What place for nurses in occupational medicine?

A particularly rich program animated for four days the National Congress of Medicine and Occupational Health, which was held in Strasbourg last week. During these interventions, perspectives were drawn up for nursing practice in the field of work environment, especially during one of the sequences devoted to new practice in the field of work environment.

A reform of 2021

Pr Sophie Fantoni-Quinton, PU-PH in occupational medicine at Lille University Hospital and doctor of law recalled the contours of the law of 2. August 2021. In particular, this reform introduces the concept of Prevention and Occupational Health Services (SPST), which replaces the former Occupational Health Service (OHS). The text also specifies the role of the overall business risk assessment document (Duerp): “It is no longer a simple list of risks, as this document must include preventive measures or even a prevention program for companies with more than 50 employees”she explained.

The law contains a section on the delegation of actions to nurses (Idest). “This extended delegation option is strict and monitored according to the recommendations formulated by the Council of State. The nurse can not come up with suggestions, conclusions or indications based on elements of a medical nature as this will be characteristic of an illegal practice of medicine., Sophie Fantoni-Quinton remarked. The occupational physician remains in control of what he wants to delegate, depending on Idest’s skills.

Extended practice, advanced practice

The text indicates the visits that can be delegated: periodic visits for individual follow-up, visits to the healing and pre-convalescence and visits in the middle of the career. “Nurses can also participate in the inventory part of closing or closing visits. In addition, they can also conduct nursing interviews as part of their own competencies.she added.

Occupational health nurses are therefore given expanded competencies. This raises the question of creating appropriate publicity in advanced practice. Nadine Rauch, Chair of the Group of Occupational Health Nurses (GIT) demonstrated the relevance of this proposal. “In countries that have occupational health and safety APNs, the question of their added value no longer arises. They enable global and regular monitoring of chronic pathologies and better access to care in rural areas or for people in situations of exclusion.” She also sees in the opening of advanced practice to Idest the possibility of achieving autonomy, developing finer analyzes and a rigorous methodology.

A new profession to create

However, training in advanced practice in the field of working environment does not currently exist. “After a first year of a joint master’s degree, it will be necessary to develop a master’s program 2 centered on professional reintegration and job retention, chronic work-related pathologies, ergonomics or even peer supervision”proposed the chairman of the GIT.

Ultimately, the challenge will be to give employees the opportunity to benefit from the expertise of health professionals at the master’s level. An aspect that Pr Jean-Marc Soulat, Head of the Department of Occupational and Environmental Diseases at Purpan Hospital in Toulouse, and moderator of this roundtable discussion. “Occupational health APNs will pursue a new profession different from nurses who have an extended practice. The basic training will take place over two years within the medical faculty. Their role is not yet defined, but we must forget that they are nurses. “ A position that won the conference room approval, full to bursting point.

Lisette Gries

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