How to get injured employees back in the workplace sooner and safer

'The philosophy of 'Don't come back until you're 100%' is very costly.'

Traditional wisdom rightly holds that the longer injured employees stay out, the harder it is to get them back to work. A light-duty transition approach sounds reasonable, but can be difficult in reality. It's just one issue in the surprisingly complex but important process of navigating a safe return to work for the injured employee.

"When we set up our return-to-work program, we thought we were doing a good thing by getting injured workers back to work quickly," says Bonnie LaTour, RN, COHC, an occupational health nurse at NSK Steering Systems America in Bennington, VT. "We set up jobs that would be meaningful, that we could tailor to meet the restrictions set forth by the doctor."

However, it soon became apparent that some workers liked the light duty jobs better than their own. "They malingered to avoid returning to their own work area," says LaTour.

Work restrictions are still accommodated by the company, but only in the employee's own area. "This keeps them up to date in their own department, and helps with job tasks that other employees don't have time for," she says.

Restricted duty is capped at 12 weeks, and the employee is then put out of work on the Family and Medical Leave Act (FMLA). "Once their FMLA clock starts ticking and they could potentially lose their job and seniority, they are more motivated to return to work full duty," she says.

Restricted duty jobs offered in the manufacturing area include taking measurements and doing paperwork and scheduling. "Sometimes, it can be as simple as answering the phone and freeing up someone else," says LaTour.

Reach out to physicians

Contact the doctors in your area that you use the most, and invite them to your facility for a tour so they can see firsthand what employees do. "This will open the lines of communication, and allow them to see you are open to providing restricted work," says LaTour.

By getting the employee back in the door early, you can track his or her progress." Convey things to the doctor that will likely move their advancement in restrictions along," she says. All restrictions should be in writing from the doctor, and should specify what the employee can and cannot do.

If employees feel that the employer isn't interested in their well-being, they're likely to stay out of work longer. "When this happens, people talk," she says. "If other employees think this person is getting a free ride, morale begins to drop."

Having an occupational health professional act as an injured employee's case manager is the key to a successful return-to-work program, according to Lisa Rodriguez, RN, COHN, HEM, PHOR, safety coordinator for PeaceHealth's Oregon region in Portland. "They are able to manage the injured employee from the time they are injured, to returning them back to full duty," she says.

Occupational health is knowledgeable about length of disability for injuries, and can provide guidance on various treatment or therapy options. Also, occupational health can make sure that the appropriate information flows through the correct channels to the provider, therapists, department managers, and the claims manager at the workers' compensation insurance agency.

"This provides the best outcome for the injured worker, which in turn is beneficial for the employer," says Rodriguez. Here are her recommendations:

Do an accurate job task analysis for all jobs in the company, listing all essential tasks and accurate physical requirements. If the provider knows what the employee's regular job involves, he or she can make a good judgment as to what light duty to assign. "It is also helpful to any occupational or physical therapists that are working with the injured employee," adds Rodriguez.

Be sure to communicate well with the injured employee. Give advice on immediate first aid and treatment options, and inform employees what symptoms to expect and what they may need to watch out for. "If the correct treatment is used right away, many strain and sprain injuries will not need to go to claim," she says.

Send the job task analysis for the employee's regular job and options for modified work to the first provider appointment. If the provider has to guess what the employee may be asked to do when on modified duty, and the employee is hesitant to return to modified duty, there is a chance they will be taken off of work needlessly.

"If employees can be kept on their same shift and worksite, they will benefit," says Rodriguez. "Many injured workers benefit greatly from the support they receive from their co-workers."

Work with human resources

In order to have a successful return to work program, your company's policies and procedures must cover both long and short term disability, and disability retirement. "In other words, HR has to be on board," says Christine M. Kalina, MBA, MS, RN, FAAOHN, COHN-S/CM, director of global employee health and wellness at MedImmune in Gaithersburg, MD.

Use a team approach with occupational health, safety, supervisors, legal, and HR represented. "A cross functional team is needed," Kalina says.

Consider whether light duty or transitional duty will be offered, how long an employee will be able to stay on this type of duty, and compliance with employment laws. "All of these things have to be sorted out," she says.

Transitional duty may be preferable to putting employees on light duty, but it isn't always available. "That's where the registered nurse, board-certified in occupational health and medical case management comes into play," she says. "The occupational health/employee health and wellness team should drive this change. Work with the employee's physician to determine the strategy for transitional duty."

Do you have a case management (CM) credential? "That credential is very important," she says. "It demonstrates your commitment as a healthcare professional to your professional growth and development, and therefore, to the return to optimum health and wellness of the employees under your watch."

Returning an employee to work can quickly become complicated. "Passing an exam in medical case management can serve to solidify the various components of the complex return to work process," says Kalina.

The employee's work ethic, feelings of value, workers' compensations laws, federal and state laws and regulations, the influence of family and friends, and members of the outside healthcare team such as physical therapists, all come into play.

"Pulling together a return to work plan with optimal health outcomes for the employee and business outcomes for the company takes academic preparation and experience," she says.

In any case, decisions should be based on the employee's diagnosis, physical condition, and any coexisting diagnoses. "There should be consideration of what the employee has to do," says Kalina. "There is a difference between moving a 400-pound barrel and sitting at a desk."

Indeed, an employer's insistence that all injured employees return to full duty when they come back to work may result in more than one expensive mistake.

"The philosophy of 'Don't come back until you're 100%' is very costly," says Richard W. Bunch, PhD, PT, CBES, CEO of ISR Institute, and manager/owner of WorkSaver Employee Testing Systems, both in Houma, LA.

If the employee gets back into the job environment with restrictions, he or she can be gradually phased into full duty. "The employer who does not want to offer restrictions or accommodation stands a much bigger risk of having the person stay out a much longer time, and perhaps not go back to work at all," says Bunch.

A functional job description, validated by an ergonomist or physical therapist, outlines exactly what the job requires physically. For example, an employee may have to lift, climb stairs, push or pull, climb ladders, or work out in the heat or cold.

A functional capacity evaluation tells the physician what the employee can and can't do without aggravating the condition. This determines if the employee can go back to work either with no restrictions, or with restrictions.

"When a functional capacity evaluation is ordered, the evaluator can compare the person's performance to the actual job demand," says Bunch. "He or she can tell their employer what they can and can't do. This gets the employee back to work sooner."

Without an unbiased objective evaluation, there is a risk that the treating physician may agree to keep the employee out of work for longer than is necessary. "If the patient says, 'I'm not ready to go back to work,' the doctor will probably agree to keep the employee out for two more weeks," says Bunch.

Don't make it adversarial

It's a mistake to allow the treatment and rehabilitation phase to continue endlessly, based solely on subjective responses from the employee. "An employee may be getting 80% of their pay tax-free. They are sometimes making even more money on workers' comp than they will going back to work," notes Bunch.

The key is to communicate with the injured employee constantly. "The biggest complaint I see from employees who have already filed a lawsuit, and it's now become an adversarial relationship, is feeling disenfranchised and not valued," says Bunch.

Employees make statements such as "'They never even called me once' or 'They don't care about me,'" he says. "Everybody wants to feel valued. When they don't, they feel resentful. They see a lawyer on TV saying, 'If you got hurt at work, call me,' and they call."

One of Bunch's clients goes all out to stay in touch with injured employees. "They not only stay in contact on a daily basis, but if the worker needs groceries or their grass cut, they send somebody there to do it," he says. "It doesn't take much time or money to stay in touch with somebody."

Sources

For more information on the occupational health role in return to work programs, contact:

Christine M. Kalina, MBA, MS, RN, FAAOHN, COHN-S/CM, Director, Global Employee Health and Wellness, MedImmune, Gaithersburg, MD. Phone: (301) 398-2805. E-mail: cmkalina@sbcglobal.net.

Bonnie LaTour, RN, COHC, Occupational Health Nurse, NSK Steering Systems America, Bennington, VT. Phone: (802) 442-5448, ext. 191. Fax: (802) 442-5927. E-mail: latourb@nssa.nsk.com.

Lisa Rodriguez, RN, COHN, HEM, Safety Coordinator, PeaceHealth Oregon Region. Phone: (541) 222-2539. E-mail: LRodriguez@peacehealth.org.

Richard W. Bunch, PhD, PT, CBES, CEO, ISR Institute/Manager/Owner, WorkSaver Employee Testing Systems, LLC, Houma, LA. Phone: (985) 853-2214. Fax: (985) 580-3092. E-mail: rbunch@worksaversystems.com.

Donna Cohen, RN, BSN, COHN-S, CCM, Manager, Occupational Health Services, Memorial Health University Medical Center, Savannah, GA. E-mail: cohendo1@memorialhealth.com.

Deborah L. Dicken, RN, BSN, MSHSA, CCM, COHN-S, CLNC, Legal Nurse Services, Pace, FL. Phone: (850) 393-3365. E-mail: deborah@legalnurseservices.net.