By Gary Evans, Medical Writer
Employee health programs are woefully understaffed nationally, with a new survey suggesting it would take a 60-hour workweek to do what they are trying to accomplish in 40.
The staffing survey1 by the Association of Occupational Health Professionals in Healthcare (AOHP) raises the issue of whether employee health programs need to establish a standard staff-to-worker ratio to address the problem.
“We would really like to have a position statement through AOHP that recognizes what we see as the [appropriate] staffing ratio per employee,” says Mary Bliss, RN, COHN, executive president of the AOHP. “It’s going to be hard because all of our facilities are set up differently. That is a goal for the AOHP board, but it certainly needs to be validated because we hear it all the time from our membership. We do a lot of work with less staff than many other departments.”
The AOHP sent the online survey to 864 active members of its association. Responses came in from 156 individuals in 36 states. Hospitals were the primary work site reported by 91% of respondents. However, 55.8% listed other facility types as well, indicating employee health professionals were also working in clinics and other settings.
The average ratio of an employee health nurse to healthcare worker was 1:1,344.
The highest staffing levels allocated in terms of full-time equivalent (FTE) positions were medical assistants, averaging 2.4 FTE, and registered nurses, with an average of 2.3 FTE. Employee health “providers” had an average of 2.3 FTE per program, with clerical staff reporting an average of 1.6 FTE.
A Half FTE Short
The average amount of work not completed at the end of the week across all job categories was 19.6 hours. Breaking it down, that suggests the average employee health professional would need to work a 60-hour week to get all of their work caught up.
“Exactly, people indicated that there is a lot of work not completed at the end of the week — across the board it seems to be fairly common,” says Carol Brown, PhD, lead author of the survey and a researcher at the Center for Health, Work, and Environment at the University of Colorado Anschutz Medical Campus. “We defined the full-time week as 40 hours, so we are sitting at about 20 hours [over]. Averaging that across these sites and departments, that would be about another half FTE that people need to keep up with the work.”
Still, it may be challenging for the individual employee health department to estimate the hours needed to complete assigned responsibilities because the duties don’t necessarily lend themselves to arbitrary division of labor lines.
“It is so difficult to determine how much work is done and not done because we can work 24/7 and never be done,” Bliss says. “You come in every morning and there is still stuff to do that was obviously there the day before. In our jobs, I don’t know that anybody can say that they are ever going to get it all done. But I totally agree that employee health typically is not staffed for the amount of work load that we do.”
Employee health programs were usually managed by nurses, with 68% of departments led by an RN. Not surprisingly, the survey showed corresponding increases in nursing, provider, and clerical FTE for employee health as the number of healthcare workers at a facility increased. For example, a hospital with 4,000 to 4,999 employees averaged 4.3 FTE, which included 2.7 FTE in nursing.
“We only have 2.8 FTEs here for close to 5,000 employees, so we are not anywhere near that [4.3],” says Bliss, coordinator of employee health services at UnityPoint Health-Methodist/Proctor Hospital in Peoria, IL. “So I certainly believe [employee health departments] are understaffed because we fall into that category.”
Again, the major takeaway from the survey going forward is to establish an equitable ratio for employee health personnel to healthcare workers.
“I think our membership wants that from us, and that’s why we are considering writing a position paper on this,” Bliss says. “There is really nobody out there, no governing group that is saying what the staffing should be. It’s important — our employees are just as valuable as our patients. There needs to be a standardized recommendation for that.”
Flu Tasks Dominate
The AOHP survey included a series of questions designed to estimate the time allotted to various duties.
“We tried to group them by type of tasks by provider, nursing, and administrative,” Brown says. “I think what came out of that is, by far, the nursing tasks are what take up the most time. And within that, clearly the flu shots and the flu reporting are things that take a lot of time in these [employee health programs].”
Indeed, within the nursing tasks, influenza immunization programs had the highest average time spent per month: 111.6 hours.
“We administered this [survey] in May or June. So it wasn’t at the height of flu season, which might have led to overreporting the flu [hours] because they were the midst of these massive flu [immunization] campaigns,” Brown says. “I think that, going forward, that is something we could follow up on try to get a better indication why that number is so high and make sure that number is accurate.”
The estimate is likely accurate because flu vaccination, tracking, and reporting has become a labor-intensive task that includes working with infection control to report worker vaccination rates to the CDC’s National Healthcare Safety Network (NHSN), Bliss says.
“It consumes us,” she says. “Every year it’s the same thing — from Oct. 1 through March 31 is flu season. Plus the fact that we have to track it and report our numbers because the NHSN and certainly people in the hospital want reports on how many flu shots [we have administered]. They look at those to make sure we are still at the right percentage that we want to have.”
Pre-placement Tasks Time-consuming
While flu was the leading time-consuming task reported by nurses, those identifying as providers in employee health programs reported spending an average of 26 hours a month on administering pre-placement medical exams. These exams are performed for employees who have been hired, but not assigned to a hospital unit.
“We asked them the things they tend to do in those exams and those included a healthcare questionnaire, a physical exam, vision testing, drug testing, and immunizations,” Brown says.
The shifting demographics and churn of turnover mean pre-placement exams are an ongoing duty for employee health, says Bliss.
“It’s very time-consuming because of the turnover in nursing,” she says. “New nurses, new grads, they stay a period of time and then they look for something else. That’s across the nation — there is always that need to have more nurses.”
That, in turn, requires repetitive labor for the multiple steps of the pre-placement medical exams.
“We schedule all the pre-placement physicals, and then we schedule their appointment to come see us after the physical,” Bliss says. “We have to review the physicals when we get them and enter them into our system. Then when we see them, we do all the follow-up like their TB [tests], immunizations, any titers that need to be ordered. So for every employee, no matter where they are working, there is a lot of time involved.”
The survey included an open-ended question about other job duties, and Brown says common responses included counseling/mental health, workers’ compensation, wellness programs, safe patient handling, and education.
In terms of professional certification, 30.4% of respondents were Certified Occupational Health Nurses (COHN) and 41.8% had specialist degrees (COHN-S). Breaking that down further, 13.2% of survey respondents said certification was required by their employer and 67.2% said it was “preferred” by their employer.
REFERENCE
- Brown C, Shore E. AOHP 2016 Online Staffing Survey Results. AOHP Journal Fall 2016:1-7.
