Transitional work keeps employees on the job
Transitional work keeps employees on the job
Temp jobs may be good fit for injured workers
The longer employees are out of work due to injury, the less likely they are to 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 worker to a desk job or telling her to limit her tasks. It’s a formalized program that involves senior management support, supervisor involvement, and employee education, says Livia Pontani Bailey, RN, MA, COHN-S, risk control supervisor for PMA Insurance, a workers’ compensation insurer in Blue Bell, PA.
"The whole purpose of this [program] is to transition employees back to their full capacity," says Bailey.
At El Camino Hospital in Mountainview, CA, the transitional work program has contributed to a steady decline in lost work days, 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."
How you structure a transitional work program may be critical to its success, say Bailey and Deex. Here are some major components:
• 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.
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," says Deex. "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," says Deex. "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."
The policy would state who is eligible for transitional work. For example, some hospitals might include non-occupational injuries as part of an integrated disability management program, notes Bailey. The policy defines transitional work as 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.
Laws may limit pay for transitional duty
The policy also outlines what steps employees and managers should take after a work-related injury and specifies each party’s accountability and responsibility. 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, says Deex. "If you made $20 an hour, you would work 24.5 hours a week to get to that $490," he says.
• 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," notes Bailey.
You want the treating physician or clinician to be as specific as possible, says Bailey. A physical capabilities form can enable the physician to identify what tasks must be curtailed, such as repetitive motion, and what can still be performed. (To see the "Return to Work Physical Capabilities" form, click here.)
When you set up a 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, notes Bailey. Otherwise, managers may have a disincentive to create transitional work positions.
"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," says Deex. "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.
The jobs should conform to the expertise of the injured employee, says Bailey. "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," she says. "The goal is to transition them back to their position. You want them to have maximum potential."
• 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," says Deex.
Facilities can compare their lost work days 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, Deex says.
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