Occupational health care in South Africa has lagged behind that of other countries because it was developed within the context of a fragmented, racist, and conservative legislative framework. This legislation has been improved in recent years. 2. Complex legislation, the demographic profile of workers, mortality and morbidity profiles, occupational injuries and diseases, changes in technology, and poor working conditions are present challenges for occupational health nursing practitioners to provide a comprehensive program for the protection of worker health and safety. 3. Most occupational health services are provided by private sector companies. There is a lack of occupational team members, especially physicians, occupational hygienists, and rehabilitation workers. Occupational health nurses provide primary health care, as well as occupational health care in their clinics. 4. Occupational health nursing has developed into a formally recognized post-graduate specialization, with a strong national professional society and the promotion of research.