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Light duty gaining acceptance for workers
Tailoring light duty to job, employee aids success
When an employee at your facility reports back after an injury or illness with a physician's order for "light duty" in hand, is the prescription a guide to what the employee can do, what he or she can't do, or a chance to look at the employee's ability to contribute in a new way?
Denise Zoe Gillen, RN, BSN, MBA, COHN-S/CM, practice leader in integrated health and productivity management for Mendham, NJ-based Risk Navigation Group, subscribes to the last approach.
"Now we oftentimes use 'transitional' or 'alternate duty' instead of 'light duty,' because to say they are assigned to 'transitional duty' means they are in transition — that what they are doing is not 'light' work, but is an assignment made so they don't have to do tasks they're not physically capable of doing," she says.
When the employee is a nurse, Gillen says she first looks at the nurse's regular job, to see if it can be broken down into components and a new, less physically demanding version created from the individual parts. "If you break down the tasks of their job, then you can say, 'they can maybe only lift 10 to 20% of what they ordinarily can, but they can do all the other components of their job,'" Gillen explains.
That type of change means a floor nurse's ability to do her regular duties is going to be much more affected by limitations on lifting than a nurse who works in the neonatal intensive care unit (NICU), for example. "You always have to consider the employer and the setting when an employee returns on light duty," she says. "So even if a nurse has limits on what they can lift, a NICU nurse is not going to be lifting 50 or 100 pounds," and so limits on lifting would not necessarily be a factor in whether or not that nurse could return to his or her original assignment.
What's 'light' depends on job
The scenario Gillen describes — an employee returning to work to his or her same job, but doing only the parts of it that he or she is capable of — is what the U.S. Department of Labor refers to as "limited duty" in its workers' compensation laws. Many employers use the terms "light duty," "limited duty," "modified duty," or "transitional duty" interchangeably, while others apply one — usually limited duty — to employees returning from a job-related injury or illness, and another — light duty — to employees returning from a non-work-related condition.
The Department of Labor says limited duty includes responsibilities that are part of an employee's regular position, that meet the employee's work capabilities as determined by his or her doctor.
But the real meaning of light or limited duty is determined by the employee's regular job. What is light duty for one person might be heavy work for another, depending on the job, setting, and physical limitations, Gillen points out. "Depending on the employer, it's a good idea to develop job tasks by position ahead of time, so if you're in health care, for example, break down the job tasks of your nurses by where they work and what their duties are," she says.
Judy Van Houten, RN, COHN-S, CCM, manager of occupational medicine services at Glendale (CA) Adventist Medical Center, says the occupational health nurse "has to wear two hats" when working with employees returning on light duty. "I'm looking at it from a clinical point of view," she explains. "I have to give the employer or the supervisor the restrictions, and at the same time tell the employee what he or she can or can't do."
The light-duty prescription can be taken as a positive, as in "this is what this employee CAN do," but most often is taken as its negative meaning: "This is what this employee CANNOT do," she says
Being comfortable with light duty and understanding what it means can be different things. Often, supervisors — or the employees themselves -- might have incorrect ideas about what light duty is and is not. "There are often differing perceptions of what the employee's restrictions and limitations are, and there's often a difference between what the restricted person thinks they can do or not do, what the job demands are, and what the employer's expectations are," says Van Houten.
Gillen says the occupational health nurse or case manager can help clarify those distinctions. "The case manager or occupational health nurse's job is to explain the role of the nurse as well as what everything means and to let the employee know that when the doctor puts you on light duty, it doesn't mean you can't work, but it does mean we don't want you to do too much and thereby limit your recovery time," says Gillen. The idea is to help the employee not only become functional at work again, but also to be functional at home, she adds.
Typically at Glendale Adventist, Van Houten says, nurses who return to work on limited duty are placed in a different are of the hospital until they are ready to go back to their regular jobs. "The method to the madness is in a couple of things," she explains. "If they are in a different department and not their home department, the employee is not burdened with the guilt of feeling like they are not doing their jobs and are not a member of the team." The second part is that it becomes a positive for the department where the employee is temporarily assigned, because they get an extra set of hands for free, Van Houten says. Pay for light duty comes out of a separate cost center for modified duty and transitional work, so neither department carries the expense of paying the employee's salary.
Finally, while it makes financial sense in most cases for the employer to find light duty for an injured worker to return to, and occupational health experts say recovery is hastened when workers can get back to work, providing light duty to employees is not something employers are required to do.
But light duty doesn't have to feel like a bad thing to the employer or employee. "Light duty has gained a lot more acceptance from the supervisors' and employers' points of view," Van Houten says. "There are fewer and fewer employers who, when they get a [light duty note] from the doctor, throw up their hands and say to the employee, 'Don't come back until you're 100%!' More of them are OK with limited duty, and more employees are OK with doing limited duty."