Injured nurses struggle with financial loss

'Workers' compensation fails the nurse'

"I was injured at work almost seven years ago. I am still going through financial difficulties. I can never return to nursing. I am left with a lot of nerve damage to my legs and continuous back pain. I receive about $400 biweekly from worker's comp. This is nowhere near my pre-injury pay. Learning to live with pain and limited mobility and chronic money problems has been the worst of it all. — Nurse's post on an online forum of Work Injured Nurses' Group (WINGUSA)."

In 2008, 16,560 hospital employees injured their backs at work badly enough to require days away from work — more such injuries than workers in any other industry, according to the U.S. Bureau of Labor Statistics. In addition to pain and lost work time, those health care workers also suffer significant financial losses, says Anne Hudson, RN, a back-injured nurse from Coos Bay, OR, who founded WING USA (Work Injured Nurses' Group USA).

Hudson and occupational health consultant William Charney, DOH, of Newfane, VT, are now asking the American Nurses' Association and other unions to step up to help their injured colleagues by creating a special fund.

"Workers compensation at best is inadequate to meet the needs of injured workers," says Hudson, who co-authored a book with Charney (Back Injury Among Healthcare Workers: Causes, Solutions, and Impacts, Lewis Publishers, 2004) and donates all royalties to help back-injured nurses. "It's slow. People are denied care...and [provided] incomplete and inadequate care. They're never made whole."

Workers' compensation laws vary widely across the nation and often tie benefits to the statewide average weekly wage. That means higher paid workers, such as nurses, will feel a greater income loss from their injury, says Carol Telles, JD, senior analyst with the Workers Compensation Research Institute in Cambridge, MA.

For example, Iowa provides a maximum of $1,366 weekly for permanent total disability, while Arizona provides a maximum of $461.60 weekly, according to a 2009 survey by the research institute. "It's not the goal of workers compensation to make workers whole in terms of income benefits," says Telles. "It's to replace a certain portion of those benefits and that portion varies by state."

The definition of a permanent disability also may be restrictive, Telles says. The workers' compensation system is designed to respond to the accidents of the industrial age, such as when workers were at risk of amputation, she says.

Losing the safety net

For nurses, the greatest risk of long-term occupational injury is from work-related musculoskeletal disorders. Hudson herself suffered a back injury as a bedside nurse. She struggled to win workers' compensation benefits but was unable to return to the hospital because of a lack of accommodations for her lifting restriction. Hudson currently works as a public health nurse, which makes hers a re-employment success story (although her wages are far lower than they were as a bedside nurse).

She says she fields frequent calls and emails from other back-injured nurses who are having trouble making ends meet, whether or not they receive workers' compensation benefits.

"[Employers] may cover a muscle strain but deny the spine injury, which is the disabling portion of the claim," she says. "That's just one example of the way workers compensation fails the nurse."

Back-injured nurses may lose their jobs, their health insurance, and their safety net, says Charney. "They lose all their capability of monetary support," he says.

The American Nurses Association advised Hudson and her fellow nurses to bring up the issue through the House of Delegates, a governing body of nurse representatives from each state.

Nancy Hughes, MS, RN, director of ANA's Center for Occupational and Environmental Health, says she has heard from some injured nurses and encouraged them to work through their "constituent member associations," or the affiliated state nursing associations.

Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU), stresses that a bigger fix needs to occur through the workers' compensation system.

"Every study shows workers comp only provides a very small percentage of income replacement and coverage for medical related costs," he says. "The bulk of the payment comes out of the Social Security system when nurses become injured and apply for disability benefits." That means individual employers do not face the full burden of compensating injured workers, he says.

"I'm not suggesting ANA or anyone can create a fund that's going to make you whole," says Hudson. "That's not realistic. But certainly there could be something to [help injured nurses] meet immediate needs. There should be some place nurses can turn for help."

Others try to help nurses

Meanwhile, there are some other efforts to help injured nurses. Nurses House, established in 1922 as a Long Island, NY, respite for weary nurses, now provides a fund to assist nurses in need. However, the organization says it can only help about half of those who apply.

"Over the past three years, we've helped nearly 300 nurses, with grants totaling almost $300,000. That's an admirable record, but the truth is, we can't keep pace with the ever-increasing demand," Nurses House says on its website. "In fact, with current levels of charitable giving, we can only assist about half of those seeking our help. While many nurses face truly dire circumstances, there are simply not enough funds in reserve to help them all."

The Minnesota Nurses Association has addressed one potential gap in workers' compensation by placing language in contracts assuring continued health insurance for injured nurses for 24 months. The California Nurses Association has targeted the issue of work-relatedness of injuries. A bill in the 2009 California legislature would have created a presumption that certain injuries or illnesses, including neck or back injuries, are work-related unless the employer proves otherwise.

The California Chamber of Commerce opposed the bill, saying that hospital workers should not be given special legal status. "The fact that hospital employees face specific types of risks in the workplace is not a justification for altering the legal standard for determining what is or is not an industrial injury," the chamber argued.