Dear Elaine
I must say, despite being a reasonably young nurse in Occ Health, but of 8
years experience and with prevention as a main aim, I agree with Margaret in
that there is a definite benefit to a treatment service, providing it is
managed well. The guidelines as clearly stated in Securing Health Together
(HSE 2000/1) and subsequently Taking a Public Health Approach (2003), we
must reduce sickness absence. In my experience Margaret is quite correct
in saying employees who are used to having an hour lie down if genuinely
unwell and then going back to work once better (if they are fit to do so) is
better than them going home. In these circumstances you are most likely to
have the ones who get cross and just leave or the tuffies, who stay at work
but become a safety risk as ill health may cause lack of attention. So
treatment in these cases are, in my mind, prevention. Prevention of a
worse scenario.
I too agree with the empowerment of first aiders, but not to the extent that
the nurse is unavailable should further medical attention be required as
this then may prevent unnecessary hospital referrals when the first aider
would need back up.
Furthermore providing it is coupled with good preventative health screenings
and proactive health promotion I have, by listening to employees who come
for paracetamol found in fact in many cases their trouble is not simply the
headache. There is often another issue, such as work related stress,
working conditions, stress at home, sickness in the family, or in some cases
severe illness that the GP ignored but we knew the employee better and could
put a case forward for them as we new they were not usually the malingering
type. By referral up to Occ Health Doctor they were referred back to the
GP and successful diagnosis of a serious illness was made for which the
employee now receives treatment. So again in this case prevention of
death.
On a final note although I can understand your desire to change the 'old
fashioned approach' I found it sad to hear your undertoned comments. The
Company must have been happy with the nurse to have employed her/him for so
long. Whilst I support underpinning practice with the best possible
research based evidence, I have no doubts in my mind that a good Enrolled
Nurse with 20 years Occ Health experience (who may also have some evidence
for what she does - we don't know) would be preferable, to a young
inexperienced, Degree Registered Nurse with no knowledge of the Company in
which she works as there is evidence to suggest it is essential to 'know
your company'. Keeping on that note, it is said in a number of health
promotion books including one by Ewles and Simnett (1999) it is better not
to try to change the internal politics in these situations but to learn it
and work around it.
So in summary, I agree a compromise would be sensible, with a good sound
knowledge of the company, to avoid conflict and anarchy in the ranks. A
gentle shift towards prevention with introduction to how to help yourself,
health promotion including work related things, but also when to ask OH and
when to see the GP etc etc. and some health screenings etc and work place
monitoring, but with the employees knowing they are still cared for, may be
the way forwards.
Regards
Kaaren
-----Original Message-----
From: Reddoch, Margaret [mailto:[log in to unmask]]
Sent: 29 January 2004 13:21
To: [log in to unmask]
Subject: Re: TREATMENT SERVICE
Dear Elaine
What about suggesting compromises? If the staff are used to this 'nursing'
service, they are not only going to miss it if it is discontinued at a
stroke, but are likely to feel resentful which could be counterproductive to
overall OccHealth service. What's wrong with having a rest room where women
with dysmen. can lie down with or without a hot water bottle? the OH nurse
doesn't necessarily have to minister to them, or even be around.Ditto people
with migraine, post epileptic fit etc etc.most of these people will go back
to work after half an hour or so whereas otherwise they would more than
likely have gone home. I've found giving people a chance to discuss their
general health concerns reaps benefits both in their view of the overall OH
service and in keeping them productive at work and it doesn't have to take
up much time. A paracetamol machine will solve most peoples OTC medication
needs. I agree about empowering first aiders
Allthe best
Margaret
From: Elaine Dobson [mailto:[log in to unmask]]
Sent: 29 January 2004 11:37
To: [log in to unmask]
Subject: TREATMENT SERVICE
Dear All
I have prepared a presentation for a company who has asked for an assessment
and recommendations for the future of their OH service. I am happy with it
so far but would like some more "ammunition" as to why the present treatment
service should be discontinued.
Current service
SEN who has been in post for 20 years and is retiring - wears uniform!
Rest room with two hospital beds, she gives hot water bottles to women with
dysmenorrhoea!
Not surprisingly I was shown a cupboard full of OTC medicines!
I was hoping to be able to quote some legislation as to why the OHN should
not be administering OTC medication to back up my arguments. None of this
medication is specifically related to hazards on site. It appears that if
the Dr is willing to produce a standing order for this stuff then why
shouldn't the OHN continue to administer it. I can not find any evidence to
back up my recommendation to remove this service.
I have covered cost effectiveness in use Of OH time
Safety issues keeping people at work who are ill and who work on production
line
Promoted pro active rather than reactive service
Empowerment of First Aiders as she still sticks the plasters on
This is a good time to reshape the service. Your comments would be
appreciated.
Many thanks
Elaine
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