Hospital’s return-to-work program values nurses

Clinical duties fit within job limits

Time is money when an employee is injured and can’t return to work. Besides the financial burden for the employer in temporary disability payments, medical costs, and extra staffing, rehabilitation actually can suffer as employees stay idle at home.

The stakes are even higher when it comes to nurses, the backbone of the hospital.

"We’re going into one of the biggest nursing shortages we’ve ever had," says Pat Dalton, RN, COHN-S, occupational health administrator at Pitt County Memorial Hospital in Greenville, NC.

"Just because they can’t do everything [physically], we throw them out. What you really need the nurse for is cognitive skills and abilities, not just physical abilities," she says.

Pitt County Memorial solved that dilemma with a special Alternative Staffing program for nurses, which supplements a limited duty program for employees with occupational injuries and nonoccupational medical disabilities.

Being at work — even with restrictions and reduced hours — can help employees feel needed and involved, Dalton says. "You do have to look at getting people better from more than just a physical perspective," she says.

Dalton uses a physical demands analysis to determine how strenuous a particular job would be and whether it would match the employee’s needs. The analysis evaluates the time spent sitting, standing, twisting, crouching, lifting, and other activities.

If a nurse cannot be accommodated in her home unit with her physical restrictions, Alter-native Staffing places her in positions where she can use her cognitive skills within the prescribed restrictions. For example, an Alternative Staffing nurse could conduct assessments on a unit while the unit nurses perform other patient care duties.

"We don’t want to waste any of the nursing capabilities that we have," says Dalton. "We want to use them every way we can."

Limited duty pay is lower

Dalton created the Alternative Staffing program to address the special issues posed by injured nurses. Replacing an injured nurse can be costly, but allowing her to return to her usual duties too quickly may delay her recovery. In fact, nurses will sometimes push themselves beyond what is safe, she says. "They care about their patients. They care about their co-workers. [They] are always going to do better if we have them doing something useful and in their professional field."

The Alternative Staffing program reflects the hospital’s view of nurses and their value to the organization. They receive their regular salary in the program, while limited duty employees receive reduced pay.

"It’s not that we’re favoring nurses over other people. It’s that nurses have a lot of flexibility in what they can do and still be of great value," she explains. "They are actually performing regular nursing duties, but in alternative departments where accommodations can be made. They are paid by the department in which they work."

Limited duty is a tiered program. Phase I applies to workers with a temporary disability due to a work-related injury. Phase II employees have work-related injuries but have reached their "maximum medical improvement" and need permanent accommodations. Phase III is designed for employees with long-term disabilities that are not work-related but qualify for accommodations under the Americans with Disabilities Act.

For Phase I, after the treating physician determines work restrictions and writes an order to place the employee on limited duty, a certified vocational evaluator provides testing to determine the employee’s skills and interests, then matches the employee to a suitable job.

"We have designed jobs that have some variability in terms of the skills that people would need, educational level, as well as physical ability," Dalton says. "We’ve got to prove that the injured person is able to work in a particular job, making sure it is suitable for that individual. If we don’t do that, then we have to continue to pay temporary total disability."

"We make these jobs as meaningful as we can," Dalton says. "We use tasks that are part of other people’s jobs and make a limited duty job out of them.

"Each of the jobs has a written job description and a physical demands analysis. By assuming some of the work that other employees normally have to do, the injured worker is seen by both co-workers and managers as being helpful to the unit," she points out.

Rehab program — not ’make-work’

The limited duty job bank has about 30 jobs that are filled only by employees on limited duty. "We don’t want to have what plaintiff attorneys refer to as make-work.’ That is not good rehabilitation," Dalton says, "and won’t hold up in litigation."

Limited duty also involves a financial incentive to return to full duty.

"Many hospitals will continue to pay the person what they normally make no matter what they’re doing. They may be doing a third of what they were doing before," she says.

"The whole program is a bridge between their total inability to work and their getting back to their regular work," Dalton says. "Therefore, they are paid more than they would make if they stayed home and less than they will make when they return to their regular job.

"We tell them this whole program is a rehabilitation tool. The purpose is to get the person back to whatever work they can safety do," Dalton explains.