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A Changing Health & Safety Culture

A United Kingdom-trained occupational health nurse detects some changes in this country’s attitude and approach to health and safety.

When experienced occupational health nurse (OHN) Maria Burns emigrated to New Zealand from the United Kingdom (UK) five years ago, she was shocked by the both this country’s workplace fatality statistics and the “she’ll be right” attitude to health and safety (H&S).

As someone passionate about workplace H&S, she’s glad to be playing a small part in trying to change those statistics and that culture. “All workers should be able to go to work, do their jobs and come home safe to their families without being injured or killed or made ill by their work activities,” she said.

In her current role as a full time OHN employed by a large general practice in Christchurch, Burns is providing a range of services to a range of clients – from comprehensive pre-employment health assessments for large Australian mining firms to asbestos education for construction workers on the Christchurch rebuild. Moorhouse Medical Centre, with an enrolled population of 9000 patients and many casual patients, has eight GPs, 21 practice nurses, a range of ancillary health services including physiotherapy, phlebotomy and radiology, and for the last 18 months, a dedicated OHN. Burns does not know of any other general practice which employs an OHN.

The innovative role came about in the face of increasing demand, and the Christchurch rebuild got underway. A practice nurse had been providing some screening services for workers but as demand increased for a broader range of services, the centre decided to employ an OHN “to develop and professionalise the service. I think it was insightful of the practice to realise that such a role was needed,” Burns said. She works closely with a GP at the practice who has a particular interest in occupational health.

Before joining the practice, Burns had worked for a private OHN service in the city. In the UK, her first OHN job was with Rolls-Royce in Derby where round the clock OHN cover was provided to 14,000 employees. Staff training was taken equally seriously, with a two year in-house training for OHNs. “After completing that training, I was supported to complete my diploma in occupational health. It was a great start in professional practice.”

Burns had also worked for the National Health Service providing occupational health services and also to local small and medium-sized businesses.

In the five years since her arrival in New Zealand, Burns has seen some positive progress in the field she’s passionate about. The improvements have been fuelled by a combination of factors – the Canterbury earthquakes, the Pike River mining disaster and subsequent report of the Independent Taskforce on Workplace Health and Safety, and new H&S legislation due to come into effect on April 1 next year.

Opportunities for nurses

“It is great to feel part of delivering improvements. Now is a fantastic time for nurses to get involved in helping companies improve their H&S culture. It has got to get better and nurses should be involved in all aspects of that.”

Burns is playing her role in doing so. Moorhouse Medical Centre overlooks a patch of weed-infested, concrete-pocked wasteland, just one of hundreds of grim reminders of the havoc wreaked on the city more than three years ago. That havoc has resulted in a great deal of work associated with asbestos removal, as ruined buildings are demolished or damaged buildings repaired.

It’s an area of occupational health Burns is passionate about. She has identified about 100 workers exposed to asbestos working on the rebuild – “young men and women, including some migrant workers, who are unskilled labourers, 90 per cent of whom smoke. The mix of working with asbestos and smoking is a potential nightmare.”

Burns, working closely with Worksafe New Zealand, has developed robust screening, protection and education for those exposed to asbestos. Workers undergo a lung function test and Burns has been surprised at the incidence of undiagnosed, poorly controlled asthma she has encountered. She links these workers with Canterbury’s respiratory nurses.

Burns educates the workers on respiratory protection, the need to be clean shaven and to ensure their personal protective equipment fits properly. Each worker should have a chest x-ray. “Worksafe New Zealand is starting to insist on asbestos medicals, including an initial chest x-ray and then one every five years. Compliance is questionable but we are beginning to see an increase in requests for asbestos medicals. It’s very important these workers get the right input at the beginning. They need to know their health is at risk. We are doing what we can to raise the issue and doing everything we can to reduce the risks.”

She admits it is hard for workers to grasp that what they do today will have an impact on their health tomorrow – “particularly young ones who feel bullet-proof”.

Burns says that when she does lung function tests, it is often the first time anyone has taken an interest in these workers’ health. “That one-on-one time talking about their health and their work is really invaluable, as they might never have accessed a health professional in any other capacity.”

Burns thinks the “She’ll be right” attitude to H&S is slowly changing. “There is a growing momentum out there. It’s not something you’ll see immediately – it will take five to ten years for a culture change. The new legislation has significant impacts, eg the charge of corporate manslaughter, and means H&S has to be taken seriously – there are real risks which really harm people. In some smaller companies, H&S has taken a low priority, with the responsibility given to staff with no training of experience. That’s not good enough now. Business managers will have to take ownership, rather than pass it down the line.” She’s detected some winds of change. “As I’m walking around there is visible evidence – hearing protection, dust masks, hard hats, better traffic control – that risks are being managed. That’s encouraging.”

Flu vaccinations

Burns and her team delivered around 1700 flu vaccinations, both at the centre and at worksites, from mid-March to mid-May, a considerable logistical exercise. “It’s a very valuable service and the demand is very high. All the companies we work with pay for their workers’ vaccination. It is a way of valuing employees, who see it as a caring gesture.”

Working for a private provider at the time of the 2010/11 earthquakes meant Burns was involved in providing support in workplaces and to people who were afraid to return to work. “We weren’t counselling as such, but were using our listening skills as nursing professionals.” She was also involved in developing procedures and processes for hepatitis A and B immunisations for those shovelling liquefaction.

Burns says OHNs as well as having to know the physical and mental risks of different workplaces, must be able to collaborate well with other health professionals, communicate well, multi-task and prioritise – “particularly in the flu season.”

She has concerns about nurses going into occupational health nursing, perhaps calling themselves screening nurses, as sole providers with no training or experience. “Occupational health is not a tick-box exercise. Those nurses don’t know what they don’t know. Unless they have support and training, occupational health will not be done well.”

Burns thinks the field offer great career opportunities. “Nurses new to the specialty need to be supported and mentored and to gain the relevant diploma. We need new blood and more people to be interested and passionate about it. OHNs offer a valuable service to workers, the community and the economy.”

Reprinted from KaiTiaki Nursing New Zealand.