|Year : 2014 | Volume
| Issue : 3 | Page : 113-117
Does occupational health nursing exist in India?
Rajnarayan R Tiwari1, Anjali Sharma2, Sanjay P Zodpey3, Shobha M Khandare4
1 Division of Occupational Medicine, National Institute of Occupational Health, Ahmedabad, India
2 Division of Academics Program, Public Health Foundation of India, New Delhi, India
3 Public Health Education, Government Medical College and Hospital, Nagpur, Maharashtra, India
4 Department of Radiology, Government Medical College and Hospital, Nagpur, Maharashtra, India
|Date of Web Publication||12-Dec-2014|
Rajnarayan R Tiwari
Scientist D, Occupational Medicine Division, National Institute of Occupational Health, Meghani Nagar, Ahmedabad - 380 016
Source of Support: None, Conflict of Interest: None
Background: Occupational health services are important to develop healthy and productive work forces, which should be delivered through occupational health team. Occupational health nurse (OHN) is an important member of this team and is required to apply nursing principles in conserving the health of workers in occupational settings. Purpose: This article attempts to map the occupational health nursing courses in India and design competencies and curriculum for such a course. Materials and Methods: Information through the Internet, printed journals, and perspectives of the key stakeholders were the principal sources of data. Discussion: In India, there is a need to initiate a course on occupational health nursing to provide occupational health services for the organized and unorganized sector workforce. A certificate course for occupational health nursing for 3-4 months duration offered through contact session mode can be an opportune beginning. However, to cater employed nurses an online course can be another effective alternative. The theoretical part should essentially include modules on occupational diseases, industrial hygiene, and occupational health legislation, whereas the modules on practical aspects can include visits to industries. Taking into account the existing norms of Indian Factories Act for hazardous units of organized sector an estimated 1,34,640 OHNs are required. Conclusion: There is a need-supply gap in the number of occupational health nursing manpower in India, which can be attributed to the absence of any course to train such manpower.
Keywords: India, occupational health nursing, occupational health services, workforce
|How to cite this article:|
Tiwari RR, Sharma A, Zodpey SP, Khandare SM. Does occupational health nursing exist in India?. Indian J Occup Environ Med 2014;18:113-7
|How to cite this URL:|
Tiwari RR, Sharma A, Zodpey SP, Khandare SM. Does occupational health nursing exist in India?. Indian J Occup Environ Med [serial online] 2014 [cited 2020 Feb 28];18:113-7. Available from: http://www.ijoem.com/text.asp?2014/18/3/113/146907
| Introduction|| |
Global economics are currently challenging every employer. During the next few years, companies must develop healthy, productive work forces engaged in every aspect of their business to overcome and prosper in an increasingly global and competitive business environment. Indian economy being one of the fastest growing economies only next to China provides opportunity for wide-scale infrastructure development for industrialization and urbanization. This has resulted in increased employment in the newer sectors, although the traditional occupations such as agriculture and mining still continue to employ a significant proportion of working population.
There are two types of workforce in India, that is, organized or formal sector and unorganized or informal sector. The organized sector is regulated through the available laws of the land for workers' health and welfare, whereas the unorganized sector is not included in the purview of any of these laws and thereby are devoid of the facilities of health and welfare. The total workforce in the organized sector in India is 26.9 million,  which principally includes 1.4 million in agriculture, hunting, forestry, and fishing; 1.2 million workers in mining and quarrying; 0.93 million in construction; 2.7 million in transport storage and communication; 2.2 million in financing and insurance sector; and 11 million in community, social, and personal services. However, the organized sector accounts for approximately 8%-10% of the total workforce, and 90%-92% workforce is employed in the unorganized segment. 
Health and safety at work, the socioeconomic status of a country, the quality of life, and general wellbeing of working people are closely linked. Maintenance of positive health at work and of healthy work environments not only make a major contribution to productivity, and thus to a country's gross national product, but also to individual worker's motivation and job satisfaction. The aims of occupational health care are to create a healthy and safe working environment and a functional working community, prevent work-related diseases and accidents and promote working ability.  In the Declaration on Occupational Health for All  governments are encouraged to develop national policies and programs, which ensure that occupational health services are available for all workers. Such services should include the education of health care professionals in occupational health.
In India also to respond to the rising burden of occupational diseases, we would require appropriate occupational health services, which should be delivered through a multiprofessional occupational health team. The occupational health team mainly comprises of occupational health physician, safety officer, industrial hygienist, and occupational health nurse (OHN). Occupational health nursing involves the application of nursing principles in conserving the health of workers in occupational settings. It involves prevention, recognition, and treatment of illness and injury and requires special skills and knowledge in the fields of health education and counseling, environmental health, and rehabilitation.  However, it is generally acknowledged that in most developing countries the human resources engaged in occupational health services are deficient or at a very early stage of development.
Presently, in India no statistics are available on the existing and required OHNs to address the challenges surrounding rising burden of occupational diseases and for provision of occupational health care services. Against this background, the current study is undertaken to estimate the need and supply gap in OHNs based on present regulations, to map the institutions offering courses to develop OHNs and to design competencies and curriculum for such a course.
| Materials and methods|| |
The search strategy was a three pronged approach, which included searching the information through the Internet, printed journals, and communication with experts in the field.
The first strategy comprised of procuring the information available on the Internet, which was used to estimate the current need and supply situation of OHNs in the country. The Internet search was conducted using the Google and PubMed search engines. A set of key words encompassing various domains related to occupational health manpower in India was identified. The key words included "occupational health nurse, occupational health manpower, occupational health workforce, and human resources in occupational health."
The information on work force in the organized sector in India was gathered from the Ministry of Statistics, Planning, and Implementation, Government of India website.  The information on the number of registered factories, working/operational factories, workforce therein, the number of OHNs in these factories was obtained from the official website of Directorate General Factory Advisory Services and Labour Institutes, Government of India.  The norms of employing OHNs were considered as recommended by Indian Factories Act and State Factories Rules.  The average size (number of people employed) of factories was calculated using the number of working/operational factories and the total workforce employed in these factories. The number of OHNs required was calculated with two assumptions. First, it was assumed that all these are hazardous industries and thus assuming that the factories which employ more than 200 workers would require one OHN as per the Indian Factories Act.  Then it was assumed that all these are nonhazardous industries and thus assuming that the factories which employ more than 500 workers would require one OHN as per the Indian Factories Act. 
The second strategy involved a detailed literature review of the OHN statistics and curriculum. Indexed and nonindexed journals in the field of occupational health of last two decades were identified and searched for such information. This strategy along with the first strategy was used to map the institutions providing courses for occupational health nursing in India.
The third strategy comprised of taking the perspectives of the key stakeholders in the field of occupational health about OHN through a structured questionnaire. This included the nurses, academicians, industry owners, and occupational health physicians. The stakeholders were asked about the existence of program for occupational health nursing in the country and need for relevance of developing such a course. This information along with the information gathered through literature search was used to suggest competencies and curriculum development for occupational health nursing in the country.
| Results|| |
The total workforce in the organized sector in India is 26.92 million (2,69,28,000).  As per the Directorate General Factories Advisory Services and Labour Institutes estimates of 2007, there are 2,54,951 working registered industrial factories in India with approximately 11.16 million (1, 11, 62,501) workers.  Taking into account the existing norms of Indian Factories Act  for hazardous units and assuming each of the working factories employ more than 200 workers, 1,34,640 OHNs are required for the organized sector, thereby indicating a huge deficit. Further assuming that all these units are nonhazardous and following the norms of Indian Factories Act of one OHN for 500 workers, the estimated numbers are 53,856 OHNs.
The literature search for mapping the institutions offering courses on occupational health nursing revealed that only one short-term course run by the Central Labour Institute, Mumbai,  on occupational health nursing exists. This course is of one week duration. Currently no certificate program or full-time course for occupational health nursing exists in India. 
The perspective of 50 key stakeholders, which included nurses, industry owners, academicians, and occupational health physicians revealed that majority of stakeholders (63.2%) did not know of any course on occupational health nursing. More importantly, 73% of the stakeholders did not undergo any training on occupational health and safety. Thus OHN at workplace can also be a source of training to the workers and employers. All the stakeholders agreed that a course on occupational health nursing is needed and majority (51%) felt that the duration of such course should be for 6 months duration.
Some of the select courses on occupational health nursing being offered globally are shown in [Table 1].
|Table 1: Some select courses on occupational health nursing offered globally |
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| Discussion|| |
Since independence, the nursing education has grown rapidly with a significant rise in the infrastructure and manpower. The Indian Nursing Council, an autonomous Body under the Government of India, Ministry of Health and Family Welfare, which was constituted by the Central Government under section 3(1) of the Indian Nursing Council Act, 1947, of parliament governs the nursing services and education in India.  There are several basic and additional qualifications offered by institutions and universities. The universities and teaching hospitals run short-term specialty programs on different specialized areas of medicine. These programs are designed for cardiovascular and thoracic nursing, oncology nursing, critical care nursing, neurology nursing, nephrourology nursing, orthopedics nursing, gastroenterology nursing, obstetric and gynecological nursing, pediatric (child health) nursing, psychiatric (mental health) nursing, and community health (public health) nursing.  However, what is most striking is that there is no program on occupational health nursing, which is being offered currently.
Most of the nurses doing the role of OHN are trained in General Nursing or in Pharmacy and have been placed in that role by sheer chance. The traditional caregiver role of nurse included those activities that assist the client physically and psychologically while preserving the client's dignity. However in a workplace setting, it includes triage and transportation of the victim to the nearest advanced care facility after providing onsite first-aid. An OHN also requires special skills and knowledge in the fields of health education and counseling, environmental health, and rehabilitation.
Although the birth of occupational health nursing is attributed to Betty Moulder, employed by a Pennsylvania coal mine in 1888,  in India, it has largely been an alien concept until recently. However in the recent years, occupational health nursing is fast growing its influence at workplaces in India due to the economic liberalization and increasing presence of multinational companies, which bring in their corporate guidelines as well as thinking that investing in human asset would give them a competitive advantage. 
Now with a growing realization among enterprises that they can gain competitive advantage by protecting and promoting human health, the workplace medical units have changed their working and work priorities to support the business. Thus the nurses at workplaces have to change their roles accordingly to effectively support the Occupational Health Physician. Now, OHNs have moved into disease management, safety audits, and environmental protection and hearing conservation initiatives besides being first-aid trainers. They are now not only the care givers, but get increasingly involved in referral, follow-up, return to work assessments, and rehabilitation.
Given the changing role and heightening influence at workplace, the OHNs are also required to change their competencies. They have to assume the role of a social counselor, change agent, leader, administrator, health educator, and a case manager. This would involve developing competencies such as reading electrocardiogram with increasing cardiac morbidity seen at the workplace. OHN needs to read and interpret medical investigations report given that Occupational Health Physician may not be able to give adequate time to the employee since Occupational Health Physicians are more expected to design and develop Occupational Health Strategy for the organization. An OHN is expected to support workplace improvement initiatives, wellness campaigns, ergonomic assessments, biomedical waste management, OSHAS certification, and so on.
However, except for a short-term course run by Central Labour Institute, Mumbai, on occupational health nursing no other course is available in this domain in India.  In one of the studies analyzing occupational health manpower status in the country, it is clearly evident that a wide gap exists between the demand and supply in the OHNs in India. As per the existing norms laid down in the national legislation for nonhazardous and hazardous nature of industries approximately 53,856 and 1,34,640 OHNs are required for the organized sector workforce. Another nine times of this will be required to cater to the whole of the country's workforce. This can be addressed through upscaling of the existing academic programs and starting new programs related to occupational health training in specialized domains of occupational health. Although the National policy on Safety, Health, and Environment at Workplace policy articulates the need of training programs both in terms of quality and quantity of personnel engaged in the field of occupational health and safety, a more specific occupational health manpower policy should be formulated considering the current situation.
Thus, on the basis of information gathered, it is suggested to develop a certificate course for occupational health nursing in India. Such a course on occupational health nursing should aim to develop independent judgment and problem-solving skills; analytical skills and critical awareness to both the theory and practice of occupational health nursing; knowledge and understanding of government legislation and policies in relation to the health and safety of workers; ability to be proactive to changing circumstances and national needs in occupational health and safety; practice in a manner to improve occupational health and safety and incorporate environmental, biomedical, and social action perspectives; and provide a high standard of care in the participating nurse.
Ideally, such a course should be offered in contact sessions mode through nursing schools in collaboration with occupational health institutions. The duration can be kept for 3-4 months on the lines of certificate course mentioned under Factories Act for the occupational health physicians. However, considering the fact that many nurses are employed, it may not be possible for them to attend such contact sessions, so another alternative can be an online course to deliver the concepts of occupational health nursing. Although many stakeholders responded that a 6-month program will be sufficient to develop skills on occupational health nursing, it is suggested that in future further updation and revamping of course can be done both for content and duration.
The syllabus for the occupational health nursing should include theoretical as well as practical aspects. The theoretical part should essentially include modules on occupational diseases, industrial hygiene, and occupational health legislations. The modules on practical aspects can include visits to industries to have a firsthand experience to exposures occurring at workplaces, methodology to monitor them, and the existing occupational health services to mitigate them. In addition, some modules for developing skill can also be delivered to develop leadership and decision-making skills. Similar training in European Union is five module training where modules include training on health promotion in occupational health nursing, the work of an OHN and interaction, planning an occupational health service, administration and organizations, and evaluation and development of occupational health services.
Such training should emphasize to develop competencies in nursing professionals to develop a specialized OHN. The Specialist OHN is a fully trained Registered Nurse who, in addition to their general nursing education and training, will have undertaken an additional period of formal study in occupational health, leading to a recognized specialist qualification in occupational health nursing, most often at University degree level.  Some select courses on OHN in developed world ,,,,, is shown in [Table 1].
Thus, to conclude, it is of utmost need to have training program for developing occupational health nursing manpower as the OHN play an important role in the prevention of occupational injury and disease through a comprehensive proactive occupational health and safety strategy. They can also contribute to the promotion of health and work ability, by focusing on nonoccupational, workplace preventable conditions that, while not caused directly by work, may affect the employees' ability to maintain attendance or performance at work, through a comprehensive workplace health promotion strategy. They can also cater to the wider public health agenda by improving environmental health management.
Ironically, although the OHNs are the single largest group of health care professionals involved in workplace health management in Europe, we still do not have any such program in India despite a great demand by the growing industrial workforce and mandated by the law. It is thus a pressing need to understand that OHN is the key to creating healthy and productive workplace and one of the drivers in providing high standard of patient care along with improving energy, resilience, and productivity, which can positively impact health care costs and business success.
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