What to do when you can’t do it all

EHPs learn to set limits, priorities

Do more with less. Comply with regulations; manage workers’ compensation costs; and create new injury prevention programs. But, by the way, we’re cutting your staff.

Too often, that is the mixed message from administration. In a time of ever-tighter resources, employee health professionals must sort through the demands on their time to determine what must be done and what can be sidelined.

"It’s been a learning experience for me to say, This is all I can do,’" says MaryAnn Gruden, MSN, CRNP, NP-C, COHN-S/CM, employee health nurse practitioner at Western Pennsylvania Hospital in Pittsburgh and executive president of the Association of Occupational Health Profes-sionals in Healthcare.

She lost 12 hours a week of clinical help when her nurse’s hours were cut back from 32 to 20; she has no clerical support. With just 1.5 full-time equivalent employees to provide services for 2,500 health care workers, Gruden needed to set priorities and parameters.

She told administrators how services would need to modified in order to accommodate the reduction and sent e-mails to managers with some new procedures. Employees can no longer drop in to employee health and request documentation of past test results. Looking up those records will now take seven to 10 days. Daily walk-in times were established for routine services such as TB testing and immunizations. Other types of visits, such as return-to-work reviews and evaluation of work-related injuries, are scheduled by appointment.

"We’ll see them as soon as we can," Gruden says. "If we’re in the middle of physicals and it’s not an urgent event, that person can wait. It’s a shift in the paradigm. That’s hard, because as nurses, we’re used to being all things to all people at all times. I feel I’ve had to draw the line in the sand and say, This is what I can and can’t do.’"

In fact, employee health experts say it’s important for employee health professionals to focus on the big picture — reducing injuries — and not to become overwhelmed by the routine tasks.

An analysis of a survey by the American Board of Occupational Health Nursing in Hinsdale, IL, found that occupational health nurses are spending more of their time evaluating outcomes and using business skills to set priorities.

"Sometimes we forget we aren’t just here to do exams, TB tests, and physicals," explains Charlene M. Gliniecki, RN, MS, COHN-S, vice president of human resources at El Camino Hospital in Mountainview, CA, and a former employee health director. "We’re really here to support the organization, to support employees to be healthy on the job, to support managers, and to be very aligned with the business."

Here are some keys to working with limited resources:

Stay focused on your top priorities.

Your days are spent with tasks that must be accomplished to stay current with regulations and expectations of the Occupational Safety and Health Administration (OSHA) and the Joint Commission on Accreditation of Healthcare Organizations. But you should seek efficiency in those tasks and instead spend time on injury prevention, which could have a direct impact on workers’ compensation costs, Gliniecki advises.

For example, some employee health professionals use health history questionnaires to determine which newly hired employees should receive focused physical exams. El Camino Hospital still conducts pre-placement physicals, but she notes that they are "very focused" exams.

"You do have to challenge assumptions. Doing more with less means saying, Why do we do this? Do we really need to do this? Why do we do this this way?’" Gliniecki points out.

Keep managers and administrators informed of employee health goals and processes.

Managers can be the best allies of employee health. In fact, you need their active support to prevent injuries among staff. At El Camino, the employee health department analyzes the incidence and cost of injuries by unit. Managers are responsible for addressing those issues.

"Employee health professionals have expertise that can help managers identifying preventive strategies, supporting employees who need some coaching, helping with transitional work, and reducing lost workdays," Gliniecki says.

For example, in one unit with a high number of lost workdays, employee health helped design ergonomic interventions. The CEO later highlighted the unit’s injury reduction as an example of quality improvement.

"Helping people get credit for the successes makes them more interested in having you around," Gliniecki says.

Employee health presents information at the nursing management council and the performance improvement committee. Meanwhile, employee health relies on managers to help with basic tasks. They can make sure their staff are up to date on immunizations and that they respond to reminders about TB tests.

Tap into other resources at the hospital.

If you don’t have enough man-hours to do the work, who are you going to turn to? Sometimes, you can build partnerships among the staff or even make use of volunteers.

Gruden uses volunteers to help with some basic clerical tasks, such as organizing the filing system. However, concerns about confidentiality limit the clerical tasks that can be delegated.

Some hospitals train unit nurses to read TB tests. If there is any reaction at all, the employee is referred to employee health. Meanwhile, employee health staff still must track down employees who have not received the annual screening.

Make employee health part of the bigger picture.

No matter how great or small your resources are, your job will be easier if you are viewed as an integral part of the organization.

At El Camino, job descriptions from housekeepers to senior managers include a health and safety component. Failure to comply with basic requirements can affect the performance review or even the paycheck.

"If people don’t get their TB screen, they will not be scheduled to work. It is a requirement," Gliniecki notes. Needless to say, that improves compliance, and it places the burden on the managers and the employees themselves.

Employee health provides quarterly information on lost workdays to division vice presidents. Again, that encourages those executives to share in the solutions.