Return to Light Duty Is Key to Full-Time Work
Set expectations of return after injury
Healthcare workers’ physical injuries account for almost 50% of all injuries reported nationally. The proverbial insult that follows is that the longer they miss work, the less likely they are to return at all. At six months, there is less than a 50% chance they will return.1
“It is so important that at the outset you look at your employee and say, ‘I expect you to make a full recovery,’” said Mary Giovannetti, APRN, DNP, BC-FNP, employee health director at Spartanburg (SC) Regional Healthcare System. Giovannetti oversees employee health for 9,000 healthcare workers across six clinics. “‘We are going to help you recover.’”
The key justification for returning injured employees to light duty is that it is significantly associated with a return to full-time work and can positively re-engage workers, Giovannetti said at a recent webinar held by the Association of Occupational Health Professionals in Healthcare.
Giovannetti cited a recent study that illustrated this link. “Earlier return to light duty is associated with earlier return to full duty after shoulder arthroscopic surgery in patients with a workers’ compensation (WC) claim,” the authors wrote. “Additionally, WC patients who returned to early light duty in the first 100 days postoperatively had a higher rate of return to full duty than patients who did not return to early light duty.”2
This intentionality must be set first. Part of fulfilling the result is setting up a program that allows a return to light duty. “Start with a letter that the employee must sign, explaining to them the return-to-work process and that you expect them to return to work,” Giovannetti explained. “Address their pain. Of course, we’re not saying put everybody on hydrocodone, but make sure they’re taking enough ibuprofen.”
Likewise, deal with any depression and anxiety at the onset, possibly referring them through an employee assistance program.
“Provide multiple disciplinary resources [and] early interventions,” Giovannetti suggested. “Studies have shown that if you intervene and they can seek treatment within the first six weeks, there’s a higher likelihood of return to work.”
Giovannetti left needlesticks and follow-up out as a separate talk for another day but considered these common injuries in healthcare workers:
- In 2020, there were approximately 51,700 cases of nonfatal occupational injuries and illnesses among healthcare workers.
- Sprains and strains account for more than 50% of injuries among hospital workers.
- In 2019, nursing assistants had a rate of approximately 370 musculoskeletal disorders per 10,000 workers, the highest of any occupation.
- Slip, trip, and fall incidents represent 25% of all reported injury claims among healthcare workers.2
Factors of Influence
Policy must proceed program. Light-duty protocols are no exception. “No. 1 is going to be your organizational policy, which needs to support light duty,” Giovannetti said. “You need to get the assistance of your executive administration and managers throughout the organization. It’s important to have departments that you can call on for light duty assignments if someone cannot be accommodated within their department.”
Factors of influence for workers include prior experiences with work-related injuries, perhaps at another facility. “If your employee worked for another company that placed somebody out of work for every hangnail, then they might expect that [from] you,” Giovannetti noted. “You have to educate them about your policy.”
In addition to personal work ethic, subjective variables that can influence the process include pain tolerance, education level, and socioeconomic status. “Do they have a job that requires heavy lifting?” Giovannetti asked. “Do they have to drive to work?”
“Self-efficacy,” as Giovannetti termed it, is the employee’s belief that he or she can achieve their goals, their recovery expectations, and their perceived ability to work. One advantage is that the employee does not have to use his or her vacation time and receives full pay. Still, some employees may not like light duty, thinking they should just be off to recover or are unenthused about the assigned tasks.
“Sometimes, managers may not want to accommodate it,” Giovannetti said. “From the manager’s perspective, if the employee can’t do full duty, they are going to have to pay somebody else to pick up the slack. There also might be some co-worker jealousy.”
Of course, the nature and severity of the injury — a torn muscle to an open wound — is going to be a factor in determining when their provider recommends a return to work.
“When I worked as a family nurse practitioner before I started doing occupational health, I would write a note based on how I felt about their conditions and what the employee was asking for,” Giovannetti said. “When you’re in family practice, you’re not balancing the needs of the organization with the needs of the patient. You’re solely focused on the patient. That’s not a bad thing. But when you’re talking about workers’ comp, you need someone who is knowledgeable and going to balance those needs. Communication between the provider, the organization, the case manager, and the workers’ compensation specialist is essential.”
Various factors influence costs. Laws on workers’ compensation, sick leave, paid vacation, and more might differ by state and individual facility.
“It reduced our cost by about $2 million per year when this program was implemented,” Giovannetti said. “Retention is very important right now with our turnover, and [retaining staff] can lower your insurance premium.”
The hospital’s insurance provider estimates that if an injured employee is out fewer than 30 days, there is a 95% chance that he or she will return to work full duty. “If they’re out [fewer] than 90 days, there is an 80% chance of returning,” Giovannetti said.
By one year off the job, the chance of a worker returning to duty is down to 20%.
“An important thing that I’ve seen our workers’ comp specialists and our nurse practitioners say to injured employees is, ‘I’m sorry that you’re hurt,’” Giovannetti recalled. “Even if we don’t believe they were hurt on the job, we look at them and say, ‘I am sorry that you’re hurt.’ That actually goes a long way for that employee and includes the perception of support from employee health.”
REFERENCES
- CatalystRTW. Return to work statistics. Apr 13, 2017. https://catalystrtw.com/return...
- Massey PA, Sampognaro G, Fincher P, et al. Earlier return to light duty is associated with successful return to full duty of workers’ compensation patients treated with shoulder arthroscopic surgery. Arthrosc Sports Med Rehabil 2022;4:e927-e933.
- Castillo L. Healthcare worker injury statistics. Gitnux. Last updated Dec. 16, 2023. https://gitnux.org/healthcare-...
Healthcare workers’ physical injuries account for almost 50% of all injuries reported nationally. The proverbial insult that follows is that the longer they miss work, the less likely they are to return at all. At six months, there is less than a 50% chance they will return. The key justification for returning injured employees to light duty is that it is significantly associated with a return to full-time work and can positively re-engage workers.
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