage having excellent self-rated competence (triangles) also increases. 75% excellent competence) – others are further apart. Key: 1 PPE 6 Injury/illness data 11 Return to work 16 Sharps/needlestick 21 Health/wellness 26 Data handling 2 Work organisation 7 Training 12 Rehab 17 Immunisation 22 Health surveillance interpretation 3 H&S 8 Travel health 13 Mental health 18 DSE 23 Health surveillance 4 Cost-benefit 9 Home/off-site 14 Counselling 19 OH law 24 Assessing fitness for work 5 Attendance 10 First aid 15 Fitness for work standards 20 Disability 25 Pre-employment questionnaires 72 Performance indicators and benchmarking in OH nursing Results and analysis . The Y axis shows the percentages of OH nurses in lead roles and the corresponding self-rated competence levels.

More nurses have a lead role in confidential handling of health and personal data than any other skill area (table 57). Provision of personal protective equipment is the lowest ranked. with cost–benefit analysis of OH interventions the lowest (table 58). injury and illness data Attendance monitoring Cost–benefit analysis of OH interventions Health and safety risk assessment Advising on work organisation and design Provision of personal protective equipment 77 73 71 67 62 50 46 44 44 42 39 39 38 38 34 29 27 27 27 24 23 23 22 22 21 8 73 Performance indicators and benchmarking in OH nursing Results and analysis . In terms of self-rated competence ranking. Table 57: Competence area – ranking by percentage in lead role Ranking Competence area % in lead role 1 2 3 4 5 6 7 8= 8= 10 11= 11= 13= 13= 15 16 17= 17= 17= 20 21= 21= 23= 23= 25 26 Confidential handling of health and personal data Analysing of pre-employment/pre-placement questionnaires Assessment of fitness for work Delivering health surveillance Interpretation of health surveillance General health and wellness screening Disability assessments and adjustments Display screen equipment assessments Interpreting and advising on OH law Immunisation Sharps/needlestick prevention and management Developing fitness-for-work standards Confidential counselling Assessing risks to mental health Vocational rehabilitation Delivering return-to-work interviews Travel health advice/provision Organisation of first aid and first-aid training Home/off-site visits to workers on sick leave Provision of training and education Monitoring work-related accident. nurses rate confidential handling of health and personal data as their most competent skill area.

injury and illness data Travel health advice/provision Advising on work organisation and design Provision of personal protective equipment Cost–benefit analysis of OH interventions 75 72 61 59 56 50 48 44 41 37 35 34 32 30 30 30 29 29 29 29 28 26 23 21 17 15 74 Performance indicators and benchmarking in OH nursing Results and analysis .Table 58: Competence area – ranking by percentage rating their competence as excellent Ranking Competence area % excellent 1 2 3 4 5 6 7 8 9 10 11 12 13 14= 14= 14= 17= 17= 17= 17= 21 22 23 24 25 26 Confidential handling of health and personal data Analysing of pre-employment/pre-placement questionnaires Assessment of fitness for work Delivering health surveillance Display screen equipment assessments Interpretation of health surveillance General health and wellness screening Immunisation Sharps/needlestick prevention and management Delivering return-to-work interviews Organisation of first aid and first-aid training Confidential counselling Disability assessments and adjustments Interpreting and advising on OH law Home/off-site visits to workers on sick leave Attendance monitoring Assessing risks to mental health Developing fitness-for-work standards Provision of training and education Health and safety risk assessment Vocational rehabilitation Monitoring work-related accident.

Key: 1 Home/off-site visits to workers on sick leave 6 Cost–benefit analysis of OH interventions 11 Delivering return-towork interviews 16 Health and safety risk assessment 21 Assessing risks to mental health 26 Confidential handling of health and personal data 2 Travel health advice/provision 7 Immunisation 12 Advising on work organisation and design 17 Confidential counselling 22 Disability assessments and adjustments 3 General health and wellness screening 8 Provision of training and education 13 Vocational rehabilitation 18 Developing fitnessfor-work standards 23 Interpretation of health surveillance 4 Provision of personal protective equipment 9 Attendance monitoring 14 Display screen equipment assessments 19 Interpreting and advising on OH law 24 Delivering health surveillance 5 Organisation of first aid and first-aid training 10 Monitoring work-related accident. The Y axis shows the percentages of OH nurses rating the service as essential. and the corresponding percentages where the service is rated as comprehensive. injury and illness data 15 Sharps/needlestick prevention and management 20 Analysing of preemployment/pre-placement questionnaires 25 Assessment of fitness for work 75 Performance indicators and benchmarking in OH nursing Results and analysis .Essential services and level of provision The extent to which respondents’ organisations provide a comprehensive service in the various practice areas is plotted against respondents’ views as to whether the service is essential (figure 67). Figure 67: Essential services and level of provision 100 26 90 25 23 24 25 26 80 19 20 21 20 22 24 23 70 17 16 14 15 17 18 22 60 10 8 9 11 13 12 Per cent 50 4 5 5 6 7 7 11 13 15 9 10 12 16 18 19 40 3 3 21 30 1 1 2 2 4 6 8 20 10 0 0 5 10 15 20 25 30 Essential service Comprehensive provision Note: the x axis refers to the 26 service areas. arranged in increasing order of perceived importance.

Cost–benefit analysis of OH interventions is the lowest ranked. with home/off-site visits to workers on sick leave as least essential. Table 59 ranks the services according to whether or not respondents perceive them as essential. general health and wellness screening and home/off-site visits to workers on sick leave – the percentage with a comprehensive service is lower than the percentage deemed as essential. as can be seen. DSE assessments. 76 Performance indicators and benchmarking in OH nursing Results and analysis . for example. One might expect that the more a service is seen as essential (circles). In all but four cases – analysis of pre-employment/pre-placement questionnaires. the more organisations would be providing a comprehensive service (triangles). yet only 42% are deemed to be providing a comprehensive service. arranged in order of increasing percentages as essential functions – the functions are described in the key. However.The graph plots all 26 of the above nursing practice/service delivery areas in pairs. The x-axis refers to the 26 service areas. The discrepancies are shown clearly in table 59 where the service areas are ranked according to how essential it is perceived by practitioners and the level of comprehensive provision. is seen as an essential service by 81% of respondents. Assessing risks to mental health. according to the percentage of nurses describing each as an essential function and the percentage describing their organisation’s provision as comprehensive. Table 60 shows that handling confidential health and personal data is followed by the assessment of fitness to work and analysis of pre-employment/pre-placement questionnaires as the areas where organisations provide comprehensive services. although there is a general upward trend in service provision the more a service is deemed essential. Handling confidential health and personal data is seen as most important. there is often a wide discrepancy between what practitioners see as essential and the organisation actually providing a full level of service.

Table 59: Service delivery ranking as essential with comparison figures for organisation’s provision as comprehensive (all sectors) Ranking Competence area % essential % comprehensive 1 2 3= 3= 5= 5= 7 8 9 10 11 12 13 14 15 16= 16= 18= 18= 20= 20= 22= 22= 24 25 26 Confidential handling of health and personal data Assessment of fitness for work Delivering health surveillance Interpretation of health surveillance Disability assessments and adjustments Assessing risks to mental health Analysing of pre-employment/pre-placement questionnaires Interpreting and advising on OH law Developing fitness-for-work standards Confidential counselling Health and safety risk assessment Sharps/needlestick prevention and management Display screen equipment assessments Vocational rehabilitation Advising on work organisation and design Delivering return-to-work interviews Monitoring work-related accident. injury and illness data Attendance monitoring Provision of training and education Immunisation Cost–benefit analysis of OH interventions Organisation of first aid and first-aid training Provision of personal protective equipment General health and wellness screening Travel health advice/provision Home/off-site visits to workers on sick leave 95 88 84 84 81 81 77 76 71 68 66 63 62 61 59 58 58 53 53 50 50 44 44 39 25 23 88 84 74 73 64 42 80 49 47 57 43 43 62 47 33 47 37 38 31 46 21 39 26 41 24 25 77 Performance indicators and benchmarking in OH nursing Results and analysis .

NHS and other public sectors. There are some notable differences. respectively. 17th and 17th in the other private. whereas commercial OH providers and other private sector respondents rank this in 20th and 21st place. injury and illness data Advising on work organisation and design Provision of training & education Provision of personal protective equipment Home/off-site visits to workers on sick leave Travel health advice/provision Cost–benefit analysis of OH interventions 88 84 80 74 73 64 62 57 49 47 47 47 46 43 43 42 41 39 38 37 33 31 26 25 24 21 Tables 61–64 give the sector rankings according to respondents’ views on whether or not the service is essential and the corresponding level of comprehensive provision. Return-to-work interviews are ranked 10th by respondents from commercial OH providers.Table 60: Service delivery ranking by percentage rating the organisation’s provision as comprehensive (all sectors) Ranking Service % comprehensive 1 2 3 4 5 6 7 8 9 10= 10= 10= 13 14= 14= 16 17 18 19 20 21 22 23 24 25 26 Confidential handling of health and personal data Assessment of fitness for work Analysing of pre-employment/pre-placement questionnaires Delivering health surveillance Interpretation of health surveillance Disability assessments and adjustments Display screen equipment assessments Confidential counselling Interpreting and advising on OH law Developing fitness-for-work standards Vocational rehabilitation Delivering return-to-work interviews Immunisation Health and safety risk assessment Sharps/needlestick prevention and management Assessing risks to mental health General health and wellness screening Organisation of first aid and first-aid training Attendance monitoring Monitoring work-related accident. but 16th. respectively. 78 Performance indicators and benchmarking in OH nursing Results and analysis . such as NHS respondents viewing the management of sharps/needlesticks as the fourth most important function.

Service delivery ranking as essential with comparison figures for organisation’s provision as comprehensive (by sector) Table 61: Commercial OH provider Ranking Competence area % essential % comprehensive 1 2 3 4 5 6 7 8 9 10= 10= 12 13 14 15= 15= 17 18 19 20 21 22 23 24 25 26 Confidential handling of health and personal data Assessment of fitness for work Delivering health surveillance Interpretation of health surveillance Assessing risks to mental health Analysing of pre-employment/pre-placement questionnaires Disability assessments and adjustments Interpreting and advising on OH law Developing fitness-for-work standards Confidential counselling Delivering return-to-work interviews Display screen equipment assessments Health and safety risk assessment Attendance monitoring Advising on work organisation and design Provision of training and education Vocational rehabilitation General health and wellness screening Cost–benefit analysis of OH interventions Sharps/needlestick prevention and management Organisation of first aid and first-aid training Monitoring work-related accident. injury and illness data Immunisation Provision of personal protective equipment Travel health advice/provision Home/off-site visits to workers on sick leave 95 88 87 85 82 77 74 72 71 62 62 61 60 56 55 55 54 51 50 49 48 45 39 35 33 18 88 89 78 78 47 81 62 54 55 46 55 76 37 49 34 28 47 55 30 28 39 28 34 23 29 28 79 Performance indicators and benchmarking in OH nursing Results and analysis .

injury and illness data Display screen equipment assessments Attendance monitoring Confidential counselling Vocational rehabilitation Delivering return-to-work interviews Advising on work organisation and design Provision of training and education Organisation of first aid and first-aid training Sharps/needlestick prevention and management Cost–benefit analysis of OH interventions Provision of personal protective equipment General health and wellness screening Immunisation Travel health advice/provision Home/off-site visits to workers on sick leave 97 88 84 81 81 79 76 74 74 71 70 66 63 62 62 61 58 58 58 52 51 47 38 33 29 24 88 81 66 72 70 33 48 76 47 49 51 59 46 52 51 49 33 37 52 30 24 27 40 31 29 26 80 Performance indicators and benchmarking in OH nursing Results and analysis .Table 62: Other private sector Ranking Competence area % essential % comprehensive 1 2 3 4= 4= 6 7 8= 8= 10 11 12 13 14= 14= 16 17= 17= 17= 20 21 22 23 24 25 26 Confidential handling of health and personal data Assessment of fitness for work Disability assessments and adjustments Delivering health surveillance Interpretation of health surveillance Assessing risks to mental health Interpreting and advising on OH law Analysing of pre-employment/pre-placement questionnaires Developing fitness-for-work standards Health and safety risk assessment Monitoring work-related accident.

Table 63: NHS Ranking Competence area % essential % comprehensive 1 2= 2= 4 5= 5= 7 8 9 10 11 12 13 14 15 16 17= 17= 19 20= 20= 22 23 24 25 26 Confidential handling of health and personal data Assessment of fitness for work Delivering health surveillance Sharps/needlestick prevention and management Interpretation of health surveillance Immunisation Analysing of pre-employment/pre-placement questionnaires Assessing risks to mental health Confidential counselling Disability assessments and adjustments Interpreting and advising on OH law Developing fitness-for-work standards Health and safety risk assessment Advising on work organisation and design Vocational rehabilitation Display screen equipment assessments Delivering return-to-work interviews Monitoring work-related accident. injury and illness data Cost–benefit analysis of OH interventions Provision of training and education Provision of personal protective equipment Attendance monitoring General health and wellness screening Organisation of first aid and first-aid training Home/off-site visits to workers on sick leave Travel health advice/provision 96 89 89 88 85 85 83 81 79 78 77 70 66 60 59 57 54 54 46 44 44 37 28 24 21 12 93 90 76 79 76 85 90 49 66 61 50 46 44 34 46 61 48 26 15 30 27 22 34 24 18 16 81 Performance indicators and benchmarking in OH nursing Results and analysis .

injury and illness data Delivering return-to-work interviews Immunisation Cost–benefit analysis of OH interventions General health and wellness screening Attendance monitoring Provision of training and education Provision of personal protective equipment Organisation of first aid and first-aid training Travel health advice/provision Home/off-site visits to workers on sick leave 96 92 86 86 85 82 81 77 72 68 66 66 64 62 61 57 55 53 51 51 50 50 47 36 23 23 81 82 65 47 72 70 43 69 76 31 34 31 34 32 58 31 35 35 15 42 31 22 18 31 19 28 82 Performance indicators and benchmarking in OH nursing Results and analysis .Table 64: Other public sector Ranking Competence area % essential % comprehensive 1 2 3= 3= 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19= 19= 21= 21= 23 24 25= 25= Confidential handling of health and personal data Assessment of fitness for work Disability assessments and adjustments Assessing risks to mental health Interpretation of health surveillance Delivering health surveillance Interpreting and advising on OH law Confidential counselling Analysing of pre-employment/pre-placement questionnaires Sharps/needlestick prevention and management Developing fitness-for-work standards Advising on work organisation and design Vocational rehabilitation Health and safety risk assessment Display screen equipment assessments Monitoring work-related accident.

the proportion of nurses describing their competences as excellent is relatively low in many other functions rated as essential. However. health surveillance and analysing employment health questionnaires. functions such as disability assessments and workplace counselling are central roles of OH nurses and these results highlight areas where levels of competence could be raised and training targeted. only 15% of OH nurses rate their competence in cost–benefit analysis of OH interventions as excellent. advising on work organisation and design. By contrast. just 32% rate their competence as excellent (and one in nine practitioners rate their competence as unsatisfactory). interpreting and advising on OH law and in the provision of confidential counselling. the majority of OH nurses rate their competence as excellent in handling confidential information. However. Perhaps of even greater significance is that while 81% of OH nurses say that disability assessments and adjustments are essential components of the OH service. yet 50% rate this as an essential service. 83 Performance indicators and benchmarking in OH nursing Results and analysis . general health and wellness screening is the seventh-highest ranked function in terms of competence (48% of respondents rate their competence as excellent and only 4% as unsatisfactory). For example. counselling (68% v 34%) and vocational rehabilitation (61% v 28%). A high level of competence in the OH nurse would not necessarily be an issue if other professional colleagues undertook these functions. while. It could be argued that some of the functions perceived as essential – such as health and safety risk assessment and advising on work organisation and design – could be undertaken by other professionals in a multidisciplinary team (such as the health and safety manager or ergonomist). all of which are perceived as important functions of the OH service.Essential services and OH nursing competence The match between respondents’ rating of what functions they consider essential and the overall self-ratings of competence in delivering those services is less good (figure 68). As can be seen. DSE assessments. although self-rated competence is relatively high in data handling. it is 24th out of the 26 functions in terms of its perception as important (only 39% of respondents view it as essential). The situation is similar for mental health assessments (81% essential v 29% excellent). assessing fitness for work. nurses are more likely to describe their performance simply as satisfactory in disability assessment. For example. assessing risks to mental health. the fact that OH nurses tend to rate their competence lower in some areas compared with others supports the notion that there is room for improvement. health surveillance. And a third of OH nurses describe their competence in this area as unsatisfactory – the poorest ranking of all the studied functions. It can also be argued that satisfactory competence does not imply that services are not being delivered. analysis of pre-employment/pre-placement questionnaires and DSE assessments. assessing fitness for work.

arranged in increasing order of perceived importance. Key: 1 Home/off-site visits to workers on sick leave 6 Cost–benefit analysis of OH interventions 11 Delivering return-towork interviews 16 Health and safety risk assessment 21 Assessing risks to mental health 26 Confidential handling of health and personal data 2 Travel health advice/provision 7 Immunisation 12 Advising on work organisation and design 17 Confidential counselling 22 Disability assessments and adjustments 3 General health and wellness screening 8 Provision of training and education 13 Vocational rehabilitation 18 Developing fitnessfor-work standards 23 Interpretation of health surveillance 4 Provision of personal protective equipment 9 Attendance monitoring 14 Display screen equipment assessments 19 Interpreting and advising on OH law 24 Delivering health surveillance 5 Organisation of first aid and first-aid training 10 Monitoring work-related accident. The Y axis shows the percentages of OH nurses rating the service as essential and the corresponding percentages where the OH nurses rate their own competence in delivering these functions. injury and illness data 15 Sharps/needlestick prevention and management 20 Analysing of pre-employment/ pre-placement questionnaires 25 Assessment of fitness for work 84 Performance indicators and benchmarking in OH nursing Results and analysis .Figure 68: Essential services and self-rated competence 100 26 90 25 23 24 80 19 20 21 22 26 70 17 16 13 10 8 9 11 12 14 14 15 18 20 60 25 24 Per cent 50 3 4 5 6 7 7 15 11 23 40 3 5 17 22 1 1 2 2 4 6 8 9 10 12 13 16 18 19 21 30 20 10 0 0 5 10 15 20 25 30 Essential service Excellent competence Note: the x axis refers to the 26 service areas.

85 Performance indicators and benchmarking in OH nursing Results and analysis . Less than one-quarter (23%) rate their competence as excellent and 13% as unsatisfactory (1% not stated). The vast majority (87%) believe this skill to be essential (9% desirable) (figure 70b). OHN competence in research skills and awareness Figure 69a: Level of competence 70 60 50 40 Per cent 30 20 10 0 Excellent Satisfactory Unsatisfactory Figure 69b: Importance rating 60 50 40 Per cent 30 20 10 0 Essential Desirable Negligible Team working OH nurses rate their competence in team working as either excellent (71%) or satisfactory (26%) (figure 70a). More than half (51%) rate this skill as essential and 43% desirable – only 3% felt it was of nil/negligible importance (2% not stated) (figure 69b).Results 4: Generic OH nursing skills Research skills and awareness Nearly two-thirds (63%) of OH nurses rate their competence in research skills and awareness as satisfactory (figure 69a).

most view this function as either essential (44%) or desirable (42%) (figure 71b). 17% excellent. 26% unsatisfactory.OHN competence in team working Figure 70a: Level of competence 100 Per cent 50 0 Excellent Satisfactory Unsatisfactory Figure 70b: Importance rating 100 50 0 Essential Desirable Negligible Per cent Budget management OH nurses are less confident of their competence in budget management (56% satisfactory. However. 2% not stated) (figure 71a). OHN competence in budget management Figure 71a: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Figure 71b: Importance rating 60 40 Per cent 20 0 Essential Desirable Negligible 86 Performance indicators and benchmarking in OH nursing Results and analysis .

3% not stated) (figure 73a). Two-thirds (66%) rate this skill as essential and 25% desirable (5% nil or negligible. and 15% unsatisfactory (figure 72a). with 57% rating their competence as satisfactory. most OH nurses see this skill as either essential (54%) or desirable (37%) (figure 72b).Resource management A slightly more positive picture emerges for OH nursing skills in resource management. 27% as excellent. 48% satisfactory. 6% unsatisfactory. Again. OHN competence in resource management Figure 72a: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Figure 72b: Importance rating 60 40 Per cent 20 0 Essential Desirable Negligible Leadership skills Most nurses are confident of their leadership skills at an operational level (43% excellent. 4% not stated) (figure 73b). OHN competence in leadership sills at an operational level Figure 73a: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory 87 Performance indicators and benchmarking in OH nursing Results and analysis .

Virtually all nurses rate this as either essential (71%) or desirable (24%) (2% nil/negligible. 88 Performance indicators and benchmarking in OH nursing Results and analysis . 54% satisfactory and 19% unsatisfactory).Figure 73b: Importance rating 80 60 Per cent 40 20 0 Essential Desirable Negligible Fewer nurses believe their competence to be excellent at strategic-level leadership skills (25% excellent. OHN competence in leadership skills at a strategic level Figure 74a: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Figure 74b: Importance rating 60 40 Per cent 20 0 Essential Desirable Negligible Interpreting developments in OH practice Most respondents rate their competence in interpreting developments in OH practice as either excellent (33%) or satisfactory (59%) (figure 75a). more than half (52%) rate this skill as essential and 36% desirable (9% nil/negligible and 3% not stated) (figure 74b). Again. 3% not stated) (figure 75b).

OHN competence in interpreting developments in OH practice Figure 75a: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Figure 75b: Importance rating 80 60 Per cent 40 20 0 Essential Desirable Negligible Communication with clients and OH colleagues Most OH nurses (81%) rate their competence in communication with clients and OH colleagues as excellent (18% satisfactory) (figure 76a). 2% not stated) (figure 76b). OHN competence in communication with clients and OH colleagues Figure 76a: Level of competence 100 50 0 Excellent Satisfactory Unsatisfactory Per cent Figure 76b: Importance rating 100 50 0 Essential Desirable Negligible Per cent 89 Performance indicators and benchmarking in OH nursing Results and analysis . Nearly all (respondents (94%) see this function as essential (4% desirable.

1% not stated) (figure 78a). with 23% excellent and 13% unsatisfactory (2% not stated) (figure 77a). 48% satisfactory. OHN competence in presentation skills Figure 78a: Level of competence 50 40 30 Per cent 20 10 0 Excellent Satisfactory Unsatisfactory 90 Performance indicators and benchmarking in OH nursing Results and analysis . 6% unsatisfactory. Three-fifths (58%) rate this as essential and 37% desirable (figure 77b). OHN competence in conflict management Figure 77a: Level of competence 80 60 Per cent 40 20 0 Excellent Satisfactory Unsatisfactory Figure 77b: Importance rating 60 40 Per cent 20 0 Essential Desirable Negligible Presentation skills OH nurses are generally confident of their presentation skills (45% excellent.Conflict management Nearly two-thirds (62%) of OH nurses rate their competence in conflict management as satisfactory. Two-thirds (65%) rate this skill as essential (figure 78b).

OHN competence in coaching and mentoring Figure 79a: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Figure 79b: Importance rating 60 40 Per cent 20 0 Essential Desirable Negligible Clinical supervision A similar picture is seen regarding OH nurses’ skills in clinical supervision. with 31% describing their competence as excellent and 51% satisfactory (figure 80a). More than half (55%) rate this skill as essential and 35% desirable (7% nil/negligible. However. 3% not stated) (figure 80b). 91 Performance indicators and benchmarking in OH nursing Results and analysis . This function is generally seen as essential (55%) or desirable (36%) (figure 79b).Figure 78b: Importance rating 80 60 Per cent 40 20 0 Essential Desirable Negligible Coaching/mentoring Most OH nurses rate their competence in coaching and mentoring as either excellent (33%) or satisfactory (55%) (11% unsatisfactory. a significant minority (15%) say their competence in this area is unsatisfactory (2% not stated). 1% not stated) (figure 79a).

The biggest gaps in this context were for conflict management (58% rated as essential. fewer OH nurses describe their competence as excellent compared with the number rating the skill area as essential. However. 33% excellent). in all 12 areas. The closest fit was for communication skills (94% essential. 92 Performance indicators and benchmarking in OH nursing Results and analysis . As can be seen from figure 81. 81% excellent). 23% rate competence as excellent) and interpreting developments in OH practice (71% essential. the percentage describing their competence as excellent also increases. as the essential rating increases.OHN competence in clinical supervision Figure 80a: Level of competence 60 40 Per cent 20 0 Excellent Satisfactory Unsatisfactory Figure 80b: Importance rating 60 40 Per cent 20 0 Essential Desirable Negligible Importance rating and competence The 12 OH nursing skills discussed above were plotted in pairs according to whether OH nurses rate them as essential and whether nurses rate their own skills as excellent.

and teamwork are viewed as the most essential of the 12 skill areas in this section of the research (table 65). 93 Performance indicators and benchmarking in OH nursing Results and analysis . These two skill areas are also the two where more nurses rate their competence as excellent (table 66). Just 17% of OH nurses rate their skills in budget management as excellent – the lowest-ranked skill area – despite the fact that 44% see this skill as essential. Of interest is that these are the only two of the 12 skill areas where more than half of the nurses rate their competence as excellent.Figure 81: Importance rating and competence 100 12 90 11 80 12 70 8 9 10 11 60 7 4 5 6 Per cent 50 1 2 3 8 9 40 6 10 30 4 3 2 5 7 20 1 10 0 0 2 4 6 8 10 12 14 Essential rating Excellent competence Key: 1 Budget management 7 Conflict management 2 Research skills 3 Leadership skills – strategic level 9 Leadership skills – operational level 4 Resource management 1 0 Interpreting developments in OH practice 5 Clinical supervision 6 Coaching/ mentoring 1 2 Communication with clients and OH colleagues 8 Presentation skills 1 1 Teamwork Communication with clients and OH colleagues.

Table 65: Competence ranking by perceived importance
Ranking Competence area % rating as essential

1 2 3 4 5 6 7= 7= 9 10 11 12

Communication with clients and OH colleagues Teamwork Interpreting developments in OH practice Leadership skills – operational level Presentation skills Conflict management Coaching/mentoring Clinical management Resource management Leadership skills – strategic level Research skills Budget management

94 87 71 66 65 58 55 55 54 52 51 44

Table 66: Competence ranking by self-rated competence
Ranking Competence area % excellent

1 2 3 4 5= 5= 7 8 9 10 11 12

Communication with clients and OH colleagues Teamwork Presentation skills Leadership skills – operational level Interpreting developments in OH practice Coaching/mentoring Clinical supervision Resource management Leadership skills – strategic level Conflict management Research skills Budget management

81 71 45 44 33 33 31 27 25 23 23 17

94
Performance indicators and benchmarking in OH nursing Results and analysis

Results 5: OH performance indicators
Management–OH referral times
Respondents were asked to estimate the average time taken, in days, between a management referral and a worker being seen by an OH professional. Table 67 shows that across all sectors the mean referral time is 6.05 days (standard deviation, sd = 6.05). The mean delay was longest in the NHS (8.23 days) and shortest in the other private sector (4.51). The mean score for self-employed respondents was 4.15 days, but with only 11 respondents this figure needs to be interpreted with caution.

Table 67: Average referral time (days) between management referral and being seen by OH professional
Sector Mean Standard deviation Commercial OH provider Other private sector NHS Other public sector Self-employed All sectors

5.43 4.26

4.51 4.23

8.23 4.61

6.90 5.43

4.15 4.18

6.05 4.78

The spread of responses shown in figures 82 and 83 is also interesting. Nearly one-quarter (22%) of commercial OH providers claim that the average management–OH referral time is one to two working days; with the majority (59%) reporting that average referral times are no more than five days. The other private sector fares even better, with 73% of respondents reporting that average referral times are no more than five days. By contrast, just 6% of NHS referrals are achieved in one to two working days, and only 29% are seen within five days. The other public sector respondents report that 16% are seen within two days and 57% within five days.

Figure 82: Average referral time (days) between management referral and being seen by OH professional (all sectors)

35 30 25 20 Per cent 15 10 5 0 1 to 2 3 to 5 6 to 10 11 to 20 > 21 Don’t know

Average days to referral

95
Performance indicators and benchmarking in OH nursing Results and analysis

Figure 83: Average referral time (days) between management referral and being seen by OH professional (by sector)
45 40 35 30 25 Per cent 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed*

1 to 2 days

3 to 5 days

6 to 10 days

11 to 20

21+

Don't know

* Note – there were just 11 self-employed respondents

Fitness-for-work reports
Respondents were asked to estimate the length of time in days it takes to deliver a fitness-forwork report after the employee has been seen by the OH professional. The average (mean) response time across all sectors was 2.63 days (sd = 2.18); with the commercial OH providers (2.63 days) and other private sector (2.83 days) outperforming the NHS (3.53 days) and other public sector (2.99 days) (table 68). However, there is considerable variation within sectors, as indicated by the relatively large standard deviations. Figure 84 shows that most respondents report fairly rapid delivery of fitness-for-work reports (90% within five days). Although 88% of NHS respondents estimate that reports are generally delivered within five working days, figure 85 shows a shift towards slightly longer delivery times when compared with the other sectors. For example, 47% of NHS respondents say that reports take at least three days to be delivered. This compares with 30% in the commercial OH providers, 31% in other private sector, and 41% in the other public sector respondents.

Table 68: Average time (days) to deliver a fitness-for-work report
Sector Mean Standard deviation Commercial OH provider Other private sector NHS Other public sector Self-employed All sectors

2.63 2.18

2.83 2.74

3.53 3.61

2.99 2.65

3.45 4.16

3.00 2.91

96
Performance indicators and benchmarking in OH nursing Results and analysis

4 days (sd = 6.32) with slightly longer times recorded for the NHS and other public sectors (table 69). One-third of respondents (31%) were unable to answer this question. The mean response time was 13.Figure 84: Average time (days) to deliver a fitness-for-work report (all sectors) 70 60 50 40 Per cent 30 20 10 0 1 to 2 3 to 5 6 to 10 11 to 20 > 21 Don’t know Average days to referral Figure 85: Average time (days) to deliver a fitness-for-work report (by sector) 70 60 50 40 Per cent 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed* 1 to 2 days 3 to 5 days 6 to 10 days 11 to 20 21+ Don't know * Note – there were just 11 self-employed respondents Time taken to be seen by external specialist Respondents were asked to estimate the average time in days for an employee to be seen by an external specialist following a referral. 97 Performance indicators and benchmarking in OH nursing Results and analysis .

Table 69: Average time (days) to be seen by external specialist Sector Mean Standard deviation Commercial OH provider Other private sector NHS Other public sector Self-employed All sectors 11.44 6.87 5. Figure 86: Average time (days) to be seen by external specialist (all sectors) 35 30 25 20 Per cent 15 10 5 0 1 to 2 3 to 5 6 to 10 11 to 20 > 21 Don’t know Figure 87: Average time (days) to be seen by external specialist (by sector) 45 40 35 30 25 Per cent 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed* 1 to 2 days 3 to 5 days 6 to 10 days 11 to 20 21+ Don't know * Note – there were just 11 self-employed respondents 98 Performance indicators and benchmarking in OH nursing Results and analysis .23 15.96 16.15 13.50 4.47 14. Figure 87 shows a shift towards longer referral times in the other public sector (49% of respondents say average referral times are 11 days or longer).52 6.20 5. compared with the commercial OH providers (29% 11 days or longer).47 6.94 12. other private sector (40% 11 days or longer) and NHS (37% 11 days or longer).32 Figure 86 presents the spread of response times across all sectors.

NHS waiting lists and time taken by a private health consultant. As figure 88 shows. Figure 88: Main factors delaying referral for specialist health/medical assessment (all sectors) 70 60 50 40 Per cent 30 20 10 0 Occ physician Line manager Employee Employee’s GP NHS waiting list Private health consultant Note: respondents could tick more than one box 99 Performance indicators and benchmarking in OH nursing Results and analysis . They were asked to select any of the following possible factors: I signing off by occupational physician I signing off by line manager I lack of cooperation from employee I time taken by employee’s GP I NHS waiting list I time taken by private health consultant.Respondents were also asked to state the main factors that can delay referral for a specialist health or medical assessment. the three main factors were the time taken by the employee’s GP. Respondents from the NHS were particularly frustrated by the delay caused by NHS waiting lists (81% of NHS respondents selected this option) (figure 89).

All 113 NHS respondents reported that PEP is available.00 am to 5. 6% three to six hours.30 pm) (figure 91).) 100 Performance indicators and benchmarking in OH nursing Results and analysis . but this concerns administration of the PEP drugs. not whether or not the individual receives secondary OH care. The spread of responses from NHS respondents (38% less than one hour. either through the OH department (46% provide this service) or through an accident and emergency (A&E) or other department (75%) – some respondents say PEP is provided both by the OH department and through A&E (figure 90). Figure 92 shows the time taken between a reported needlestick injury and the worker being seen by the OH professional (NHS only).Figure 89: Main factors delaying referral for specialist health/medical assessment (by sector) 90 80 70 60 50 Per cent 40 30 20 10 0 Commercial OH provider Other private sector NHS Other public sector Self employed Occ physician Line manager Employee GP NHS list Private consultant Note: respondents could tick more than one box Provision of post-exposure prophylaxis Respondents who work with either the healthcare sector or emergency services were asked to provide information on the provision of post-exposure prophylaxis (PEP) following a needlestick injury. 13% not known) reflects the fact that where PEP is provided by A&E the employee will not be seen immediately by the OH professional – the vast majority of cases are seen by the OH department within a relatively short time. The vast majority (94%) of NHS respondents say that PEP is available outside normal hours (8. 14% seven to 24 hours and 4% more than 24 hours. 25% one to two hours. (Department of Health guidelines recommend that PEP is give within one hour of a needlestick injury.

22 other public sector. 27% state that PEP is available through the OH department. Figure 90: Provision of post-exposure prophylaxis (respondents working with the NHS and emergency services only) 80 70 60 50 Per cent 40 30 20 10 0 NHS Other public sector Commercial OH provider Other private sector Through OH dept A&E or other provider No provision Note: respondents could select more than one option n = 113 NHS. 20 OH provider. 46 other private sector 101 Performance indicators and benchmarking in OH nursing Results and analysis .Figures 90 and 91 also include responses from the other sectors. the comparatively large number of responses from the sector suggests that some practitioners were answering this question from beyond the target healthcare or emergency services. 68% through A&E and 14% have no provision. Of the 22 responses from the other public sector (which would include emergency services). Although some respondents from the other private sector will be working in healthcare.30 pm to 8. 46 other private sector Figure 91: Out-of-hours provision of PEP (5. 20 OH provider.00 am) 100 90 80 70 60 Per cent 50 40 30 20 10 0 NHS Other public sector Commercial OH provider Other private sector Yes No Don't know n = 113 NHS. More than two-thirds (68%) say that PEP is available out of hours – unsurprising given that this matches the number saying that provision was via A&E departments. 22 other public sector.

Figure 92: Time taken between needlestick injury and worker being seen by OH professional (NHS only) 40 35 30 25 Per cent 20 15 10 5 0 <1 1 to 2 3 to 6 7 to 24 >24 Don’t know Average time in hours 102 Performance indicators and benchmarking in OH nursing Results and analysis .

103 Performance indicators and benchmarking in OH nursing Results and analysis . support or negligible role in the development and/or delivery of that policy. if so.Results 6: Role in OH policies and policy development Respondents were asked to state whether or not their organisation had a policy covering various areas of OH practice and. whether they had a lead. OH nurses are more likely to have a support role (64%) in this area than lead role (19%) (figure 94). Medical confidentiality Just 6% of respondents report that their organisation does not have a policy on medical confidentiality and health data security (figure 93). However. Figure 93: Medical confidentiality and health data security policy 45 40 35 30 25 Per cent 20 15 10 5 0 Lead Support None/negligible No policy Don’t know Attendance Most organisations have a sickness absence policy (just 2% do not). Nearly half (43%) of practitioners have a lead role in developing and/or delivering this policy and 36% a support role.

Figure 94: Sickness absence policy 70 60 50 40 Per cent 30 20 10 0 Lead Support None/negligible No policy Don’t know n = 473 Disability There is a very similar situation concerning OH nurses role in the organisation’s disability policy. Figure 95: Disability policy 70 60 50 40 Per cent 30 20 10 0 Lead Support None/negligible No policy Don’t know n = 473 104 Performance indicators and benchmarking in OH nursing Results and analysis . with 63% having a support role and 17% a lead role (figure 95).

Just 6% of organisations do not have a stress policy. half (50%) have a support role and just 14% no or negligible role (figure 97). Figure 97: Stress policy 50 45 40 35 30 Per cent 25 20 15 10 5 0 Lead Support None/negligible No policy Don’t know n = 473 105 Performance indicators and benchmarking in OH nursing Results and analysis . Two-thirds of respondents (62%) have a support role.Bullying and harassment Most respondents’ organisations have a policy on bullying and harassment (4% have no policy). Figure 96: Bullying and harassment policy 70 60 50 40 Per cent 30 20 10 0 Lead Support None/negligible No policy Don’t know n = 473 Stress A larger proportion of OH nurses (29%) have a lead role in developing and/or delivering a stress policy. 5% a lead role and 28% no/negligible role (figure 96).

12% a lead role and 27% no or negligible role (figure 100). more than one-quarter (26%) have no or negligible role and just 15% a lead role. with 58% having a support role. Figure 100: Health and safety policy 70 60 50 40 Per cent 30 20 10 0 Lead Support None/negligible No policy Don’t know n = 473 106 Performance indicators and benchmarking in OH nursing Results and analysis . However.Manual handling More than half (54%) of OH nurses have a support role in developing/delivering the manual handling policy. A similar picture emerges for the development/delivery of the policy on the reportable injuries. Figure 98: Manual handling policy 60 50 40 Per cent 30 20 10 0 Lead Support None/negligible No policy Don’t know n = 473 Health and safety and the reporting of injury and illness data Two-thirds (67%) of respondents have a support role in the development and/or delivery of the health and safety policy – 19% have no or negligible role and 11% a lead role (figure 99). diseases and dangerous occurrences (RIDDOR).

Figure 100: RIDDOR policy 60 50 40 Per cent 30 20 10 0 Lead Support None/negligible No policy Don’t know n = 473 Bloodborne viruses Most organisations have a policy on bloodborne viruses (12% do not). Figure 101: Bloodborne virus policy 40 35 30 25 Per cent 20 15 10 5 0 Lead Support None/negligible No policy Don’t know n = 473 107 Performance indicators and benchmarking in OH nursing Results and analysis . More OH nurses have a lead role (37%) than have a support role (30%) in developing and/or delivering the policy (figure 101).

Substance misuse Most organisations have a policy on substance abuse (8% do not). Half (50%) of OH nurses have a support role in this area. Figure 102: Substance misuse policy 50 45 40 35 30 Per cent 25 20 15 10 5 0 Lead Support None/negligible No policy Don’t know n = 473 108 Performance indicators and benchmarking in OH nursing Results and analysis . with 22% having a lead role and 18% no role.

The ratings for 10 generic performance indicators are shown in tables 70 to 79. 36% of other public sector respondents describe legal support as unsatisfactory. 27% unsatisfactory). The other public and other private sectors were marginally ahead on scores for opportunities for professional development (41% and 42% respectively said it was excellent) compared with the NHS and commercial OH providers (34% and 33%). -1 = unsatisfactory. 32% unsatisfactory). These calculations give a general idea of whether OH nurses rate the performance higher (positive mean scores) or lower (negative scores). for example. 27% unsatisfactory) and clinical supervision (66% excellent or satisfactory. And just 11% of the public sector respondents described clinical supervision as excellent (all-sector mean = 18%). with 21% of the other private sector. There are few meaningful differences between sectors. Similarly. 109 Performance indicators and benchmarking in OH nursing Results and analysis . The lowest scores are for strategic planning (62% excellent or satisfactory. with separate scores given for all respondents and by sector. 36% unsatisfactory) and opportunities for trainee OH nurses/interns (55% excellent or satisfactory. NHS respondents reported better opportunities for trainee nurses. 9% as unsatisfactory). evidence-based practice (88% excellent or satisfactory. compared with 31% to 37% in the other sectors. which have been grouped according to the mean overall performance ratings. 7% unsatisfactory). 0 = satisfactory. Half (50%) of the public sector respondents describe service delivery auditing as unsatisfactory. The all-sector responses are shown in figures 103–105.Results 7: Clinical governance Respondents were asked to rate various areas of OH nursing practice within their organisation as excellent. 20% unsatisfactory) (figure 103). A slightly higher percentage (35%) of respondents from the public sector described peer support and mentoring as unsatisfactory. A limited number of additional cross analyses were made. Nurses tend to rate their organisations’ OH nursing practice highly on access to occupational physicians (90% of respondents rate the performance as excellent or satisfactory. ethics (91% excellent or satisfactory. compared. The ratings are not quite so good for peer support and mentoring (70% excellent or satisfactory. satisfactory or unsatisfactory. 32% unsatisfactory) (figure 104). 10% unsatisfactory) and opportunities for professional development (79% excellent or satisfactory. Tables 70–79 also show the mean scores and standard deviations according to the arbitrary rating: +1 = excellent. 42% unsatisfactory) (figure 105). compared with 27% for the overall mean. compared with the other sectors (table 79). service delivery auditing (62% excellent or satisfactory. though other public sector respondents tend to mark their practice down compared with the overall response (tables 70–79). legal support (71% excellent or satisfactory. just 11% of public sector respondents describe this aspect of their practice as excellent (all-sector average = 21%).

The data was analysed according to whether or not the respondent was working alone or as part of an OH team (tables 83–92). There are surprisingly few differences in the overall responses on clinical governance.69 59 32 8 0 0.51 0.65 64 27 9 1 0. 46% v 33% unsatisfactory). Rating of clinical governance by sector Table 70: Access to occupational physician (% responses and mean ratings*) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating* Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 56 34 9 1 0.51 0. the scores are only marginally lower for lone workers (35% v 40% excellent. peer support/mentoring (table 82). Of the 107 lone practitioners answering the question. but not statistically significant. but again not significantly different. however. Lone workers record slightly lower scores for service delivery auditing (19% v 18% excellent. A higher percentage of lone worker respondents (33%) report that peer support and mentoring is unsatisfactory compared with those working as part of an OH team (23% unsatisfactory).48 0. 35% v 48% satisfactory.40 0. The largest difference of note concerns opportunities for trainee OH nurses and interns.65 57 35 7 1 0. compared with 34% of responses from those working as part of a team.65 27 45 18 9 0. 46% v 39% satisfactory). access to occupational physician (table 81). negative scores indicate poor performance overall 110 Performance indicators and benchmarking in OH nursing Results and analysis . 57% say that opportunities are unsatisfactory.74 * Note: positive mean scores indicate relatively good performance overall.62 50 36 11 2 0.Working across more than one workplace had no significant impact on the level of clinical supervision (table 80). Even when looking at lower opportunities for professional development.56 0.10 0. around half (47%) of both groups report being satisfied in this context.

02 0.71 111 Performance indicators and benchmarking in OH nursing Results and analysis .62 44 43 12 2 0.77 45 27 18 9 0.38 0.70 34 58 6 1 0.02 0.15 0.75 33 45 21 1 0.19 0.40 0.57 45 36 9 9 0.70 Table 72: Evidence-based practice (% responses and mean ratings) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 35 53 10 1 0.59 36 57 5 1 0.82 Table 74: Peer support/mentoring (% responses and mean ratings) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 25 45 27 3 -0.04 0.34 0.28 0.76 24 47 28 2 -0.10 0.32 0.Table 71: Ethics (% responses and mean ratings) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 41 50 7 2 0.33 0.70 Table 73: Opportunities for professional development (% responses and mean ratings) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 38 41 20 1 0.24 0.74 18 45 18 18 0 0.76 41 38 22 0 0.74 20 43 35 1 -0.73 29 43 27 2 0.59 38 52 6 4 0.30 0.26 0.57 35 52 11 2 0.65 32 53 15 0 0.73 42 40 16 2 0.25 0.40 0.72 29 45 24 2 0.18 0.18 0.63 41 43 14 2 0.12 0.68 43 50 6 1 0.28 0.72 34 40 24 2 0.05 0.33 0.67 45 36 9 9 0.

Table 75: Legal support (% responses and mean ratings) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 20 51 27 2 -0.68 15 50 31 4 -0.66 14 47 37 2 -0.68 12 49 39 0 -0.10 0.17 0.17 0.17 0.69 18 44 36 2 -0.75 27 45 18 9 0.67 27 55 9 9 0.08 0.72 17 55 25 3 -0.10 0.67 22 42 36 0 -0.20 0.71 19 49 27 4 -0.73 11 49 38 3 -0.68 18 46 35 1 -0.27 0.24 0.15 0.53 Table 77: Strategic planning (% responses and mean ratings) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 16 50 32 2 -0.69 19 51 29 1 -0.18 0.18 0.63 112 Performance indicators and benchmarking in OH nursing Results and analysis .15 0.02 0.56 0.69 23 53 21 2 0.74 Table 76: Clinical supervision (% responses and mean ratings) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 18 48 32 3 -0.28 0.08 0.70 18 47 33 2 -0.65 45 36 0 18 -0.14 0.

70 17 48 32 3 -0.01 0.33 0.16 0.18 0.74 22 27 49 3 -0.36 0.23 0. negative scores indicate poor performance overall 113 Performance indicators and benchmarking in OH nursing Results and analysis .73 27 44 26 3 0.12 0.73 27 27 36 9 -0.70 * Note: positive mean scores indicate relatively good performance overall.72 21 46 32 1 -0.77 18 32 45 5 -0.28 0.28 0.20 0.10 0.72 15 34 50 1 -0.81 9 36 36 18 -0.71 Rating of clinical governance – impact of working across more than one workplace Table 80: Clinical supervision – effect of working across more than one workplace Responsible for more than one workplace % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating* Standard deviation Responsible for one workplace % 18 48 31 3 -0.35 0.Table 78: Service delivery auditing (% responses and mean ratings) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 18 44 36 1 -0.88 Table 79: Opportunities for trainee OH nurses (% responses and mean ratings) Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 20 35 42 4 -0.13 0.11 0.73 19 49 31 1 -0.70 18 43 37 2 -0.77 15 34 48 4 -0.

Table 81: Access to occupational physician – effect of working across more than one workplace Responsible for more than one workplace % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Responsible for one workplace % 58 34 8 1 0.50 0.72 114 Performance indicators and benchmarking in OH nursing Results and analysis .09 0.64 54 34 11 1 0.69 Table 82: Peer support/mentoring – effect of working across more than one workplace Responsible for more than one workplace % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Responsible for one workplace % 27 45 26 2 0.74 21 46 29 3 -0.02 0.43 0.

16 0.64 * Note: positive mean scores indicate relatively good performance overall. negative scores indicate poor performance overall 115 Performance indicators and benchmarking in OH nursing Results and analysis .68 16 50 32 1 -0.68 18 49 31 2 -0.22 0.70 Table 85: Strategic planning Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating* Standard deviation Part of a team % 15 50 34 1 -0.19 0. negative scores indicate poor performance overall Table 84: Clinical supervision Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Part of a team % 15 50 31 5 -0.Clinical governance – Impact of working alone or as part of a team Table 83: Evidence-based practice Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating* Standard deviation Part of a team % 40 54 5 1 0.36 0.57 34 53 12 1 0.17 0.68 * Note: positive mean scores indicate relatively good performance overall.13 0.

64 Table 88: Opportunities for professional development Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Part of a team % 35 46 20 0 0.37 0.15 0.76 18 48 33 1 -0.62 41 50 7 2 0.35 0.66 59 32 8 1 0.27 0.72 40 39 21 1 0.15 0.Table 86: Ethics Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Part of a team % 45 48 7 0 0.19 0.50 0.52 0.61 Table 87: Access to occupational physician Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Part of a team % 60 31 9 0 0.76 Table 89: Service delivery auditing Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Part of a team % 19 35 46 1 -0.70 116 Performance indicators and benchmarking in OH nursing Results and analysis .

70 29 47 23 1 0.08 0.78 117 Performance indicators and benchmarking in OH nursing Results and analysis .56 0.07 0.07 0.Table 90: Peer support and mentoring Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Part of a team % 17 47 33 4 -0.72 20 51 27 2 -0.17 0.07 0.72 Table 91: Legal support Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Part of a team % 22 49 29 0 -0.61 27 38 34 2 0.69 Table 92: Opportunities for trainee nurses/interns Lone worker % Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Not stated Mean rating Standard deviation Part of a team % 6 30 57 7 -0.

Figure 103: Clinical governance in OH nursing practice I – good performers 60 50 40 Per cent 30 20 10 0 Access to occupational physician Ethics Evidence-based Professional development Excellent Satisfactory Unsatisfactory Figure 104: Clinical governance in OH nursing practice II – mixed performers 60 50 40 Per cent 30 20 10 0 Peer support Legal support Clinical supervision Excellent Satisfactory Unsatisfactory 118 Performance indicators and benchmarking in OH nursing Results and analysis .

compared. for example. Nearly half (45%) of self-employed OH nurses have no access to OH support. Figure 106 shows the all-sector response. Figure 106: OH support for OH team (all sectors) No provision In-house Independent provider In-house provision Independent provider No provision 42% 27% 31% 119 Performance indicators and benchmarking in OH nursing Results and analysis .Figure 105: Clinical governance in OH nursing practice III – poor performers 50 45 40 35 30 Per cent 25 20 15 10 5 0 Strategic planning Service auditing Opportunities for trainee nurses Excellent Satisfactory Unsatisfactory Occupational health support for the OH team Respondents were asked to state who provides OH support for the members of the OH team: in-house. NHS respondents were least likely to report that they did not have access to OH provision – 20% said there was no provision. or no provision. with almost a third (31%) having no provision and only 27% having independent OH support. Nearly half (47%) of NHS respondents report that they rely on in-house OH provision for their own OH support. Two-fifths (42%) of respondents rely on the in-house OH team for their OH support. with 35% of commercial OH providers and 36% in the other private sector. independent OH provider. though 36% use an independent provider.

such as the sector that the practitioner works in. (Care must be taken when interpreting data that could be confounded by other factors. 46% said that they did not have access to OH support for themselves.Figure 107: OH support for OH team (by sector) 50 45 40 35 30 Per cent 25 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed 7 In-house Independent provider No provision Not stated n = 473 Of the 107 sole OH practitioners answering the question. This compares with just 21% of practitioners working as part of an OH team.) Figure 108: OH support by sole practitioner or part of OH team 50 45 40 35 30 Per cent 25 20 15 10 5 0 Lone practititioner Part of OH team In-house Independent provider No provision Not stated 120 Performance indicators and benchmarking in OH nursing Results and analysis .

0 = satisfactory.Competence of occupational medicine Respondents were asked to rate the general level of occupational medicine competence that they have access to: excellent. Table 83 also shows the mean scores and standard deviations according to the arbitrary rating: +1 = satisfactory. were found across all sectors. There is little variation between sectors (figure 109). -1 = unsatisfactory. unsatisfactory or non-existent. Figure 109: Occupational medicine competence (all sectors) 50 45 40 35 30 Per cent 25 20 15 10 5 0 Excellent Satisfactory Unsatisfactory Non-existent Figure 110: Occupational medicine competence (by sector) 50 45 40 35 30 Per cent 25 20 15 10 5 0 Commercial OH provider Other private sector NHS Other public sector Self employed Excellent Satisfactory Unsatisfactory Non existent n = 469. Positive mean scores. four respondents did not answer the question 121 Performance indicators and benchmarking in OH nursing Results and analysis . The vast majority (96%) of respondents report that they have access to occupational medicine (figure 108). A large majority of respondents (87%) rate the occupational medicine competence as either excellent (46%) or satisfactory (41%). satisfactory. suggesting a generally high rating.

38 0.67 45 43 7 5 0 0.40 0.65 47 43 7 3 0 0.42 0.63 50 37 10 2 1 0.62 45 36 9 9 0 0.67 44 44 11 0 2 0.41 0.Table 93: Rating of occupational medicine competence Sector Excellent (+1) Satisfactory (0) Unsatisfactory (-1) Non-existent Don’t know Mean rating* Standard deviation All sectors Commercial OH provider Other private sector NHS Other public sector Self-employed 46 41 9 3 1 0.33 0. negative scores indicate poor performance overall 122 Performance indicators and benchmarking in OH nursing Results and analysis .40 0.70 * Note: positive mean scores indicate relatively good performance overall.

NHS Other comments included ‘appropriate updating of skills’. by far the most common theme was that of ‘communication and listening’. competence and diplomacy’. The full list of responses is given in table 94. private sector One respondent explained the reasoning behind knowledge as the most essential competency: ‘Knowledge – such a diversity of illnesses and individual needs. commercial OH provider Another nurse explained the importance of interpersonal skills: ‘Interpersonal and influencing skills. and ‘tact. knowledge. indicated by 47 respondents.Results 8: Core competences The final item on the survey questionnaire invited respondents to give an open response to the question: What do you think is the most important competency of an OH nurse. mentioned by 129 respondents (33% of the total). The importance of communication was exemplified in some of the specific comments: ‘Excellent communication skills – ability to communicate at all levels and make good use of the pivotal role of an OH nurse’ – OH adviser. NHS ‘Effective communication skills to enable the OH adviser to communicate effectively with the customer and the OH organisation in order to deliver a professional standard of service’ – regional OH adviser. This was followed by ‘interpersonal skills’. which is perhaps another way of describing the same attribute. Understanding the impact of these on a person’s capabilities’ – OH nurse adviser. and why? Of the 394 responses. 123 Performance indicators and benchmarking in OH nursing Results and analysis . ‘hands-on experience’. Technical skills will only be applied if you can get heard!’ – group OH and safety manager. ‘common sense’.

Table 94. OH nurses’ perception of the single most important OH nurse competency (unprompted responses) Communication and listening Interpersonal skills Knowledge and education Confidentiality Flexibility and adaptability Legislation awareness Leadership. self-motivation and proactive working Knowing own limitations Teamwork Evidence-based practice n = 394 129 47 41 40 38 21 21 18 13 9 124 Performance indicators and benchmarking in OH nursing Results and analysis .

Turning to the survey findings. ‘Let’s have a stepwise approach so someone can come in [to OH] with basic state registration. discussion focused on three themes: qualifications and education. OH education and qualifications The focus group considered the question: should there be a minimum level of qualification in order to practice as an OH nurse? If so. Another delegate said that it wasn’t always easy for nurses to become qualified in occupational health. He cautioned against what he saw as an exclusive focus on degree-level qualifications and called for more training courses at all levels. 125 Performance indicators and benchmarking in OH nursing Results and analysis . At least a diploma having 11 competences gives them confidence and I hope that it will inspire them to go on and do further study afterwards – and that’s what education should be about. but what I want to do is give them the confidence … Some of them would be terrified doing a degree. manpower. particularly when nurses are funding their own training. and perceptions of service delivery. We can all aim for the degree but let’s not inhibit people trying to get on through a different route. ‘I think we are getting bogged down in certificates.Results 9: Focus group Around 50 delegates at the RCN/SOHN annual conference took part in a focus group discussion of the survey results.’ Another delegate agreed that the profession was moving too quickly towards a degree-only approach.’ she said. this should not be the only approach.’ she said. with a number of nurses commenting that they found difficulty in completing certain items of the questionnaire because of their responsibility to more than one organisation. how could this be achieved? One delegate said that the requirement to be fully OH-qualified would depend on the nature of the work – and depended particularly on whether or not the OH nurse in question had access to other OH expertise. This was echoed by a delegate who called for greater focus on vocational training. ‘I’m a programme organiser at a university and if [the students] go on to do a degree and an MSc that’s fantastic.’ Another delegate complained that too many jobs demanded an OH degree and that this discriminated against some of the older nurses in the profession who did not come through this academic route. ‘Do I need – or want – to be taking on another level of study?’ she asked. While she wanted to encourage more nurses to take degrees. ‘It depends on whether you are working in isolation or whether you are working as part of a larger team where you have access to other qualified nurses. We need to look at the core competences to see what we would expect of an occupational health nurse. There was some debate on the survey itself. diplomas and degrees. do certain courses to move up to certificate or diploma status.

Manpower: is there an ideal ratio between the number of OH nurses and the number of employees in an organisation? While there was some agreement that broad recommendations could be made on manpower. The survey findings highlight the limited number of training posts currently available in OH nursing. We do a lot of driver medicals. there was near unanimous agreement that all physicians working in an OH capacity should be OH-qualified or at least in training. where there are some interventions which are not so time-consuming.’ said one delegate. however. It was pointed out. One urged employers to create more training posts. It may reflect what our interventions are in those particular industries. It would. ‘I actually think it is unfair that service providers don’t offer more training posts. but these may be deliverable by different professionals. Coming from the NHS we do a lot of benchmarking in terms of vaccination. any recommendation on service provision needed to reflect more than total employee numbers. also need to take account of the risk levels within particular industries and the types of OH interventions appropriate for that industry. ‘If I want to be a midwife I have to train to be a midwife.’ she said. However. If I want to be a health visitor I have to train to be a health visitor.’ Another delegate suggested that you could not stipulate how many OH nurses were required in a given size of organisation because so much OH work was done by multidisciplinary teams. a delegate from one of the national OH providers disagreed: ‘At any one time we have a lot of people training and will continue to do so. Even though there was a range of opinions on whether or not OH nurses needed to have special OH qualifications. while another called for greater commitment to training from the big OH service providers. depending on what it is you are expecting them to do. They shouldn’t be working outside their competence but there are things that you can have a non-OH qualified doctor doing. were concerned that there was nothing to stop a registered nurse working in occupational health. This point was taken up by a number of delegates. that there simply are not enough OH physicians to meet demand and one delegate said that nonOH physicians could continue to fill certain functions. with no specific OH qualifications. ‘You have to look very carefully at what the whole service is 126 Performance indicators and benchmarking in OH nursing Results and analysis . for example. whereas other organisations may be equally risky. but in a different way. An OH service needs to look at what levels of service are required. however. and that this portrayed the profession in a bad light. we don’t need an OH physician to be doing driver medicals.Others. which is very labour-intensive.’ she said. she said. ‘There is a role for the non-OH qualified doctor.’ she said. But without any qualifications I can go and work in occupational health and call myself an occupational health adviser and that sends out a very weak message. One delegate commented: ‘We might be able to come up with something on an industry basis but it is not necessarily about risk.

Even if it were possible to say how many nurses were required to deliver quality services. because people will work in multi-disciplinary ways and they might at times work outwith a traditional occupational health nurse definition. and essential or desirable. ‘What we haven’t done is marketing occupational health services and measuring their impact. respondents were asked to assess aspects of service delivery and OH nursing competences using subjective terms such as satisfactory or excellent. Most felt that the subjective terminology was helpful in setting goals for improving service delivery.’ he said.required to deliver.’ OH nurses need to be careful not to be over-territorial about their work. There’s just not enough people trained to the right level. 127 Performance indicators and benchmarking in OH nursing Results and analysis . We are going to end up being perceived as not cost-effective in terms of service provision. perceptions may differ depending on one’s perspective – as an OH professional or as a customer or employer. The discussion also raised wider issues of OH service provision in general. But did others outside the profession agree? According to one delegate: ‘If we aim for excellent and our customers’ expectations are only for satisfactory we are going to be delivering beyond the needs of our customers. would there be enough competent nurses to meet demand? According to one delegate: ‘There is not enough resource in Scotland to meet minimum numbers and that’s an issue for OH education.’ The balance between what ‘customers’ expect from the OH service and what OH practitioners perceive as essential In completing the questionnaires.’ But more could be done to bridge this gap. and also for the [professional] organisations. If indeed that is the right definition. Although delegates were confident that they had an inherent understanding of such terms in respect of their own work and skills.

DISCUSSION Occupational health nurses practice in a wide range of situations. and a 24% response rate. However. 128 Performance indicators and benchmarking in OH nursing Discussion . the data represents a valuable cross-section of opinion. it must be acknowledged that this phenomenon creates some uncertainty in the findings where respondents were asked to quantify or rate the available OH nursing services in their particular area of work. to members of large multidisciplinary teams in the NHS. educators and policymakers can consider when deciding how to address gaps in OH nursing provision. The experiences of OH nurses are inevitably diverse and this research has shed light on the different situations and challenges faced by nurses. The research is based on responses to a mailed questionnaire – with no telephone follow-up – and no account has been taken for self-selection bias. for the first time. Overall. the different roles OH nurses have in delivering those services and nurses’ own perception of their competence in performing the functions required of them. The focus group discussion raised issues concerning the need for OH nurses – and physicians – to be appropriately qualified and how best to deliver OH nurse education. taken en masse the data provide a strong body of evidence as to the gaps in provision. however. Others are self-employed and contract their services to several client organisations. the perceived lack of training opportunities for nurses new to the field. The research identifies other wider issues. major companies and commercial OH providers. variable referral-response times and areas where the general level of OH nurse competences might be improved. of the levels of OH services provided by organisations across all employment sectors. how their practice differs between sectors. such as the inconsistent level of OH provision for OH nurses themselves. Although good data were revealed on the number of nurses working in more than one place of work. the research provides a detailed picture of the work of OH nurses in the UK. from single practitioners working in isolation for medium-sized private sector businesses. with nearly 500 replies across all employment sectors. and evidence that OH providers. It also provides a comprehensive insight. It must also be borne in mind that many of the findings represent the subjective views of respondents. the value placed on those services by the OH nurses themselves. The questionnaire did not accommodate nurses who may have wished to comment differently for different organisations.

but are also viewed as competent to deal with health screening and the treatment of injuries. 2004). including the development of a quality framework for occupational health. They are considered approachable and accessible. and perceptions of their role can appear anachronistic. OH nurses are often the first point of contact for many users of OH services.LITERATURE REVIEW Aims and objectives The literature review aims to support the research project being undertaken by the At Work Partnership for the RCN covering the development of core and specialist competences for occupational health nurses. and cheaper than physicians. psychosocial services and OH clinical governance. But nurses are not considered to be familiar with employers’ needs and have a lower status than other professionals. and I customer needs and priorities: studies examining the service priorities of the main stakeholders in an OH service. and OH nurses are perceived to have a more caring than diagnostic role (O’Hara et al. I the provision and delivery of occupational health (OH) services: published research and policy papers covering employees’ access to the range of OH support services. OH nurses are the most frequently used professionals. preventative measures. absence. Employers and employees are more familiar with the role of the OH nurses than the occupational physician. The role and required competences of OH nurses International work to scope and define occupational health covers the role and required competences of occupational health nurses (OH nurses). physical intervention services. including assessment and monitoring. before physicians and GPs. disability and rehabilitation management. 129 Performance indicators and benchmarking in OH nursing Literature review . Employers see an overlap between the two roles of nurse and doctor and believe there is a need to differentiate them more clearly. It seeks to review material published by accredited researchers. focusing on employers and employees. academics and official bodies in three main areas: I the role and competences of occupational health professionals: published research and multi-government and agency policy papers covering the competences and learning outcomes for OH physicians and nurses. so there is also scope for their value to be undermined. They are seen by users as sources of comfort and sympathy.

including those of clinician. adapting current practices and developing new approaches to problems. such as a family doctor or OH physician. 130 Performance indicators and benchmarking in OH nursing Literature review . and their knowledge and experience of the working environment. responsible and accountable for their own professional practice. related and complimentary roles in the workplace. Their roles also vary with the needs of the employing organisation. the health of workers’ spouses). These form part of the document on the role of the OH nurse. emergency care: the OH nurse is a registered nurse with clinical experience and may provide initial emergency care in cases of workplace accidents. a move away from the OH nurse acting as a doctor’s assistant towards a position where s/he works as an independent. systems of work. OH nurses are often on site and accessible – providing opportunities for early intervention. attend or be productive. but could affect the worker’s ability to concentrate. the broad thrust of developments in recent years is the same – that is. and with the ability of the organisation to use the full range of expertise possessed by the OH nurses. Although roles differ between EU countries. with the expectations of management. This is likely to be a large part of the job in sectors/areas that are remote from emergency services (for example. autonomous professional. (The WHO has produced guidance on how to determine the function of an OH nurse in an individual organisation. which can act as a catalyst for changes in the workplace.Role of the OH nurses The most detailed attempt to describe the role of OH nurses in workplace health management was undertaken by the WHO regional office for Europe in 2001 (Whitaker and Baranski.) OH nursing practice is not static but is based on a core range of skills according to the different roles being performed: Clinician: primary prevention: including formulating plans to modify working environments. Drawing up core activities and tasks is not easy – OH nurses are constantly learning new skills. The OH nurse is a unique ‘front liner’ and gets approached for help and advice on a range of issues that extend beyond traditional work health and safety ones (for example. or where hazardous conditions exist at work. or change working practices in order to reduce the risk of hazardous exposure. counsellor and researcher. OH nurses can present these concerns to management in an objective. Because of their proximity to workers. OH nurses are in a good position to identify early changes in working practices. OH nurses fulfil several. and to identify workers’ concerns over OH. 2001)). oil rigs). adviser. health educator. specialist. independent way. These may be beyond an employer’s duty of care. treatment services: often in conjunction with other primary care workers. including the need to identify goals for the service and matching resources to achieving these goals. coordinator. manager.

pre-employment or pre-placement examinations. and to coordinate the examination of working practices in order to protect others potentially exposed to similar risks. The OH nurse should know when to refer to an OH physician or other specialist. including young men and ethnic workers. OH nurses can 131 Performance indicators and benchmarking in OH nursing Literature review . in a return-to-work plan. They are also in a good position to provide health information to hard-to-reach groups. they can assess the needs of individuals and groups and can analyse. advising managers on preventing absence. They can offer advice on a range of issues not directly caused by work. interpret. individual and group care plans: for example. devise the rehabilitation programme. Collaboration with physicians may be necessary depending on law and accepted practice. but the potential to perform this role will depend on the level of OH nurse education. and is in a good position to monitor return to work. the OH doctor and line manager). Specialist: OH policy and practice development. general health advice and health assessment: OH nurses can give advice on a wide range of health issues and on their relationship to working ability. and nurses have the skills to apply the approach in the population they serve. rehabilitation: the OH nurse is often the key person in a return-to-work plan. health surveillance: where there is residual risk and surveillance is legally required. the OH nurse can (with the patient’s consent) liase with primary healthcare providers to ensure a comprehensive approach is maintained. the employee. It is a health-based model rather than one based on disease. but which can affect performance at work. skills and experience. developing referral procedures. but this does require a high degree of clinical skill. sickness absence management: training line managers and supervisors. For example. ensuring that medical confidentiality is protected. implementation and evaluation: the OH nurse is in a good position to advise management on the development of policy. OH assessment: fitness for work. monitor progress and communicate with the parties involved (for example. and can complete a risk assessment. the OH nurse will be involved in undertaking and evaluating the results of screening. and research: OH nurses will be able to use research to support their work in fostering the general health of the working population.nursing diagnosis: this is a holistic concept that considers the whole person and their healthcare needs in the broadest sense. and individual health assessments for lifestyle risk factors. plan and implement strategies to achieve specific goals.

coordinating the work of other health professionals and acting as the budget holder for the department. monitoring expenditure. budget planning: OH nurses may be involved in securing resources and managing the financial assets of the department. maintenance of work ability: health advice or planned programmes of work hardening to maintain or restore ability to work. research: OH nurses use findings from a wide range of disciplines and need to have the skills to read and critically assess research findings from these different disciplines and to incorporate findings into an evidence-based approach to their practice. administration: maintaining medical and nursing records. Protecting the confidentiality of workers’ health data and the privacy of workers is key. hazard identification: new hazards may emerge out of new processes or working practices. health and safety: the OH nurse’s experience in risk assessment. staffing levels and skills mix.also develop proactive rehabilitation programmes to detect early changes in health before the onset of long-term absence. OH nurses need to undertake regular workplace visits in order to maintain an up-todate knowledge and awareness of working processes. advice on control strategies: OH nurses can provide advice and information on controlling the risks identified in risk assessments. and OH nurses are in a good position to advise management on mental health at work strategies. these will involve psychosocial issues. and in evaluating the delivery of OH services. Increasingly. S/he needs to have the skills to sit alongside other line managers within the organisation. and OH nurses are likely to become quickly aware of these because they have close contact with workers. risk assessment: this technique underpins much health and safety legislation in the UK. Manager: management: an OH nurse may manage an OH unit. for which they need research skills. 132 Performance indicators and benchmarking in OH nursing Literature review . and ethics: OH nurses are trusted professionals. and OH nurses can play a part in this process. and this enables them to practice more effectively. surveillance and environmental health management can be used by health and safety specialists in developing an organisation’s health and safety practices. OH nurses may also be involved in producing management reports for employers on accident and absence trends.

using communication. and as a conduit to other external health or social agencies: for example. and continuing professional development: the nurse manager is in a good position to identify their own and the team’s professional development needs and to ensure that these are met to maintain the competences of professional staff. service level agreements: OH nurses may be involved in setting up these within an organisation. particularly in the absence of other specialists. OH nurses will still need to ‘sell’ the benefits of OH internally to line managers and senior level people. Coordinator: OH team: in many cases. Health educator: OH nurses can assess needs for health promotion. and deliver health promotion strategies.marketing: even in units that do not sell services externally. encouraging workers to seek help from GPs and specialist support services. 133 Performance indicators and benchmarking in OH nursing Literature review . and to show them how best to use the service. for use with internal and external clients. quality assurance: OH nurses can contribute to continuous quality improvements. the OH nurse is the only permanent member of the team and is in a unique position to shape and direct the OH programme. involvement. or in wider clinical auditing where all the clinical team participate in multidisciplinary audit. Adviser: to management and staff on workplace health management: for example. consult with management and workers. making presentations to health and safety committees. management and organisational skills. and in monitoring the delivery of services against predetermined levels. worker education and training: the OH nurse should be involved in informing and educating workers in how to protect themselves from occupational hazards and to raise awareness of nonoccupational but preventable diseases. develop and plan programmes. professional audit: OH nurses will be involved in auditing the nursing practices within the department. and environmental health management: OH nurses can advise management on basic environmental policy. planning.

reviewing available evidence (including guidelines and protocols). counselling and listening skills: providing these with the support of additional professional services. semi-structured interviews.Counsellor: the OH nurse may be the only healthcare professional around. and need problem-solving skills developed through nurse education and training. 2003). Researcher: health needs assessment: this can be used as the basis for individual case management or OH programme planning. where they may be the sole health professional responsible for workers’ health and education. research skills: simple survey techniques. 2001 Competences of the OH nurse The WHO prepared a curriculum for OH nurses in 2003 as part of its work on developing several post-qualification curricula for nursing and midwifery in Europe (WHO. and applying these in a practical way. This could form a valuable model for a framework in the UK. I OH nurses require a well-developed knowledge base. together with specialist skills in risk assessment and health promotion related to the particular type of work conducted in their setting. OH nurses should also be skilled in identifying gaps in current knowledge. evidence-based practice: skills in literature searching. 134 Performance indicators and benchmarking in OH nursing Literature review . and descriptive statistical techniques to present data. and problem solving skills: OH nurses are often approached for advice on personal issues. Source: Whitaker and Baranski. and epidemiology: OH nurses need to be familiar with the principles and basic methods used. and may be the first point of contact for many people experiencing stress or other mental ill health. Key principles for the training and practice of OH nurses are: I OH nurses must be equipped with the expertise to make sound clinical judgements within the work setting.

surveillance and screening. an ability to 135 Performance indicators and benchmarking in OH nursing Literature review . OH nursing curriculum: The WHO curriculum presents seven training modules covering the role of the OH nurse. four of which are common to the entire specialist nursing curricula it has developed as part of a continuing development programme. industry or enterprise in which they work. I maintain accurate and punctual completion of nursing documentation. OH nursing I: competences and learning outcomes include: demonstrating knowledge of national legislation affecting OH and safety and its impact on work practices. on completion of a course in OH nursing. and I OH nurses need to be aware of how an individual worker’s occupation may affect family life and vice versa. These could usefully be used in drawing up a UK framework for performance: introductory module: competences and learning outcomes include: understanding how previous learning and experience can inform and enrich the new knowledge and skills necessary for the practice of OH nursing. and the rehabilitation of ill or injured workers. students should be able to: I contribute positively and effectively to the development. including: occupation-related health and safety promotion and health education. and in close collaboration with nurses and other health professionals in hospitals. health centres and other health services. delivery. and I provide leadership which is appropriate to the setting and which is underpinned by knowledge and understanding of the OH and safety risks present in the sector. I recognise and support the rights of all those employed in the work setting to work in a healthy and safe environment. I maintain an accurate and up-to-date database of all national legislation and policies of specific relevance to the work setting in which s/he is employed. management and evaluation of all aspects of OH nursing. first aid for injuries and treatment of minor ailments. advice and nursing care for workers with specific work-related injuries or illnesses. and an understanding of competence and its relevance in nursing practice and in the team approach to care. Learning outcomes: The WHO recommends that. risk assessment and accident prevention.I OH nurses must be able to work as a full member of a multidisciplinary team in the work setting.

and to prepare protocols in conjunction with others on the safe use of new technology. This broad definition of an OH service includes hazard identification. using a broad definition drawn up by the Health and Safety Executive (HSE). sight and lung function tests. information management and research: competences include: the ability to analyse different sources of information and apply them. OH nursing II: competences include: the ability to describe social and psychological factors that influence employers’ and employees’ behaviour at work. and to differentiate between strategic and clinical/ethical decision making in nursing. chemical and other work processes. and to recognise confidentiality. such as pre-employment health assessment and hearing. the ability to plan and conduct physical examinations. an ability to describe the exercise of accountability and responsibility in relation to the care of workers in the OH setting. the workplace and the work processes. risk management and the provision of health information. including the modification of work activities. the 136 Performance indicators and benchmarking in OH nursing Literature review .3% of employers provide a more comprehensive range of interventions. and to provide referral to other members of the OH team or to external health services as appropriate. set measurable outcomes for nursing practice. use OH nursing staffing protocols to schedule adequate staffing cover. Provision and delivery of occupational health UK-wide provision A 2002 study concludes that only 14. and OH nursing III: competences include: applying and evaluating a risk assessment and management approach with a triple focus on the worker. and to play a part in maintaining standards and to contribute to quality assurance monitoring.describe the principles of health promotion. health education and health clinic activities which meet the needs of the workforce. including immunisation and vaccination where necessary. leadership and managing resources: competences include: demonstrating an understanding of management principles and processes and their application to the organisation and management of the OH nursing service. training on health-related issues. ethical and legal issues which have implications for OH nursing practice and be able to take appropriate action. and their capacity for work. health education and health surveillance in work settings.9% of all UK employers provide a basic occupational health service. to conduct health promotion. and define possible research questions from day-to-day practice. reporting when safe levels cannot be achieved. Only 3. decision-making: competences include: demonstrating an understanding of the complexities of clinical decision making.

which was conducted to form a baseline against which to assess performance towards the target of improving access to OH provision by 2003. They often feel that many health and safety initiatives are not directly relevant to them. small.measurement of workplace hazards and the monitoring of health trends. such as health surveillance. The nature of the risks in the employer’s sector is the most important factor determining the existence of specific OH initiatives. 2002). Small companies: OH provision tends to reflect the hazards present. Micro employers: those employers with fewer than 10 employees rely on external sources of OH support. no money is specifically allocated for OH support and in-house provision is mostly limited to a health and safety poster and a first aid box. segregating employers into micro. medium and large enterprises. Owners and managers have direct and sole responsibility for health and safety. examines the provision of different levels of OH service by organisation size. Safety 137 Performance indicators and benchmarking in OH nursing Literature review . according to whether they offer services in line with the HSE’s broad or stringent definition of ‘occupational health’: Table 95: Occupational health provision by employer size OH support Micro (%): (broad/stringent definition) Small (%): (broad/stringent definition) Medium (%): (broad/stringent definition) Large (%): (broad/stringent definition) Hazard identification Formal risk management Information on health related issues Modifying work activities Training on health related issues Measuring workplace hazards Monitoring trends in health Health surveillance Rehabilitation programmes Promoting general health OH service by doctor or nurse Employee counselling 100/100 100/100 100/100 69/100 68/100 46/100 44/100 36/63 29/53 34/53 13/23 13/30 100/100 100/100 100/100 75/100 77/100 53/100 50/100 52/78 41/49 38/51 21/34 17/27 100/100 100/100 100/100 81/100 81/100 72/100 63/100 62/79 50/57 51/67 33/45 30/37 100/100 100/100 100/100 88/100 85/100 88/100 82/100 83/93 71/80 70/79 70/80 64/72 Source: Pilkington et al. in addition to the above three elements included in the broad definition (Pilkington et al. 2002. In general. This study by the HSE. and those enterprises with a statutory requirement to undertake surveillance tend to buy in these services as required. Most micro employers surveyed by the HSE did not expect the level of provision in their business to change significantly and felt that HSE initiatives need to be simplified and the anticipated outcomes clearly explained. Table 95 shows the percentage of respondents in each of the size categories providing different OH services.

and in particular. Most wished to develop more proactive approaches to OH. compared with the 23% of large companies having full-time physician support. Medium-sized companies use occupational physicians on an ‘as required’ basis. small or medium-sized companies in the HSE’s 2002 study had inhouse occupational health nursing support. This group is also more likely to have specialist OH personnel providing the service. Most small companies are satisfied with the level of OH provided. This group is more likely to have formal structures for involving employees in the area. No formal evaluation of the cost/benefits of providing OH is conducted. safety had a higher profile than health in determining policy and resources in medium-sized companies. As with micro and small companies. Medium companies: seven of the 12 medium companies participating in the follow-up interviews for the HSE used external OH providers.is seen as a more important priority and to have more immediate benefits – OH is often a second priority within health and safety. The stratification of OH provision by enterprise size described in the UK-wide study by the HSE. the need for ongoing health surveillance. such as ergonomists or occupational psychologists on a regular basis. Auditing and benchmarking is growing. Some acknowledge that they are limited by a lack of knowledge and time or resources. This concludes that 48% of small employers have no access to occupational physicians. determines how much is spent on OH – for example. OH provision in the NHS Three studies of OH provision for NHS staff paint a variable picture of the development of the service since the late 1990s: 138 Performance indicators and benchmarking in OH nursing Literature review . the findings on access to specialist OH professionals. and its hazards. Large companies: Nine of the 18 large employers in the follow-up interviews had in-house provision and the services had often been established for more than 10 years. This group felt that more structured surveillance programmes are required and that changes in customer/client expectations from an OH service will prompt shifts in future service provision. 2004). and has no distinct identity. and believe that psychosocial issues like stress and bullying will shape provision in future. None of the micro. But few large companies report using other specialists. yet OH is still often perceived as a cost without clear benefits by boards and senior managers. is supported by an EEFsponsored study of employers’ OH priorities (Reetoo et al. Insurance companies are driving the development of OH in large companies. one had an in house service and four had no formal provision. The nature of the industry or sector. particularly in relation to health surveillance. They feel that paperwork should be reduced and that information from the HSE and others should be more concise and concentrate on what is required to comply with legislation.

27% were provided with OH from another trust.1998 99. More than two-thirds (69%) of departments had at least one nurse with a degree in OH or an OH nursing diploma. 2001 The amount of doctor time available for the occupational health of NHS employees increased between 1998 and 2001. No real rise in the number of doctors in training in the specialty took place between 1998 and 2001. as did the proportion of doctors holding professionals qualifications (Hughes et al. There was also wide variability in the quality and range of OH available. the preferred option for NHS employers. There was no suggestion in 1998 that inadequate doctor cover was supplemented by additional nurse cover. big variations in service levels continued to exist and government policy that all NHS staff should have access to a consultant led service had not yet been implemented. However. There was substantial inequality of access to OH services and the NHS had not met its 1994 target of providing access to specialist OH services to all staff (Hughes et al. I the number of potential clients per OH nurse varied.838 clients per nurse. It was clear that provision of an OH service from within the NHS was. More than two-thirds (69%) of nurses worked full time and 96% of departments had at least one full-time nurse. I Only 38% of OH departments in 1998 employed a doctor full time and almost two-thirds employed one for half time or less. and is. I at least half of in-house OH departments employed three or fewer nurses. more doctors were working more sessions for their trusts and were better qualified in OH and many also undertook the OH function in settings other than their NHS trust environment. and only a third of employers had access to a specialist occupational physician. However. It was estimate that only 27% of the total NHS workforce received specialist medical OH services. and 3% from the private sector. It is also possible that an increase in the medical staffing in NHS OH services may not have been matched by improvements in other crucial OH staffing provision. 61% of these nurses held a recognised OH qualification and a further 15% were in OH training positions. 1999): I 70% of trust employees in the late 1990s had access to a service based with their employer. and I OH in primary care was virtually non-existent: 79 out of 90 health authorities had no formal arrangements to provide OH services to GPs or their staff. for example nurses: 139 Performance indicators and benchmarking in OH nursing Literature review . 2002). but not as widely as the doctors’ lists. but virtually no service was provided to primary care staff. with an average of 1.6% of trusts claimed to provide access to OH in 1998.

compared with only 30% of mental health trusts and 17% of ambulance trusts. 35% contracted OH from another trust. I sickness absence in trusts falls as OH spending per employee increases (but this finding is based on only 13% of trusts). but this was usually only available during normal office hours. lack of resources for investing in OH (72% of ambulance trusts. promotion and education). I the services provided are largely reactive (for example. 2003). I staffing varies widely. and problems with accommodation/geographic location (around a third of all trusts cited this as a barrier). and there was a small increase in the proportion of specialist registrar grades in OH. Of the rest. The number of trusts signing up to NHS Plus had levelled off and some noted that the resources generated by this scheme to sell OH services to non-trust employers were not being invested in improving the provision of services: I all trusts provided OH in 2002/03. I constraints on provision included difficulties recruiting suitable staff (just under half cited this as a barrier).I the number of consultant staff rose by 50% between 1998 and 2001. Part of the reason for the reactive nature of OH in the NHS is that the allocation of resources is dictated by legal requirement to provide OH checks on staff. 2002/03 All NHS trusts provided some OH but this was largely reactive and the quality and accessibility varied (National Audit Office. and I there was a 50% rise in the number of full-time doctor posts and a rise in the number of sessions worked by doctors in OH departments amongst the remainder between 1998 and 2001. and 140 Performance indicators and benchmarking in OH nursing Literature review . rehabilitation and post exposure screening) rather than proactive (for example. 3% from a non-NHS provider. I 82% of acute trusts had dedicated in-house staff. and only 50% had arrangements for staff who required out-of-hours cover. especially when they move to another trust. health surveillance. I the proportion of doctors working in OH departments without an OH qualification fell from 33% to 22%. I the proportion of doctors holding an FOM qualification rose to 60%. and 5% used a combination of provision. 41% of acute trusts). This means fewer resources are available for proactive services.

28% carry out pre-employment screening and 14. However. OH provision in SMEs: I only three out of the 28 SMEs in the 2001 research (Bradshaw et al. Access to OH in primary care Practice managers in primary care identify some improvement in OH provision in recent years (Reetoo et al.I 68% provided fast track treatment programmes for particular conditions (for example. awareness of the available provision is variable and some managers regard their services to be understaffed and difficult to access due to location. and checking of immunisations. that 7. and are oriented towards safety issues. Researchers seeking to undertake studies of SMEs and OH encounter great difficulties in securing this sector’s involvement and participation. Just over half collect health-related absence data. Research in 2001 (Bradshaw et al.2% carry out health promotion. 2001) suggests that 14. Knowledge of available OH provision amongst GPs was quite limited. In terms of OH activity.8% use a part-time OH nurse. Small and medium-sized employers Many recent initiatives in the area of widening access to OH have focused on one particular group of hard-to-reach employers – small and medium-sized enterprises (SMEs). and GPs would like to see quick access to services where concerns over confidentiality are minimised. and 67% believe that a doctor or nurse is the best person to provide an OH service. physiotherapy for MSDs). for example. I the use of OH professionals varied significantly. for example. A quarter of SMEs nominate a person in the company to have responsibility for OH issues. Practice nurses also feel that provision has improved. I employers have low levels of awareness of the qualifications held by the OH professionals they use. Mental health problems were the greatest concern for this group.2% employ a health and safety adviser. 2000) had a written OH policy.4% of small employers use the services of a part-time OH physician. This reflects the findings for micro/small employers in the HSE research conducted in 2001. only one manager in the study of 28 organisations was aware that their OH physician was an AFOM. one employer used a consultant for only one session every two years. citing protocols for needlestick injuries. 2004). particularly in the case of non-work related issues. 141 Performance indicators and benchmarking in OH nursing Literature review . rather than health ones. Managers in many SMEs are confused over the degree to which employers should be responsible for workers’ health. and that 10. SMEs tend to use accident rates as the only marker for evaluating OH input.

less time on activities related to the working environment. Table 96: Small employers’ attitudes to the provision of OH Statement We are constantly on the lookout to improve the health of our employees We recognise occupational health is important. 2001 The majority of SMEs in a 2004 HSE-sponsored study (Reetoo et al. The OH professionals operating in sites with multidisciplinary OH teams spend most of their time on surveillance and preventative activities and relatively little on curative. raising issues of confidentiality. Those sites relying on external doctors backed up by internal or external OH nurses spend more time on curative services for non-occupational diseases and. services for individual workers.4%) 14 (50%) 2 (7. occupational health nurses are used more widely. and I 82. although health records are sometimes kept by mangers in SMEs.4% agree that OH is an important part of running the company. resulting in wide variations – and possibly inequalities – in access to OH for employees in different parts of the same organisation. This latter group of OH services are also less likely to be involved in the planning and follow-up of surveillance in the 142 Performance indicators and benchmarking in OH nursing Literature review .5%) Source: Bradshaw et al. (%) employers agreeing 6 (21. and awareness of this group as a source of advice is low amongst managers in SMEs. 2004) report little or no access to occupational physicians. These differences reflect the type of OH set-up in each part of the organisation.1%) 1 (3. Perceptions of OH amongst SME employers: I 71. 2001). but it is not a major priority We provide measures required by law. depending on the respondent) and the likely costs of employing specialist doctors. but not much beyond that Health issues are not really relevant to us No. primarily from the point of view of lost-productivity due to sickness absence (‘if someone is ill then that is 25% of our workforce down’). although 100% also thought that workers should take responsibility for their own health. However. and I only one SME employer had carried out an audit of their OH service.1% thought they had a responsibility for their workers. consequently.I managers do not consider that employees are reluctant to use the OH service out of fear of losing their job. Barriers to the greater use of specialist physicians included perceived bias (either towards the employer or employee. more reactive. Multi-national organisations Considerable differences exist between the OH activities of different sites within multi-national organisations (Bratveit et al.

an activity which tends to be conducted by external consultants at such sites. this work was carried out by external consultants and the in-house OH service was not briefed on the results). using external or internal doctors in combination with external or internal nurses. multidisciplinary OH service. occupational hygienist. only one in 10 had at least one year’s specialisation in occupational medicine. OH provision in the past three years at one multi-national: I those sites with access to a multidisciplinary service spent less than 10% of time on curative services for non-work conditions. had specialised in occupational medicine for at least one year. psychologist. employing at least three of the following professions – doctor. All the doctors in these services. nurse. including one in the UK. The standalone services were rarely involved in the development of strategies for OH programmes or in planning new workstations/work organisation.working environment. External doctors and nurses were individual practitioners working part-time for the enterprise. except one. ergonomist. 143 Performance indicators and benchmarking in OH nursing Literature review . had no provision for OH. Of the doctors. OH professional input: I two out of the eight distribution centres in the 2001 study of a multi-national. These stand-alone services are less likely to use doctors with a specialist qualification in occupational medicine. I eight out of the 20 sites studied drew on the services of an inter-enterprise. I activities related to the working environment accounted for a considerable fraction (25%–50%) of the multidisciplinary teams’ work. Standalone services using external doctors spent less time on these topics (in some locations. including vaccinations. I curative services for occupational diseases were provided at most locations in the multinational. as were health examinations after workers returned to work after more than three weeks’ sick leave. I pre-employment health examinations were carried out at most locations. and I up to 20% of time in all OH departments at the multi-national was spent on health promotion activities like smoking cessation and healthy diet. and I other locations had stand-alone services. social worker.

have sought to draw up recommended elements for an occupational health service in recent years. 144 Performance indicators and benchmarking in OH nursing Literature review . but overlapping needs in a workplace health service. 1995 Employer and employee OH priorities Employers. health education and medical surveillance). and the medical schools and government agencies of individual states. whereas employees see the preventative role of OH departments as more important (for example. medical screening. For example. A number of studies exploring the OH needs and priorities of stakeholders use the Occupational health services convention and recommendation published by the ILO in 1995. a study of the Irish civil service finds that more HR managers than employees perceive OH as important or very important (Reid and Malone. 2003). HR managers prioritise OH functions connected with assessing fitness for work (for example. including the World Health Organisation (WHO). pre-employment health assessments). the International Labour Office (ILO).Accepted standards and performance measures for OH Definitions of OH activities Various bodies. which is summarised below: Table 97: Elements of an OH service Surveillance of individuals’ health in relation to work: Provision of curative services for occupational diseases/accidents: Provision of general healthcare services: Securing future working environment: pre-employment health examination periodic health examination of all workers specific examination of selected groups of workers diagnosis and treatment of occupational diseases treatment and first aid for occupational accidents rehabilitation and resettlement of employees with diseases diagnosis and/or treatment of non-occupational diseases vaccination of employees strategies of occupational health programmes the planning of new or changed workstations/practices/ work organisation walk through surveys with guidance/checklists risk assessment of chemical/physical/ergonomic hazards psychological/psychosocial assessments ergonomics/climate/dust exposure/chemical hazards/noise personal protective equipment general health information to the workers information about healthy lifestyle/health promotion information/training in first aid Surveillance of the current working environment: Advice on the control of hazards at work: Health education and health promotion: Source: ILO. employees and other stakeholders in an OH service have different. and attach different priorities to occupational health generally.

2003 The major sponsors and users of OH services – employers and workers – agree that the training of OH physicians reflects their priorities for an occupational health service. The ranking of the eight most important functions of an OH unit vary slightly between employees and managers as follows.Overall. advice on law and ethics is a top priority for employers. There are no differences by age. Research conducted for the HSE (Reetoo et al. more than 80% of managers and employees in the Irish civil service view the OH unit as important or very important. Employers rank the required competences of OH physicians in decreasing order as follows: I advice on law and ethics I assessment of occupational hazards to health I assessment of disability and fitness for work I communication I assessment of environmental exposures to health 145 Performance indicators and benchmarking in OH nursing Literature review . suggesting that a uniform service can be provided to all workers. together with research. followed by assessments of occupational hazards and fitness for work. when asked to rank these. grade or occupation. showing that HR managers view pre-employment and promotional screening as significantly more important than do employees. are not considered central to the role by employees (table 98): Table 98: Most valued functions of an occupational health unit Function General medical screening Occupational health education General health education Medical surveillance Research Ill-health retirement assessments Pre-employment/promotional medical assessments Return-to-work (after sick leave) assessments HR managers’ ranking Employees’ ranking 1 2 3 4 5 6 7 8 7 2 3 6 8 4 1 5 Source: Reid and Malone. Screening and medical surveillance of workers with specific OH health risks. 2004) concludes that employers and employees agree that all the competency areas covered in occupational physician training are important. regardless of these differences. sex. However.

there are overlaps. although public sector organisations rate the assessment of fitness for work higher than employers in other sectors. Benchmarking OH performance As different stakeholders have different needs and demands from an OH service. advice on ill-health retirement or fitness for work). The quality and effectiveness of OH is influenced by the extent to which services meet the perceived demands of users. within limits and according to legislative requirements. and 146 Performance indicators and benchmarking in OH nursing Literature review . Identifying these demands and needs should enable the quality of OH to be enhanced by focusing on those most valued. process – whether the service correctly selects and carries out the techniques and procedures which all the health professionals in the unit believe to meet the needs of clients. Research suggests there are no significant differences in the competences that employers require occupational physicians to possess by company size or sector. These different perceptions will influence attempts to benchmark and measure the performance of OH at the micro level: I ‘Quality’ to the OH professional means: outcomes – whether the service meets the professionally assessed needs of its clients. they do express a need for further training on the provision of advice on stress-related issues. so the various actors and client groups will have different perceptions of ‘quality’ and ‘performance’. where pure patient-to-doctor relationships can be confused with managerial issues (for example. Also. 2004 Although employers believe that the core competences for physicians set out above cover most aspects of occupational medicine as set out in the ILO convention. providers and purchasers of OH both agree that OH training needs to focus on equipping doctors to deal with situations where they are ‘between medicine and management’. notably in areas of occupational and general health education. I ‘Quality’ to the manager of the OH service means: the selection and deployment of resources in the most efficient way to meet client needs. Although differences exist in the priorities of HR managers and employees.I research methods I health promotion I management Source: Reetoo et al.

flexibility. particularly in countries where GPs or other nonspecialists carry out some of the functions of OH physicians (for example. tests Adaptability. prescriptions. It reflects the core competency requirements for the physician and the work profiles of physicians in different countries. acceptability Efficiency. mortality Quality of life. occupational physicians and nurses. OH is complex – at the level of the workplace. 147 Performance indicators and benchmarking in OH nursing Literature review . Despite this complex matrix. Effectiveness. information Referrals. and competences required in. Table 99: Different quality criteria. equipment. client satisfaction is still widely accepted as one of the main aims and criteria of the OH service. speed Clinical data. The training and core competences of occupational physicians have evolved in Europe in response to continuous changes in working life and to the needs of society. coverage. which reflect wider society. complaints. according to stakeholder demands/needs Stakeholder Structure Process Outcome OHS professionals Employees Premises. continuity. fitness assessments and examinations). The document reflects developments and trends in occupational medicine as a science and in practice. validity for reimbursement or lower EL premiums Cost-benefit. safety Professional performance Communication. legislation Good working environment and culture. incidents Employers Costs-benefit. Needs are also determined by external legal requirements. satisfaction OHS managers Costs. reduced personnel costs related to ill health.I ‘Quality’ to the clients and users of the service means: whether the direct beneficiaries perceive the service as giving them what they expect. working culture conductive to health and safety Society Evidence based judgements Source: MacDonald et al. joint committees and works councils). It is designed for medical schools and national regulators to give them a common understanding of the scope and core functions of occupational medicine. occupational medicine in 2000 to assist member states to harmonise a training curriculum for occupational physicians. The WHO prepared guidelines on the scope of. conforming to legal requirements. increase in productivity and quality. staff Accessibility. 2000 Developing competences in OH The development of accepted standards in occupational health encompasses the roles and required competences of the different professionals working in the area. Describing the scope of OH is seen as important by the WHO. in particular. OH is usually the responsibility of the employer acting with the commitment of the employee (through partnership working. morbidity.

occupational hygienists. which range from formulating health and safety policy with due attention to occupational health law and ethics. areas of knowledge: including a description of the general clinical knowledge and skills required (from haematology to mental health). occupational therapists. and knowledge areas and skills in occupational medicine: uses the 1997 Glasgow Conference on Core Competences. in most. including identifying and assessing risks. formulating OH policy. The relationship between the OH doctor and other members of the team will depend on legislative and organisational factors. laboratory technicians and occupational psychologists – the use of each of these varies throughout Europe. The most frequent members of interdisciplinary OH teams include nurses. and as an adviser. but has little to say on the nurse-doctor professional relationship. ergonomists. safety engineers. advising on implementing OH and safety legislation. advising on work organisation. including: I whether the use of a multidisciplinary approach is compulsory. to developing a multidisciplinary OHS. A section of the WHO guidelines deals with the relationship between occupational physicians and others working in a multidisciplinary service. I whether the OH practitioner is full or part-time. a source of knowledge. legal surveillance. and on protective equipment. safety and hygiene. organising first aid and treatment. and working as part of a multidisciplinary team. competences: sets out the core competences for occupational physicians. pregnant workers). the different disciplines are not organised into formal teams. providing information and training. contributing to scientific knowledge. advising on the protection of vulnerable groups (for example. promoting work ability. I whether the service is nurse-led or led by another specialist. participating in workplace health promotion programmes. physiotherapists. managing the OH service. Although the use of a multidisciplinary approach is compulsory in many EU countries. but are drawn on when required. recognising and advising on hazardous exposure. acting as a counsellor. and 148 Performance indicators and benchmarking in OH nursing Literature review . advising on OH.The WHO sets out in detail the role and functions of occupational physicians under the following headings: ethics and the occupational physician the role of the occupational physician: including his or her role as an agent of change.

I whether the service is provided by an institute offering comprehensive advice or is a service provided by an individual occupational physician. 149 Performance indicators and benchmarking in OH nursing Literature review .

Philipp R. Provision and staffing of NHS occupational health services in England and Wales. HR managers = 25. 53: 47–51. It finds that the amount of doctor time per NHS employee increased between 1998 and 2001. Summary: this is a follow-up study to the 1998/99 one described above. Occupational and Environmental Medicine 1999. Hughes A. Occupational Medicine 2002. Malone J. However. whereas employees view the preventative role of OH as more important (for example. medical screening. Many doctors also undertake an OH function in settings other than their NHS trust environment. Occupational Medicine 2003. Hughes A. and that the proportion of doctors holding professional OH qualifications also rose. NHS occupational health services in England and Wales: a changing picture. Methods: postal surveys of employees and HR managers were conducted in which participants were asked to rank eight functions of an OH unit for the Irish civil service. It shows that the NHS had not implemented its 1994 target of providing access to specialist OH services to all staff by 1998/99. big variations in service continued to exist and government policy for all NHS staff to have access to consultant led service had not yet been met. Method: a postal questionnaire of OH medical staff working in the NHS in England and Wales. more doctors were working more sessions for their trusts and were better qualified in OH. A cross-sectional study of employer and employee occupational health needs and priorities within the Irish Civil Service. There was also wide variability in the quality and range of OH support.6% of trusts claimed to provide access to OH. 150 Performance indicators and benchmarking in OH nursing Literature review . 53: 41–45. Harling K. health education and medical surveillance). Sample sizes: employees = 524. HR managers prioritise those functions of an OH unit connected with assessing fitness for work (for example. Only a third of trusts have access to a specialist occupational physician. but virtually no service was provided to primary care staff. The study only examines the role of doctors and recognises that gains in the medical input from this profession may not have been matched by progress in other crucial OH staffing provision.Summary of sources Reid A. Philipp R. Summary: More HR managers than employees perceive OH as important or very important. The study concludes that there is substantial inequality of access to OH services in the NHS but offers no real explanation. Harling K. The authors conclude it is slightly disconcerting that no real rise in the number of doctors in training in the specialty had taken place between 1998 and 2001. However. Summary: 99. Method: two postal surveys of purchasers and providers in the NHS in England and Wales were conducted in 1998/99 to inform discussions on the formation of NHS Plus. 56: 714–717. pre-employment health assessments).

4% of the employers used the services of a part-time OH physician. Provision and perception of occupational health in small and medium-sized enterprises in Sheffield. Those sites relying on external doctors backed up by internal or external nurses spend more time on curative services for non-occupational diseases. Activity profiles of the occupational health services in a multinational company. There is confusion in SMEs as to the degree to which employers should be responsible for workers’ health. rather than stand alone services. 51: 39–44. Fishwick D. Method: a baseline assessment of the services provided by each of the OH services in a multinational’s European production and distribution sites was conducted using the ILO OH convention and recommendation to define the range of OH services. multidisciplinary OH services spent most of their time on surveillance and preventative activities.8% used a part-time OH nurse. rather than health ones. It is likely that doctors with specialist training gravitate towards the more multidisciplinary/preventative units. 10. and less time on activities related to the working environment.5% collected health related absence data. SMEs tend to use accident rates as the only marker for evaluating OH input.2% carried out health promotion. which tended to be conducted by external consultants in these ‘stand alone’ OH services. and relatively little time on curative. Method: face-to-face interviews with 28 managers in small to medium sized enterprises in Sheffield. Summary: considerable differences in the OH activities of different sites were revealed – interenterprise. 151 Performance indicators and benchmarking in OH nursing Literature review . The study raises issues of causality – it could be that differences in the activities undertaken by different parts of the multinational reflect the levels of training in occupational medicine of the staff concerned. UK. exploring the provision and perception of OH in their organisations. Eskin F. 25% had nominated a person to take responsibility for OH. 28% carried out pre-employment screening and 14. Curran AD. Occupational Medicine 2001.2% employed a health and safety adviser. more reactive. Summary: 14. 53. particularly in the case of non-work related issues. Occupational Medicine 2001. The researchers encountered great difficulties in securing sufficient involvement of SMEs in the research. Bratveit M. services for individual workers. and are oriented towards safety issues. The authors conclude that these services are more in line with ILO recommendations on accepted levels of service. This was followed by up site visits and structured interviews with representatives from the local OH units. rather than the structure or strategy of the service in that part of the enterprise. 7. This group was also less likely to be involved in the planning and follow-up of surveillance in the working environment. 67% believed that a doctor or nurse is the best person to provide an OH service. Moen BE.Bradshaw LM. McCormack D. 51: 168–173.

a move away from OH nurses acting as a doctor’s assistant towards a position where they work as an independent. London: NAO. I OH nurses require a well-developed knowledge base. The role of the occupational health nurse in workplace health management. questions on the health of workers’ spouses).pdf Summary: the WHO prepared a curriculum for OH nurses in 2003 as part of its work on developing several post-qualification curricula for nursing and midwifery in Europe. autonomous professional. WHO Europe occupational health nursing curriculum. Summary: all NHS trusts provide some OH but this is largely reactive and the quality and accessibility varies. the broad thrust of developments in recent years is the same – namely.dk/document/e73312. together with specialist skills in risk assessment and health promotion related to the particular type of work conducted in their setting.National Audit Office.euro. health educator. WHO Europe. but ones that could affect the worker’s ability to concentrate. OH nurses are usually onsite and accessible – providing opportunities for early intervention. www. The OH nurse is a unique front liner and tends to get approached about a range of issues beyond the traditional work health and safety ones (for example. www. WHO regional office for Europe.who.who. attend or be productive. 2001. counsellor and researcher. manager. Baranski B (editors). adviser. 152 Performance indicators and benchmarking in OH nursing Literature review . However. 2003 HC 623. Method: a survey of NHS trusts in the context of a 2001 Department of Health statement on the range of OH services that should be available for all staff in the NHS. where they may be the sole health professional responsible for workers’ health and education. Report by the Comptroller and Auditor General. Key principles: I OH nurses must be equipped with the expertise to make sound clinical judgements within the work setting. Although the role differs between EU countries. This could form a valuable model for a framework in the UK. this does not mean there is no teamwork – all health and safety professionals are interdependent. specialist. Whitaker S.int/document/e81556. 2003. coordinator. responsible and accountable for their own professional practice.pdf Method: research study looking at the role and required competences of OH nurses. including those of clinician. These are issues beyond the immediate responsibility of the employer. A safer place to work: improving the management of health and safety risks to staff in NHS trusts. Summary: OH nurses fulfil several. World Health Organisation. This report follows up a similar NAO study in 1996. The number of trusts signing up to NHS Plus had levelled off and some note that the resources generated by NHS Plus were not being invested in improving the provision of services. related and complimentary roles in workplace health management.

Guidelines on quality management in multidisciplinary occupational health services. assess and satisfy these hidden or disguised needs (for example. 1999. Bilthoven. in some cases the ‘demands’ of the different stakeholders will be different. Baranski B (editors). particularly in countries where GPs or other non-specialists more commonly carry out some of the functions of OH physicians (for example.dk/document/E68239.pdf Summary: The WHO prepared this document in 2000 to assist member states in harmonising a training curriculum for occupational physicians. exposure to carcinogenic chemicals and other factors affecting fertility. Summary: these guidelines were produced in 1999 and include a section on identifying demands and needs in OH. It reflects the core competency requirements for the physician and the work profiles of physicians in different countries. and in close collaboration with nurses and other health professionals in hospitals.dk/document/e68883.who. MacDonald E. where employees request physiotherapy. 2000. Bilthoven. www. It is designed for medical schools and national regulators to give them a common understanding of the scope and core functions of occupational medicine. health centres and other parts of healthcare. on the basis that quality – or the success of an OH unit – depends on meeting the expectations and needs of the customers (usually the employer and employees). and I OH nurse needs to be aware of how an individual worker’s occupation may affect family life and vice versa.who. The document reflects developments and trends in occupational medicine as a science and in practice. or the case of MSDs. 153 Performance indicators and benchmarking in OH nursing Literature review . Occupational medicine in Europe: scope and competences. but what they really need is improvements in work organisation or ergonomics).pdf. It is therefore the job of OH professionals to identify. WHO European Centre for Environment and Health. Westerholm P. or hidden until revealed and explained by OH professionals.I They must be able to work as a full member of a multidisciplinary team in the work setting. fitness assessments and examinations). However. Wilford J (editors). WHO European centre for environment and health. Baranski B. www. The provision of a description of the scope of the discipline was seen as important by the WHO. The training and core competences of occupational physicians have evolved in Europe in response to continuous changes in working life and to the needs of society.

MacDonald EB. with health promotion and management low down the list.hse. 2002. practice nurses and managers expressed concern that clarification was needed surrounding the respective responsibilities of employers. practice nurses and practice managers in Sheffield and Manchester. www. exploring why this group of primary care professionals does not get more involved in offering OH advice and support and therefore in widening access to this provision. HSE research report 254. especially amongst SMEs.Reetoo KN. Competencies of occupational health physicians: the customer’s perspective.gov. followed by assessments of occupational hazards. 2004. primary care and the NHS in the area of OH. It finds that all the established competency areas for OH are seen as important. 2004.gov.hse. but that advice on law and ethics is the top priority. OH nurses were used more widely. www.uk/research Methods: focus groups of GPs. The study was designed as a baseline to assess progress against the 154 Performance indicators and benchmarking in OH nursing Literature review . Summary: this research study looks at whether the users of OH physicians (employers and employees) consider that the curriculum for this group accurately reflects the priorities of clients. depending on the respondent) and the likely costs of using them.uk/research Method: structured telephone interviews with 4950 companies followed by 50 face-to-face interviews with a representative sample of employers. Summary: examines the proportions of employers who use different levels of OH support and looks at variations by size. O’Hara R.uk/research Method: questionnaire of EEF member companies and other employers examining their use of OH services. and organisational priorities for such a service. Pilkington A. Followed up by focus groups. so that awareness of this group of professionals as a source of advice was low. The majority of SMEs reported little or no access to occupational physicians. Summary: a lack of training and knowledge of the world of work and occupational hazards is the main barrier to the provision or signposting of OH in primary care. This is the most comprehensive study of UK access to OH. HSE research report 247. HSE research report 445. fitness for work.gov. Graham MK et al. Survey of use of occupational health support. Concludes that practice nurses and practice managers are best placed to respond to the OH agenda given support. GPs. sector and region. The study confirms the low level of OH provision in most of British industry. Elms J et al. the authors conclude. Harrington JM. training and resources. Barriers to the greater use of occupational physicians included the fact that they were perceived as biased (either towards the employee or employer. but the additional studies above provide a more detailed picture of provision in the key areas of the NHS and SMEs. The profile of patients’ occupational health in primary care.hse. www.

Concludes that. when a stringent definition of OH support is used. only 19% of the organisations in the study provide it.HSE’s target of increasing the proportion of employers using OH support by 10% by 2003. This proportion extrapolates into only 3% of all UK companies once adjustments for the UK-wide distribution of companies by size and sector are taken into account. 155 Performance indicators and benchmarking in OH nursing Literature review .

WHO regional office for Europe. 2004.pdf Whitaker S. Survey of use of occupational health support. WHO Europe occupational health nursing curriculum. Occupational Medicine 2002.euro. Curran AD. 53: 47–51. www.gov. Fishwick D.gov. Hughes A. Philipp R. www. 1999. HSE research report 254. Hughes A. O’Hara R.pdf 156 Performance indicators and benchmarking in OH nursing References . MacDonald EB. Elms J et al. WHO European centre for environment and health.dk/document/e68883. International Labour Organization. 51: 39–44. A cross-sectional study of employer and employee occupational health needs and priorities within the Irish Civil Service. Harling K. www. www. Report by the Comptroller and Auditor General. Occupational medicine in Europe: scope and competences. Activity profiles of the occupational health services in a multinational company. WHO Europe. Occupational and Environmental Medicine 1999. Guidelines on quality management in multidisciplinary occupational health services. 2002. HSE research report 445. 56: 714–717. www. Baranski B (editors). McCormack D. Occupational Medicine 2001. 53: 41–45. Philipp R. Provision and perception of occupational health in small and medium-sized enterprises in Sheffield. Baranski B (editors).int/document/e81556.uk/research Reetoo KN. Occupational health services convention and recommendation.dk/document/E68239. 2003 HC 623. Malone J. Provision and staffing of NHS occupational health services in England and Wales.uk/research Pilkington A. UK. 51: 168–173. 1995.pdf World Health Organisation.who. NHS occupational health services in England and Wales: a changing picture. 2004. Bilthoven. Bratveit M.dk/document/e73312. Occupational Medicine 2001. Baranski B.who. WHO European Centre for Environment and Health. Wilford J (editors). 2001.gov. The role of the occupational health nurse in workplace health management. Graham MK et al. Competencies of occupational health physicians: the customer’s perspective.hse.who. London: NAO.uk/research Reid A. Moen BE. Harling K. Harrington JM.hse. Occupational Medicine 2003. Westerholm P.who. www. www.pdf National Audit Office. Bilthoven. The profile of patients’ occupational health in primary care. A safer place to work: improving the management of health and safety risks to staff in NHS trusts. 2003. 2000. HSE research report 247.REFERENCES Bradshaw LM. MacDonald E. Eskin F.hse.

APPENDIX 1 The performance indicators questionnaire 157 Performance indicators and benchmarking in OH nursing Appendix .

158 Performance indicators and benchmarking in OH nursing Appendix .

159 Performance indicators and benchmarking in OH nursing Appendix .

160 Performance indicators and benchmarking in OH nursing Appendix .

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