Transitional work keeps employees on the job

Create policy, job bank for injured workers

The longer your employees are out of work due to injury, the less likely they are to ever return. That is a maxim that has led hospitals to embrace transitional work programs, which enable employees to continue working with physical restrictions.

Transitional work means more than sending a nurse to a desk job or telling him or her to limit tasks. It’s a formalized program that involves senior management support, supervisor involvement, and employee education, points out Livia Pontani Bailey, RN, BS, MA, COHN-S, risk control supervisor for PMA Insurance Group, a workers’ compensation insurer based in Blue Bell, PA.

"The whole purpose of this [program] is to transition employees back to their full capacity," Bailey says.

At El Camino Hospital in Mountainview, CA, the transitional work program has contributed to a steady decline in lost workdays, from 36 in the first quarter of 1999 to 17 in the last quarter of 2001, says John Deex, RN, MS, OHNP, COHN, the hospital’s director of employee health and safety.

"We have opportunities for people to do transitional work as opposed to losing days," says Deex, who notes that the labor shortage in health care makes such programs even more valuable.

But it also has a direct benefit to the employees, he says. "By keeping people productive within their professional environment, they get better."

Program’s structure is key to success

How you structure your transitional work program may be critical to its success, Bailey and Deex say.

Some major components for a transitional work program include:

Gain buy-in from senior management.

As with many other health and safety initiatives, the full support of senior management can make the difference between success and failure. After all, the supervisors need to identify appropriate placements for injured workers, and the employees need to have a positive feeling about the program.

"You’ve got to have the commitment from senior management that all the departments are going to cooperate with you to come up with a bank of positions that you can place people in," Bailey says. "This gives you the control you need [to develop transitional work]."

Create a formal, written policy.

Managers may informally arrange for workers to perform lighter tasks when they return after work-related injuries. But a transitional work program involves definitions, protocols, and limitations.

Set a time limit on the transitional job

Transitional work programs typically set a time limit of 90 days in which the employee can remain in the transitional job.

"The philosophy is progress [toward recovery] within the scope of work," Deex says. "If you’re not making progress within 90 days, then [perhaps] something we’re doing is putting a barrier in front of you getting better."

By placing a cap on the duration of transitional work, employers avoid creating new, permanent jobs. "Under the Americans with Disabilities Act, you have to be very careful about modifying work," Deex says.

"If you let it go on for a period of time, you have established a sense of permanence. That could be perceived as creating an [permanent work] accommodation," he says.

Who will be eligible?

The policy would state who is eligible for transitional work. For example, some hospitals might include nonoccupational injuries as part of an integrated disability management program, Bailey notes.

It defines transitional work: Temporarily modifying the current position to meet the restrictions; placing the employee in a transitional duty position in the same department or another department; temporarily altering the number of hours an employee may work, or placing the employee in another division or business unit, she says.

The policy also outlines what steps employees and managers should take after a work-related injury, and states what accountability and responsibility each party has. Employees generally are paid their regular rate of pay while on transitional duty.

In some states, workers’ compensation laws may dictate how much they can earn per week. For example, in California, the maximum workers’ compensation benefit is $490 per week, Deex says. "If you made $20 an hour, you would work 24.5 hours a week to get to that $490."

Find jobs that fit the restrictions.

Who will decide what transitional work an injured employee should perform? That is the duty of a team made up of the employee, supervisor, and transitional work program coordinator.

The physician who examines an injured employee should have a copy of the employee’s job description so they have an idea of what types of restrictions might be necessary.

"Sometimes their work restrictions may meet the job description and there’s no need to put them in transitional duty," Bailey notes. You want the treating physician or clinician to be as specific as possible, she says.

A physical capabilities form can enable the physician to identify what tasks, such as repetitive motion, must be curtailed and what can still be performed. (See sample form.)

Set up a job bank

When you set up your transitional work program, you may want to designate a "bank" of possible jobs. These will not be charged to a department’s budget, but will be part of a separate transitional work program budget, Bailey notes.

Otherwise, managers may have a disincentive to create transitional work positions, she explains.

"When a physician assigns restrictions, then there is dialogue between the manager, employee, and nurse practitioner who handles the case, to try to determine if there are accommodations that can be made within the usual and customary work," Deex says.

"If that is possible, that is the ideal situation. If that is not possible, then we look at other work alternatives, with the home department being the preference," he adds.

"If their manager does not have anything, then we would utilize their skills elsewhere in the facility or hospital, depending on the need from managers who have called employee health," Deex says.

Match duty to employees’ skills

The jobs should conform to the expertise of the injured employee, Bailey says. "You want to make sure the employee is being utilized to the fullest capacity in that position, and you want to make sure it’s meaningful work.

"The goal is to transition them back to their position. You want them to have maximum potential," she says.

Monitor the program.

The transitional work program coordinator should follow up with the employee periodically while he or she is in the program. After all, you don’t want employees to violate their restrictions and impede their healing process, Bailey notes.

At El Camino, employee health nurse practitioners treat patients in-house and function as case managers. "They understand the work environment and how that relates to the recovery and treating process," Deex says.

Hospitals can compare their lost workdays before and after the implementation of transitional work to show the cost impact of the program. But there are other, less tangible benefits of employee loyalty and retention, he says.

While the transitional work program seeks to rehabilitate injured workers, employee health also should analyze the causes of the injuries, Deex says.

Beyond responding to injuries, employee health professionals should consider, "How do we promote prevention and the reduction of injuries in general?" he adds.