When should injured worker return to duty?

It's a delicate balance

It's one of the toughest spots for an occupational health professional to be in. You know an injured worker needs more time to recover, but you're getting pressured from higher-ups to get that person back ASAP. What do you do?

"In some cases, there is a temptation to just bring the employee back to work so they don't have lost time. But that doesn't do anyone any good unless it's consistent with the employee's recovery," says Thomas Slavin, safety and health director at Navistar International, a Warrenville, IL-based manufacturer of trucks and diesel engines.

Slavin says that occupational health performs a valuable service by finding alternate work for injured employees that doesn't put them at risk. "People do recover faster when they are working as opposed to when they're off," he says.

You may encounter resistance from supervisors because they don't want someone who is "less than 100%." "Other employees may say, 'Why does that person get to do an easy job?' It is an art to work through those things," says Slavin. "Develop a reputation for finding meaningful work that is consistent with recovery."

Occupational health is "a great resource for matching returning employees to a temporary modified duty position for quicker return to work," says Peggy Ann Berry, MSN, RN, COHN-S, SPHR, president of the Ohio Association of Occupational Health Nurses.

Here are some good approaches:

• Get a firsthand look at the job, to be sure the worker can do it consistently.

"It's very hard to deal with a five pound weight restriction, or no bending or twisting on a doctor's restriction note, unless you actually look at the job," says Slavin. "See if the person is comfortable performing those tasks."

You need to know what is available as a temporary modified job, and know the employee's ability to do the job. "Making sure the two are in sync can be a challenge," says Berry. "Knowing the jobs, knowing the employees, and getting out on the floor makes that happen."

• Avoid the appearance of abuse.

A return to work assignment really shouldn't last for more than 30 days unless there is additional medical review to determine whether there is recovery or not, says Slavin.

"It can be extended, or a different job found depending on the injury, but it really has to be seen as not being abused," says Slavin. "It takes some work and negotiating and people skills to get it done. But it can become pretty smooth after you establish a couple of good cases."

• Make sure the physical therapist and physician have a current, accurate job description.

Facilitate an employee's return to work by keeping the lines of communication open between the employee, the employer, the workers' compensation administrator, and the physician.

"Knowing what the job is, and what the physical and mental requirements are, will ensure safe placement within the employee's physical and mental capacities," says Berry. "There are times there is a disconnect between what the employee thinks they can do and what they can do."

• Rely on evidence-based practices.

What if you are pressured to return the employee to work sooner than is appropriate? "I firmly believe in evidence-based practice, even with this type of situation," says Berry. "Stress the evidence to the employer."

For instance, present the worker's magnetic resonance imaging scan which shows a herniated disk, or documentation of a lift test showing the worker's inability to lift over 15 pounds due to pain and swelling.

"If the employee has been off a specific period of time, make it a standard procedure to use a company physician or a designated physician for a second opinion on return to work," says Berry. "Be transparent and honest with all parties. Present the facts based on the evidence."

Given the evidence of a situation, the employer either accepts it, based on your credibility and presentation of the facts, or the employer does not. "I have found that the evidence wins out," says Berry.

[For more information on an injured employee's return to work, contact:

Peggy Ann Berry, MSN, RN, COHN-S, SPHR, President, Ohio Association of Occupational Health Nurses. Phone: (937) 304-4922. Fax: (937) 436-0128. E-mail: berry_peggyrnmsn@yahoo.com.

Thomas Slavin, Safety and Health Director, Navistar International, Warrenville, IL. Phone: (312) 836-3929. E-mail: tom.slavin@navistar.com.]