Finding right staffing levels a challenge in employee health
Not too many years ago, the primary mission of employee health departments was to handle work-related injuries and job-related medical surveillance. Now the mission has expanded at many facilities to focus on overall health and well-being of the entire population of employees.
"The pendulum has swung 180 degrees," says Nicole Shaffer, DNP, CRNP-BC, COHN-S, FAAOHN, director of occupational health and wellness at Pfizer in Lititz, PA.
The holistic focus to employee health also raises questions regarding whether a department should provide episodic care, ergonomics support, or safety education, Shaffer says. Another staffing factor is determined by the type of population the health system is serving, Shaffer notes.
"We look at the demographics," she explains. "If the health care setting is in a lower-income area, then perhaps some of your staff doesn’t have access to the level of health care of a large research facility."
In that situation, employees might need the onsite clinic for episodic care, handling things like a sore throat, Shaffer says. When assessing the resource and staffing needs of an onsite employee health clinic, a health system should collect data and look at various models, searching for a good fit with its mission and population.
Shaffer offers these suggestions:
Find out your hospital’s top five diagnoses: "Pull in the benefits group to find out what are your insurance incidence rates and the top five diagnoses of employees who use health insurance," she says. "These could include cardiovascular, depression/mental health, musculoskeletal, and others."
Also, check the workers compensation top diagnoses because this gives an indication of how complex the population is, Shaffer says.
For example, in manufacturing there might be medical surveillance due to exposure or material-handling injuries, and the staffing need might be higher. In an office environment, there might be only a couple of slip-and-fall injuries reported each year or some ergonomic problems, so the focus would be on wellness and could be handled with a lower staffing level, she says.
"In hospital care, we have patient handling and a lot of musculoskeletal type of injuries from moving patients," she says. "Also, there are biological exposures from needle sticks and body fluid exposure."
Determine the type of care that is needed: While most hospitals have a separate occupational health clinic or service, some use an external service, Shaffer says.
"Most try to manage cases through case management, initial treatments, new hire exams, and blood exposure follow-up," she says.
Research hospitals have more complex organizational models, she adds.
While the American Association of Occupational Health Nurses (AAOHN) created a model decades ago that called for one RN for every 300 employees in the health care setting, today it’s clear that level of staffing is not adequate, Shaffer says.
"That was a blanket statement, and now we’re looking at all other complexities and saying, Is this site a simple site environment, or is it medium intensity, or a complex site?’" she explains.
Questions to ask to determine intensity level include:
How many injuries were there in the last year?
How many injuries required suturing, medical restrictions, prescription medications, and were OSHA reportable?
What does the occupational health clinic do? For instance, does it provide ongoing case management?
Will the clinic provide episodic care and not focus entirely on work-related health issues?
Preventive care, practice support
Other defining issues include preventive care and advanced practice support. Clinics could handle medical surveillance, pre-placement exams, as well as vaccination programs, health fairs, and health system-wide education.
"You can’t operate purely on an RN model," Shaffer says. "You also need advanced practice support, whether it’s a few physician hours or a part-time nurse practitioner or physician’s assistant."
Mid-level providers can do some of the roles that traditionally were done by RNs. Using an advanced practice model can provide better coverage and availability, she adds.
Make a case for providing ongoing case management and internal services, she recommends. Hospital health clinics traditionally have not done a great job at making sure they have a seat at the health system’s leadership table and educating leaders about the value they bring to the organization, Shaffer says.
"Their value includes decreased loss of productivity and understanding safety metrics," she adds. "They need to talk strategic instead of tactical paths."
There are some huge advantages to having an employee health clinic provide the ongoing case management and follow-up care, Shaffer notes.
For example, if an employee has injured his or her back on the job and sees a third party provider, a probable outcome is the clinician will tell them to stay off work for three weeks.
"A lot of studies show that the faster you can get someone back to work and meaningfully engaged in the workplace, they actually heal faster," Shaffer says. "It’s a cost avoidance issue more than a cost generation, and that’s where having employees in case management in house helps."
Facilities that are willing to provide health opportunity or episodic care by internal staff might help the health system keep down workers compensation and related costs and improve productivity.
If the injured employee receives treatment internally, which is easier than scheduling appointments with outside providers, then the worker is able to go back to work that same day, and it will prevent lost productivity, she notes.
Re-evaluate staffing needs regularly, she advises. Organizations with small, established health clinics, which might need additional staffing, should document their patient care hours and other services, Shaffer suggests.
"Keep track of the average week and jot it down: 17 phone calls lasting five minutes each,’" she says. "Find out how many patients you’ve seen in a day and take the averages to list out every function you perform and the amount of time it takes because that gives you a bigger picture."
Remove the emotion from the assessment: "Sometimes it’s easy to catastrophize, saying, I’m so overworked; my clinic has to be busier than anyone else,’" Shaffer says. "Then when you look at the numbers you find the clinic saw only four patients a day on average."