Safety Science 20 (1995) 219-223

International survey on the education of occupational health nurses

Kitta Rossi Finnish Institute of Occupational Health, Topelinksenkatu 41 aA, FIN-00250 Helsinki, Finland

Abstract

In 1990 the Scientific Committee on Occupational Health Nursing (SCOHN) of the International Commission on Occupational Health (ICOH) carried out a survey on the education of occupational health nurses (OHN) in various countries. A questionnaire with 23 questions was mailed to 50 countries.

Replies were received form altogether 37 countries (74%). The length of the general nursing education varies from two to five years, being three years in 21 countries. In two European countries it is less than three years.

Some special training in occupational health is included in the general nursing education in 14 countries. However, the length of this training varies considerably. The special training is the longest in Denmark, Finland and Norway.

According to the answers, special postgraduate courses are organized in 21 countries. Training in occupational health is also included in the public health nursing education of 12 countries.

University level programs on occupational health nursing are available in eight countries. Joint education on occupational health at university level has been organized for various professionals in 13 countries. The length of this education varies greatly from some months to several years. In four countries the length of this joint education is one academic year.

General nursing education is the basic requirement for occupational health nurses in most of the countries surveyed. However, training in occupational health is not included in this education in most of the countries. Special postgraduate courses in occupational health are organized in 21 countries to OHNs who are employed in Occupational Health Services. There is an urgent need to develop the education of OHNs in most countries surveyed.

1. Introduction

The World Health Organization (WHO) and the International Labour Organisation (ILO) have both published guidelines and recommendations concerning the training and education of occupational health personnel (WHO, 1988; ILO, 1985). The WHO report

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220 K. Rossi/Safety Science 20 (1995) 219-223

(1988) contains e.g., two recommendations: (1) the training programme for all nurses

should include basic education on occupational health; and (2) all curricula of postgraduate public health training should include occupational health. Correspondingly, the 1985 IL0

recommendation on occupational health services includes a proposal for specialised training of occupational health personnel including occupational health nursing.

Until now, very little knowledge has been collected systematically on the education of occupational health nurses in various countries. At the beginning of the 1980s two surveys

were made in some European countries (Katajarinne and Rossi, 1982; Katajarinne and Rossi, 1983). In 1990 the Scientific Committee on Occupational Health Nursing (SCOHN)

of the International Commission on Occupational Health (ICOH) carried out a survey described in this article on the education of occupational health nurses in various countries worldwide.

2. Method

A questionnaire with 23 questions was mailed to 50 countries mainly to a member of the ICOH, either a physician or an occupational health nurse (OHN), whose position in the respective country made it possible to answer the questions. A pilot study with three Finnish occupational health nurses was made before mailing the questionnaire.

Five of the questions dealt with background information. Sixteen questions dealing with the education were divided as follows: two questions inquired the basic professional edu- cation of the OHN, seven questions inquired the special postgraduate courses and comple- mentary courses, and three questions university level programmes. One question was reserved for additional comments. Replies were received from altogether 37 countries

(74%). Information on the countries that replied is shown in Fig. 1. The title Occupational

Health Nurse is not used in one country (China) where only middle level health care professionals are working in occupational health services.

3. Main results

3.1. Number of occupational health nurses in various countries

The total number of OHNs is less than 50 in four countries (Greece, Iceland, Israel, Panama), from 50 to 100 in two countries (Denmark, Switzerland), and more than 5,000 in four countries (England, France, Poland, USA) surveyed. Five countries (Argentina, China, Mexico, Spain and Tanzania) did not reply to this question (Fig. 2).

3.2. Statutory requirementsfor the basic qualijcation of occupational health nurses

The respondents were asked whether there are any statutory requirements in their coun- tries for the basic qualification that occupational health nurses must have passed when entering occupational health services. According to the answers there are such statutory requirements in nine countries. In one country (Finland) public health nursing (includes a

K. Rossi /Safety Science 20 (1995) 219-223 221

general nursing education) is the basic statutory requirement for all occupational health

nurses. General nursing education is the statutory requirement for occupational health nurses in six countries (Hungary, Malaysia, Norway, Philippines, Sweden, Zimbabwe), and either general or auxiliary nursing in two countries (Brazil, Zambia). This information was

missing or uncertain in two countries (Panama, Tanzania). Perhaps the question was difficult to understand. It was meant to measure the basic

professional education of an occupational health nurse before entering occupational health

services, such as Enrolled Nurse, Registered Nurse, Public Health Nurse, etc. In some replies, however, only requirements immediately after entering occupational health services

were described (see 5.2.).

3.3. Length of general nursing education

The length of a general nursing education varies from two to five years, being three years in 21 countries (Fig. 3). In four countries (Canada, Hungary, USA and Yugoslavia) various alternative categories may be found in the general nursing education depending, e.g., on the level (certificate, diploma or degree) of the education. In these countries the lowest level of general nursing education is possible to pass in two years and the highest level of

examination in four years. Only one category of general nursing education with less than three years of education is found in Poland (2 years) and Sweden (2.5 years). The general nursing education is the longest (5 years) in Brazil. The general nursing education is offered only at universities in two countries, namely in Iceland (4 years), and in Panama (3 years).

3.4. Special training in occupational health in the general nursing education

Some special training in occupational health is included in the general nursing education in 14 countries (Fig. 4). However, the length of this training varies quite a lot. More than 40 hours of special training are given in Denmark, Finland and Norway. In Canada the special training varies from 0 hours to some degree programmes, depending on whether the training is given in the hospital, college or university programmes.

3.5. Postgraduate education

Public/community health nursing education Training in occupational health is included in the public/community health nursing

education in 12 countries. The length of this training varies quite a lot, being less than ten

hours in four countries (England, Kenya, Netherlands, Tanzania), 20 hours in three coun- tries (Greece, Mexico and Zimbabwe), two weeks in Zambia and 100 hours in Australia. In Portugal special training (2 months) is optional. The special training is the longest in Panama ( 16 study weeks), and in Finland (about 7.5 study weeks of 40 hours each).

Postgraduate courses and complementary courses Special postgraduate courses in occupational health are.organized in 21 countries. These

courses are compulsory for occupational health nurses after entering occupational health services in seven countries. The length of this training is about l-l .5 study weeks in South

222 K. Rossi /Safety Science 20 (1995) 219-223

Korea and in the Philippines, four study weeks in Finland, from eight to twelve study weeks in Poland, Spain and Sweden, and 20 study weeks in Brazil.

Voluntary special postgraduate courses are organized for occupational health nurses in 14 countries. The length of the courses varies from six days in Japan and two study weeks

in Zimbabwe up to two years in the Netherlands. At least half-year courses are organized in eight countries (Australia, England, Finland, Hungary, the Netherlands, Norway, Scot- land, South Africa). In Ireland the course is a part-time course (one day a week over two

years). China indicated that a one to three month course in occupational health is available for middle level health care professionals working in occupational health services.

Until now two courses of 5-6 study weeks each have been organized for occupational health nurses in Zambia, and one course of three study weeks in Denmark.

Short complementary courses are available for occupational health nurses in most of the countries surveyed. No complementary courses are available in Japan, South Korea, Zambia and Zimbabwe.

Neither special postgraduate courses nor complementary courses for occupational health

nurses are available in seven countries surveyed (Argentina, Greece, Iceland, Israel, Italy, Portugal, Tanzania).

University level programmes University level programmes on occupational health nursing are available in eight of the

countries surveyed (Fig. 5). However, the length of the programmes varies from short

postgraduate courses (in South Korea and Sweden) to the Master’s degree programmes of at least one to two years in four countries (Brazil, Canada, England, USA).

Joint programmes in occupational health are organized for various professionals in occu- pational health in 13 countries. The length of this education varies from 33 hours in Kenya, and three months in Mexico to several years in some countries (Canada, England, Israel and USA). In four countries (Australia, Norway, the Philippines and Sweden) the length

of the joint programmes is one academic year. Thus far only a small number of occupational health nurses have participated in the university programmes mentioned above in most of the countries surveyed.

4. Discussion

The aim of this survey was to collect information on the education of occupational health nurses worldwide by a questionnaire.

A well worded questionnaire for international purposes was difficult to prepare. A pilot study with three Finnish occupational health nurses was made to test the intelligibility of the questionnaire, and consequently some changes were made to the form. Nevertheless, some questions did not seem to be clear enough, and misunderstanding of the questions may have affected some of the replies. It is also possible that a few of the replies to some questions were misinterpreted in the case of a few countries. Despite this, the survey gives much information about the level and possibilities of the training of occupational health nurses in various parts of the world in 1990.

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The training of occupational health nurses (OHNs) is entirely lacking especially in countries where the total number of occupational health nurses is small (less than 100 OHNs) . However, the situation is similar in some countries with a large number of occu- pational health nurses (Italy-1000 OHNs, Portugal-1500 OHNs). On the other hand in, some countries with a small number of occupational health nurses (Ireland-250 OHNs, Scotland-450 OHNs) both special postgraduate courses and university level programmes are available for occupational health nurses. Some improvements in the specialised training have occurred in some European countries when compared to the earlier surveys (Kataja- rinne and Rossi, 1982; Katajarinne and Rossi, 1983).

In big countries with member states (Australia, Canada, U.S.A.) both the basic training programmes of nurses and the postgraduate education programmes for occupational health nurses may vary greatly from one state to another concerning the length, level and contents of the programmes.

Since 1990 drastic economic and political changes have taken place especially in Europe. Their consequences to the education and training of occupational health nurses in various countries have been either positive or negative.

5. Conclusion

According to the survey in 1990 made by the SCOHN/ICOH in 37 countries there is great variation in the length, level and availability of the education and training of occu- pational health nurses. The WHO recommendation to include basic education on occupa- tional health in the training programme for all nurses is not met in most of the countries surveyed. Neither is the IL0 recommendation to give specialised training to all occupational health nurses met in many of the countries surveyed. There is a great need to develop the education of occupational health nurses in most countries surveyed. Further studies would be needed to evaluate the contents of the training of occupational health nurses.

References

ILO, 1985. Convention No. 161 concerning Occupational Health Services and Recommendations No.171 con- cerning Occupational Health Services. International Labour Organisation, Geneva.

Katajarinne, L. and Rossi, K., 1982. Developments affecting occupational health nursing in the countries of the European Economic Community. Paper presented at the RCN Society of Occupational Health Nursing Cont. Harrogate.

Katajarinne, L. and Rossi, K., 1983. F6retagshi%lsov&rdamas utbildning och arbete i en de1 europeiska lander samt faktorer som pilverkar detta. Paper presented in Swedish at the NIR-NORDSAM Congress, Lund.

WHO, 1988. Training and education in occupational health. Report of a WHO Study Group, Technical Report Series 762. World Health Organization, Geneva.