Plan Ahead for the Injured Returning to Work
Injury data may be skewed by underuse of workers’ comp
Injured healthcare workers returning to work may need alternate duties as they continue healing, so planning ahead in that regard is highly recommended, says Kathryn Mueller, MD, medical director for the Colorado Division of Workers’ Compensation.
“The employer needs to be thinking ahead so they already have places they can put people,” she tells Hospital Employee Health. “Nurses who are working on the floors likely will not have the ability to go back to work right away because they are not going to be able to do the required lifting. Think ahead and look at other activities that would be appropriate for a nurse to do for a short period of time or part-time. Some kind of computer entry somewhere or reviewing [files, materials] that the hospital needs done.”
Healthcare workers typically experience shoulder and back injuries, and the latter may require that they have the alternative to work standing at an adjustable desk.
“For back pain, you don’t want to be sitting for a prolonged period of time,” she says. “In fact, they usually can’t tolerate it. So, you want some ability for movement. With shoulder injuries, you obviously wouldn’t want them lifting anything heavy or anything overhead.”
While workers are recovering before returning, encourage safe movement. Becoming completely sedentary will only delay return to work, she says. “Particularly with minor injuries, you don’t want people to be off work more than a week, if possible,” Mueller says. “Think about those things, and any restrictions you may encounter. If someone is recovering, an eight-hour shift may not be a good choice. It may be better to go to four hours a day.”
Returning workers also may require physical therapy, so prepare to adjust their schedules accordingly.
“Another consideration that is often a problem is transportation,” she says. “If they have to drive to work, but they are not comfortable enough with their injury to sit comfortably, then there are transportation issues.”
In general, there should be some urgency in returning people to work once they are medically cleared, she advises.
“If you have somebody out for about a month, you’d better think of some way to get them in if the doctors are saying they can go back to work,” she says.
Workers’ Comp Underused
Another occupational injury issue is workers’ comp, which may be underused if employees go outside that system to access health insurance. These injury data may be lost to analysis, meaning you may not be getting a true picture of the extent and cost of worker injuries.
“Workers’ compensation is the primary system that provides insurance against lost earnings and medical and rehabilitation costs incurred by workers with occupational injuries and illnesses,” the authors of a recently published study1 note. “Yet, despite substantial workers’ compensation expenditures, evidence continues to grow about the costs of occupational injuries and illnesses that are paid for outside the system by workers.”
In a study designed to estimate the extent to which work-related injuries contribute to medical expenditures paid for by group health insurance, the researchers analyzed administrative data on OSHA-recordable injuries suffered by healthcare workers.
Using a sample of matched patient care workers at two different hospitals, the researchers found that injury was associated with increased group health insurance expenditures.
The results held for non-sharps injuries and when sharps injuries were excluded from the model, they noted.
“We looked at sharps because sharps injuries are very common, but tend to be treated without a lot of additional expense,” says lead author Jessica Williams, PhD, a professor at the University of Kansas School of Medicine in Kansas City. “People tend to test the patient rather than the employee. So, they tend to be less costly in that sense. One thing we wanted to check was whether or not that was essentially affecting our results — whether sharps injuries were changing how the [data] came out, because they are such a large portion of injuries. When we took out people with sharps injuries, we got similar results.”
Since workers’ comp costs are a common measure of the effect of occupational injuries, underutilizing the system may correspondingly understate the importance of preventing such injuries.
“Basically, the idea is that all expenditures related to a work-related injury should be covered by workers’ comp,” she says. “If that system is working properly after an injury, we should see no difference in the group medical expenditures between those two [comparison] groups.”
There are various reasons workers’ comp may be underused, including workers being unaware of their eligibility or disinclined to spend the time to file a claim. More disturbingly, they may feel some pressure not to draw attention to an occupational injury or fear “retaliation,” Williams and co-authors warn.
“For these workers, the costs of lost income and medical care fall outside the workers’ compensation system,” they concluded. “Even if they file for and receive benefits, those benefits have been shown to cover only a small fraction of lost earnings. In the private sector, nursing assistants were one of the three occupations with the highest number of cases resulting in days away from work in 2015.”
1. Williams J, Sorensen G, Hashimoto D, et al. Impact of Occupational Injuries on Nonworkers’ Compensation Medical Costs of Patient-Care Workers. J Occup Environ Med 2017;59(6):e119–e124.
Injured healthcare workers returning to work may need alternate duties as they continue healing, so planning ahead in that regard is highly recommended,
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