When an employee reports an injury or illness, the astute employee health professional is well aware that many other life stresses and work pressures may be simmering just beneath the surface.
“I’ve always had, philosophically, a more holistic view of health. Things are connected,” says Thomas E. Jackson, MSN, FNP-BC, director of employee health and wellness at East Tennessee Children’s Hospital in Knoxville. “I remember one of my professors said if somebody comes in for a sore throat — there are thousands of people out there with a sore throat today — is that what motivated them to come in for care?”
As a result, Jackson has come by a compassionate curiosity which he recently described in an interview with Hospital Employee Health.
“Lots of times when I am seeing an employee about a minor thing, and after we have addressed that, I ask, ‘How is everything else going in your life?’” he says. “You find out they have a spouse with cancer or a parent dying, a child that is having problems, or they are going through a divorce. So you sort of tap into that. ‘How can we help you care for yourself?’ That is a kind of a multidimensional opportunity.”
HEH: Can you tell us a little about your employee wellness and occupational health program?
Jackson: I am a family nurse practitioner and have been the director of employee health and wellness here at Children’s Hospital in Knoxville for the past 10 years. It’s one of the things where, for years, we would see hospital employees have a lot of knowledge in terms of how to maintain health and teach health education, and take care of their families and everything else. Unfortunately, knowledge doesn’t seem to be enough when you are trying to make personal behavior changes and to take the time to tend to your own needs. Here in our hospital, we have close to 1,400 employees. When I came here, we as a staff sat down and said, “Is there a vision — a way we can help our employees be healthier?” That is the business we are in — healthcare.
HEH: What approach did you end up with?
Jackson: We set up a clinic model, where we have an employee health and wellness clinic which is open to all employees at no charge. So, we see employees for all kinds of reasons — primary care, or as a “minute clinic” for acute care issues like sore throat, UTIs, cough, sore shoulder, whatever. In developing that model, it gave us an opportunity to get to know our employees a little better and establish some trust. When we originally developed the model, it was made very clear to our CEO and administration that when they came into the clinic, that was confidential information. That was kind of sacred territory. If we didn’t have that, [we wouldn’t] have trust. That was the foundation of how we started, and we opened it up as we got to know our employees. They would come for something and we may notice they are a smoker. We say, “Look, if you are interested, we would love to help try to address that.”
HEH: What kind of problems are you seeing in healthcare workers?
Jackson: People come in with blood pressure, blood glucose issues — the kinds of things that we believe lead to avoidable or preventable illness. With our benefits group, we looked at what is causing the most pain in people’s lives, and also the most cost to the organization. When you look at a lot of these issues — blood pressure, heart disease, high cholesterol, blood glucose problems — those are the things that lead to enormous costs — not only in pain, but also in dollars. We reviewed different third-party organizations and brought in a group. They come in once a year and do a full metabolic panel to give the [workers] feedback. Where is blood pressure, cholesterol, blood sugar?
HEH: How does your department use this information?
Jackson: We have tried to take a more results-oriented approach to this. I’ve been in other organizations where you have stair-step or pedometer competitions. The way I personally look at it is you can have physical activities and blitz people with all kinds of information, which does help some. But in general, if you really focus on the results, the numbers that we know scientifically lead toward disease — blood pressure, blood glucose and lipids — you can give people a snapshot of [their numbers]. It gives them a “wake-up” opportunity, and it gives us the opportunity to engage with them and keep them from falling off that cliff.
HEH: It seems like you have gone to more of a primary care model instead of traditional occupational health.
Jackson: That’s exactly right — we decided to do that. I’ve been a nurse practitioner for about 30 years and I have worked in other organizations with unionized environments. If you are only in an occ health model, there is not the intimacy of knowing people’s lives beyond the work injury. We still treat work injuries. In the state of Tennessee, if you have a work injury the state gives you the right to see a choice of three physicians, and we make that available to employees. But, we treat about 90% of our work injuries in-house through our clinic. They are resolved and people don’t use the outside model. We do pre-employment physicals, which are kind of an occ health plug-in. We do work injury treatment, but over and beyond that, we plugged in that minor acute illness primary care piece. We don’t treat blood pressure and blood glucose and those kinds of things requiring medication treatment; we refer that to their primary care providers. By offering the doc-in-the-box model, it’s a win-win — we catch [problems] earlier, they get better quicker, and they don’t miss work.
HEH: How are you faring on the age-old problem of needlesticks?
Jackson: Needlesticks and safety are another area of our heightened awareness and concern. In our organization, we have a program called Destination Zero. Our goal is to have zero needlesticks and work injuries. It is a lofty goal, but it reminds us to protect ourselves and protect each other. Be more mindful. When you are out there, every time there is a sharp in your hand or someone else’s hand, pay attention. We don’t want you to have a sharps injury, ever. We have safety coaches throughout the organization now that are trying to help raise awareness so people are paying more attention. We see fewer needlesticks. We haven’t achieved zero, but we are paying attention to it.
HEH: Safe patient handling would not seem to be a major issue in a pediatric hospital.
Jackson: Being a children’s hospital, we are at a bit of an advantage on [that issue] compared to the adult institutions. Let’s face it, obesity illness is an epidemic. We’ve got a lot of NICU babies, infants, and small children, but we are seeing diabetes and obesity impact children in our culture now like never before. So, we do have larger, heavier children now.
We had a bariatric support team that went throughout the organization to make sure we have hover mats and lifting assist devices that help redistribute weight and help move larger children in a safe way for both the patient and the hospital employees. We have very few back injuries. I often will see more back injuries in staff that are pushing or pulling than we see from moving bodies. But it is still a challenge and it is something we are constantly looking out.
Our safety coaches preplan in case we admit an [obese patient]. There are times we have nurses come here from an adult institution that are changing career paths. They tell me they are seeing, every day, multiple 300-pound, 400-pound patients. I tell them, “Don’t assume that our hospital is full of NICU babies.” We still have some of those challenges.