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South Africa is a developing, resource constrained country with a quadruple burden of disease. The health delivery model is based in primary health care of which the nurses are the cornerstone. Occupational Health Nursing (OHN) has had to evolve in this ever changing health service environment. This has created a need for an integrated approach to the Occupational Health program within the work place. The work environment in the 21 st Century will pose significant challenges to Occupational Health.Careful consideration is therefore required with respect to the selection, monitoring and evaluation of specialised occupational health services. Critical to the selection of integrated OH services is the scope of practice and competencies of the OHN need clearly defined.The success of OHN providing an OH service is a matrix model of applied activities which is totally integrated into an Occupational health program. Within the multi professional team the OHN is best equipped to identify the needs and advise on the optimum utilisation for all. This will enable a more productive workforce.The challenge for OHN is the evolving dynamic work environment in which the OHN finds herself, one which has increasing use of technology, emerging global threats to health and evolving risks to health of workers. The OHN has to be flexible and adaptive in order to meet the demands of this dynamic worker health environment. One solution to this complex health milieu is an integrated model of OH services in order to meet the difficulty of the health and wellness demands of workers in a complicated environment of risk.